By Leslie Baer Cohen, Ph.D.

 With summer right around the corner, many parents are actively exploring summer programs for their children.  As a child psychologist, one of the more common questions that I hear from parents during this process is, “What, if anything, should I tell my child’s counselor/camp about his/her neurobehavioral problems?”   For many parents, a tension exists between wanting to make their child’s camp experience a positive one and at the same time worrying that telling a camp about their child’s vulnerabilities will somehow be stigmatizing.  Although one size never fits all in the world of children with neurobehavioral difficulties, the following guidelines may serve as useful pointers:

1. Be proactive — Ask questions

Before making a final selection on a camp, you should be prepared to ask very specific questions about how the camp is run. Find out who will be working with your child, how old they are, what kind of training they have had and how behavior problems are handled.  The following questions also are helpful to ask: How much structure does the camp provide? What is their daily routine? What is the adult: child ratio? How many children share a cabin together? Has the camp worked successfully in the past with children who have had similar difficulties?  What kinds of options exist for a one-on-one aide?  What is the camp’s philosophy? Is it competitive?  If camp personnel are unable to answer these questions to your satisfaction, it is probably not the best place for your child.

2.  Define the problem

Most good camps will want to know as much as possible about your child’s strengths and vulnerabilities.  Generally speaking, knowledge is empowering.  Give the staff a true and honest account of your child’s special needs (e.g., level of inattention/hyperactivity; motor problems; language problems; trouble with peers; sensory issues; previous experience with camp, medications). Make sure they know this is something you consider to be important. You can help educate the staff by spending time with them and answering and asking questions before you drop off your child.  Rather than simple giving a label that is open to interpretation, it is often more helpful to provide specific behaviors that your child is likely to exhibit.  For instance, instead of just saying “My child has ADHD,” it may be more helpful to say, “My child has ADHD, which means that his ability to pay attention for extended periods is not as strong as others his age.”

3. Offer ideas

When discussing your child’s special needs, offer some easy to implement strategies that you have found to be helpful.  Enlist help from your child’s teachers and other specialists (e.g., speech/language, therapist, psychologist, occupational therapist).  At the same time, provide some predictions about what types of activities at camp may be the most challenging for your child (e.g., unstructured time, overstimulating activities, getting dressed after swimming, lunch) so that the counselor can take a proactive stance.  Remind the counselor about the importance of positive reinforcement, close supervision, and appropriate boundaries and consequences. 

4. Provide references

Don’t assume that camp staff will understand exactly what your child’s neurobehavioral disorder entails. Provide some simple and direct printed information stating what the problem is and how it may manifest at camp. (Staff at RNBC can help you with this information.) It is considerably more likely that teenage counselors will read a one-page summary than a book and a mountain of papers.  If your child is taking medication and will be attending sleep-away camp, be sure to provide the phone number of the child’s prescribing physician.  In addition, provide the staff with a list of emergency phone numbers and email addresses, and make sure they know how to reach you at all times during your child’s camp stay. You may even want to sign a release for your child’s specialist to speak with particular camp staff, such as his/her therapist.

5. Keep in touch

Check in with your child’s counselor on a regular basis to see how things are going. Give them permission to tell you about any problems right away, and work collaboratively with them to resolve the situation. If counselors are willing, send a report form that lists desirable behaviors that can be checked off and returned to you each day. Be sure to read any information sent home from camp and respond promptly with questions.

The following list includes some camps that offer specialized programs for children with neurobehavioral difficulties:

Camp STAR  www.jcys.org/campstar

Camp Hug the Bear (autism spectrum disorders-NSSRA)

Cove/Hyde Park Day School-summer reading and math programs

Camp Neeka (Josselyn Center, IL)

Julie Herr & Associates (Chicago) www.julieherr.com

Camp Firefly www.campfireflyjcfs.com

Hidden Valley Camp (Maine) www.hiddenvalleycamp.com

The Learning Camp (Vail, CO) www.learningcamp.com

Camp Buckskin www.campbuckskin.com

Wolfeboro: The Summer Boarding School www.wolfeboro.org

Summit Camp (Pennsylvania) www.summitcamp.com

SOAR (North Carolina) www.soarnc.org

Global Works www.globalworkstravel.com

Outward Bound www.outwardbound.com

Talisman Programs www.talismancamps.com

 Rush University Medical Center also maintains a web-based resource which includes camp information.  The direct link to the summer camps is http://www.rush.edu/rumc/page-1234554460333.html

Disclaimer

There may be camps other than those identified in this article that would be suitable for this patient population. None of the camps identified in this article are owned by, affiliated with, related to or agents of Rush University Medical Center.

