Phenylketonuria or PKU is when the body
can’t process an amino acid phenylalanine or Phe. High levels of Phe are found
in most proteins. Their bodies do not have the enzyme, phenylalanine
hydroxylase (PAH), which converts phenylalanine into a different amino acid
into tyrosine. Failure to convert the amino acid results in the buildup of phenylalanine
(Phe) and too much Phe becomes toxic to the central nervous system. The degree
of Phe in each person is different; therefore the result of a toxic nervous
system varies with each patient. Some signs of untreated PKU in infancy are;
mental retardation, behavior problems, hyperactivity, irritability,
restlessness, seizures, eczema, fair hair and skin, and a musty or mousy body
odor (www.newbornscreening.info). A
newborn screening can indicate the child may have PKU. It is not definitive
until a series of tests confirm the child has PKU. If a newborn has PKU the
development of the child gives the impression of normal development. The result
of PKU starts to show around six months of age. If immediate treatment of PKU
occurs the effects may be prevented and in some cases lessoned or reversed. The
main treatment of PKU is a special diet made up of low Phe foods, special
medical foods and medicinal formula. Some foods to avoid are; eggs, fish, milk,
all dairy products, nuts, regular flour, meat, poultry, regular formula, peanut
butter and dried beans (www.pkunews.org, www.newbornscreening.info). Also
aspartame should be avoided as it contains high levels of Phe and raises the
blood levels of Phe rather quickly (www.newbornscreening.info). This
diet should be followed for life and those, adolescence or adults, who do not
stick to the diet with high Phe levels may have the following symptoms; irritability,
trouble paying attention, eczema, slow thinking, problems making good
decisions, tremors and bone loss (osteopenia) (www.newbornscreening.info). If
this occurs then the diet should be resumed.
Children with PKU that has been treated
immediately after birth and maintained low Phe levels in the blood most likely
will develop normally in growth and intelligence. Some children will have
problems in school, even when treated right away, while those who were treated
several weeks after birth may have learning disabilities and/or delays. To keep
track of Phe levels routine blood tests are taken to measure the Phe. If the
levels are not balanced then the diet is adjusted to reflect the change.
References
Schuett, Virginia. “What is PKU?” National PKU News. National PKU News. February 2008. Web. 22 May 2010.
“About PKU.” PKU- Phenylketonuria. BioMarin Pharmaceutical Inc. n.d. Web. 22 May 2010. “Amino Acid Disorders.” Newborn Screening Info. STAR-G. 16 December 2007. Web. 22 May 2010.
Many students struggle with social interaction. One major reason that parents seek full inclusion for their child to build the social skills necessary so that they may develop relationships and relationship skills to last throughout their life. Students with autism spectrum disorder (ASD) have a great need for social interaction as they have fewer friendships and an increasingly more difficult time of being included as they transition to middle school and high school (Able et al., 2015). Typically developing students are not sure how to interact with students with ASD and the same goes for students with ASD. Many students with ASD excel in academics have a hard time when others would struggle with the same content and/or do not strictly follow the same rules (Abel et al., 2015).
A great place to start is in the beginning of the year when all of the students are in a new environment. It is important to discuss how to have positive interactions in the classroom. Each student should have an understanding of how to interact with others, how to have disagreements without hurting each other's feelings, what it means to be different, and how to support each others weaknesses and celebrate strengths. There are many ways to do this regardless of age. The earlier that students understand how to build positive relationships the better for their lives and social interactions throughout their school careers. One fabulous activity about monitoring ones words is the toothpaste squirt lesson, from Corkboard Connections, where students see that spoken words are like toothpaste, once it is out it cannot go back. While these activities help the entire class, students with ASD continue to struggle with many social aspects described in Views from the trenches: Teacher and student supports needed for full inclusion of students with ASD:
Social-relationship needs: Social skills is a deficit in individuals with ASD and are usually seen playing alone at recess, are isolated, remain fixed on their own interests (thinking and talking about one subject especially when peers are talking about and doing other things). There is a lack of understanding of what social rules exist and how to follow them. Bullying is also a major concern and problem for individuals with ASD.
Social-academic needs: As stated from above a major strength for students with ASD (typically those with Aspergers) is academic skills. One contingency for students to enter into full inclusion is the need for the students academic skill to fit the class. As most with ADS like learning (not necessarily school) they have difficulties when their peers do not take school as serious as they do and may even call their peer names when others do not understand the content as well as they do.
