Office Echoes MayJUNE 2012
Hi Everyone Attached is the latest newsletter from West Links Family Services. Kind regards Bill MurrayCo-ordinatorCloud 9 Children’s FoundationP O Box 51176 Tawa 5249Tel. (04) 232 4795Email: [email protected]: www.withyoueverystepoftheway.com
Content
Issue 14
WEST LINKS FAMILY SERVICES
suppor ng families with invisible disabili es: e.g. AD/HD, Aspergers, ASD, ODD, CD
Office Echoes 2012
In this issue : Thanks to our Funders News from the Desk Autism NZ event Dyslexia
Being young for grades research review
MAY/JUNE Issue
1 2 3
4-7 8-11
12-14
Hi everyone, Term 3 is nearly upon us; we hope you & yours have made progress as term two has unfolded. The school holidays can prove challenging during the cold, wet, winter months and parents may find themselves stretched to the limit organizing suitable indoor activities for their children. Keeping humour uppermost can make the difference in keeping a lighthearted atmosphere in your home - laugh lots whenever possible! We’re always interested in hearing about your successes or challenges, so please feel free to contact us about them.
Social Skills/Stories
Importance of Visual Strategies
15
Whanau Marama course Books to Read
16 17
Support Group details & Spotlight on… 18 Contact Us Map - How to find us 19 20
If you wish to submit anything personally or have any specific queries, please don’t hesitate to contact us and explore this further. As always, please feel free to ring us at the office: (09) 836-1941 to chat about how we can help you, preferably before any crises develop. It’s always easier to find solutions [to problems] before they become seemingly insurmountable.
BP Vouchers for Volunteers COGS Auckland Manukau & Waitakere
NZ POST SKY CITY
Sue
MSD - Community Response Fund
To our Funders:
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Quotable Quotes:
The trouble a kid causes is never greater than the pain s/he feels ! Rick Lavoie
News from the desk…...
As usual this newsletter includes a variety of topics relating to AD/HD and/or Aspergers. We have included a section on Dyslexia this month, as it is common to find children may be affected to some degree or other - yet as parents how can we tell if this is the case for our child? This article gives some good information and there is also a ‘check list’ to work through which may help give a definitive clue whether you need to explore further. I found another article which reviews research re whether age differences when starting school may have an impact on children & eventual considerations for diagnosis - with some interesting outcomes/food for thought… We hope the information we have put together in this newsletter may prove insightful!
Office hours: The office will be attended daily between 9am - 5pm.
REMEMBER...
A child’s disappointment over something we find trivial, is just as real as our disappointment over something they find trivial.
However there may be odd times when we are away attending meetings etc. If you experience this at any time, then please leave us a message and we will get back to you as soon as we can.
l Clinica g trainin alone… ’t doesn ensure te accura n tio percep
Websites of interest...
tonyattwood.com.au (Dr. Tony Attwood) ADD.org (info for AD/HD Adults) Amen Clinic.com (Dr. Daniel Amen)
www.westlinksfamilyservices.co.nz
www,dilemmas.org www.wotsnormal.com CHADD.org ParentingAspergers.com
help4adhd.org (info & resources) www.sparklebox.co.uk (resources and printables) www.youthlaw.co.nz (legal advice for youth)
www. insomniaspecialist.com/ forms.php
www.cesa7.k12.wi.us/ sped/autism/structure/ str11.htm
parent2parent.org.nz Autism.org.nz www.templegrandin.com (information and support) (Temple Grandin) www.calm.auckland.ac.nz Cloud 9 Children’s ricklavoie.com Foundation (Dr. Rick Lavoie) (Aspergers information) www.
And don’t forget YOU TUBE !
yoursleep.aasmnet.org
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Fundraising event for Autism NZ
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DYSLEXIA…
University of Washington - research/study 1999
Dyslexic Children use nearly five times the brain area as normal children, to perform an ordinary language task…
Dyslexic children use nearly five times the brain area as normal children, while performing a simple language task, according to a study by an interdisciplinary team of Researchers at the University of Washington. The study shows for the first time that there are chemical differences in the brain function of dyslexic and non-dyslexic children. The research, published in the American Journal of Neuroradiology, also provides new evidence that dyslexia is a brain-based disorder. Dyslexia, is the most common learning disability, affecting an estimated 5 percent to 15 percent of children. The UW researchers, headed by developmental Neuro Psychologist Virginia Berninger and neuro-physicist Todd Richards, used a non-invasive technique called proton echo-planar spectroscopic imaging (PEPSI) to explore the metabolic brain activity of six dyslexic and seven non-dyslexic boys during oral language tasks. The researchers used PEPSI which is about 32 times faster than conventional magnetic resonance spectroscopy, to detect specific brain chemicals, such as the levels of brain lactate activation. Lactate is a by-product of energy metabolism produced by neurons when the brain is activated. Most, but not all, of this brain activity took place in the left anterior, or frontal lobe of the brain, which is known to be one of the centres for expressive language function. "The dyslexics were using 4.6 times as much area of the brain to do the same language task as the controls," said Richards, a professor of radiology. "This means their brains were working a lot harder and using more energy than the normal children." "People often don't see how hard it is for dyslexic children to do a task that others do so effortlessly," added Berninger, a professor of educational psychology. "There are clear learning differences in children. W e can't blame the schools or hold teachers accountable for teaching dyslexic children, unless both teachers and the schools are given specialized training to deal with these children." The 13 boys in the study were between 8 and 13 years of age and the dyslexic and control groups were well-matched in age, IQ and head size, but not in reading skills. The controls were reading at a level above normal for their age and had a history of learning to read easily.The dyslexics had delayed reading skills and were reading well below average for their age. Their families also had a history of multi-generational dyslexia that was confirmed in a concurrent family genetics study. The boys, fitted with earphones were asked to perform four tasks while their brains were being imaged. Three of the tests involved pairs of words and the fourth used pairs of musical tones. In the language tests, the boys heard a series of word pairs that consisted of either two nonrhyming words such as "fly" and "church," two rhyming words such as "fly" and "eye," a nonrhyming real word and non-word such as "crow" and "treel," and a rhyming word and non-word such as "meal" and "treel." The boys were asked if the word pairs rhymed or didn't rhyme and if the pairs contained two real words or one real and one non-word. They responded by raising a hand to indicate yes or no. In the music test, the boys heard pairs of notes and raised one hand if they thought the notes were identical and the other if they believed them to be different.
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DYSLEXIA…
University of Washington - research/study 1999 - cont’d
While the dyslexic boys exhibited nearly five times more brain lactate activation during a lan- guage task that asked them to interpret the sounds of words, there was no difference in the two groups during the musical tone test. This means the difference between the dyslexics and the normal children relates to auditory language and not to non-linguistic auditory function, according to Richards and Berninger. They also said the findings are important because they shed new light on brain mechanisms involved with dyslexia at a developmental stage, when it is still amenable to treatment. In addition, the functional differences between dyslexics and control subjects add evidence that dyslexia is a brain-based disorder. "When a child has a brain-based disorder it is treatable, although it may not be curable, just as diabetes is," said Berninger. “Dyslexia is a life-long condition, but dyslexics may learn to compensate for it later in life. We know dyslexia is a genetic and neurological disorder. It is not brain damage. Dyslexics often have enormous talents in other parts of their brain and shine in many fields. Einstein was a dyslexic, and so were inventor Thomas Edison and financier Charles Schwab. "While it is useful to show there are brain differences between dyslexic and non-dyslexic children, considerably more research is needed to precisely define the chemical and neurological markers of dyslexia. W hat we found is a metabolic marker, but there could be a more fundamental cause. We need to understand the molecular and neural mechanisms underlying dyslexia," said Berninger.
Other members of the UW research team and co-authors of the study are: Stephen Dager, professor of psychiatry and behavioural science;; David Corina, assistant professor of psychology;; Cecil Hayes, profes- sor of radiology;; Robert Abbott, professor of educational psychology;; Susanne Craft, adjunct associate pro- fessor of psychiatry and behaviour science;; Dennis Shaw, assistant professor of radiology;; and Stefan Pos- se, affiliate assistant professor of radiology. In addition, UW doctoral students Sandra Serafini, Aaron Heide, Keith Steury and Wayne Strauss participated in the research. The study, part of a wider UW effort to understand the basis of dyslexia and develop treatments for it, was funded by the National Institute of Child Health and Human Development. (USA)
Brain images show individual dyslexic children respond to spelling treatment
Joel Schwarz, Feb. 8, 2006
Brain images of children with dyslexia taken before they received spelling instruction show that they have different patterns of neural activity than do good spellers when doing language tasks related to spelling. But after specialized treatment emphasizing the letters in words, they showed similar patterns of brain activity. These findings are important because they show the human brain can change and normalize in response to spelling instruction, even in dyslexia, the most common learning disability. Photograph of a child preparing for a func onal MR spectroscopic imaging scan (with the PEPSI technique). The child is near the bore of the General Electric Signa magnet which operates at 1.5 Tesla. The earphone connec on is also visible (black tubing).
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Background to the research/study...
