2012年3月17日 星期六

Motivating Autistic Children With a Variety of Activities


For those parents of autistic children, you are probably aware of how to motivate the child by employing a variety of activities. However, if your child has just been diagnosed with Autism you are most likely not aware of this as you may not have had the time yet to educated yourself about how this affects the individual. Children as well as teenagers and adults with Autism have a great deal of difficulty conversing and interacting with others while also having impaired communication skills.

In order to help autistic children develop behavioral, language, and social skills, you have to find ways of motivating them to pay attention and learn from this. The key to developing certain life skills may be an early intervention, but these have become easier to teach thanks to the help of some newer motivational methods that are now available. The following are some suggestions for how to motivate autistic children by employing a variety of activities to accomplish this.

Use play therapy that encourages self-expression, provides a sense of accomplishment, and teaches skills to motivate children with Autism.

Allow autistic children to choose the activity they want to engage in such as dancing or jumping and then be sure that you participate in these activities with them. Keep participating with them in these different activities until they communicate with you spontaneously and make eye contact.

Activites involving scripting or "social stories" should be encouraged as it oftentimes helps the non-verbal child with Autism to become more verbal while learning more appropriate behavioral skills. This also helps to improve their communication skills and has the tendency to decrease social isolation.

Employ positive reinforcement during their learning periods and therapy sessions in order to keep communication going. Praising correct answers or prompting another answer after an incorrect one is an excellent way to motivate them into responding more frequently.

Introduce new drills and tasks while still using familiar ones in order to make learning more fun and interesting. Granted, routine and structure are essential to providing autistic children with a comfort zone and teaching them numerous skills. However, Autism studies have revealed that when tasks are interesting and varied, autistic children are better behaved, give more correct answers, learn quicker, and stay more focused.

Incorporate activities that involve sensory integration. These will decrease or increase the level of sensory stimulation that autistic children receive. When a child with Autism is overwhelmed with sensory input, occupational therapists help them to participate in certain activities that help them to filter the amount of sensory input they are receiving.

Finally, children with Autism can also be motivated by employing music therapy and singing. In some cases, autistic children who cannot speak a single word can sing when they are exposed to tunes with repetitive and simple lyrics or phrases. This actually helps them to develop language skills that are lacking while at the same time helping them to eliminate those monotone speech patterns that are so common with autistic children.




For the latest videos and training information on child development as well as books and curricula on Autism please visit childdevelopmentmedia.com.





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2012年3月16日 星期五

Teaching Children With Autism Better Verbal Communication Skills


Children with autism commonly face problems with verbal communication. This is usually due to the frequent speech and language problems associated with the disorder. Though the actual reason that these problems are faced by autistic children is unknown, many experts believe that they are the result of several conditions occurring before, during, or after the child's birth that have had an impact on the development of the brain. The inability to properly communicate verbally can make interpretation and interaction with the child's world much more difficult.

The communication problems experienced vary from child to child, depending on the individual's social and intellectual development. While some may not be able to speak at all, others may maintain extensive vocabularies and can express themselves regarding complex topics. However, most children with autism experience some form of communication difficulty usually with the appropriate use of the language, for example difficulty with intonation, rhythm, and word and sentence meaning.

Autistic children who are able to speak may say things without true information, expression, or content. They are only words with no meaning to the situation. Others will use echolalia, where they simply repeat what they have heard, even if they have been asked a question. And yet other autistic children will use delayed echolalia, using the question previously posed in order to ask for what they want. For example, a child who had earlier been asked "are you hungry?" may say "are you hungry" at a later time to express his or her hunger.

Many autistic children will have a stock of phrases that they use in specific conditions. For example, a child may introduce him or herself at the beginning of every conversation. Some autistic children learn scripts from television shows, commercials, books, or other recorded dialogs.

Autistic children able to speak can frequently speak extensively about a topic without the ability to actually converse with others. They may also make up a voice to use other than their own such as a robot voice, a deep voice, a squeaky voice or another similar type of alteration.

It is possible to help an autistic child to better his or her verbal communication skills with improvements made through the use of appropriate treatments.

The first step is to consult a speech and language pathologist in order to have your child's communication skills evaluated. Specific treatments suitable for your child may be recommended during this evaluation.

No single method of communication treatment has been universally found to improve all autistic children, but starting early increases the chances of significant improvements. Try to target your child's specific communication strengths and weaknesses. Different forms of goal orientated therapy for useful communications are the most successful techniques, though not guaranteed to work for all children. Periodic in-depth evaluations from a specialist are recommended for perfecting and altering the therapy to best work for your child's unique needs.

Many parents find that consulting physical and occupational therapists can also be very helpful for helping to reduce unwanted behaviors during communication, which are common hindrances to the development of skills.

Find out what your child best responds to: a structured behavior modification program, an in-home therapy program, or another type of therapy that utilizes reality-based situations as a foundation for the therapy.

It may surprise you to discover that music therapy and sensory integration therapies may have a large impact on your child's ability to use verbal communication. This is because stimulation of the senses often helps to improve the child's ability to respond to sensory information, and therefore helps him or her recognize what he or she is hearing through verbal communication and seeing through non-verbal communication. The goal is to help improve the effectiveness of sensory understanding.

Medications may also improve an autistic child's attention span, which in turn can help to improve verbal communication in your child. However, with long-term medication use there is the possibility of undesirable side effects.

To be certain that your child is at his or her fullest potential, mineral and vitamin supplements, as well as a tailored diet, psychotherapy, and overcoming sleep challenges may greatly assist in focus and attention, which should help improve verbal communication.




Grab your free copy of Rachel Evans' brand new Autism Newsletter - Overflowing with easy to implement methods to help you and your family find out about autism treatment options plus information on improving autism verbal skills





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Special Education - How to Use an Independent Educational Evaluation to Benefit Your Child


Do you have a child with a learning disability or with autism that is

not making academic progress, even though they are getting special

education services? Would you like to know what educational and

related services your child needs in order to learn how to read, or do

other academics? This article will discuss what an Independent

Educational Evaluation (IEE) is, and how you can use one to benefit

your child with a disability.

The definition of an Independent Education Evaluation (IEE) is:

An independent educational evaluation is an evaluation conducted by a

qualified person, who does not work for the school district. Parents

of children with a disability often get IEE's so that they understand

what educational needs their child has and what services they require.

Most independent evaluations are parent initiated and paid for by the

parent.

Once you have decided to get an IEE, there are several things to

consider about the evaluator:

a. Make sure that they are qualified to perform the educational

evaluation. For Example: a registered Occupational Therapist could

conduct an Occupational Therapy evaluation. If sensory processing

disorder (used to be called sensory integration disorder) is an issue,

make sure that you find a registered Occupational Therapist who is

SIPT certified. If your child has autism, make sure the evaluator

specializes in educational evaluations for children with all types of

autism.

b. Whether this person is now, or ever has been an employee of

your school district. Talk to the person, and make sure that they do

not have a relationship with your school district. Be careful, even if

they used to work for another school district, make sure they are

truly independent, and willing to make recommendations for what your

child needs.

c. Make sure that the evaluator is willing to write a detailed

report, to include recommendations for related and educational

services. Ask the evaluator if they are willing to recommend specific

amount of minutes of service and specific methodology for educational

and related services. If they are not, consider going to a different

evaluator.

Once you have answered these questions, make an appointment and take

your child. Bring up any concerns that you have, and make sure that

you understand what tests will be conducted on your child. When the

report is finished, have the evaluator mail a copy to you. If you have

concerns about what is written, you may contact the evaluator and tell

them your concerns. Make sure recommendations are specific for

minutes, #of times per week, goals, methodology, etc.

Call the school district and set up an IEP meeting to discuss the

results of the IEE. If they request a copy up front, you can give it

to them. If possible, set up with the evaluator, a time that she or he

can participate in the IEP meeting by telephone. By having the

evaluator participate, special education personnel will have a harder

time not including the evaluators recommendations.

At the IEP meeting, if the school personnel will not put the

recommendations in your child's IEP, they must give you prior written

notice (PWN), as to why they are not willing to accept, the evaluators

recommendations. This notice must include the reason that they are not

accepting the recommendations, and what evaluations they are using to

refuse. If at the IEP meeting the school personnel do include the

recommendations, ask for reimbursement of the independent educational

evaluation.

An independent educational evaluation can be invaluable to your child.

By understanding what your child's educational and related needs are,

you may be a more effective advocate, for needed educational and

related services. If your child does not receive an appropriate

education their future may be in jeopardy!




JoAnn Collins is the parent of two adults with disabilities, has been an educational advocate for over 15 years, an author, as well as a speaker. JoAnn's recently released book: Disability Deception; Lies Disability Educators Tell and How Parents Can Beat Them at Their Own Game helps parents develop skills to be an assertive and persistent advocate for their child. For more free articles, press release, upcoming speaking engagements, go to http://www.disabilitydeception.com Can be reached at Phone Number 815-932-9263

You are welcome to publish this article in its entirety, electronically or in print, free of charge, as long as you include my full signature file, and my Web site address in hyperlink for other sites. Please send a courtesy E-mail to JoAnn@disabilitydeception.com.

