PKU: Phenylketonuria

Phenylketonuria

   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.

Building Social Interactions in the General Ed Class

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.

Positive Reinforcement

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.

Building Rapport

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 conditions exist. 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.