Subject Characteriza on The University of Washington Human Subjects Ins tu onal Review Board approval was obtained for this study, and each subject (as well as parent/guardian) gave wri en, informed consent. All subjects were right handed (90-100% on the Edinburgh Handedness scale(30)). The control boys had a history of learning to read easily and were reading above normal for age (average was one standard devia on above mean for age using the Woodcock Reading Mastery Test-Revised (31)) . The dyslexic boys had a developmental history of extreme difficulty in learning to read despite many forms of extra assistance at school and also had a family history of mul -genera onal dyslexia, which was confirmed in a concurrent family gene cs study (W. Raskind, personal communica on) at our cen-‐ ter. The dyslexic boys were reading on average 1.66 standard devia ons below the mean for age using the Woodcock test (31). In addi on, all the dyslexic boys were shown to have a triple deficit in three skills that predict ease of learning to read and response to interven on, phonological (phoneme seg-‐ menta on and/or memory for spoken nonwords), rapid automa zed naming, and orthographic (speed of coding wri en words and/or accuracy of represen ng them in memory)(32) . Based on independent t-tests, the 7 controls ( M=127.3, SD=10.8) and 6 dyslexics (M=124.3, SD=11.1) did not differ in age in months (t(11) = 0.49,p=0.637). Likewise, the controls (M=15.6, SD=3.2) and dys-‐ lexics (M=13.2, SD=1.6) did not differ in age-corrected WISC-III vocabulary scores (t (11)= 1.68, p=0.12), which provide the best es mate of Full Scale IQ. However, the controls and dyslexics did differ significantly in age-corrected standard scores for reading real words on the Word Iden fica on (WI) subtest of the Woodcock Reading Mastery Test-Revised (WRMT-R) and for reading pseudowords on the Word A ack (WA) subtest of the WRMT-R: t(11)=6.81, p < 0.001 on the WI subtest and t(10) = 6.02, p<0.001 on the WA subtest. The differences for both real word reading (WI, controls, M=115.1, SD=9.2; dyslexics, M=75.5, SD=11.8) and pseudoword reading (WA, controls, M=110.2, SD=6.8; dyslexics, M=79.0, SD=10.7) were large as well as sta s cally significant.
Source: Richards et al, American Journal of Neuroradiology, 20, 1393-1398, September, 1999 From the Departments Radiology (T.L.R., S.R.D, A.C.H., C.E.H. D.S.), Psychiatry and Behavioral Science (S.R.D., S.C.), Psychology (D.C., K.S.), Speech and Hearing Sciences (S.S.), Bioengineering (T.L.R., S.R.D., W.S.), College of Educa on (R.D.A., V.W.B.), University of Washington, Sea le; Geriatric Research Educa-‐ on and Clinical Center, Veterans Affairs Puget Sound, Sea le (S.C.); and Ins tut fur Medicine, For-‐ schungszentrum, Julich GmbH, D-52425, Germany (S.P.). Grant support: This work was funded by a special mul disciplinary learning disabili es Center Grant from NIH (NICHD), P50 HD33812. Presenta on at mee ng: This paper was presented in part to the Cogni ve Neuroscience Society 1998 Annual Mee ng, see Poster 67 , Tuesday 4/7/98.
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How to tell whether your child may be affected by dyslexia…
SCORE
0= Never Exhibited 1= Sometimes Exhibited 2= Often Exhibited 3= Very Descriptive of Individual
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Has difficulty reading at grade level. Has significant spelling challenges . Cannot spell high frequency words or retain spelling words from one week to the next. Has poor handwriting. There may be changes in pressure, scrolling over, and/or letters or words that do not stay on the lines. Cannot tell time on a face clock. Has or had difficulty tying shoes until later ages (3rd grade or above). Cannot sound out unknown words despite knowing phonics. Guesses at words based on the appearance of the word. Has difficulty with word call. May have to stop and think about words often (“It’s on the tip of my tongue,”) or many stutter. Has difficulty with directionality: left/right, below/behind, east/west. Has difficulty learning multiplication tables . Has difficulty remembering the days of the week or months of the year in or- der. [Sequencing] Difficulty learning cursive. Typically all handwriting is in print. Began to talk (as a baby) relatively late. (After 2 or 3 years old.) Difficulty learning to rhyme and/or did [does] not enjoying rhyming games. Does not read for pleasure…may actively avoid reading although enjoys be- ing read to. Has trouble with written expression. May ignore grammar such as capitals, punctuation, etc. Despite being a good story teller, can’t get their thoughts on paper, in writing, in an acceptable form. Mixes up sounds in multi-syllabic words (ex: aminal for animal, bisghetti for spaghetti, hekalopter for helicopter, hangaberg for hamburger, mazageen for magazine, etc.) Has difficulties in math. May have trouble showing work or remembering the steps to completing a problem. Long division may prove a significant challenge. Is messy and/or disorganized. [Room, locker, backpack, desk] But there may be other reasons for this (see ADD symptoms). Has difficulty with schedules, timelines and agendas. May misunderstand what to do next. May seem confused and have to ask (confirm) what to do often.
18 19 20
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Being Young for Grade Increases Odds of ADHD Diagnosis
ADHD is the most commonly diagnosed neurobehavioral disorder in children and substan al evidence indicates that biological factors play an important role in its development. For example, although the exact mechanism by which gene c factors convey increased risk for ADHD remains unclear, the importance of gene c transmission has been documented in a number of published studies. Even though biological factors are widely regarded as important in the development of ADHD, no medical or biological test is recommended for rou ne use when diagnosing ADHD. Instead, like virtually all psychiatric disorders, ADHD is defined by a constella on of behavioral symptoms that are generally reported on by a child's parents and teacher. Also, in nearly all cases, it is parents' and/or teachers' concerns about a child's ability to focus and regular their behavior that leads to a child being evaluated for ADHD in the first place. While some children display sufficient ina en ve and/or hyperac ve-impulsive behavior to be diagnosed with ADHD as pre-schoolers, it is generally not before children enter school that concerns related to a en on and hyperac vity arise. This may be especially true for ina en ve symptoms, as demands for sustained a en on become much greater when children start in school. Teachers can observe how a child's ability to regulate a en on and behavior compares to an en re classroom - something parents typically can't do - and their judgements may thus be par cularly influen al in whether a child is evaluated for ADHD and diagnosed with the disorder. A number of factors may contribute to differences in children's ability to focus and regulate their behavior when they enter school. One factor certainly is ADHD, as children with the condi on will be observed by teachers to be more ina en ve and/or hyperac ve. Another factor - and one that may be frequently overlooked - is their age rela ve to most of their classmates. This is the issue inves gated in the studies that are summarized below. Three recently published studies provide compelling evidence that a child's age rela ve to his or her classmates is an important factor in whether they are diagnosed for ADHD. Results from these studies are summarized below. Public school systems have specific dates that a child must be born by to begin kindergarten. Consider two children in a school system where the cut-off is December 31st. Jack is born on December 31st, 2007 and would thus be eligible to enter kindergarten during fall 2012. Compared to most of his classmates who were born as early as 1/1/2007, he will be rela vely young. On average, in fact, Jack would be about 6 months younger than his peers. John is born on January 1st 2008 and would thus be ineligible to enrol in the fall. Instead, he would need to wait un l fall 2013 before star ng kindergarten. Thus, compared to most of his classmates who could be born as late as 12/31/2008, he will be rela vely old; on average, he would be about 6 months older. Although an age difference of 6 roughly may make li le if any difference in the ability of older children and adolescents to focus, a end, and regulate their behavior, it may make a substan al difference in 5 and 6 year-olds. And, differences in nearly a year - which may be present between the oldest and youngest child in a grade - could be associated with large differences on these dimensions. This suggests that children rela vely young for grade at the start of school will, on average, be less able to regulate their a en on and behavior than their classmates. As a result, young-for-grade children may be more likely to be seen as struggling by teachers who would convey their concerns to parents. In many cases, this may lead parents to have their child evaluated for ADHD and poten ally increase the rate of ADHD diagnosis and treatment in young-for-grade children. Is there evidence that this is the case?
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Being Young for Grade Increases Odds of ADHD Diagnosis
Study 1 The first study of this issue [Evans, et al., (2010). Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children. ,i>Journal of Health Economics, 29, 657-693] used data from the Na onal Health Interview Survey (NHIS), an annual survey of households in the US that collects data on the extent of illness, disease, and disability in the civilian popula on. The informa on collected includes whether sample members had been diagnosed with ADHD and prescribed s mulant medica on. The authors used survey data from 1997 to 2006 and only included children from states with a state-wide birth date cut-off for school entry in place when the child was five. Based on this cut-off, which varied by state, they examined ADHD diagnosis and treatment rates for over 35,000 7 to 17 year olds who were born up to 120 days before (i.e., rela vely young for grade) or up to 120 days a er (i.e., rela vely old for grade) the state cut-off. Results indicated that 9.7% of young-for-grade children had been diagnosed with ADHD compared to 7.6% of those rela vely old-for-grade, a difference of approximately 27%. Rates of s mulant usage were also significantly different, 4.5% vs. 4%. Study 2 A second study [Elder (2010). The importance of rela ve standards in ADHD diagnosis: Evidence based on exact birth dates. Journal of Health Economics, 29, 641-656] used data from another large na onal data set - the Early Childhood Longitudinal Study - to examine this issue. The data set ini ally included over 18,600 kindergarten students from over 1000 kindergarten programs in the US in the fall of 1998; children were followed periodically through 2007 when most were in 8th grade. Available informa on includes parent and teacher ra ngs of children's ADHD symptoms, diagnoses, and s mulant medica on treatments; final results were based on over 11,750 children. ADHD diagnosis and treatment rates were calculated for children born the month before (young-forgrade) and the month a er (old-for-grade) the state mandated cut-off, which was September 1 for some states and December 1 for others. For states with the September 1 cut-off, 10% of children born in August were diagnosed with ADHD compared with 4.5% born in September. Rates of s mulant medi-‐ ca on treatment were 8.3% vs. 2.5% respec vely. For states with a December 1st cut-off, the diagno-‐ sis rate for children born in November was 6.8%, more than triple the 1.9% rate for those born in De-‐ cember; rates of s mulant treatment were 5.0% and 1.5% respec vely. The author examined the impact of rela ve age on whether children were diagnosed with learning problems other than ADHD, including developmental delays, au sm, dyslexia, socio-emo onal behav-‐ ior disorder, or other learning disabili es. For these other learning problems, no rela ve-age effects were found. The author also demonstrated that school star ng age had a much stronger effect on teachers' per-‐ cep ons of children's ADHD symptoms than on parents' percep ons. He suggests this may be be-‐ cause teacher’s rate children's behavior rela ve to other children in the class and rela vely young children are less able to regulate their a en on and behavior. Parents, in contrast, may use more absolute standards since they are less above to observe their child in rela on to a classroom full of peers.