JoAnn Collins Copyright 2008





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2012年3月15日 星期四

What is Autism?


Most reputable scientists now believe that autism has existed throughout the history of humankind. Some have speculated that ancient legends about "changelings" are actually stories of children with autism. Celtic mythology is redolent with stories of elves and visitors from "the other side" who steal a human child and leave their own damaged child in its place. The child left behind is usually mute, remote and distant, staring into space and unresponsive to its adult caretakers. We must bear in mind that in times gone by, and in some cultures today, children who are unlike the average expected child are seen to be victims of evil or some sort.

In 1801 the French physician Itard took into his care a boy who had been found wandering naked in the forest. It was believed at the time that the boy had lived alone in the forest since early childhood. The boy could not speak and was unresponsive to human contact. He has come to be known as "sauvage de l'Aveyron," or "wild boy of Aveyron". Itard's tireless efforts to help this boy mark the beginning of special educaiton. Although autism was not a term used at the time there are those who speculate that the wild boy of Aveyron was a child with autism.

The real history of autism dates back only one hundred years to the time of the Swiss psychiatrist Eugen Bleuler. In 1911 Bleuler was writing about a group of people then identified as having schizophrenia. In his writing he coined the term "autism" to describe their seeming near total absorption with themselves and distance from others.

Writing in the early 1920's, Carl Gustav Jung introduced the terminology of extrovert and introvert. Jung viewed these personality types as being present in all people to one degree or another. However he noted that in extreme cases, cases that in the language of his day were called "neurotic", a person could become totally absorbed into himself or herself.

It was not until the late 1930's and early 1940's in America that the term "autism" joined the official psychiatric nomenclature. Psychiatrists Leo Kanner, who started working with a particular group of children in 1938, and Hans Asperger, both publishing findings and writing in 1943 and 1944, wrote about groups of children they had studied and called either "autistic" or children with "autistic psychopathy". Both authors believe these children displayed a constellation of symptoms that were unique and represented a syndrome not previously identified. As the children they studied seemed unable to engage in normal human relationships they borrowed Bleuler's term "autism" to identify the syndrome. The defining difference between the work of Kanner and Asperger and that of Bleuler is that for the former two the condition they describe is present at birth while for Bleuler the condition appears much later in life.

Another important difference in these early pioneers of autism is that Kanner group is quite self-contained and comprised of individual all sharing the same "core" symptoms. Asperger's group is quite wide, ranging from the children like Kanner's to children with near normal characteristics. The vestiges of these two differing descriptions, now bearing the names of their illustrious "discoverers" remains to this day. In the literature and in lay terminology we still hear people described as having "Kanner's autism" or "Asperger's syndrome.

Around the time of Kanner and Asperger another famous, indeed in autism circles infamous, name appears. This is Bruno Bettelheim. In 1944 Bettelheim directed the Orthogenic School for Children in Chicago, Illinois. There he worked out his own theory of the cause of autism and started intervention programmes. Bettelheim believed that autism was a result of children being raised in severely unstimulating environments during their early years. He believed it was parents, particularly mothers, who were unresponsive to their children that caused autism. The unfortunate term "refrigerator mother" arose during this time.

Although Bettelheim's psychological theories were eventually discredited it was not for many years that science advanced to the point that mother's were not blamed for autism. Indeed, the author's own post-graduate training in the mid to late 70's was characterised by lectures about "refrigerator mothers" having caused autism. The legacy of Bettelheim's theory is undoubtedly one of terrible harm inflicted on so many mothers for so many years. [I cannot help but wonder if we really have progressed since I have so often heard mothers of children with autism being described as "over-anxious", "clinging", "over-involved" and "pushy or aggressive" by some educators, psychologists and physicians]

From the 1980's onward considerable research has been undertaken to uncover the "cause" of autism. So many theories have come forward: genetic, environmental, toxins, endocrine, metabolic, unusual reactions to certain foods or additives and the current favourite, immunizations. Despite all this theorising autism still remains a puzzle. Little scientifically valid evidence supports any particular theory and research continues into the cause of autism.

What do we know about autism?

It is now and accepted fact that autism is a neurodevelopment (sometimes called neurobiological) condition. This places the site of autism within the human brain itself, not in the form of physical brain abnormalities that appear on physical examination or X-ray, but rather in the chemical and electrical activity of the brain. It is know that autism is present at birth, is more common amongst boys than girls and is a life-long condition with no "cure". We know that autism can be treated effectively and there are a wide number of treatment options available. It is now known that education is particularly important in the treatment of autism and that early intervention is critically important. Children born with autism can improve along a number of pathways but they will always have autism no matter how seemingly like others they may become.

Having said what was said about autism being incurable and a life-long condition there are those who say it can be cured. Interesting forms of treatment being studied in New Orleans, Louisiana involve testing children with autism for low-level presence of lead in there system, then providing treatment to eliminate any traces of autism. This is said to have "cured" over 1,500 children of the condition (personal conversation with the lead physician). It has to be cautioned that such extreme and emphatic statements must be put to the rigorous test of scientific study and that the sorts of assessments being completed on these children in New Orleans are not in favour in Europe at the moment.

What is autism?

The neurodevelopment or neurobiological condition known as autism is highly variable. No two people with autism are alike. Having said that, all people with autism share common characteristics. These characteristics exist along what is called the "Triad of Impairment".

The Triad of Impairment consists of significant deficits across three developmental areas:

1. Social impairment

2. Verbal and non-verbal communication impairment

3. Impairments of thinking and behaving

1. Impairment of Social Interaction

There are several sub-types of behaviours that characterise this group of people with autism. They can be quite aloof, behaving as if other people did not exist at all, making little or no eye contact and have faces that seem to lack any emotional display whatever. Less common is the passive group who will accept the advances of others, can be led to participate as a passive partner in an activity and who return the eye contact of others. Another subtype has been called the "active but odd group". These people pay no attention to others, have poor eye contact and may stare too long and often shake hands far too vigorously and strongly. The last subtype is the overly formal and stilted group. They tend to use language in a very formal way when it is not called for, are excessively polite and try to stick to the rules of social interaction but don't really understand then. They tend to have well developed language skills that can mask their real social deficits.

2. Impairment of Communication

Significant deficits in communication are present, to one degree or another, in all people with autism. They may have problems is using speech (expressive language), ranging from having no speech at all (about 20% of cases) to have very well developed speech. They make repeat words spoken to them (echolalia) or repeat phrases they associate with something they want (e.g. "Do you want to play" instead of "I want to play"). They will also have deficits in understanding speech (receptive language). Confusing between sounds of words can be present (e.g. meat and meet). Difficulty with irony, sarcasm and humour is often found in those with well-developed expressive language. They may have problems understanding when an object has more than one meaning (e.g. soup bowl, toilet bowl).

In addition to the problem listed about in receptive language people with autism can often have significant difficulty with modulating their tone of voice and putting expression into what they say. They can sometimes sound robotic and speak with a droning monotone. Sometimes they can emphasise the intonation of certain words with unnecessary force. Sometimes they are too loud, sometimes too quiet (more frequent).

It is important to recognise that communication is more than speech. Non-verbal communication is important for human social interaction to proceed smoothly. People with autism have deficits in understand non-verbal communication. They may not be able to interpret facial expression or to use it themselves. They may have odd and unusual body posture and gestures. They may not understand the body posture and gestures of others.

3. Impairment of Thinking and Behaving

People with autism have pronounced difficulty with play or imagining. The lack of the ability to play has a profound effect on the ability to understand the emotions of others therefore sharing joy or sorrow with another can be impossible. Repetitive and stereotyped movements or activities are often present in autism. They may want to taste, touch or smell things. They may have a need to twirl things before their eyes. Sometimes they may jump up and down and make loud noises. In more severe cases they may bang their heads against walls or floor or pull and scratch at their skin. People with autism have a strong need for consistency and sameness. They become unsettled when routine changes. All these behaviours and characteristics point to a pronounced inflexibility in thinking and behaving.

Although every person with an autistic spectrum disorder has deficits in all three parts of the triad each varies significantly in the nature of their deficits. This makes is imperative for people working with children with autism to individualise their interventions. Autism is a highly variable condition with no two children alike and with some children, seemingly near normal but having subtle deficits.

Problems that may accompany autism

In addition to deficits across the triad there are a number of problems often associated with autism, though it is not known yet if they are caused by autism. Among the most common are: epileptic seizures (particularly in adolescence), sensory integration deficits (difficulty integrating the reception of sensations such as sound, sight, taste, hearing or movement), general learning disabilities, Fragile X syndrome (about 2-5% of people with an ASD), tuberous sclerosis (benign tumours in the brain or other organs, occurs in about 2-4% of people with an ASD), ADHD, Tourette's syndrome and dyslexia. Proper treatment of autism must include appropriate treatment of any associated condition.

Education of children with autism

Many children with autism can be educated in the mainstream with appropriate supports. These supports typically include speech and language therapy, occupational therapy, psychological services and special education. Though they perceive the world differently from those around them they benefit from placement in mainstream classroom and the other children benefit from having them in their class.