A need for self-advocacy skills: Students need to understand and be able to express to their teachers and peers what their strengths and weaknesses are. It is important to know how to ask for help or clarity when they do not understand what is expected of them in a given situation.
Peer-related needs: There is a need for peers to understand what special needs are and what it means to be someone with special needs. Every person is valued and necessary to make the classroom complete. As students get older the need for social acceptance increases and the expectations of each person is to be socially acceptable and display socially acceptable behavior. Association with someone who does not follow these rules may be bullied or ostracized.
Recognizing these needs a first step and there is much that can be done to alter the social climate in and out of the classroom. Students should be empowered to understand how to take ownership of their own behavior and how to react to others in difficult situations (Ackerman, 2007). Explaining and practicing appropriate behavior will ensure the classroom to be a welcoming and safe environment to learn in.
Resources
Able, H., Sreckovic, M. A., Schultz, T. R., Garwood, J. D., & Sherman, J. (2015). Views from the trenches: Teacher and student supports needed for full inclusion of students with ASD. Teacher Education and Special Education, 38(1), 44-57. doi:10.1177/0888406414558096
Ackerman, B. (2007). Praise: Effectively guiding student behavior. Colorado Springs, CO: Association of Christian Schools International.
There is a consequence to everything that a person does. The purpose of positive reinforcement is to increase or maintain a desired behavior (Burden, 2013). Many teachers, especially in the early elementary school years, utilize reinforcers to build positive behaviors in their students. Some classes have a card pulling system, which is more in the behavior management category instead of positive reinforcement, but in some classrooms at the end of the day the student may earn a sticker, tickets, or an edible. Those rewards are meant to increase or maintain desired behaviors. They are good to use in the classroom, but for the behaviorally challenged student, most of the mentioned reinforcers are not powerful enough to create a lasting behavioral change. They may become satiated with earning a sticker or a candy every day. In regards to reinforcers it is important to let the child choose the reinforcer, not the teacher. The reinforcer should fit certain criteria according to Paul Burden, the student perceives what is offered as a reinforcement, it is continent to the behavior performed, and the reinforcement furthers the child's appropriate behavior (2013). If chewing gum is not allowed, then gum should not be offered as a reinforcement. Beth Ackerman, further explains the properties of positive reinforcement, as reinforcement needs to be immediate and it is continent on a specific behavior (2007). If calling out in class is the targeted behavior for Susie, then she should be reinforced immediately when she raises her hand without calling out. The teacher could give social reinforcement by calling on her name, or she could receive a token when another is taking a turn. If one waits to reinforce a behavior then the child may perceive that they are being reinforced for another action. Later the child may act out and it would not be appropriate to say, "Remember to raise your hand, but since you did that earlier you can have a token." This sends a mixed message letting the child be confused about what is expected from them. If a child is acting correctly then they should be reinforced consistently.
Paul Burden (2013) describes the many types of reinforcement:
Social Recognition: acknowledging what the student is doing correctly. Thank you for raising your hand! Wow, look how Susie is raising her hand with a quiet voice! I think Susie deserves a 'woot woot'! (the class together says 'woot woot').
Special Privileges and Activities: This is especially useful for the entire class. A favorite song may be played, a student may be allowed to choose a story for story time, allowing the student to choose a favorite classroom helper job.
Items or Tangibles: An object the student can hold. A coloring page, toy, sticker, edibles, a positive note.
Token Economy: Tokens are a way to systematically thin out reinforcement as the student or students add a desired behavior into their repertoire. A classroom money system, token boards, first/then boards (utilizing the premack principle).
Educate Autism is a great resource for printable token boards that has templates designed to fit PECS icons, pictures, and written reinforcement.
From http://www.educateautism.com/free-materials-and-downloads.html
An easy token board made based off of a students interests. All that is needed is paper, a laminator, and velcro.
First/Then boards:
From http://firstgradeblueskies.blogspot.com
She also offers free first/then templates!
A first/then board for the entire classroom.
From http://www.allthingskatiemarie.blogspot.com
One example of a whole class reinforcement from GoNoodle.com is a brain break featuring Koo Koo Kangaroo. GoNoodle is favorite and has many different activities that delight students.
Resources
Ackerman,
B. (2007). Praise: Effectively guiding
student behavior. Colorado Springs, CO: Association of Christian Schools
International.