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Being Young for Grade Increases Odds of ADHD Diagnosis - cont’d
Study 3
The final study [Morrow et al., (2012). Influence of rela ve age on diagnosis and treatment of a en on-deficit/hyperac vity disorder in children. Canadian Medical Associa on Journal, DOI:10.1503/cmaj.11619] examined the associa on between age-for-grade and ADHD diagnosis in a study of over 935,000 youth from Bri sh Columbia who were 6-12 years of age at any me between December 1997 and November 2008. Thus, the value of this study is that the sample comes from a different country and en rely different health care system than the US. The cut-off for school entry in Bri sh Columbia during this me was December 31. Similar to the results reviewed above, boys born in December were 30% more likely to be diagnosed with ADHD than boys born in January; girls born in December were 70% more likely to be diagnosed with ADHD than girls born in January. Boys were 41% more likely and girls were 77% more likely to be treated with medica on if they were born in December rather than January.
Summary and Implica ons
Results from 3 independent studies that employed large and representa ve samples indicate that children who are young for their grade are significantly more likely than peers to be diagnosed with ADHD and to be treated with s mulant medica on. Based on addi onal analyses conducted in one of these studies, the rela ve age effect is primarily related tp teachers' percep ons and does not extend to other learning disorders. These la er two issues were examined in only one of the three studies, however, and thus require replica on. Why might being young for grade increase the odds of a child's being diagnosed with ADHD? One plausible explana on is that focusing a en on and regula ng behavior are abili es that develop over me. At school entry, being up to 12 months younger than classmates represents a substan al por on of a child's total age, and these capaci es have had less me to develop. As a result, rela-‐ vely young children will generally be less capable than classmates of regula ng their a en on and behavior and more likely to be iden fied by teachers as struggling on these dimensions. They will thus be referred for evalua on and diagnosed with ADHD at higher rates. It is important to note that none of the researchers suggest that their data raise ques ons about the validity of ADHD as a 'real' disorder with neurobiological underpinnings. In my view, using these findings to ques on the validity of the condi on would be highly problema c. Instead, these findings suggest that many children who are young for their grade are diagnosed not because they have the disorder but because they are developmentally less advanced than many of their classmates. By the same token, children who are rela vely old for their grade may be underdiagnosed because their ina en veness and hyperac vity do not seem excessive in rela on to their younger class-‐ mates. Both outcomes are poten ally harmful and speak to the complexi es involved in diagnosing ADHD but not to the validity of ADHD as a legi mate disorder. Results from these studies highlight the importance of careful and accurate diagnos c evalua ons. These studies make an important contribu on to the field by raising awareness of the role that rela ve age can play in increasing or decreasing the risk of receiving an ADHD diagnosis. Although there is no easy way to address this complica ng factor, there are several steps that may be useful to take.
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Being Young for Grade Increases Odds of ADHD Diagnosis -
cont’d
First, clinicians evalua ng young children should be especially careful when that child is also young rela ve to his classmates. For children born close to the cut-off for school entry, special considera-‐ on should be given to whether rela ve age may be an important factor in the child's behavior at school. Second, there may be value in narrowing the age ranges used in many of the widely used behavior ra ng scales. Results from these studies suggest that there are significant norma ve differences in ina en ve and hyperac ve symptoms between children born during different months in the same year, let alone in different years. What is 'normal' for a child 6 years and 1 month old differs from what is typical for a child 6 years 11 months old. However, behavior ra ng scales generally have age categories that encompass mul ple years. Thus, rather than comparing whether the ina en ve behaviors a teacher reports for a young 6 year old are excessive rela ve to other young 6 year old's, the child's score will be determined in rela on to a 'norma ve group' that includes children who are several years older. As a result, children at the low end of the age range may be more likely to receive elevated ADHD symptom ra ng scores than children at the upper end of the age range. This is very different from how standardized IQ and achievement tests are constructed, where scores are calculated in rela on to age groups that span only several months. Third, these findings highlight the value of ongoing efforts to develop a reliable objec ve assess-‐ ment measure for ADHD that is not effected by rela ve age effects. As discussed in a prior issue of A en on Research Update, Quan ta ve EEG (qEEG) may be a helpful tool in this regard - see www.helpforadd.com/2008/november.htm
Finally, the associa on between rela ve age and risk of diagnosis highlights the importance of systema cally re-evalua ng children each year. As children develop, the importance of rela ve age on the ability to regulate a en on and behavior is likely to diminish. For example, one would expect less difference in the ability to sustain a en on between younger vs. older 15 year-olds compared to younger vs. older 6 year- olds. Thus, if a child was incorrectly diagnosed with ADHD because s/he was rela vely young at school entry, and thus less capable than peers of regula ng a en on and behavior, annual re-evalua ons should iden fy this as the child moves into later grades.
****************************** Source: Attention Research Update - this month’s edition is a bit different than most. Rather than present a detailed review of a single study, in this issue I provide an overview of 3 recent studies published on a similar topic. The question addressed in each study is whether children who enter school young relative to their classmates because of when their birthday falls relative to the cut-off in their district are more likely than others to be diagnosed and treated for ADHD. As you will see, findings from all 3 studies that use large national data sets converge on this conclusion. In my view, this is extremely important to be aware of and highlights the care that must be taken when evaluating children for ADHD.
David Rabiner, Ph.D. Associate Research Professor Dept. of Psychology & Neuroscience Duke University Durham, NC 27708
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Social Skills & Social Stories...
Excerpt from: Dave Angel - paren ngaspergers.com
Social stories are used to show accurate social and emo onal interac on for children. They have been made famous (certainly in the ASD world) with Carol Gray h p:// www.thegraycenter.org/ and are very effec ve for people on the au s c spectrum. Find out first how the child with Aspergers views different social situa ons, in order to direct the skills to the desired behavior. So for example they may be OK at gree ng people ini ally by saying “hi” or “hello” but then launch straight into telling that other person all about their favourite subject. So a social story would concentrate on showing the child exactly what to do in this second phase of the conversa on; once the ini al “hellos” are out of the way. Informa on shared has to be presented in a personal manner, so that the child with Aspergers can relate and comprehend internally. For example I worked with a child who had no real bed me rou ne at home. The school developed a social story breaking down all of the different stages e.g. * 5pm Dinner * 6pm TV * 6:30pm Bath * 7pm Into bed for stories * 7:30pm Lights out Each of these points was accompanied by a picture of his favourite Pokémon character doing that ac vity. Which can be done simply by copy and pas ng from images on the web (h p://www.google.co.uk/imghp?hl=en&tab=wi) and pu ng them into a simple Microso Word document with the appropriate text. Obviously there would be copyright issues if you were to do this outside of the home, in a school, or commercially – but in your own home for your child I think you’re pre y safe! Always use posi ve language. As with all teaching (not just social skills) accentua ng the posi ve through language is key to help your child stay mo vated and feel valued through the experience. Use social stories to learn relevant social cues. Social cues are compared to road signs or direc ons on a map; if not followed correctly the outcome means you are lost. So for example if you are beginning to bore someone in conversa on there will be subtle clues such as if they are looking away, their body language (e.g. fidge ng or looking like they want to walk away) and their non-engagement in the subject. They are less likely (although with younger kids it’s more possible!) to come out and say “I am bored”. So by ignoring the more subtle social cues the child with Aspergers may put themselves in the situa on of being walked away from, ignored, talked about behind their back (as being boring), and struggling to make or maintain friendships.
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Social Skills & Social Stories...
cont’d
Give examples of appropriate ques ons to ask for iden fying a person’s emo on. For example the child could ask “do you like talking about dinosaurs with me or is there something you would like to talk about?” And then the child needs to be coached to listen if the other child says “no I’d rather talk about baseball”. Because the child may not know anything about baseball so s/he would then need to go into “inves ga ve mode” and ask ques ons to keep the conversa on rolling like: * “Do you like to play baseball or watch it?” * “What team is your favourite?” * “What posi on do you like to play?” * “Have you ever been to a real baseball game – and what was it like?” * “Who is your favourite baseball player and why do you like them so much?” Similar Interests and Humour From roughly ages 7-10, parents can begin to introduce children who like the same things. They might enjoy wildlife, basketball, computers, photography, a par cular TV show, or par cular games (including video games) for example. Having a topic of common interest will promote a natural flow of conversa ons and behavior. This is much more likely to provide posi ve social experiences as the child with Aspergers will have more confidence in this situa on because of the prior knowledge that they have on the topic (even if they lack confidence in social skills). Help can be obtained from local parent support groups. There are generally support groups in your local vicinity for parents of children with ASD, which you can find locally on the internet. They are excellent places for you to “network” on behalf of your child to find like-minded individuals that they could interact with. Failing this there are also online support groups where you could try to find other children with similar interests to yours. Teachers can introduce children who share a common academic interest; So for example kids that are really interested in geography or math can be paired together to work on projects and will likely be able to bond and build a team work approach to tasks with a shared interest.