People with autism vary to an enormous degree as has been said above. As they progress through the educational system the types of supports they require and the intensity of these supports can vary as well. It is important to recognise that children with autism can be educated and reach their optimum level of potential. The task may be difficult and progress may be slow but progress will be made when supports are present and all work cooperatively together.

When autism is severe and accompanied by extremely challenging behaviour such as aggression, self-harm, extreme disorganisation and complete lack of language the education being provided often must take place in a specialist setting. The goal in these settings is to attempt to re-integrate the child back into the mainstream. For children whose autism is of such a severe nature psychiatric services may be required as an adjunct to the educational programme.

People with autism can be educated and a great many of them can enter the work force, sometimes independently and with great success, at other times requiring the support of a job coach and in some cases may require sheltered work settings. As well as entering the work force many people with autism can live independent lives, some will require structured and supported accommodation and some will require accommodation is specialist settings.

Autism and the brain

Considerable research is underway to investigate the exact nature of brain functioning in a person with autism. A lot is being learned but there is more to be learned in the future. What is known now is that there seems to be differences in the brain functioning of people with autism. With advances in nuero-imaging it is now possible to look at the brain with performing an autopsy. This makes it possible to study how the brain works while it is working. These imaging methods (CT scans, MRI scans PET scans and others) have shown that there seem to be a number of brain structures associated with autism and autistic spectrum disorders. These include the cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem. These structures are responsible for cognition, movement, emotional regulation and coordination as well as sensory reception. Other studies are looking into the role of neurotransmitters such as dopamine, serotonin and epinephrine. There seems to be a genetic factor involved in some of these brain dysfunctions and some research indicates that unusual brain growth may take place in the first three months of life, is a genetic factor and that results in autism appearing in early childhood.

What is being learned turns other theories, such as Bettelheim's, upside down. Autism is no one's fault. It is a neurodevelopment disorder affecting more boys than girls (4:1), occurring in about 3-6% of the population. This makes autism less common than general learning disabilities but common than cerebral palsy, hearing impairment and visual impairment. Translating these statistics into something more comprehensible it can be said that about 1 in 500 to 1 in 150 people will be born with autism. The implications for these figures are alarming because it means that virtually every school in the country has a child on the spectrum and that the vast majority of these children have not been diagnosed and are perceived in a pejorative light by their teachers, sometimes seemingly odd or obstreperous and sometimes lazy or unable to learn.

Autism and the family

Autism is a family condition. When there is one child in the family with autism there is a condition present that affects every single-family member including those who do not live in the same home. On receiving a diagnosis of autism parents sometimes feel a certain relief, now knowing that it isn't their fault the child is different. Others react with anger, grief, shame, denial or rage. Sometimes they become angry with the diagnostician and refuse to believe the findings. Although diagnosis at an early age is a good predictor of successful outcome if appropriate treatment is provided it is always accompanied by considerable trauma to family life. The impact of the diagnosis is always greatest on the mother.

The impact of living with a person on the spectrum has been shown to be harder on the mother than the father. The lessened paternal impact has a lot to do with factors associated with the gender role of the man in the traditional family: out of the home and working much of the time. Mothers are left in the major caretaker role and face the day-to-day stress of rearing a child with autism. For fathers the major impact of autism in the family is associated with the stress it puts on the mother. Figures in the US seem to indicate that the divorce rate in families of children with autism is not higher than in other families. This is something that has not been studied extensively in other countries however one study conducted in the UK indicates that the lone parent rate in families with autism is 17%, compared with 10% in other families.

Studies have shown that the emotional impact of autism on the mother can be quite severe. Many mothers experience enough emotional distress to require medication or psychotherapy. One study showed that 50% of mothers of children with autism screed positively for significant psychological distress and that this was associated with low levels of family support and brining up a child with challenging behaviour. Another study raised this figure to 66%. The emotional stress on the mother appears to have a significant effect on the work status. Many cannot work outside the home. For those that manage to work outside the home there is an increased incidence of tardiness, missed days and reduction to part-time status. Mothers are also the person most likely to be held responsible for their child's behaviour by others outside the family including neighbours and teachers. Mothers tend to cope differently with these stresses than fathers. Fathers tend to hide their feelings and suppress them, the result often being increased episodes of anger outburst. Mothers tend to cope by talking about their difficulties with friends, particularly other mothers of children with autism. They also cope by becoming avid information seekers, often knowing more about autism then the educators of their children.

The impact of autism on the siblings is not to be underestimated. They know from an early age that their brother or sister is "different". They will have a great many questions but most often don't ask them for fear of hurting the parent's feelings. The will have a deep love of the sibling with autism but this love is sometimes associated with anger and resentment due to the increased time the parents spend on the sibling with autism. They will often worry about their own future and obsess about whether or not they will "get" autism or will they pass it on to their own children one day.

The impact is not always negative and several studies have shown that being a sibling of a child with autism is associated with greater self-confidence and social competence. Care-taking skills often improve as well. Levels of tolerance to difference can be higher than in the siblings of children who do not have autism. So, what do we know about the impact of autism on the family? It is a mixed bag of results. At times is can be devastating, at other times it can lead to higher levels of coping skills and a sense of self-mastery. A lot depends on the family itself and the community in which it is embedded. A lot more depends on the supports and treatments available, especially the educational interventions and supports that can be provided. One this is certain: autism is a family condition affecting everyone.




David J. Carey, Psy.D.
297 Beechwood Court
Stillorgan
Dublin, Ireland
http://www.davidjcarey.com





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Autism Therapy Options For Your Child


There is no definite cure for autism; but a lot of children with the disorder can develop and learn with the proper education and treatment. Early intervention can definitely minimize the problems connected with the disorder, decrease disturbing behavior, and give the patient some measure of independence.

There are numerous options out there, although treatment is dependent on the patient's individual needs. Generally, making use of a combination of treatment methods yields successful results. Autism normally requires lifelong therapy.

One of the options available is occupational or physical therapy. Occupational therapy aids the person in developing independent function and educates as to how to go about enhancing basic skills such as brushing your teeth or bathing. Physical Therapy entails exercises or other physical measures such as massage to help patients in controlling the way they move their bodies.

Behavior Modification

To equip autistic patients with the skills necessary to function in their environment, there are a lot of methods of behavior modification available. This type of therapy stems from the theory that good behavior or conduct that is rewarded will have more chances of being repeated than the conduct that is ignored. We call this theory applied behavior analysis (ABA), and this entails structured skill-oriented activities basing on the patient's wellbeing and specific needs. Typically, this entails concentrated, one-on-one sessions with a therapist.

Sensory integration therapy

This form of therapy centers on helping autistic patients survive by the use of sensory stimulation. Treatment involves allowing patients to hold objects with various textures, or listen to a range of sounds. Play therapy is one form of behavior modification that can enhance emotional growth, which results to better social skills. Social stories are also used to enhance social skills. Here, stories created to aid the patients in understanding ideas, opinions, and feelings of other people, or to make suggestions as to how one can address a situation differently. This can also help patients comprehend their own feelings.

Communication therapy

This type of therapy is utilized to instigate language development in children with the disorder, and to provide treatment to those who are experiencing difficulties in verbal interaction.

Picture exchange communication systems (PECS) makes it possible for autistic patients to interact with the use of pictures or visuals that signifies items, ideas, or activities. With this, the patient is able to communicate his requests, needs and ideas to others by giving them a picture.




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2012年3月14日 星期三

The Key to Higher Learning


(A look into music and its effect on brain development)

Music brings to each person their own unique experience and emotional response. For each of us enter life with music. From the sound of our mother singing lullabies to the final funeral march; music is a constant in our lives. Have you ever wondered why music is playing in the grocery store, the dentist office, the doctors' office, and elevators? Why do people feel the need to bring in music that does not relate to their business? Is it that music provides something to our state of mind? I believe that music has a direct influence on our actions. Music impacts who we are and who we will become.

Music cleanses the understanding; inspires it, and lifts it into a realm which it would not reach if it were left to itself. ~Henry Ward Beecher

For over fifty years, the link between music education and brain development or intellectual growth has been researched. Several studies have shown astonishing results establishing that music does play an important role in who we become. Music helps "unlock" the learning potential in our brain which is needed to enhance our knowledge. Music aids in developing communication skills, strengthening memory, enhancing creativity, increasing self esteem and social skills, developing perceptual motor skills, increasing learning capabilities, healing the body, providing sensory integration, and motivating or increasing productivity. Music is a part of shaping each and every person's life. Music does influence us.

The following research supports the theory that music not only can be calming, but also assists in regaining the ability to focus and attend to tasks. This new found attention is what brings us to a higher level of learning. Therefore it is important to include music in the daily activities of children and teens. Music can be a very beneficial tool in every classroom for behavior management, as well as keeping children on task, opening them up for further learning. This is our children's key to success.