While supporting your child with nightly assignments it is important to monitor the amount of time needed for assignment completion.  If you feel that the time is excessive or that your child clearly does not understand the assignments or requires total supervision in order to complete them, share your concerns with the classroom teacher(s).  If your child already has and IEP or a 504 Plan, homework accommodations can be added.  Suggestions for accommodation are: set a limit on the time spent completing nightly assignments, modify the length of assignments, break lengthy assignments into manageable steps, provide a check-out to make sure all assignments are written down and that necessary materials needed for completion are taken home.

Below is a list of recommendations which may help your child complete homework more effectively, efficiently and independently and hopefully provide some added time for leisure activities. 

Organization Strategies

• Teach prioritizing of assignments, i.e., completing those that a most difficult first, completing assignments that are due tomorrow before working on a long-term project.
• Model HW time management, i.e. ask your child to estimate the time it will take to complete an assignment, set a timer, compare the estimated time with the actual time.
• Teach task analysis of long term assignments.
• Prepare a locker list reminding your child what needs to be taken home.

 Support for Reading

• Use books on tape.
• Enlarge print.
• Purchase an extra set of textbooks for home so that your child can write notes and highlight in text.
• Review post-reading assignment expectations prior to doing the reading assignment.
• Pre-teach reading concepts to be covered.
• Relate concepts in the story to your child’s personal experiences.
• Create “purpose for reading assignment” sheet, i.e., as you read look for, highlight or jot down personality traits of the main character.

Support for Math

• Copy problems from the book for your child.
• Copy problems on a lined piece of notebook paper turned so that the lines are vertical.  Use the vertical lines as a grid, writing one number in each space.
• Give adequate space to complete problems and limit the number of problems written on page.
• Draw a box around each problem.
• Use different colored pencils for addition, subtraction and multiplication signs.
•  Break down multi-step problems.
• Write each step on a sequence card and have your child use the sequence cards to complete HW.
• Use manipulatives to represent numbers.
• Use a number line.
• Use a multiplication chart.
• Use a calculator.
• When completing story problems; review math vocabulary i.e. addition, plus all together, in all; highlight relevant information, i.e., only numbers needed to complete problem and process required; use visual representation i.e. drawing pictures

 Support for Spelling

• Present one spelling concept at a time (long “A” sound)
• Review and pretest one spelling concept at a time
• Write words in a tray filled with salt or shaving cream
• Use clay or Play Doh to write words

 Support for Vocabulary

• Limit number of new vocabulary words presented at one time.
• Highlight vocabulary words on worksheets.
• Give page numbers to help your child locate and find meaning of vocabulary words.
• Ask your child to draw pictures that define vocabulary words.
• Ask your child to act out new vocabulary words.

Support for Written Expression

• Use jot lists, outlining and webbing.
• Create graphic organizers (ideas can be found on-line).
• Use computer graphic organizers, i.e., Kidspiration, Inspiration
• Use a tape recording when formulating ideas.
• Allow your child to dictate ideas.
• Write questions to be answered in a different color and then provide adequate space for your child to respond.
• Tell your child how many sentences are necessary for each answer or paragraph (write 3–4 sentences).
• Create rubrics to make expectations clear.
• Create a checklist of elements on the rubric or assignment requirements.
• Provide a sequence of tasks for the proofreading and editing process, i.e., Are all words capitalized at the beginning of each sentence?  Does each sentence end with a period?
• Encourage use of computer.
• Expect use of spell check and grammar check.

Support for Test Preparation and Test Taking

• Request prior notice for all tests and quizzes to avoid “cramming” at the last minute.
• Create study guides with necessary names, dates, concepts, etc.
• Use index cards for individual concepts and group similar concepts.
• Create acronyms when memorizing lists.
• Create pretests.
• Remind your child to read and highlight instructions before beginning tests.

Strategies to Support Inattention

• Reduce the number of extraneous materials present in the homework area.
• Create a private key word, e.g., “focus”, that can be used as a cue.
• Physically refocus attention, e.g. touching the shoulder.
• Break down instruction into separate parts and use fewer words.
• Give one instruction at a time.
• Write down multi-step instructions.
• Ask your child to repeat and rephrase directions in order to confirm that he/she has heard, understood and retained the information.
• Break down complex tasks into smaller, more manageable components.