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After School Groups (including Social Skills Support Groups)
Ac vi es involving social skills should be limited once the school day is over. This is because children with Aspergers use so much energy at school that a er school should be a me for relaxa on. Whether this is a social skills group, or just a regular a er school sports club or hobby club. With other like-minded children, the chance of cri cism is greatly reduced. If your child is in a group of children who share a common interest, and has a suppor ve teacher running the group, this is an excellent environment for some really posi ve social learning just through simply par cipa ng. Groups can promote growth of true friendships. Because of the nature of shared interest there is a much be er chance of true friendships forming, which will hopefully extend beyond the group se ng to other mes in school, play dates and social ac vi es together. These groups can develop into a different type of self-help group as they get older. With more specific social skills groups they will evolve over me to meet the needs of the age of the children. So for younger children it will be more basic learning and developing of skills. But over me the young people will be able to dictate more what they want to discuss e.g. ge ng a girlfriend/boyfriend, going on ac vi es with friends (without parents and/or teachers). And also they will have more experiences to draw on and share with each other. So there can be more peer learning as well as just from the facilitator/teacher.
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The Importance of Visual Strategies For Children with Asperger’s
(featuring Linda Hodgdon) - excerpt from Dave Angel - paren ngaspergers.com
Linda is a Speech-Language Pathologist from Troy, Michigan with over 35 years experience in working with children who have Asperger’s and ASD. Linda is very enthusias c about the use of visual strategies to help aid communica on for children with Asperger’s. Visual strategies very simply are anything that involves communica on to a child that they can see – whether that’s wri ng on a page, pictures, schedule boards, videos, I pads, computers etc.
1. Children learn be er through visual strategies. They can remember and respond be er when communica on is in this form. This is true for most people in the neuro-typical community too. Linda gave me an example at one of her seminars where she asked the audience (of parents) whether they had referred and re-referred numerous mes to the wri en pamphlet to get more informa on about the seminar. Most, if not all, of the parents had done this. So underlining how we all benefit greatly from visual strategies. 2. Speech is very “flee ng”. When someone speaks to a child with Asperger’s the speech is only there in the moment. A er that it is gone forever. So if the child at the me was not paying a en on. Maybe they had something in their hands they were concentra ng on, or some visual s m-‐ uli on the wall. Then the child will not have taken in all, or even part of the communica on. Whereas if the communica on is visual; it is more permanent and you can go over it several mes if you need to understand it. 3. Visual strategies are o en easier to use to get the focus and concentra on of an individual. A computer, I pad or good old piece of paper is very much there in front of the child (in a way that speech can never be). So the child has a be er chance of ge ng involved and understanding this way. Now this does not need to be on any grand scale or necessarily need expensive equipment like computers or I Pads. Like I say good old pen and paper can work great. 4. With speech there can o en be misunderstanding as to what the child has understood. The child may well nod or look as if they have taken in what they have just been told. But in reality they have not done so at all – and without anything wri en to refer back to; this can quickly cause problems. 5. How clear was the original communica on from the parent? O en parents (and teachers) feel that they have been very clear in their verbal communica on to a child with Asperger’s. But in actual fact the communica on may have been as “clear as mud” to the child with Asperger’s! For example it may have contained abstract concepts, dual meaning words, idioms, slang and such like that the child could not fully process or understand. It may have also been delivered at too quick a pace or in too noisy or loud an environment. Linda gave a great example when she was consulted by the mom of a teen boy with Asperger’s. Every night there became a huge ba leground when it came to the simple communica on of mom asking him to put on his pyjamas prior to bed. A er hearing Linda speak at a conference the mom went home and changed things that very night…Instead of talking to her son she simply handed him a note that said “it’s me to put your pyjamas on”. And guess what… He went off and did this with no issue whatsoever! Whilst a rela vely small issue in some ways; this li le story illustrates the power of using visual strategies. Well I hope this has been a helpful introduc on as to what visual strategies are, and why they can be so important. If you want to find out more about Linda and her work you can do so at her website Au sm Family Online
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Whanau Marama... Parenting Courses starting next term.
Effective Discipline of Our Tamariki/ Children (10 weeks)
Begins Tuesday 17 July 2012 Based on the S.K.I.P. (Strategies with Kids Information for Parents) 6 Characteristics of Effective Discipline. Suitable for parents of children 4 to 14 years.
The First 3 Years (9 weeks)
Begins Wednesday 18 July 2012 Based on the book “Dance with Me in the Heart” by Pennie Brownlee, Brainwave Trust Material and the S.K.I.P. (Strategies with Kids Information for parents) 6 Char- acteristics of Effective Discipline. Suitable for parents of children Birth to 3 years.
Connecting with Our Children by using the 5 Languages of Aroha (4 weeks)
Begins Thursday November 2012 Based on The first S.K.I.P. (Strategies with Kids Information for Parents) Principle or Characteristic of Effective Discipline and the book “The Five Love Languages of Chil- dren” by Gary Chapman and Ross Campbell. Most suitable for parents of children 4 to 14 years. Also helpful for adult relationships
Parenting Adolescents (10 weeks)
Begins 19 July 2012 Course cost: $35.00 You can enrol on line @ www.whanaumarama-parenting.co.nz Venue: Whānau Marama 212 Archers Road, Glenfield. (Under Glenfield Tax Accountants) For further information call Tamati Ihaka Ph: 4410208 or Elizabeth Cameron on Ph: 4410209 or TXT 0274 932273
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Books to read...
The following books are HIGHLY recommended:
1001 Great Ideas for Teaching & Raising Children with Autism or Aspergers Ellen Notbohm & Veronica Zysk Congratulations it‘s Aspergers – Jen Birch Asperger‘s and Girls – Tony Attwood & Temple Grandin The Complete Guide to Asperger‘s Syndrome – Tony Attwood Driven to Distraction - Edward M Hallowell & John J Ratey How to Teach Life Skills to Kids with Autism or Aspergers—Jennifer McILwee Myers THE ADHD AUTISM CONNECTION - Diane M Kennedy The Explosive Child - Ross W Greene Ph.D. The BLT Hypothesis - Peter M DiMezza & James E Kaplar It‘s So Much Work to Be Your Friend – Richard Lavoie Good News for the Alphabet Kids – Michael & Greta Sichel No more Meltdowns – Jed Baker, PhD Exploring Feelings: Anxiety & Anger – Tony Attwood The Gift of Learning – Ronald D. Davis Tips for Toileting – Jo Adkins & Sue Larkey Thinking in Pictures / My life with Autism – Temple Grandin Your Defiant Teen—Russell A Barkley A Beginners Guide to AUTISM SPECTRUM DISORDERS - Paul G Taylor Kids in the Syndrome Mix—Martin L Kutscher
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Support Group Dates 2012
Daytime Group = DT
Waitakere Community Resource Centre : 8 Ratanui St, Henderson. 10am - 12pm
[Last Friday each month] Daytime meetings CANCELLED July to Sept 2012
Evening Meetings
Ignite Waitakere: 184 Lincoln Rd, Henderson.
7:30 pm - 9:30pm
[1st Wednesday & 3rd Monday each month]
Mark them on your calendar or in your diary to keep track...
January NIL April 4th & 16th 27th (D/T) May 3rd & 21st 25th June 6th & 18th 29th (D/T) July 4th & 16th August 1st & 20th October 3rd & 15th 26th (D/T) November 7th & 19th 30th (D/T) December 5th & 17th 21st (D/T)
February 1st & 20th 24th (D/T) March 7th & 19th 30th (D/T)
September 5th & 17th
Spotlight on...
Who we are and what we do We understand that autism can be an extremely challenging condition for your child and for your family. Our unique services are specifically designed to help you manage the intense emotional and practical impact of autism. We are here to help you. If your child is affected by autism (Asperger Syndrome, ASD, PDD), we offer to guide, support and provide practical, family-centred solutions for the journey ahead. The goal of Childrens Autism Foundation is to help you create a rewarding and meaningful life for your child within your family dynamic. Our vision is to see society fully accept and include people with disabilities; and the framework starts within the family. Our mission is to provide the support needed in order for families and their child with Autism Spectrum Disorder to have a great life.
Contact Ph: 09 555 0966
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Contact Us
West Links Family Services P .O.Box 45-104 Te Atatu Peninsula, AUCKLAND, 0651 Office Ph: 09 836 1941 Mobile: 021 101 5864 E-mail: [email protected]
We are a not-for-profit, community based organisation. We have charitable status… CC41424
DONATIONS to WEST LINKS FAMILY SERVICES (large or small) … are gratefully accepted... OR you can support us via an annual subscription of $35 Please consider making your dona on via electronic banking or A/P to: Westpac A/C: 03-0155-0739555-00 Please include your name & telephone number as a reference & receipts are issued for tax purposes.
THANK YOU!
The time is right to make a difference... Won’t YOU join us ?