The Mozart Effect:

According to Don Campbell (1997), the power of Mozart's music came to public attention in 1993 when Gordon Shaw and Dr. Frances Rauscher, and their team at the Center for the Neurobiology of Learning and Memory in Irvine, founded "the Mozart Effect". Rauscher and Shaw hypothesized that listening to a specific music would produce a short term enhancement of spatial-temporal reasoning skills. They chose a particular Mozart sonata which had natural sequences of patterns and symmetries. These patterns actually match the internal structure of the brain. The study of thirty-six undergraduates from the psychology department proved an increase in spatial-temporal reasoning skills. These college students' IQ increased by nine points after listening to music of Mozart. Although the effect lasted only ten to fifteen minutes, the relationship between music and spatial reasoning skills was evident. The theory developed that listening to Mozart, whose music has a mathematical complexity, will make you smarter. Dr. Shaw and his research partner, Dr. Frances Rauscher furthered their studies by proving that keyboard lessons given to pre-schoolers, over a period of six months, also increased their spatial-temporal reasoning skills by 34 per cent more than pre-schoolers who did not receive the music lessons. Furthermore, this effect would be long term. Dr. Gordon Shaw was quoted as saying, "Mozart's music may warm up the brain. We suspect that complex music facilitates certain complex neuronal patterns involved in high brain activities like math and chess." (Campbell, 1997, pg.15-17) Media termed the results of these studies as "the Mozart effect" and the public grew increasingly interested. Hence, further studies were promoted.

A follow-up study was conducted by projecting sixteen abstract figures, similar to folded pieces of paper, on an overhead screen for one minute each, for seventy nine students. The students were tested to see if they could tell how the items would look when they were unfolded. Over a five day period, one group listened to Mozart, another to silence and another group heard mixed sounds, including music, short stories and dance pieces. At the end of five days, the Mozart group scored sixty two per cent higher while the silence group increased by only fourteen per cent and the mixed group increased by eleven per cent. The scientists suggested that listening to Mozart helps to organize the firing patterns of neurons in the cerebral cortex in association with higher brain function. (Campbell, 1997, pg.15-17)

Again in March 1999, Neurological Research published Dr. Shaw's study reporting that second graders who played the piano scored twenty seven per cent higher on proportional math and fraction tests. (Campbell, 1997, pg.180-181) The connection between playing an instrument and higher grades in math was confirmed once again.

Another study at Bolton Elementary School in Winston-Salem, North Carolina was conducted to challenge the "Mozart effect". This school was populated with students who averaged an IQ of ninety two among the second and fifth graders. These children had few advantages and not much extracurricular stimulation; as well seventy per cent were poor enough to qualify for free or reduced-price lunches. The principal hired a quintet for three years to play for the first, second and third graders for two to three half-hour sessions per week. As well, classical music was played over the school's intercom system in the halls, library and lunch room. After just three weeks, the first grade teacher noticed a difference in her students' ability to listen. After the three years, eighty five per cent of the students who had exposure to the classical music tested above grade level for reading and eighty nine per cent tested above average for math. This study further acclaimed the incredible impact that music has on children's learning abilities and academic performances.

Media attention provoked continuous studies. Mozart's music was known to improve attention and performance in students. Was this increased attention and performance due to the fact that Mozart's music opens the ear to listening, not just hearing? Listening is an active skill, while hearing is passive. I believe that the theory of the Mozart Effect lives with the awakening of our listening abilities - the ability to concentrate and focus. Once we develop this skill, we are capable of increasing our learning potential.

However, my interpretation is that if we expose children to music, whether as a listener or a player, it is good for the brain. Music stimulates a creative thinking and active listening that can only lead to true learning.

Multiple Intelligences:

Within the essence of true learning, we must realize that we have various strengths working together to reach our potential. Dr. Howard Gardner, a professor at Harvard University, created a theory of multiple intelligences in 1983. His theory suggested that the traditional measurement of intelligence, based on IQ testing, is far too limited. Instead, Dr. Gardner proposed eight different intelligences to account for a broader range of human potential in children and adults. These intelligences are:

Linguistic (word smart)

Logical / Mathematical (number/reasoning smart)

Interpersonal (people smart)

Intrapersonal (self smart)

Bodily-kinaesthetic (body smart)

Musical (music smart)

Spatial (picture smart)

Naturalist (nature smart)

Gardner's Theory of Multiple Intelligences provides a theoretical foundation for recognizing the different abilities and talents of students. This theory acknowledges that some students may not be verbally or mathematically gifted, but may have an expertise in other areas, such as music, spatial relations, or interpersonal knowledge. Teaching and assessing learning in this manner allows a wider range of students to successfully participate in classroom learning. This suggests educating the whole person. In Fowler's (1990) article, Gardner states, "As important as intelligence is, character and vision and responsibility are at least as important, probably more important". This, once again, validates teaching to the whole child.

We all use different forms of intelligences combined for optimal learning experiences. However, it is important to note that we may have a higher level of one intelligence than another. These intelligences form our strengths and weaknesses of who we are. Since we all learn differently, music may provide an area in which some students may excel in - an area where they experience a sense of achievement. Music can complete the process of educating.

The intelligences can be linked to each other through developing various skills. Making music helps children utilize, develop, and strengthen several aspects of intelligence. Through listening to music, singing, playing an instrument, our minds gets excited about learning. This, in turn, equates to stimulating young children's abilities to develop acquisition skills. Turner (2004) also states that singing improves verbal and linguistic ability and promotes communication skills and self confidence. Words and music are linked together because children are acquiring skills in both language and music at the same time. Singing also relaxes children, enabling them to breathe deeper and more frequently, feeding their brain with oxygen, and boosting their sense of well-being. (pg.111-116)

By connecting sound, movement, speech and interaction with a musical component, it is possible to activate and integrate more of the brain than with any other educational tool. By drawing to music, speaking in different accents (the musical quality of language), rapping spontaneously, and becoming aware of both the active (playing an instrument or singing) and passive (listening, imaging, or using music in the background) aspects of music, children can improve their mathematics, language, coordination, social and personal skills. The use of multiple forms of intelligence allows them to integrate and harmonize as well as use their brains to their greatest potential. (Campbell 2000)

Therefore, students who are involved with music in any way, create a positive influence on their overall intelligence.

Brain Activity and Development

Many questions have arisen about the effect that music has on brain development. We must recognize that music has an influence on our brains. It is interesting to note that several studies have acknowledged that musical activity involves nearly every region of the brain.

Trainer (2005) explains that different aspects of music, such as pitch, tempo and timbre, are analyzed by different neural regions. Listening to music starts with the brain stem, the cerebellum, and then moves up to auditory cortices on both sides of the brain. Trying to follow along with familiar music, involves additional regions of the brain. The Hippocampus, our memory center, and the subsections of the frontal lobe, particularly the frontal cortex, are all stimulated. The frontal lobe is associated with planning, self-control, and with perceptual organization. Tapping along with music involves the cerebellum's timing circuits. The cerebellum is involved in emotions and the planning of movements. Performing music involves the frontal lobes again for the planning behaviour, as well as the motor cortex in the parietal lobe. The parietal lobe is associated with motor movements and spatial skill. The sensory cortex provides tactile feedback when you have pressed the right key on your instrument, or moved the baton where you thought you did. Reading music involves the visual cortex, in the back of your head in the occipital lobe, which is responsible for vision. Listening to or recalling lyrics invoke language centers, as well as other language centers in the temporal and frontal lobes. The temporal lobe is associated with hearing and memory. All areas of the brain respond to music.

Studies continue to show how music influences brain activity with both long term and short term effects. However, further consideration confirms that music effects how the brain develops.

The brain is a very complex organ of the human body. Due to the size of the female pelvis, the brain cannot grow to its full size until after birth. The brain will continue to grow, at the same rate as prenatally, for two years. A process of myelination, which covers the brain's nerve pathways with a fatty, insulating substance called myelin, enables nerve pathways to improve their performance. As each section of the brain myelinates, that section becomes functional. Interestingly, the auditory nerve in the brain becomes myelinized prenatally which allows babies to hear before they are born.

Studies have shown that fetuses can sense sounds approximately between sixteen to twenty weeks. By the time the fetus reaches twenty-six weeks, they are receptive to music. As well, fetal heart rates slow down nicely in utero when they experience music. (Turner, 2004, pg.41-42) This factor substantiates that babies seem to relax in response to music. With this in mind, some delivery rooms will have relaxing music for both the mother and infant during the birthing process.

As the baby grows and the brain continues to develop, the baby forms perceptions about everything in its environment. Learning occurs through movement and emotional associations; both which music is involved. The continuous brain growth accelerates in the seventh year when the skull expands. After this, the child will start a two year growth period in the auditory area. During this growth, fine discrimination in hearing and producing sounds are developed which makes it the ideal time for music. (Campbell, 2000, pg.189-190) It is within this time, between the second and third grades, children develop more complex skills - listening, processing visual information, and coordinating movement in the brain.