Improvement of Self-Esteem

• Remind your child that everyone makes mistakes and that nobody is perfect.
• Acknowledge efforts that your child makes to complete an assignment.
• Base comments on the effort being made and not on the result.
• Model making mistakes in front of your child in order for him/her to see that a person can survive when making an error or when a project comes out less than perfect.
• Model how to handle difficult tasks.  For example, when experiencing difficulty with a task say aloud “This is hard, but I’m going to keep trying.” 
• Monitor for signs of frustration and be aware of whether the signs may be secondary to anxiety and insecurity over perceived task difficulty.
• Highlight and praise your child’s many abilities in other areas.

 Ms. Resnick serves as RNBC’s School Liaison.  She supports families through interpreting evaluations and IEP’s, developing educational programs including suggestions for goals, accommodations and teaching strategies, working with school system to secure appropriate services and providing alternative school placement recommendations.

What is school-based anxiety and school refusal?

Anxiety disorders are one of the most common problems among children and adolescents with rates varying from 10% to 20%. While a little worrying is normal, anxiety is defined as excessive worrying that is irrational or out of proportion to the feared stimulus. Symptoms of anxiety can interfere with everyday functioning as well as interpersonal relationships and school achievement. School can be an especially daunting place for children with anxiety because of the enormous interpersonal and academic demands. School-based anxiety is defined as a developmentally inappropriate reaction to the perceived consequences associated with school (e.g., failing a class, fears of getting picked on). School refusal behavior, also known as school phobia, occurs when the anxiety becomes so distressing that children and adolescents miss days, weeks, or months of school. The most common age of school refusal is 10 to 13 years, but can occur at any point in development. Parents are also more likely to see anxiety and avoidance behaviors occur during transition years (e.g., from elementary to middle school).

How does anxiety and school refusal impact youth?

Children with excessive anxiety present with a range of behaviors. Some children withdrawal from social activities or avoid difficult tasks for fear of failing or being embarrassed. They may appear inattentive, forgetful or unmotivated to engage in classroom discussions. Academic performance starts to suffer and teachers may interpret their behavior as defiant, disorganized or lazy. Socially, children may isolate themselves to avoid participation in peer interactions. They may have a poor self-concept and believe they lack the skills to initiate and sustain a friendship, which leads to further worries about being rejected by peers. Over time, children are more likely to develop sadness and develop a stable pattern of anxious thinking. Avoiding school or minimizing academic and social activities offer youth effective, short-term relief to reduce anxious feelings, but over time have serious negative consequences. Additionally, families are affected by this problem. Parents often feel blamed by the school given the common misperception that the issue is simply a matter of discipline. In reality, parents struggle to manage conflicting feelings around empathic desire to comfort their children and exasperation associated with the battle to get them to school.

 Warning Signs and Symptoms

Some warning signs that your child might be experiencing increased anxiety or school refusal include:

-       Excessive reassurance-seeking behavior

-       Clinging to an adult

-       Temper tantrums, crying

-       Sleep difficulties

-       Depressed mood, irritability

-       Difficulty concentrating

-       Complaints of physical problems that are absent on weekends or breaks

-       Frequent tardiness or absences

-       Absent on important days (tests, presentations)

-       Frequent trips to the nurse’s office

-       Frequent requests to call or go home

-       Refusal to get out of bed or go to school

-       Running away from home or school

What You Can Do

If you are concerned that your child is experiencing an increase in stress and anxiety or you have observed changes in his/her behavior that lead to school-based problems, it’s important to take steps to indentify the problem and develop an intervention plan. Parents may wish to consider one or more of the following actions:

 Medical and Psychological Evaluation

Having a routine medical check-up might be a good place to start, especially if you child is complaining of physical problems (e.g., headaches, stomach aches). Many of the symptoms commonly seen in children with anxiety can also have a medical explanation. Ruling out physical problems is critical before taking further action. On a related note, there are also a number of psychological conditions that could better explain the kinds of problems associated with school refusal. For example, a mood disorder such as depression may also cause a child to withdraw from school or lack motivation to go to school. Also, conduct problems, attention deficits and learning disabilities might manifest as school refusal and poor classroom connectedness. Finally, many children are unfortunately the targets of bullying, which can make school very unpleasant and lead to unwillingness to attend. In these cases, intervention efforts would take a different form. A comprehensive psychological evaluation would identify these or other potential contributors to your child’s school difficulties as well as guide treatment decisions.