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Our Office is located here
Waitakere Community Resource Centre 8 Ratanui Street Henderson
Parking is available in Alderman Drive (in front of Harvey Norman), at Westfield Mall or the paid parking in front of the Falls Restaurant.
WEST LINKS FAMILY SERVICES
suppor ng families with invisible disabili es: e.g. AD/HD, Aspergers, ASD, ODD, CD
Office Echoes 2012
In this issue : Thanks to our Funders News from the Desk Autism NZ event Dyslexia
Being young for grades research review
MAY/JUNE Issue
1 2 3
4-7 8-11
12-14
Hi everyone, Term 3 is nearly upon us; we hope you & yours have made progress as term two has unfolded. The school holidays can prove challenging during the cold, wet, winter months and parents may find themselves stretched to the limit organizing suitable indoor activities for their children. Keeping humour uppermost can make the difference in keeping a lighthearted atmosphere in your home - laugh lots whenever possible! We’re always interested in hearing about your successes or challenges, so please feel free to contact us about them.
Social Skills/Stories
Importance of Visual Strategies
15
Whanau Marama course Books to Read
16 17
Support Group details & Spotlight on… 18 Contact Us Map - How to find us 19 20
If you wish to submit anything personally or have any specific queries, please don’t hesitate to contact us and explore this further. As always, please feel free to ring us at the office: (09) 836-1941 to chat about how we can help you, preferably before any crises develop. It’s always easier to find solutions [to problems] before they become seemingly insurmountable.
BP Vouchers for Volunteers COGS Auckland Manukau & Waitakere
NZ POST SKY CITY
Sue
MSD - Community Response Fund
To our Funders:
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Quotable Quotes:
The trouble a kid causes is never greater than the pain s/he feels ! Rick Lavoie
News from the desk…...
As usual this newsletter includes a variety of topics relating to AD/HD and/or Aspergers. We have included a section on Dyslexia this month, as it is common to find children may be affected to some degree or other - yet as parents how can we tell if this is the case for our child? This article gives some good information and there is also a ‘check list’ to work through which may help give a definitive clue whether you need to explore further. I found another article which reviews research re whether age differences when starting school may have an impact on children & eventual considerations for diagnosis - with some interesting outcomes/food for thought… We hope the information we have put together in this newsletter may prove insightful!
Office hours: The office will be attended daily between 9am - 5pm.
REMEMBER...
A child’s disappointment over something we find trivial, is just as real as our disappointment over something they find trivial.
However there may be odd times when we are away attending meetings etc. If you experience this at any time, then please leave us a message and we will get back to you as soon as we can.
l Clinica g trainin alone… ’t doesn ensure te accura n tio percep
Websites of interest...
tonyattwood.com.au (Dr. Tony Attwood) ADD.org (info for AD/HD Adults) Amen Clinic.com (Dr. Daniel Amen)
www.westlinksfamilyservices.co.nz
www,dilemmas.org www.wotsnormal.com CHADD.org ParentingAspergers.com
help4adhd.org (info & resources) www.sparklebox.co.uk (resources and printables) www.youthlaw.co.nz (legal advice for youth)
www. insomniaspecialist.com/ forms.php
www.cesa7.k12.wi.us/ sped/autism/structure/ str11.htm
parent2parent.org.nz Autism.org.nz www.templegrandin.com (information and support) (Temple Grandin) www.calm.auckland.ac.nz Cloud 9 Children’s ricklavoie.com Foundation (Dr. Rick Lavoie) (Aspergers information) www.
And don’t forget YOU TUBE !
yoursleep.aasmnet.org
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Fundraising event for Autism NZ
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DYSLEXIA…
University of Washington - research/study 1999
Dyslexic Children use nearly five times the brain area as normal children, to perform an ordinary language task…
Dyslexic children use nearly five times the brain area as normal children, while performing a simple language task, according to a study by an interdisciplinary team of Researchers at the University of Washington. The study shows for the first time that there are chemical differences in the brain function of dyslexic and non-dyslexic children. The research, published in the American Journal of Neuroradiology, also provides new evidence that dyslexia is a brain-based disorder. Dyslexia, is the most common learning disability, affecting an estimated 5 percent to 15 percent of children. The UW researchers, headed by developmental Neuro Psychologist Virginia Berninger and neuro-physicist Todd Richards, used a non-invasive technique called proton echo-planar spectroscopic imaging (PEPSI) to explore the metabolic brain activity of six dyslexic and seven non-dyslexic boys during oral language tasks. The researchers used PEPSI which is about 32 times faster than conventional magnetic resonance spectroscopy, to detect specific brain chemicals, such as the levels of brain lactate activation. Lactate is a by-product of energy metabolism produced by neurons when the brain is activated. Most, but not all, of this brain activity took place in the left anterior, or frontal lobe of the brain, which is known to be one of the centres for expressive language function. "The dyslexics were using 4.6 times as much area of the brain to do the same language task as the controls," said Richards, a professor of radiology. "This means their brains were working a lot harder and using more energy than the normal children." "People often don't see how hard it is for dyslexic children to do a task that others do so effortlessly," added Berninger, a professor of educational psychology. "There are clear learning differences in children. W e can't blame the schools or hold teachers accountable for teaching dyslexic children, unless both teachers and the schools are given specialized training to deal with these children." The 13 boys in the study were between 8 and 13 years of age and the dyslexic and control groups were well-matched in age, IQ and head size, but not in reading skills. The controls were reading at a level above normal for their age and had a history of learning to read easily.The dyslexics had delayed reading skills and were reading well below average for their age. Their families also had a history of multi-generational dyslexia that was confirmed in a concurrent family genetics study. The boys, fitted with earphones were asked to perform four tasks while their brains were being imaged. Three of the tests involved pairs of words and the fourth used pairs of musical tones. In the language tests, the boys heard a series of word pairs that consisted of either two nonrhyming words such as "fly" and "church," two rhyming words such as "fly" and "eye," a nonrhyming real word and non-word such as "crow" and "treel," and a rhyming word and non-word such as "meal" and "treel." The boys were asked if the word pairs rhymed or didn't rhyme and if the pairs contained two real words or one real and one non-word. They responded by raising a hand to indicate yes or no. In the music test, the boys heard pairs of notes and raised one hand if they thought the notes were identical and the other if they believed them to be different.
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DYSLEXIA…
University of Washington - research/study 1999 - cont’d
While the dyslexic boys exhibited nearly five times more brain lactate activation during a lan- guage task that asked them to interpret the sounds of words, there was no difference in the two groups during the musical tone test. This means the difference between the dyslexics and the normal children relates to auditory language and not to non-linguistic auditory function, according to Richards and Berninger. They also said the findings are important because they shed new light on brain mechanisms involved with dyslexia at a developmental stage, when it is still amenable to treatment. In addition, the functional differences between dyslexics and control subjects add evidence that dyslexia is a brain-based disorder. "When a child has a brain-based disorder it is treatable, although it may not be curable, just as diabetes is," said Berninger. “Dyslexia is a life-long condition, but dyslexics may learn to compensate for it later in life. We know dyslexia is a genetic and neurological disorder. It is not brain damage. Dyslexics often have enormous talents in other parts of their brain and shine in many fields. Einstein was a dyslexic, and so were inventor Thomas Edison and financier Charles Schwab. "While it is useful to show there are brain differences between dyslexic and non-dyslexic children, considerably more research is needed to precisely define the chemical and neurological markers of dyslexia. W hat we found is a metabolic marker, but there could be a more fundamental cause. We need to understand the molecular and neural mechanisms underlying dyslexia," said Berninger.
Other members of the UW research team and co-authors of the study are: Stephen Dager, professor of psychiatry and behavioural science;; David Corina, assistant professor of psychology;; Cecil Hayes, profes- sor of radiology;; Robert Abbott, professor of educational psychology;; Susanne Craft, adjunct associate pro- fessor of psychiatry and behaviour science;; Dennis Shaw, assistant professor of radiology;; and Stefan Pos- se, affiliate assistant professor of radiology. In addition, UW doctoral students Sandra Serafini, Aaron Heide, Keith Steury and Wayne Strauss participated in the research. The study, part of a wider UW effort to understand the basis of dyslexia and develop treatments for it, was funded by the National Institute of Child Health and Human Development. (USA)
Brain images show individual dyslexic children respond to spelling treatment
Joel Schwarz, Feb. 8, 2006
Brain images of children with dyslexia taken before they received spelling instruction show that they have different patterns of neural activity than do good spellers when doing language tasks related to spelling. But after specialized treatment emphasizing the letters in words, they showed similar patterns of brain activity. These findings are important because they show the human brain can change and normalize in response to spelling instruction, even in dyslexia, the most common learning disability. Photograph of a child preparing for a func onal MR spectroscopic imaging scan (with the PEPSI technique). The child is near the bore of the General Electric Signa magnet which operates at 1.5 Tesla. The earphone connec on is also visible (black tubing).
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Background to the research/study...