Orff explained, in a typical analogy drawn from the natural world, "It is at the primary school age that the imagination must be stimulated; and the opportunities for emotional development, which contain experience of the ability to feel, and the power to control the expression of that feeling, must also be provided. Everything a child experiences at this age, everything that has been awakened and nurtured, is a determining factor for the whole of life." (Campbell, 1997, pg.186)

The auditory pathways continue to develop from the ages of nine to eleven, which enhance speech and listening. This is the time when the corpus callosum, the bridge between the left and right sides of the brain, completes its development. Studies have shown that musicians have a thicker corpus callosum which is more fully developed than other people. This validates the idea that music enlarges existing neural pathways and stimulates learning and creativity. As well, the plenum temporal, located in the temporal lobe of the cortex, is also more developed in musicians. This is the area of the brain that is associated with language processing and sound categorization, which suggests a perceptual link between music and language. (1994, Music of the hemispheres) Although, listening to and creating music is primarily a right brain function and learning is primarily a process of the left brain, music links the two halves together. When the two hemispheres are linked together, this connects the memory retrieval mechanisms which enhance learning capability.

Therefore, music does influence brain development and allows for learning to advance to a higher level.

My Own Mozart experiment

Through researching the direct effects of music on the brain, I decided to do my own research with the help of my son, Richard*. The theory of the Mozart Effect particularly intrigued me.

Richard listened to Mozart for fifteen to twenty minutes each night before bedtime. This fit in nicely with our normal routine, as he usually had one hour of reading and listening to music before bed. So, Richard started reading for one half hour and listening to Mozart for one half hour. As well, on occasion, we would play Mozart in the morning during our morning routine before school. I wanted to see if I could see a difference in my son's behaviour, interest and focus. This research does not have quantitative value and is solely based on my own opinion. Since I based this research on "Mother's intuition", my goal was to remain objective.

After a period of three months, I felt that Richard appeared to be more tolerant and more interested in talking in the morning. Previously, our morning routine consisted of my continual persistence in keeping peace between brothers. It had always seemed as though Richard consistently woke up on "the wrong side of the bed". However, he changed to seem more pleasant and more conversational during the morning. He no longer reacted with an angered response instinctively to teasing.

I also noticed that Richard seemed to more attentive and in control. I believe that the Mozart music has a calming effect which allowed Richard to "slow his thoughts down" and think before he does or says. I also believe that this effected his willingness to listen - which I believe is the key to learning.

My findings are purely subjective. I cannot be sure what cognitive effects that this has had, but I will continue to play Mozart during the mornings. Although, I cannot be sure as to what effect it has on him; it certainly can't hurt.

Conclusion

Educating children is essential for their growth and development, and music aids in this process.

Music is part of our lives long before we ever take a breath. It is a part of the exquisite universal harmony. It is there - created for us and created by us - to feel, to hear, to enjoy, to treasure through all the moments, hours, days and years of our lives. Our only hope is in keeping the beauty and splendour of music alive is in the legacy we leave our children. (Scarantino, 1997, pg.143)

Music is a necessity, as is music education. It appears that brains are designed to process, appreciate and eventually create music. Music reaches the depths of our brain and body through unconscious systems. Music education, then, is the nurturer of consciousness. It encompasses emotions, politics, cultures, and all dimensions of human life and creates a dynamic world - a world that is full of possibilities.

Music education has a multi-modal nature which reaches all learners. A school that promotes music education may be the happiest and healthiest school of all. Therefore, we must advocate for music education continuance in our schools. For we truly recognize that music is not only part of who each of us are, but music allows us to become who we are. Music education assists all who have the pleasure to experience it. We can say with a sound confidence that music education is a sound approach to advancing our children's' learning potential. For music education not only aids in increasing our children's' intelligence, but it also allows us all to become well educated. It has been proven that music education promotes higher learning capabilities. Hence, music education is indispensable and the key to higher learning potential.




Cynthia Creary

References:

Anvari, S., Trainor, L.J., Woodside, J., & Levy, B.A. (2002). Relations among musical Skills, phonological processing, and early reading ability in preschool children. Journal of Experimental Child Psychology, 88, 111-130. Armstrong, Thomas. (2000). Multiple Intelligences in the Classroom Second Edition. Alexandria, VA: Association For Supervision and Curriculum Development

Campbell, D. (2000). The Mozart Effect for Children Awakening Your Child's Mind, Health, and Creativity with Music. New York: HarperCollins Publishers Inc.

Campbell, D. (1997). The Mozart Effect Tapping the Power of Music to Heal the Body, Strengthen the Mind, and Unlock the Creative Spirit (Chapters 1,6,7). New York: The Hearst Corporation

Fowler, C. (1999). RECOGNIZING THE ROLE OF ARTISTIC INTELLIGENCES. Music Educators Journal, 77(2), 24.

Fujioka, T., Ross, B., Kakigi, R., Pantev, C., & Trainor, L. (2006). One year of musical training affects development of auditory cortical evoked fields in young children.

Brain, 129, 2593-2608. Grandin, T., Peterson, M., & Shaw, G., (1998). Spatial-temporal versus language-analytic reasoning: The Arts Education Policy Review, 99(6), 11.

McChesney Dr. Randall, Director of Richards Institute of Education & Research, USA., well known choral director, emails of February 2, 17, March 3, 2007. Music of the hemispheres. (brain development in trained musicians). Discover 15.n3 (March 1994): 15(1). Student Edition.

Petress, K. (2005). THE IMPORTANCE OF MUSIC EDUCATION. Education, 126(1), 112-115.

Scarantino, Barbara A. (1987). Music Power Creative Living Through the Joys of Music (Chapters 3,6,7,8,9). New York: Dodd, Mead & Company Inc.

Sousa, David A. How the arts develop the young brain: neuroscience research is revealing the impressive impact of arts instruction on students' cognitive, social and emotional development. School Administrator 63.11 (Dec 2006): 26(6). Health Reference Center Academic.

Trainor, L.J. (2005). Are there critical periods for music development?, Developmental Psychobiology, 46, 262-278.

Turner, J.B. (2004). YOUR musical CHILD Inspiring Kids to Play and Sing for Keeps. New York: String Letter Publishing. Wainsborough, Gillian. MUSIC AND THE MIND, Musicians scientists and educators come together to discover the role in defining who we are. McMaster Times (Fall 2006) pg.15-19.





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Dyadic Developmental Psychotherapy - An Evidence-Based Treatment For Disorders of Attachment


Dyadic Developmental Psychotherapy is an evidence-based and effective form of treatment for children with trauma and disorders of attachment . It is an evidence-based treatment, meaning that there has been empirical research published in peer-reviewed journals. Craven & Lee (2006) determined that DDP is a supported and acceptable treatment (category 3 in a six level system). However, their review only included results from a partial preliminary presentation of an ongoing follow-up study, which was subsequently completed and published in 2006. This initial study compared the results DDP with other forms of treatment, 'usual care', 1 year after treatment ended.

It is important to note that over 80% of the children in the study had had over three prior episodes of treatment, but without any improvement in their symptoms and behavior. Episodes of treatment mean a course of therapy with other mental health providers at other clinics, consisting of at least five sessions. A second study extended these results out to 4 years after treatment ended. Based on the Craven & Lee classifications (Saunders et al. 2004), inclusion of those studies would have resulted in DDP being classified as an evidence-based category 2, 'Supported and probably efficacious'. There have been two related empirical studies comparing treatment outcomes of Dyadic Developmental Psychotherapy with a control group. This is the basis for the rating of category two. The criteria are:

1. The treatment has a sound theoretical basis in generally accepted psychological principles. Dyadic Developmental Psychotherapy is based in Attachment Theory (see texts cited below

2. A substantial clinical, anecdotal literature exists indicating the treatment's efficacy with at-risk children and foster children. See reference list.

3. The treatment is generally accepted in clinical practice for at risk children and foster children. As demonstrated by the large number of practitioners of Dyadic Developmental Psychotherapy and it's presentation as numerous international and national conferences over the last ten or fifteen years.

4. There is no clinical or empirical evidence or theoretical basis indicating - that the treatment constitutes a substantial risk of harm to those receiving it, compared to its likely benefits.

5. The treatment has a manual that clearly specifies the components and administration characteristics of the treatment that allows for implementation. Creating Capacity for Attachment, Building the Bonds of Attachment, and Attachment Focused Family Therapy constitute such material.

6. At least two studies utilizing some form of control without randomization (e.g., wait list, untreated group, placebo group) have established the treatment's efficacy over the passage of time, efficacy over placebo, or found it to be comparable to or better than an already established treatment. See ref. list.

7. If multiple treatment outcome studies have been conducted, the overall weight of evidence supported the efficacy of the treatment.

These studies support several of O'Connor & Zeanah's conclusions and recommendations concerning treatment. They state (p. 241), "treatments for children with attachment disorders should be promoted only when they are evidence-based."

Dyadic Developmental Psychotherapy, as with any specialized treatment, must be provided by a competent, well-trained, licensed professional. Dyadic Developmental Psychotherapy is a family-focused treatment .

Dyadic Developmental Psychotherapy is the name for an approach and a set of principals that have proven to be effective in helping children with trauma and attachment disorders heal; that is, develop healthy, trusting, and secure relationships with caregivers. Treatment is based on five central principals.