Burden,
P. (2013). Classroom management: Creating
a successful k-12 learning community (5th ed.). New York, NY: John Wiley
& Sons, Inc.
As all teachers know, it is important to get to know their students and build a positive rapport with them. Each piece of information that the teacher acquires creates a more solid framework for the teacher to identify and meet the needs of students (Burden, 2013). Paul Burden (2013) describes the different types of information that teachers should gather to get to know their students:
Academic needs, abilities, and interests. What type of learner are they? What are their scores from achievement tests i.e. standardized testing and reporting (STAR) tests? What are their weaknesses and strengths in their academic work?
Special needs, disabilities, or learning problems. Do they have an individualized education program (IEP)? Any problems with their health? Does the student have any disabilities, emotional, physical, or intellectual?
Diversity. Which way does the student prefer to learn? Are they an ESL, english as a second language, learner? How does the culture and/or socioeconomic status (SES) relate and influence student's learning and behavior?
Interests. What do they like? What are they interested in? What are their goals? What do they do in their free time?
Difficult or atypical parent custodial arrangements. The family unit has many different facets and it is important to know if there are any special considerations or conditionsexist. Who should be called for emergencies? Who is allowed to pick up the child? Are the students parents going through a divorce and are disputing custody over the child?
It is even more important to do the same with special needs students. Some students have communication barriers that make this difficult i.e. non-verbal, use a communication device, ESL.
A GoTalk and a PECS book
From the video and the pictures of the devices you can easily see that many of the words needed to find out important information may be unavailable or difficult to find out from the child. Do not forget the importance of observations, and of course, parents. There is much you can find out from watching students at different times and in different situations. You may notice that Bob loves to play with blocks, or that Alice is humming a song, or Taylor is scripting (reciting lines) from a movie. Each of those creates what is on the child's mind, what they like to do, and their interests. It is easy to set up situations in the classroom to find additional information about your students (Burden, 2013). In the early elementary setting you could have various puzzles out and observe what the student gravitates towards. Students could draw a picture and that could show what they value. Students are constantly sharing who they are, and with communication being 97% nonverbal, one just needs to pay attention. Parents are a HUGE resource on information regarding their children, all is needed is the opportunity to share what they know. A questionnaire could be sent out regarding students strengths, weaknesses, what makes them unique, parents desires for the school year (Burden, 2013). Take in this information and add it to what you observe to make a full picture. Students with special needs may have different behaviors depending on the environment they are in and what demands are placed on them, so what parents share about their child in the home may not align with what you see in the classroom. This does not negate the parents knowledge as an expert of their child, it just creates a better picture of the whole child.
Personalities are very different and that may have a positive or a negative impact on building rapport with the student. From personal experience I have had the most satisfaction when I have worked with students that are difficult. The key is getting to know them and making what is important to them important to you. I had one client who constantly scripted her favorite shows, one being adventure time, and that is all that she would want to do. The show was much better than doing lessons. I noticed she would choose a certain character and recite all of their lines, so I chose another character and recited those lines. She got very excited when I would do this and we acted out the scene. Later we would act out different stories, i.e. the three little pigs, at home. Once she mastered that we would go to the park and get all of the children at the park to act out the story. Her goal was to increase interactions with peers and the park was a great place to see the fruition of all of the hard work to get to know her likes and interests. Without that foundation going to the park would be a different location for her to do the same thing- script a scene to herself on her own.
Resources
Burden,
P. (2013). Classroom management: Creating
a successful k-12 learning community (5th ed.). New York, NY: John Wiley
& Sons, Inc.
The one word that every general education teacher mentally shudders at. With all of the attention on autism, it is difficult to picture what it looks like, especially in a classroom with so many variables. There is such a huge variety of what autism looks like in an individual that it is difficult to be prepared and execute behavior management and lesson plans in the classroom (Able et al., 2015). The Diagnostic and Statistical Manual (DSM-5 the clinical guide to diagnosing mental disorders) defines "Autism spectrum disorder (ASD) is characterized by deficits and significant impairment in two domains: (a) social and communication deficits and (b) repetitive behaviors and fixed interests" (Parritz & Troy, 2014, p122). So what does that really mean? Individuals with autism* observe the world differently, take in input-process, function and express themselves in a different way. For general ed teachers that means differentiated instruction to the nth degree. While the DSM-5 has defined ASD the difficult part is preparing others (i.e. professionals) to interact, teach, and recognize those with autism. The best way to put it is to think of children with autism wearing plaid clothing, but each child's plaid is individual and unique to one another (Parritz & Troy, 2014). At first glance, the untrained eye will not notice any difference. It is not like Down syndrome where with one look one can tell a difference.