Subject Characteriza on The University of Washington Human Subjects Ins tu onal Review Board approval was obtained for this study, and each subject (as well as parent/guardian) gave wri en, informed consent. All subjects were right handed (90-100% on the Edinburgh Handedness scale(30)). The control boys had a history of learning to read easily and were reading above normal for age (average was one standard devia on above mean for age using the Woodcock Reading Mastery Test-Revised (31)) . The dyslexic boys had a developmental history of extreme difficulty in learning to read despite many forms of extra assistance at school and also had a family history of mul -genera onal dyslexia, which was confirmed in a concurrent family gene cs study (W. Raskind, personal communica on) at our cen-‐ ter. The dyslexic boys were reading on average 1.66 standard devia ons below the mean for age using the Woodcock test (31). In addi on, all the dyslexic boys were shown to have a triple deficit in three skills that predict ease of learning to read and response to interven on, phonological (phoneme seg-‐ menta on and/or memory for spoken nonwords), rapid automa zed naming, and orthographic (speed of coding wri en words and/or accuracy of represen ng them in memory)(32) . Based on independent t-tests, the 7 controls ( M=127.3, SD=10.8) and 6 dyslexics (M=124.3, SD=11.1) did not differ in age in months (t(11) = 0.49,p=0.637). Likewise, the controls (M=15.6, SD=3.2) and dys-‐ lexics (M=13.2, SD=1.6) did not differ in age-corrected WISC-III vocabulary scores (t (11)= 1.68, p=0.12), which provide the best es mate of Full Scale IQ. However, the controls and dyslexics did differ significantly in age-corrected standard scores for reading real words on the Word Iden fica on (WI) subtest of the Woodcock Reading Mastery Test-Revised (WRMT-R) and for reading pseudowords on the Word A ack (WA) subtest of the WRMT-R: t(11)=6.81, p < 0.001 on the WI subtest and t(10) = 6.02, p<0.001 on the WA subtest. The differences for both real word reading (WI, controls, M=115.1, SD=9.2; dyslexics, M=75.5, SD=11.8) and pseudoword reading (WA, controls, M=110.2, SD=6.8; dyslexics, M=79.0, SD=10.7) were large as well as sta s cally significant.
Source: Richards et al, American Journal of Neuroradiology, 20, 1393-1398, September, 1999 From the Departments Radiology (T.L.R., S.R.D, A.C.H., C.E.H. D.S.), Psychiatry and Behavioral Science (S.R.D., S.C.), Psychology (D.C., K.S.), Speech and Hearing Sciences (S.S.), Bioengineering (T.L.R., S.R.D., W.S.), College of Educa on (R.D.A., V.W.B.), University of Washington, Sea le; Geriatric Research Educa-‐ on and Clinical Center, Veterans Affairs Puget Sound, Sea le (S.C.); and Ins tut fur Medicine, For-‐ schungszentrum, Julich GmbH, D-52425, Germany (S.P.). Grant support: This work was funded by a special mul disciplinary learning disabili es Center Grant from NIH (NICHD), P50 HD33812. Presenta on at mee ng: This paper was presented in part to the Cogni ve Neuroscience Society 1998 Annual Mee ng, see Poster 67 , Tuesday 4/7/98.
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How to tell whether your child may be affected by dyslexia…
SCORE
0= Never Exhibited 1= Sometimes Exhibited 2= Often Exhibited 3= Very Descriptive of Individual
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17
Has difficulty reading at grade level. Has significant spelling challenges . Cannot spell high frequency words or retain spelling words from one week to the next. Has poor handwriting. There may be changes in pressure, scrolling over, and/or letters or words that do not stay on the lines. Cannot tell time on a face clock. Has or had difficulty tying shoes until later ages (3rd grade or above). Cannot sound out unknown words despite knowing phonics. Guesses at words based on the appearance of the word. Has difficulty with word call. May have to stop and think about words often (“It’s on the tip of my tongue,”) or many stutter. Has difficulty with directionality: left/right, below/behind, east/west. Has difficulty learning multiplication tables . Has difficulty remembering the days of the week or months of the year in or- der. [Sequencing] Difficulty learning cursive. Typically all handwriting is in print. Began to talk (as a baby) relatively late. (After 2 or 3 years old.) Difficulty learning to rhyme and/or did [does] not enjoying rhyming games. Does not read for pleasure…may actively avoid reading although enjoys be- ing read to. Has trouble with written expression. May ignore grammar such as capitals, punctuation, etc. Despite being a good story teller, can’t get their thoughts on paper, in writing, in an acceptable form. Mixes up sounds in multi-syllabic words (ex: aminal for animal, bisghetti for spaghetti, hekalopter for helicopter, hangaberg for hamburger, mazageen for magazine, etc.) Has difficulties in math. May have trouble showing work or remembering the steps to completing a problem. Long division may prove a significant challenge. Is messy and/or disorganized. [Room, locker, backpack, desk] But there may be other reasons for this (see ADD symptoms). Has difficulty with schedules, timelines and agendas. May misunderstand what to do next. May seem confused and have to ask (confirm) what to do often.
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Being Young for Grade Increases Odds of ADHD Diagnosis
ADHD is the most commonly diagnosed neurobehavioral disorder in children and substan al evidence indicates that biological factors play an important role in its development. For example, although the exact mechanism by which gene c factors convey increased risk for ADHD remains unclear, the importance of gene c transmission has been documented in a number of published studies. Even though biological factors are widely regarded as important in the development of ADHD, no medical or biological test is recommended for rou ne use when diagnosing ADHD. Instead, like virtually all psychiatric disorders, ADHD is defined by a constella on of behavioral symptoms that are generally reported on by a child's parents and teacher. Also, in nearly all cases, it is parents' and/or teachers' concerns about a child's ability to focus and regular their behavior that leads to a child being evaluated for ADHD in the first place. While some children display sufficient ina en ve and/or hyperac ve-impulsive behavior to be diagnosed with ADHD as pre-schoolers, it is generally not before children enter school that concerns related to a en on and hyperac vity arise. This may be especially true for ina en ve symptoms, as demands for sustained a en on become much greater when children start in school. Teachers can observe how a child's ability to regulate a en on and behavior compares to an en re classroom - something parents typically can't do - and their judgements may thus be par cularly influen al in whether a child is evaluated for ADHD and diagnosed with the disorder. A number of factors may contribute to differences in children's ability to focus and regulate their behavior when they enter school. One factor certainly is ADHD, as children with the condi on will be observed by teachers to be more ina en ve and/or hyperac ve. Another factor - and one that may be frequently overlooked - is their age rela ve to most of their classmates. This is the issue inves gated in the studies that are summarized below. Three recently published studies provide compelling evidence that a child's age rela ve to his or her classmates is an important factor in whether they are diagnosed for ADHD. Results from these studies are summarized below. Public school systems have specific dates that a child must be born by to begin kindergarten. Consider two children in a school system where the cut-off is December 31st. Jack is born on December 31st, 2007 and would thus be eligible to enter kindergarten during fall 2012. Compared to most of his classmates who were born as early as 1/1/2007, he will be rela vely young. On average, in fact, Jack would be about 6 months younger than his peers. John is born on January 1st 2008 and would thus be ineligible to enrol in the fall. Instead, he would need to wait un l fall 2013 before star ng kindergarten. Thus, compared to most of his classmates who could be born as late as 12/31/2008, he will be rela vely old; on average, he would be about 6 months older. Although an age difference of 6 roughly may make li le if any difference in the ability of older children and adolescents to focus, a end, and regulate their behavior, it may make a substan al difference in 5 and 6 year-olds. And, differences in nearly a year - which may be present between the oldest and youngest child in a grade - could be associated with large differences on these dimensions. This suggests that children rela vely young for grade at the start of school will, on average, be less able to regulate their a en on and behavior than their classmates. As a result, young-for-grade children may be more likely to be seen as struggling by teachers who would convey their concerns to parents. In many cases, this may lead parents to have their child evaluated for ADHD and poten ally increase the rate of ADHD diagnosis and treatment in young-for-grade children. Is there evidence that this is the case?
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Being Young for Grade Increases Odds of ADHD Diagnosis
Study 1 The first study of this issue [Evans, et al., (2010). Measuring inappropriate medical diagnosis and treatment in survey data: The case of ADHD among school-age children. ,i>Journal of Health Economics, 29, 657-693] used data from the Na onal Health Interview Survey (NHIS), an annual survey of households in the US that collects data on the extent of illness, disease, and disability in the civilian popula on. The informa on collected includes whether sample members had been diagnosed with ADHD and prescribed s mulant medica on. The authors used survey data from 1997 to 2006 and only included children from states with a state-wide birth date cut-off for school entry in place when the child was five. Based on this cut-off, which varied by state, they examined ADHD diagnosis and treatment rates for over 35,000 7 to 17 year olds who were born up to 120 days before (i.e., rela vely young for grade) or up to 120 days a er (i.e., rela vely old for grade) the state cut-off. Results indicated that 9.7% of young-for-grade children had been diagnosed with ADHD compared to 7.6% of those rela vely old-for-grade, a difference of approximately 27%. Rates of s mulant usage were also significantly different, 4.5% vs. 4%. Study 2 A second study [Elder (2010). The importance of rela ve standards in ADHD diagnosis: Evidence based on exact birth dates. Journal of Health Economics, 29, 641-656] used data from another large na onal data set - the Early Childhood Longitudinal Study - to examine this issue. The data set ini ally included over 18,600 kindergarten students from over 1000 kindergarten programs in the US in the fall of 1998; children were followed periodically through 2007 when most were in 8th grade. Available informa on includes parent and teacher ra ngs of children's ADHD symptoms, diagnoses, and s mulant medica on treatments; final results were based on over 11,750 children. ADHD diagnosis and treatment rates were calculated for children born the month before (young-forgrade) and the month a er (old-for-grade) the state mandated cut-off, which was September 1 for some states and December 1 for others. For states with the September 1 cut-off, 10% of children born in August were diagnosed with ADHD compared with 4.5% born in September. Rates of s mulant medi-‐ ca on treatment were 8.3% vs. 2.5% respec vely. For states with a December 1st cut-off, the diagno-‐ sis rate for children born in November was 6.8%, more than triple the 1.9% rate for those born in De-‐ cember; rates of s mulant treatment were 5.0% and 1.5% respec vely. The author examined the impact of rela ve age on whether children were diagnosed with learning problems other than ADHD, including developmental delays, au sm, dyslexia, socio-emo onal behav-‐ ior disorder, or other learning disabili es. For these other learning problems, no rela ve-age effects were found. The author also demonstrated that school star ng age had a much stronger effect on teachers' per-‐ cep ons of children's ADHD symptoms than on parents' percep ons. He suggests this may be be-‐ cause teacher’s rate children's behavior rela ve to other children in the class and rela vely young children are less able to regulate their a en on and behavior. Parents, in contrast, may use more absolute standards since they are less above to observe their child in rela on to a classroom full of peers.