At the core of Reactive Attachment Disorder is trauma caused by significant and substantial experiences of neglect, abuse, or prolonged and unresolved pain in the first few years of life. These experiences disrupt the normal attachment process so that the child's capacity to form a healthy and secure attachment with a caregiver is distorted or absent. The child lacks a sense trust, safety, and security. The child develops a negative working model of the world in which:

- Adults are experienced as inconsistent or hurtful.

- The world is viewed as chaotic.

- The child experiences no effective influence on the world.

- The child attempts to rely only on him/her self.

- The child feels an overwhelming sense of shame, the child feels defective, bad, unlovable, and evil.

Reactive Attachment Disorder is a severe developmental disorder caused by a chronic history of maltreatment during the first couple of years of life. Reactive Attachment Disorder is frequently misdiagnosed by mental health professionals who do not have the appropriate training and experience evaluating and treating such children and adults. Often, children in the child welfare system have a variety of previous diagnoses. The behaviors and symptoms that are the basis for these previous diagnoses are better conceptualized as resulting from disordered attachment. Oppositional Defiant Disorder behaviors are subsumed under Reactive Attachment Disorder. Post Traumatic Stress Disorder symptoms are the result of a significant history of abuse and neglect and are another dimension of attachment disorder. Attention problems and even Psychotic Disorder symptoms are often seen in children with disorganized attachment.

Approximately 2% of the population is adopted, and between 50% and 80% of such children have attachment disorder symptoms . Many of these children are violent and aggressive and as adults are at risk of developing a variety of psychological problems and personality disorders, including antisocial personality disorder , narcissistic personality disorder, borderline personality disorder, and psychopathic personality disorder . Neglected children are at risk of social withdrawal, social rejection, and pervasive feelings of incompetence . Children who have histories of abuse and neglect are at significant risk of developing Post Traumatic Stress Disorder as adults . Children who have been sexually abused are at significant risk of developing anxiety disorders (2.0 times the average), major depressive disorders (3.4 times average), alcohol abuse (2.5 times average), drug abuse (3.8 times average), and antisocial behavior (4.3 times average) (MacMillian, 2001). The effective treatment of such children is a public health concern (Walker, Goodwin, & Warren, 1992).

Left untreated, children who have been abused and neglected and who have an attachment disorder become adults whose ability to develop and maintain healthy relationships is deeply damaged. Without placement in an appropriate permanent home and effective treatment, the condition will worsen. Many children with attachment disorders develop borderline personality disorder or anti-social personality disorder as adults .

FIRST PRINCIPAL. Therapy must be experiential. Since the roots of disorders of attachment occur pre-verbally, therapy must create experiences that are healing. Experiences, not words, are one "active ingredient" in the healing process.

For example, one eight year old boy who had Reactive Attachment Disorder, Bipolar Disorder, and a variety of sensory-integration disorders wrote about his past therapy and attachment therapy this way (More details of this story can be found in the book Creating Capacity for Attachment, edited by Arthur Becker-Weidman & Deborah Shell):

My first therapy was with Dr. Steve. The therapy was FUN! We ate lots of snacks. I had a bottle. We played lots of cool games like thumb wrestling, pillow rides, giant walk, Superman rides, guess the goodies, eye blinking contests, hide and go seek goodies. I had to follow the rules and play the games just like Dr. Steve said.

Dr. Steve taught me how to play and have fun with my Mom. But I still didn't know how to love. I would still get real mad and try to hurt Mom and break things. Inside I still thought I was a bad boy. I was still afraid Mom and Dad would get rid of me. I had lots of tantrums at home. Sometimes I would still get out of control and break things and try to hurt Mom. I was getting even worse when I got mad.

Stuff Dr. Art Taught Me - I learned about my feeling well. Sometimes I stuff too many feelings like mad, scared and sad into my feeling well. Then the well will overflow and I could explode with behaviors. But I can stop that by expressing my feelings. Then the well can't overflow because I let some of the feelings out.

I also made pictures of my heart. I was born with a nice heart but then when I went into the orphanage I got cracks in my heart. My heart cracked because they couldn't take good care of me. I was a baby and I needed someone to hold me and rock me. But they couldn't because there were too many babies. Then I put 16 bricks around my heart. I was protecting my heart so it wouldn't get hurt anymore. But the bricks kept the love out too. I wouldn't let Mom's love in. I had lots of mad in my heart.

My hard work in therapy got rid of all the bricks. Then Mom's love got in. The love made the cracks heal. Now I have a bright red heart with no cracks.

I really liked Dr. Art now and am proud that I am strong. I still don't need therapy. I still let Mom's love into my heart! Sometimes I send e-mail's to Dr. Art. I tell him how good I'm doing.

I started missing Dr. Art and told Mom. Mom was confused and thought I wanted more therapy. I told Mom "I don't need therapy. I just want to have lunch with Dr. Art." So I sent Dr. Art an email to let him know that I wanted to have lunch with him. Then one day we had lunch together.

Sometimes it's still hard. I still get mad and sometimes I don't express my feelings well. Sometimes when Mom helps me I can express my feelings and say "I don't want to pick up my toys. It makes me mad that I have to but I will". When I say that it doesn't make me feel mad anymore. It helps me to listen to Mom. But sometimes when I get mad I pout and stomp my feet and run to my room if I forget to express my feelings. But now I let Mom help me so that I can talk about my feelings and do what she says

It's been a really longtime since I tried to hurt Mom or break things when I'm mad. I feel good about love now. I know that my Mom and Dad love me. I know that I love Mom and Dad. I don't feel like I'm a bad boy anymore.

Effective therapy uses experiences to help a child experience safety, security, acceptance, empathy, and emotional attunement within the family. A number of techniques and methods are used including psychodrama, interventions congruent with Theraplay, and other exercises.

SECOND PRINCIPAL. Therapy must be family-focused. Therapy helps the child address the underlying trauma in a supportive, safe, secure environment in "titrated" and manageable doses so that what the parents have to offer can get in and heal the child. It is the parents' capacity to create a safe and nurturing home that provides a healing environment. Being able to have empathy for the child, accept the child, love the child, be curious about the child, and be playful are all part of the "attitude " that heals. Parents are actively involved in treatment.

THIRD PRINCIPAL. The trauma must be directly addressed. Therapy helps healing by providing the safety and security so that the child can re-experience the painful and shameful emotions that surround the child's trauma. Revisiting the trauma is essential if the child is to begin to revise the child's personal narrative and world-view. It is by revisiting the trauma and sharing the anger and shame with an accepting, empathetic person that the child can integrate the trauma into a coherent self.

FOURTH PRINCIPAL. A comprehensive milieu of safety and security must be created. Traumatized children are often hyper-vigilant, insecure, and deeply distrusting. A consistent environment that is safe and secure is essential to creating the experiences necessary for the child to heal. This milieu must be present at home and in therapy. Good communication and coordination among home, school, and therapy is another important element of effective treatment. "Compression-wraps," invasive and intrusive stimulation designed to evoke rage, "re-birthing," and other provocative techniques are not part of Dyadic Developmental Psychotherapy. These intrusive and invasive techniques are not therapy, not therapeutic, and have no place in a reputable treatment program.

Fifth Principal. Therapy is consensual and not coercive. At our center we are very clear that physical restraint is not treatment and is not used in treatment in any manner. Treatment is provided in a manner consisted with the Association for the treatment and Training of Children's White Paper on Coercion in treatment.

The therapist must be well trained, licensed, and have significant experience in treating trauma-attachment disordered children. A good resource to locate such therapists is the Association for the Treatment and Training in the Attachment of Children, ATTACh. In selecting a therapist you should look for the following:

- Significant training from a recognized training program. Ask where the therapist was trained, how long ago, and for how long.

- Ongoing training. Ask when was the last training event the therapist attended and how long was the event.

- Licensure in the state in a recognized mental health discipline.

- Membership in ATTACh.

- A comprehensive informed consent document and appropriate releases.

- An initial assessment to develop a differential diagnosis and treatment plan.

DETAILED DESCRIPTION OF TREATMENT

Dyadic Developmental Psychotherapy is a treatment developed by Daniel Hughes, Ph.D., (Hughes, 2008, Hughes, 2006, Hughes, 2003,). Its basic principals are described by Hughes and summarized as follows:

1. A focus on both the caregivers and therapists own attachment strategies. Previous research (Dozier, 2001, Tyrell 1999) has shown the importance of the caregivers and therapists state of mind for the success of interventions.

2. Therapist and caregiver are attuned to the child's subjective experience and reflect this back to the child. In the process of maintaining an intersubjective attuned connection with the child, the therapist and caregiver help the child regulate affect and construct a coherent autobiographical narrative.