In regards to social and communication deficits, this typically (remembering that there is no one size fits all, but general irregularities) means that there may be speech delays, difficulty processing speech, difficulty with expressive speech, understanding social cues and what their actions/behaviors should be from these social cues. Now for examples: Speech delays/difficulty processing speech may mean they did not talk until three years old, or maybe one can only label items or use one word sentences, time delay in speech i.e. taking 5 seconds or more to reply, one does not understand pronouns i.e. my turn versus your turn, echolalia (repeating what one hears, like a parrot) is the only form of speech. Expressive speech difficulties may include lisps, correct use of tone or intonation i.e. saying what? instead of what!, they may only be able to produce certain sounds and no words, relying on gestures and/or grunts. Understanding social cues and what appropriate actions/behaviors should be. Ex: A group of children are in a group on the playground, one boy burps, everyone laughs, he burps again, they laugh again, but are less amused. Again he burps, one or two in the group giggle, someone says stop. He burps again, students louder say to stop and walk away. The boy burps in their direction, follows some from the group and burps again. They yell 'Stop! It's not funny!' and the one boy looks confused. The bell rings and they line up to go inside. The boy should have been able to read the looks on his peers faces and from the lack of laughter understand that his burping is not funny anymore and he should cease to burp, but he could not read their cues and so he did not stop burping, causing annoyance in his peers.
Another one I have seen periodically is laughing or smiling when a person is crying.
The word I use for repetitive behaviors is stimulatory or self stimulatory behavior (stims). Everybody uses stimulatory behavior. As I am typing this, my foot is moving back and forth. When I am doing this motion I am not aware that I am doing it, it is involuntary. The same principle applies for those engaging in stimming, to the exclusion of all else. I have had students and clients do this for many reasons, they are excited, scared, overwhelmed, overstimulated (noisy environment, even and especially white noise), angry, think of computer overload. The behavior in itself usually is not harmful or too distracting, but again it depends on the individual. Some flap their hands, jump, pace, but others have made certain high pitch sounds, are teeth grinders, hum (loudly, or softly), clap, etc. These while not in any way harmful may be distracting to other students. Here is Danny from AspergerExperts from the perspective of one who has ASD.
Fixed interests can also be thought of as extreme tunnel vision. Again there is a wide variety here from mild-moderate-severe. Ex: Johnny like trains. He talks, thinks, imagines, dreams, does all things connected with trains. Alice is talking in a group, Johnny is part of the group, but as he is thinking about trains, he is not paying attention to what the group is talking about and Johnny interjects about his favorite type of freight train. This is not on topic, their is a lull and either one engages Johnny about the freight train or they continue on with their topic. Some are blessed with such an interest and have the support to become an expert in a field and could be labeled as a savant in that area.
If someone off the street and asked me what autism is my typical answer of what it is: a neurological disorder that affects a person in a variety of ways, but there usually have communication deficits and behavioral excesses, i.e. difficulty talking to others and stimulatory behaviors (hand flapping, ear flicking), and have difficulty in social settings. It is thought to be inherited in the genes and there are those whose genes are vulnerable to developing, but it is not caused by vaccinations (Parritz & Troy, 2014). Some swear there was nothing wrong until they got vaccinated, but studies have shown it is not true, but that the symptoms and discrepancies do not show until around the same age. I am no expert and for those parents who are very concerned should talk to their pediatrician about the possibility of spacing out the vaccinations.
*Sidebar: I use the phrase individuals or children with autism because I recognize the person first and anything else is secondary. Yes, it is easier to say autistic. For some that label is no problem, but after dealing with some (not purposely) who talk about them as if they are not in the room, it is my way of saying, 'You are important. I see you. I respect you.'
Resources
Able, H.,
Sreckovic, M. A., Schultz, T. R., Garwood, J. D., & Sherman, J. (2015).
Views from the trenches: Teacher and student supports needed for full inclusion
of students with ASD. Teacher Education and Special Education, 38(1),
44-57. doi:10.1177/0888406414558096
Parritz, R. H., & Troy, M. F.
(2014). Disorders of childhood: Development and psychopathology (2nd
ed.). Belmont, CA: Cengage Learning