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Being Young for Grade Increases Odds of ADHD Diagnosis - cont’d
Study 3
The final study [Morrow et al., (2012). Influence of rela ve age on diagnosis and treatment of a en on-deficit/hyperac vity disorder in children. Canadian Medical Associa on Journal, DOI:10.1503/cmaj.11619] examined the associa on between age-for-grade and ADHD diagnosis in a study of over 935,000 youth from Bri sh Columbia who were 6-12 years of age at any me between December 1997 and November 2008. Thus, the value of this study is that the sample comes from a different country and en rely different health care system than the US. The cut-off for school entry in Bri sh Columbia during this me was December 31. Similar to the results reviewed above, boys born in December were 30% more likely to be diagnosed with ADHD than boys born in January; girls born in December were 70% more likely to be diagnosed with ADHD than girls born in January. Boys were 41% more likely and girls were 77% more likely to be treated with medica on if they were born in December rather than January.
Summary and Implica ons
Results from 3 independent studies that employed large and representa ve samples indicate that children who are young for their grade are significantly more likely than peers to be diagnosed with ADHD and to be treated with s mulant medica on. Based on addi onal analyses conducted in one of these studies, the rela ve age effect is primarily related tp teachers' percep ons and does not extend to other learning disorders. These la er two issues were examined in only one of the three studies, however, and thus require replica on. Why might being young for grade increase the odds of a child's being diagnosed with ADHD? One plausible explana on is that focusing a en on and regula ng behavior are abili es that develop over me. At school entry, being up to 12 months younger than classmates represents a substan al por on of a child's total age, and these capaci es have had less me to develop. As a result, rela-‐ vely young children will generally be less capable than classmates of regula ng their a en on and behavior and more likely to be iden fied by teachers as struggling on these dimensions. They will thus be referred for evalua on and diagnosed with ADHD at higher rates. It is important to note that none of the researchers suggest that their data raise ques ons about the validity of ADHD as a 'real' disorder with neurobiological underpinnings. In my view, using these findings to ques on the validity of the condi on would be highly problema c. Instead, these findings suggest that many children who are young for their grade are diagnosed not because they have the disorder but because they are developmentally less advanced than many of their classmates. By the same token, children who are rela vely old for their grade may be underdiagnosed because their ina en veness and hyperac vity do not seem excessive in rela on to their younger class-‐ mates. Both outcomes are poten ally harmful and speak to the complexi es involved in diagnosing ADHD but not to the validity of ADHD as a legi mate disorder. Results from these studies highlight the importance of careful and accurate diagnos c evalua ons. These studies make an important contribu on to the field by raising awareness of the role that rela ve age can play in increasing or decreasing the risk of receiving an ADHD diagnosis. Although there is no easy way to address this complica ng factor, there are several steps that may be useful to take.
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Being Young for Grade Increases Odds of ADHD Diagnosis -
cont’d
First, clinicians evalua ng young children should be especially careful when that child is also young rela ve to his classmates. For children born close to the cut-off for school entry, special considera-‐ on should be given to whether rela ve age may be an important factor in the child's behavior at school. Second, there may be value in narrowing the age ranges used in many of the widely used behavior ra ng scales. Results from these studies suggest that there are significant norma ve differences in ina en ve and hyperac ve symptoms between children born during different months in the same year, let alone in different years. What is 'normal' for a child 6 years and 1 month old differs from what is typical for a child 6 years 11 months old. However, behavior ra ng scales generally have age categories that encompass mul ple years. Thus, rather than comparing whether the ina en ve behaviors a teacher reports for a young 6 year old are excessive rela ve to other young 6 year old's, the child's score will be determined in rela on to a 'norma ve group' that includes children who are several years older. As a result, children at the low end of the age range may be more likely to receive elevated ADHD symptom ra ng scores than children at the upper end of the age range. This is very different from how standardized IQ and achievement tests are constructed, where scores are calculated in rela on to age groups that span only several months. Third, these findings highlight the value of ongoing efforts to develop a reliable objec ve assess-‐ ment measure for ADHD that is not effected by rela ve age effects. As discussed in a prior issue of A en on Research Update, Quan ta ve EEG (qEEG) may be a helpful tool in this regard - see www.helpforadd.com/2008/november.htm
Finally, the associa on between rela ve age and risk of diagnosis highlights the importance of systema cally re-evalua ng children each year. As children develop, the importance of rela ve age on the ability to regulate a en on and behavior is likely to diminish. For example, one would expect less difference in the ability to sustain a en on between younger vs. older 15 year-olds compared to younger vs. older 6 year- olds. Thus, if a child was incorrectly diagnosed with ADHD because s/he was rela vely young at school entry, and thus less capable than peers of regula ng a en on and behavior, annual re-evalua ons should iden fy this as the child moves into later grades.
****************************** Source: Attention Research Update - this month’s edition is a bit different than most. Rather than present a detailed review of a single study, in this issue I provide an overview of 3 recent studies published on a similar topic. The question addressed in each study is whether children who enter school young relative to their classmates because of when their birthday falls relative to the cut-off in their district are more likely than others to be diagnosed and treated for ADHD. As you will see, findings from all 3 studies that use large national data sets converge on this conclusion. In my view, this is extremely important to be aware of and highlights the care that must be taken when evaluating children for ADHD.
David Rabiner, Ph.D. Associate Research Professor Dept. of Psychology & Neuroscience Duke University Durham, NC 27708
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Social Skills & Social Stories...
Excerpt from: Dave Angel - paren ngaspergers.com
Social stories are used to show accurate social and emo onal interac on for children. They have been made famous (certainly in the ASD world) with Carol Gray h p:// www.thegraycenter.org/ and are very effec ve for people on the au s c spectrum. Find out first how the child with Aspergers views different social situa ons, in order to direct the skills to the desired behavior. So for example they may be OK at gree ng people ini ally by saying “hi” or “hello” but then launch straight into telling that other person all about their favourite subject. So a social story would concentrate on showing the child exactly what to do in this second phase of the conversa on; once the ini al “hellos” are out of the way. Informa on shared has to be presented in a personal manner, so that the child with Aspergers can relate and comprehend internally. For example I worked with a child who had no real bed me rou ne at home. The school developed a social story breaking down all of the different stages e.g. * 5pm Dinner * 6pm TV * 6:30pm Bath * 7pm Into bed for stories * 7:30pm Lights out Each of these points was accompanied by a picture of his favourite Pokémon character doing that ac vity. Which can be done simply by copy and pas ng from images on the web (h p://www.google.co.uk/imghp?hl=en&tab=wi) and pu ng them into a simple Microso Word document with the appropriate text. Obviously there would be copyright issues if you were to do this outside of the home, in a school, or commercially – but in your own home for your child I think you’re pre y safe! Always use posi ve language. As with all teaching (not just social skills) accentua ng the posi ve through language is key to help your child stay mo vated and feel valued through the experience. Use social stories to learn relevant social cues. Social cues are compared to road signs or direc ons on a map; if not followed correctly the outcome means you are lost. So for example if you are beginning to bore someone in conversa on there will be subtle clues such as if they are looking away, their body language (e.g. fidge ng or looking like they want to walk away) and their non-engagement in the subject. They are less likely (although with younger kids it’s more possible!) to come out and say “I am bored”. So by ignoring the more subtle social cues the child with Aspergers may put themselves in the situa on of being walked away from, ignored, talked about behind their back (as being boring), and struggling to make or maintain friendships.
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Social Skills & Social Stories...
cont’d
Give examples of appropriate ques ons to ask for iden fying a person’s emo on. For example the child could ask “do you like talking about dinosaurs with me or is there something you would like to talk about?” And then the child needs to be coached to listen if the other child says “no I’d rather talk about baseball”. Because the child may not know anything about baseball so s/he would then need to go into “inves ga ve mode” and ask ques ons to keep the conversa on rolling like: * “Do you like to play baseball or watch it?” * “What team is your favourite?” * “What posi on do you like to play?” * “Have you ever been to a real baseball game – and what was it like?” * “Who is your favourite baseball player and why do you like them so much?” Similar Interests and Humour From roughly ages 7-10, parents can begin to introduce children who like the same things. They might enjoy wildlife, basketball, computers, photography, a par cular TV show, or par cular games (including video games) for example. Having a topic of common interest will promote a natural flow of conversa ons and behavior. This is much more likely to provide posi ve social experiences as the child with Aspergers will have more confidence in this situa on because of the prior knowledge that they have on the topic (even if they lack confidence in social skills). Help can be obtained from local parent support groups. There are generally support groups in your local vicinity for parents of children with ASD, which you can find locally on the internet. They are excellent places for you to “network” on behalf of your child to find like-minded individuals that they could interact with. Failing this there are also online support groups where you could try to find other children with similar interests to yours. Teachers can introduce children who share a common academic interest; So for example kids that are really interested in geography or math can be paired together to work on projects and will likely be able to bond and build a team work approach to tasks with a shared interest.