3. Sharing of subjective experiences.

4. Use of PACE and PLACE are essential to healing.

5. Directly address the inevitable misattunements and conflicts that arise in interpersonal relationships.

6. Caregivers use attachment-facilitating interventions.

7. Use of a variety of interventions, including cognitive-behavioral strategies.

Dyadic Developmental Psychotherapy interventions flow from several theoretical and empirical lines. Attachment theory (Bowlby, 1980, Bowlby, 1988) provides the theoretical foundation for Dyadic Developmental Psychotherapy. Early trauma disrupts the normally developing attachment system by creating distorted internal working models of self, others, and caregivers. This is one rationale for treatment in addition to the necessity for sensitive care-giving. As O'Connor & Zeanah (2003, p. 235) have stated, "A more puzzling case is that of an adoptive/foster caregiver who is 'adequately' sensitive but the child exhibits attachment disorder behavior; it would seem unlikely that improving parental sensitive responsiveness (in already sensitive parent) would yield positive changes in the parent-child relationship." Treatment is necessary to directly address the rigid and dysfunctional internalized working models that traumatized children with attachment disorders have developed.

Current thinking and research on the neurobiology of interpersonal behavior (Siegel, 1999, Siegel, 2000, Siegel, 2002, Schore, 2001) is another part of the foundation on which Dyadic Developmental Psychotherapy rests.

The primary approach is to create a secure base in treatment (using techniques that fit with maintaining a healing PACE (Playful, Accepting, Curious, and Empathic) and at home using principals that provide safe structure and a healing PLACE (Playful, Loving, Acceptance, Curious, and Empathic). Developing and sustaining an attuned relationship within which contingent collaborative communication occurs helps the child heal. Coercive interventions such as rib-stimulation, holding-restraining a child in anger or to provoke an emotional response, shaming a child, using fear to elicit compliance, and interventions based on power/control and submission, etc., are never used and are inconsistent with a treatment rooted in attachment theory and current knowledge about the neurobiology of interpersonal behavior.

Dyadic Developmental Psychotherapy, as conducted at The Center For Family Development, uses two-hour sessions involving one therapist, parent(s), and child. Two offices are used. Unless the caregivers are in the treatment room, the caregivers are viewing treatment from another room by closed circuit T.V. or a one-way mirror. The usual structure of a session involves three components. First, the therapist meets with the caregivers in one office while the child is seated in the treatment room. During this part of treatment, the caregiver is instructed in attachment parenting methods (Becker-Weidman & Shell (2005) Hughes, 2006). The caregiver's own issues that may create difficulties with developing affective attunement with their child may also be explored and resolved. Effective parenting methods for children with trauma-attachment disorders require a high degree of structure and consistency, along with an affective milieu that demonstrates playfulness, love, acceptance, curiosity, and empathy (PLACE). During this part of the treatment, caregivers receive support and are given the same level of attuned responsiveness that we wish the child to experience. Quite often caregivers feel blamed, devalued, incompetent, depleted, and angry. Parent-support is an important dimension of treatment to help caregivers be more able to maintain an attuned connecting relationship with their child. Second, the therapist with the caregivers meets with the child in the treatment room. This generally takes one to one and a half hours. Third, the therapist meets with the caregivers without the child. Broadly speaking, the treatment with the child uses three categories of interventions: affective attunement, cognitive restructuring, and psychodramatic reenactments. Treatment with the caregivers uses two categories of interventions: first, teaching effective parenting methods and helping the caregivers avoid power struggles and, second, maintaining the proper PLACE or attitude.

Treatment of the child has a significant non-verbal dimension since much of the trauma took place at a pre-verbal stage and is often dissociated from explicit memory. As a result, childhood maltreatment and resultant trauma create barriers to successful engagement and treatment of these children. Treatment interventions are designed to create experiences of safety and affective attunement so that the child is affectively engaged and can explore and resolve past trauma. This affective attunement is the same process used for non-verbal communication between a caregiver and child during attachment facilitating interactions (Hughes, 2003, Siegel, 2001). The therapist and caregivers' attunement results in co-regulation of the child's affect so that is it manageable. Cognitive restructuring interventions are designed to help the child develop secondary mental representations of traumatic events, which allow the child to integrate these events and develop a coherent autobiographical narrative. Treatment involves multiple repetitions of the fundamental caregiver-child attachment cycle. The cycle begins with shared affective experiences, is followed by a breach in the relationship (a separation or discontinuity), and ends with a reattunement of affective states. Non-verbal communication, involving eye contact, tone of voice, touch, and movement, are essential elements to creating affective attunement.

The treatment provided often adhered to a structure with several dimensions. It is pictured in Figure 1, below. First, behavior is identified and explored. The behavior may have occurred in the immediate interaction or have occurred at some time in the past. Using curiosity and acceptance the behavior is explored. Second, using curiosity and acceptance the behavior is explore and the meaning to the child begins to emerge. Third, empathy is used to reduce the child's sense of shame and increase the child's sense of being accepted and understood. Forth, the child's behavior is then normalized. In other words, once the meaning of the behavior and its basis in past trauma is identified, it becomes understandable that the symptom is present. An example of such an interaction is the following:

Wow, I see how you got so angry when your Mom asked you to pick up your toys. You thought she was being mean and didn't want you to have fun or love you. You thought she was going to take everything away and leave you like your first Mom did, like when your first Mom took your toys and then left you alone in the apartment that time. Oh, I can really understand now how hard that must be for you when Mom said to clean up. You really felt mad and scared. That must be so hard for you.

Fifth, the child communicates this understanding to the caregiver.

Sixth, finally, a new meaning for the behavior is found and the child's actions are integrated into a coherent autobiographical narrative by communicating the new experience and meaning to the caregiver.

Past traumas are revisited by reading documents and through psychodramatic reenactments. These interventions, which occur within a safe attuned relationship, allow the child to integrate the past traumas and to understand the past and present experiences that create the feelings and thoughts associated with the child's behavioral disturbances. The child develops secondary representations of these events, feelings and thoughts that result in greater affect regulation and a more integrated autobiographical narrative.

As described by Hughes (2006, 2003), the therapy is an active, affect modulated experience that involves acceptance, curiosity, empathy, and playfulness. By co-regulating the child's emerging affective states and developing secondary representations of thoughts and feelings, the child's capacity to affectively engage in a trusting relationship is enhanced. The caregivers enact these same principals. If the caregivers have difficulty engaging with their child in this manner, then treatment of the caregiver is indicated.

Children who have experienced chronic maltreatment and resulting complex trauma are at significant risk for a variety of other behavioral, neuropsychological, cognitive, emotional, interpersonal, and psychobiological disorders (Cook, A., et. al., 2005; van der Kolk, B., 2005). Children and adolescents with complex trauma require an approach to treatment that focuses on several dimensions of impairment (Cook, et. al., 2005). Chronic maltreatment and the resulting complex trauma cause impairment in a variety of vital domains including the following:

- Self-regulation

- Interpersonal relating including the capacity to trust and secure comfort

- Attachment

- Biology, resulting in somatization

- Affect regulation

- Increased use of defensive mechanisms, such as dissociation

- Behavioral control

- Cognitive functions, including the regulation of attention, interests, and other executive functions.

- Self-concept.

Dyadic Developmental Psychotherapy addresses these domains of impairment. Dyadic Developmental Psychotherapy shares many important elements with optimal, sound social casework and clinical practice. For example, attention to the dignity of the client, respect for the client's experiences, and starting where the client is, are all time-honored principles of clinical practice and all are also central elements of Dyadic Developmental Psychotherapy

In summary, therapy for traumatized children who have disordered attachments must be experiential, consensual, and provide an environment of security, acceptance, safety, empathy, and playfulness. Only an experienced and trained therapist can provide attachment therapy.




Becker-Weidman, A., (2006) "Treatment for Children with Trauma-Attachment Disorders: Dyadic Developmental Psychotherapy," Child and Adolescent Social Work Journal. Vol. 23 #2, April 2006, 147-171.
Becker-Weidman, A., (2006). "Dyadic Developmental Psychotherapy: A multi-year Follow-up," in, New Developments In Child Abuse Research, Stanley M. Sturt, Ph.D. (Ed.) Nova Science Publishers, NY, pp. 43 -- 61.
Becker-Weidman, A., (2007) "Treatment For Children with Reactive Attachment Disorder: Dyadic Developmental Psychotherapy," http://www.center4familydevelop.com/research.pdf
Becker-Weidman, A., & Hughes, D., (2008) "Dyadic Developmental Psychotherapy: An evidence-based treatment for children with complex trauma and disorders of attachment," Child & Adolescent Social Work, 13, pp.329-337.
Craven, P. & Lee, R. (2006) Therapeutic interventions for foster children: a systematic research synthesis. Research on Social Work Practice, 16, 287-304.





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Finding a Dentist for Special Needs Kids


Good dental hygiene can be almost impossible for some special needs kids. The daily routines of life can make it easy to forget about brushing and flossing, and some kids with sensory integration issues may be very resistant to the activity.

Finding a good dentist may help. Dentists and their staff can help educate children about dental health and encourage children to brush, floss, and rinse. Parents may be able to learn tips on how to help their children take care of their teeth.

When seeking out a dentist for your child, keep in mind the uniqueness of your child and his or her needs. Here are some helpful questions to ask as your seek out a dentist.

Are your familiar with my child's disability?Many dentist offices will express their willingness to see patients with disabilities. However, as many parents know, sometimes "disabilities" are all "lumped together." There are many types of disabilities, each with unique characteristics. Successful dental appointments depend upon the dentist's and the dental staff's willingness to learn about your child's specific needs.