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After School Groups (including Social Skills Support Groups)
Ac vi es involving social skills should be limited once the school day is over. This is because children with Aspergers use so much energy at school that a er school should be a me for relaxa on. Whether this is a social skills group, or just a regular a er school sports club or hobby club. With other like-minded children, the chance of cri cism is greatly reduced. If your child is in a group of children who share a common interest, and has a suppor ve teacher running the group, this is an excellent environment for some really posi ve social learning just through simply par cipa ng. Groups can promote growth of true friendships. Because of the nature of shared interest there is a much be er chance of true friendships forming, which will hopefully extend beyond the group se ng to other mes in school, play dates and social ac vi es together. These groups can develop into a different type of self-help group as they get older. With more specific social skills groups they will evolve over me to meet the needs of the age of the children. So for younger children it will be more basic learning and developing of skills. But over me the young people will be able to dictate more what they want to discuss e.g. ge ng a girlfriend/boyfriend, going on ac vi es with friends (without parents and/or teachers). And also they will have more experiences to draw on and share with each other. So there can be more peer learning as well as just from the facilitator/teacher.
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The Importance of Visual Strategies For Children with Asperger’s
(featuring Linda Hodgdon) - excerpt from Dave Angel - paren ngaspergers.com
Linda is a Speech-Language Pathologist from Troy, Michigan with over 35 years experience in working with children who have Asperger’s and ASD. Linda is very enthusias c about the use of visual strategies to help aid communica on for children with Asperger’s. Visual strategies very simply are anything that involves communica on to a child that they can see – whether that’s wri ng on a page, pictures, schedule boards, videos, I pads, computers etc.
1. Children learn be er through visual strategies. They can remember and respond be er when communica on is in this form. This is true for most people in the neuro-typical community too. Linda gave me an example at one of her seminars where she asked the audience (of parents) whether they had referred and re-referred numerous mes to the wri en pamphlet to get more informa on about the seminar. Most, if not all, of the parents had done this. So underlining how we all benefit greatly from visual strategies. 2. Speech is very “flee ng”. When someone speaks to a child with Asperger’s the speech is only there in the moment. A er that it is gone forever. So if the child at the me was not paying a en on. Maybe they had something in their hands they were concentra ng on, or some visual s m-‐ uli on the wall. Then the child will not have taken in all, or even part of the communica on. Whereas if the communica on is visual; it is more permanent and you can go over it several mes if you need to understand it. 3. Visual strategies are o en easier to use to get the focus and concentra on of an individual. A computer, I pad or good old piece of paper is very much there in front of the child (in a way that speech can never be). So the child has a be er chance of ge ng involved and understanding this way. Now this does not need to be on any grand scale or necessarily need expensive equipment like computers or I Pads. Like I say good old pen and paper can work great. 4. With speech there can o en be misunderstanding as to what the child has understood. The child may well nod or look as if they have taken in what they have just been told. But in reality they have not done so at all – and without anything wri en to refer back to; this can quickly cause problems. 5. How clear was the original communica on from the parent? O en parents (and teachers) feel that they have been very clear in their verbal communica on to a child with Asperger’s. But in actual fact the communica on may have been as “clear as mud” to the child with Asperger’s! For example it may have contained abstract concepts, dual meaning words, idioms, slang and such like that the child could not fully process or understand. It may have also been delivered at too quick a pace or in too noisy or loud an environment. Linda gave a great example when she was consulted by the mom of a teen boy with Asperger’s. Every night there became a huge ba leground when it came to the simple communica on of mom asking him to put on his pyjamas prior to bed. A er hearing Linda speak at a conference the mom went home and changed things that very night…Instead of talking to her son she simply handed him a note that said “it’s me to put your pyjamas on”. And guess what… He went off and did this with no issue whatsoever! Whilst a rela vely small issue in some ways; this li le story illustrates the power of using visual strategies. Well I hope this has been a helpful introduc on as to what visual strategies are, and why they can be so important. If you want to find out more about Linda and her work you can do so at her website Au sm Family Online
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Whanau Marama... Parenting Courses starting next term.
Effective Discipline of Our Tamariki/ Children (10 weeks)
Begins Tuesday 17 July 2012 Based on the S.K.I.P. (Strategies with Kids Information for Parents) 6 Characteristics of Effective Discipline. Suitable for parents of children 4 to 14 years.
The First 3 Years (9 weeks)
Begins Wednesday 18 July 2012 Based on the book “Dance with Me in the Heart” by Pennie Brownlee, Brainwave Trust Material and the S.K.I.P. (Strategies with Kids Information for parents) 6 Char- acteristics of Effective Discipline. Suitable for parents of children Birth to 3 years.
Connecting with Our Children by using the 5 Languages of Aroha (4 weeks)
Begins Thursday November 2012 Based on The first S.K.I.P. (Strategies with Kids Information for Parents) Principle or Characteristic of Effective Discipline and the book “The Five Love Languages of Chil- dren” by Gary Chapman and Ross Campbell. Most suitable for parents of children 4 to 14 years. Also helpful for adult relationships
Parenting Adolescents (10 weeks)
Begins 19 July 2012 Course cost: $35.00 You can enrol on line @ www.whanaumarama-parenting.co.nz Venue: Whānau Marama 212 Archers Road, Glenfield. (Under Glenfield Tax Accountants) For further information call Tamati Ihaka Ph: 4410208 or Elizabeth Cameron on Ph: 4410209 or TXT 0274 932273
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Books to read...
The following books are HIGHLY recommended:
1001 Great Ideas for Teaching & Raising Children with Autism or Aspergers Ellen Notbohm & Veronica Zysk Congratulations it‘s Aspergers – Jen Birch Asperger‘s and Girls – Tony Attwood & Temple Grandin The Complete Guide to Asperger‘s Syndrome – Tony Attwood Driven to Distraction - Edward M Hallowell & John J Ratey How to Teach Life Skills to Kids with Autism or Aspergers—Jennifer McILwee Myers THE ADHD AUTISM CONNECTION - Diane M Kennedy The Explosive Child - Ross W Greene Ph.D. The BLT Hypothesis - Peter M DiMezza & James E Kaplar It‘s So Much Work to Be Your Friend – Richard Lavoie Good News for the Alphabet Kids – Michael & Greta Sichel No more Meltdowns – Jed Baker, PhD Exploring Feelings: Anxiety & Anger – Tony Attwood The Gift of Learning – Ronald D. Davis Tips for Toileting – Jo Adkins & Sue Larkey Thinking in Pictures / My life with Autism – Temple Grandin Your Defiant Teen—Russell A Barkley A Beginners Guide to AUTISM SPECTRUM DISORDERS - Paul G Taylor Kids in the Syndrome Mix—Martin L Kutscher
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Support Group Dates 2012
Daytime Group = DT
Waitakere Community Resource Centre : 8 Ratanui St, Henderson. 10am - 12pm
[Last Friday each month] Daytime meetings CANCELLED July to Sept 2012
Evening Meetings
Ignite Waitakere: 184 Lincoln Rd, Henderson.
7:30 pm - 9:30pm
[1st Wednesday & 3rd Monday each month]
Mark them on your calendar or in your diary to keep track...
January NIL April 4th & 16th 27th (D/T) May 3rd & 21st 25th June 6th & 18th 29th (D/T) July 4th & 16th August 1st & 20th October 3rd & 15th 26th (D/T) November 7th & 19th 30th (D/T) December 5th & 17th 21st (D/T)
February 1st & 20th 24th (D/T) March 7th & 19th 30th (D/T)
September 5th & 17th
Spotlight on...
Who we are and what we do We understand that autism can be an extremely challenging condition for your child and for your family. Our unique services are specifically designed to help you manage the intense emotional and practical impact of autism. We are here to help you. If your child is affected by autism (Asperger Syndrome, ASD, PDD), we offer to guide, support and provide practical, family-centred solutions for the journey ahead. The goal of Childrens Autism Foundation is to help you create a rewarding and meaningful life for your child within your family dynamic. Our vision is to see society fully accept and include people with disabilities; and the framework starts within the family. Our mission is to provide the support needed in order for families and their child with Autism Spectrum Disorder to have a great life.
Contact Ph: 09 555 0966
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Contact Us
West Links Family Services P .O.Box 45-104 Te Atatu Peninsula, AUCKLAND, 0651 Office Ph: 09 836 1941 Mobile: 021 101 5864 E-mail: [email protected]
We are a not-for-profit, community based organisation. We have charitable status… CC41424
DONATIONS to WEST LINKS FAMILY SERVICES (large or small) … are gratefully accepted... OR you can support us via an annual subscription of $35 Please consider making your dona on via electronic banking or A/P to: Westpac A/C: 03-0155-0739555-00 Please include your name & telephone number as a reference & receipts are issued for tax purposes.
THANK YOU!
The time is right to make a difference... Won’t YOU join us ?
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Our Office is located here
Waitakere Community Resource Centre 8 Ratanui Street Henderson
Parking is available in Alderman Drive (in front of Harvey Norman), at Westfield Mall or the paid parking in front of the Falls Restaurant.