May we tour your facility before we visit? Going to the dentist can be scary! Touring the facility ahead of time will eliminate some of the "unknown" and perhaps ease some of your child's fears. He or she can sit in the dental chair (and maybe even make it work), look at the tools, and maybe even get a free toothbrush before the scheduled appointment. Receptionists and other staff will also be familiar with your child before the appointment. Meeting the dentist and staff ahead of time is especially helpful. However, scheduling and multiple locations may limit staff availability.

If touring is not practical, check out the office's website. Some have pictures and bios of the staff, as well as virtual office tours.

Do you have a private room for your special needs patients? In many dental offices, patients are seen in one big room, perhaps partitioned by cubicles or curtains. Kids with sensory issues could be overwhelmed by sounds such as drills, cleaning tools, or by other children. Some offices provide a calmer atmosphere in private rooms for their special need patients.

How do you handle tantrums and refusals of treatment? Pediatric and adolescent dentists are well-acquainted with these issues. The best prevention of tantrums is educating or preparing the parent and child before a procedure. Some kids will refuse to have their teeth polished. Find out if there is an alternative to the cleaning tools, such as simply brushing the child's teeth.

Do you provide anesthesia for dental work? If your child is already fearful of strangers and dentists, or has severe oral sensitivities, anesthesia may be an option for cleaning and dental work.This may be found on the dentist's website. If so, familiarize yourself with the different options they offer.

Is dental work done under anesthesia performed in the office or elsewhere? Some offices offer general anesthesia for major dental work, provided by an anesthesiologist. This might be done at an out-patient surgery center. If the child needs a filling, root canal, or crown, general anesthesia might be a good option. While the child is "under," the dentist may also provide a thorough cleaning.

How do you prepare your special needs patients for the procedures? Some dentists show the tools, demonstrate on dolls or their own teeth, or even have pictures of procedures. The dentist may have suggestions for preparing the child at home, too.

Will my child see the same dentist at every visit? For people with developmental disabilities such as autism, this may be important for continuation of care. The more interactions the child has with a dentist, the more trust builds.

Do you take Medical Assistance? Many dentists do not take medical help. However, if financially feasible, paying out of pocket for a dentist that fits the child can be worth it in the long run.

Finding a good dentist can be a long process. The search is worth it!




Elizabeth Givler and her husband raise three kids, two of which are on the autism spectrum. Elizabeth has a passion for equipping other special needs families to live as "normal" lives as possible. Elizabeth consults for non profit and faith-based organizations regarding inclusion and natural supports. Currently she teaches clarinet lessons to students with and without special needs and assists families with special dietary needs through her Wildtree business. Read her blog at http://www.elizabethgivler.com or contact Elizabeth at ehgivler@yahoo.com.





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2012年3月13日 星期二

Identifying Attention Deficit Hyperactivity Disorder in the Classroom: Eight Things Teachers Should


Attention Deficit Hyperactivity Disorder (ADHD) is the phrase that is used to describe children who have significant problems with high levels of distractibility or inattention, impulsiveness, and often with excessive motor activity levels. There may be deficits in attention and impulse control without hyperactivity being present. In fact, recent studies indicate that as many as 40% of the ADD kids may not be hyperactive. Research shows that there are several things happening in the brain of the ADHD child which causes the disorder. The main problem is that certain parts of the Central Nervous System are under-stimulated, while others may be over-stimulated. In some hyperactive kids there is also an uneven flow of blood in the brain, with some parts of the brain getting too much blood flow, and other centers not getting as much. Certain medications, or other forms of treatment can be used to address these problems. Often the Attention Deficit Hyperactivity Disorder child has special educational needs, though not always. Most Attention Deficit Hyperactivity Disorder kids can be successful in the regular classroom with some help. Teachers can find over 500 classroom interventions to help children be successful in school at http://www.ADDinSchool.com. As a teacher ask yourself these questions: 1. Can the child pay attention in class? Some ADHD kids can pay attention for a while, but typically can't sustain it, unless they are really interested in the topic. Other ADHD kids cannot pay attention to just one thing at a time, such as not being able to pay attention to just you when you are trying to teach them something. There are many different aspects to "attention," and the ADHD child would have a deficit in at least one aspect of it. 2. Is the child impulsive? Does he call out in class? Does he bother other kids with his impulsivity? These kids often cannot stop and think before they act, and they rarely think of the consequences of their actions first. Impulsivity tends to hurt peer relationships, especially in junior high school years. 3. Does he have trouble staying in his seat when he's supposed to? How is he on the playground? Can he wait in line, or does he run ahead of the rest of the class? Does he get in fights often? 4. Can he wait? Emotionally, these children often cannot delay gratification. 5. Is he calm? They are constantly looking for clues as to how they are doing. They may display a wide range of moods, which are often on the extremes: they act too sad, too angry, too excited, too whatever. 6. Is the child working at grade level? Is he working at his potential? Does he/she stay on task well? Does he fidget a lot? Does he have poor handwriting? Most ADHD kids have trouble staying on task, staying seated, and many have terrible handwriting.

7. Does he have difficulty with rhythm? Or the use of his time? Does he lack awareness about "personal space" and what is appropriate regarding touching others? Does he seem unable to read facial expressions and know their meanings? Many children with ADHD also have Sensory Integration Dysfunctions (as many as 10% to 20% of all children might have some degree of Sensory Integration Dysfunction). SID is simply the ineffective processing of information received through the senses. As a result these children have problems with learning, development, and behavior. 8. Does he seem to be immature developmentally, educationally, or socially? It has been suggested by research that children and teens with Attention Deficit Hyperactivity Disorder may lag 20% to 40% behind children without ADHD developmentally. In other words, a ten year old with ADHD may behave, or learn, as you would expect a seven year old to behave or learn. A fifteen year old with ADHD may behave, or learn, as you would expect a ten year old to behave, or learn. There is a lot to learn about ADHD. Both teachers and parents can learn more by visiting the ADHD Information Library's family of web sites, beginning with ADDinSchool.com for hundreds of classroom interventions to help our children succeed in school.




Douglas Cowan, Psy.D., is a family therapist who has been working with ADHD children and their families since 1986. He is the clinical director of the ADHD Information Library's family of seven web sites, including http://www.newideas.net, helping over 350,000 parents and teachers learn more about ADHD each year. Dr. Cowan also serves on the Medical Advisory Board of VAXA International of Tampa, FL., is President of the Board of Directors for KAXL 88.3 FM in central California, and is President of NewIdeas.net Incorporated.





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Dermatillomania in Children


Compulsive skin picking is a type of obsessive-compulsive spectrum disorders (OCSD). OCSD symptoms typically begin during the teenage years or early adulthood, but recent research shows that some children may develop the illness even during the preschool years. Research also indicates that at least one-third of OCSDs in adults begin in childhood. Compulsive skin picking also called psychogenic excoriation is also sometimes seen in children. It is disappointing to know that there are very few resources available to parents whose children suffer from this sometimes debilitating disorder.

Skin picking most likely starts due to inadequate messages from the skin to the central nervous system and a decreased sensitivity to pain. It is more likely to occur during periods of boredom or stress, and occurs most often at bedtime, in the bathroom, in class, and in the car. Through excessive skin picking, children tend to convey messages for which they can't find the words. It may be almost impossible for a child to describe all the thoughts and feelings that are making him to pick but the evidence alone of compulsive picking is enough to signal to a parent that medical intervention is needed.

Effort should be made to eliminate the possibility of a physical cause for picking. If there is a physical cause, that must be treated and the urge to pick will probably go away. A number of products are available to help alleviate the discomfort and distress associated with this disorder. Physical impediment devices such as special gloves can be used. They are helpful in only a small number of cases.

Finger nails of children should be regularly trimmed to avoid compulsive skin picking. Also, their fingernails should be clean and tidy to reduce the chances of infection in the areas that a child is picking.

Sensory stimulation can be provided to help reduce the incidence of the picking. An occupational therapist trained in sensory integration can do an assessment and make recommendations for activities that increase sensory stimulation, such as skin brushing and play activities such as playing with a stress ball that are fun as well as effective in reducing the need to pick. A trained professional can also provide insight into the mental outlook of a child and thus prove to be of great help.

It may become necessary to treat skin picking in children with oral or topical medications. There are special formulations of these drugs for children and care should be taken that children receive these special doses. This treatment should be observed for sometime in case there are signs of improvement in these children. It's quite likely to witness these children get better with continued treatment.

Since this disorder results from anxiety, drawing undue attention to the activity could likely make it worse. It is important to note that punishment, lectures, nagging, consequences, undue fussing, blaming and shaming and all the responses we persist in do not work. In fact, the increased anxiety could actually lead to an increase in picking.




Curing dermatillomania isn't as difficult as you may think, too many people rely on lengthy and expensive therapy sessions or medications; Compulsive skin picking can be cured without leaving the house.

If you'd like to know how to cure this disorder please keep reading Dermatillomania Cure





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