School-Based Interventions

Parents are strongly encouraged to work closely with the school in developing an intervention plan. In order to be successful, the plan should start with a school refusal assessment that identifies the target behaviors, as well as antecedents and consequences (i.e., what happens before and after the behavior) at home and school. For example, if the child’s refusal seems to occur on days when there are tests, the school might implement a plan providing accommodations and support around test taking. Other common school-based interventions include structured behavior plans with rewards and consequences, social work support, reduced time spent at school, reduced or modified work expectations, or a systematic re-entry plan.

Home-Based Interventions

Parents play an important role in their children’s treatment plan. Successful interventions will include ongoing, consistent communication with the school and specific ways of handling anxiety and school refusal at home. Parents may be guided on how to respond to children’s complaints of feeling sick or temper tantrums. Forcing your child to go to school when the child is having a meltdown is one of the hardest things parents face. The result is feelings of guilt and frustration; parents may feel compelled to let the child stay home. This response inadvertently reinforces the anxiety and makes the problem worse. Establishing a contingency plan that involves the school will be helpful in guiding your decisions during these intense moments.

There are a number of other things parents can do to support anxious children, in general. Being supportive and consistent in discipline as well as providing a structured, predictable routine can alleviate anxiety symptoms. Be patient and avoid being overly critical or punitive. Praise effort over outcomes and be prepared to listen and encourage expression of feelings. Also, be mindful of your own anxiety and make efforts to model relaxation strategies such as positive self-talk and deep breathing

Other Considerations

Seeking outside help is strongly recommended if the problem persists and continues to impact the child’s ability to attend school or engage in daily activities. Individual or family therapy can be very helpful to reduce anxiety and support parents. Cognitive-Behavioral Therapy is a well-supported treatment approach that teaches children to manage anxiety using a combination of physiological, behavioral and thinking strategies. For extreme cases, parents may consider enrolling their children in partial– or full-hospitalization programs designed specifically to treat school refusal. Also, anti-anxiety or anti-depressant medication may also be a component of treatment.

If you have concerns about your child experiencing anxiety or school refusal and would like an evaluation and/or treatment through our Stress and Anxiety Clinic, please call 847–933-9339 to schedule an appointment.

 1. Diagnostic Clarity

Does Joe have ADHD? A learning disability? Executive functioning problems? Anxiety? Depression? A combination of things? These are all potentially valid hypotheses.  Children are complicated and a host of factors may account for a similar behavioral presentation.  For instance, children who look like they are not paying attention often have undiagnosed learning disabilities.  The reverse is also true in that children who have attention deficit disorders may appear to have learning difficulties because they cannot consistently produce academically.  Similarly, children who are anxious or depressed may have difficulty concentrating or be unavailable for new learning. One major goal of a comprehensive evaluation is to determine which problem areas are primary and which are secondary, and ascertain whether the data are suggestive of a specific diagnosis.  Often, there is a combination of factors which need to be understood.

 2. Learning style

In addition to diagnostic clarification, another major purpose of a comprehensive evaluation is to understand how a child like Joe learns the best.  One size does not fit all.  Testing provides a profile of a child’s unique strengths and weaknesses across multiple areas of functioning and sheds light on how a child processes information.  Such information is invaluable for teachers and other professionals who are working with children on a daily basis and may be unclear about how to most effectively intervene.

 3. Road Map

A comprehensive evaluation should provide a road map for parents, teachers and other pertinent professionals about how to address their child’s needs. Such interventions may include tutorial support, medication, psychotherapy, speech/language therapy, occupational therapy, social skills groups or school-based learning resource support.  Sometimes, a change in school placement is recommended.  Regardless of the type of intervention, once a full evaluation has been completed, the best combination of supports and specific goals for each is more readily understood.

 4. Monitoring Tool

Comprehensive evaluations provide concrete data about a child’s level of intellectual, academic, social/emotional and attentional functioning at a snap shot in time.  Nonetheless, children are moving targets.  As such, children like Joe need to be monitored over time to determine whether in fact they are progressing, hitting a plateau or falling behind.  Periodic evaluations are a very helpful tool in this monitoring process.  Interventions often need to be updated or changed to accommodate children’s continual development.  As such, 2–3 year re-evaluation intervals are typically recommended for school-aged children, while annual re-evaluations are ideal for children under age 5.

 If you have questions about psychological/neuropsychological evaluations at RNBC, please contact our office at (847) 933‑9339

The meeting begins with an introduction of all in attendance and the Student Identification Information and Parent/Guardian Information form is reviewed.  Parents should carefully check over this page to make sure all the information is correct, i.e., address, telephone numbers, date of birth.  On the bottom of this page is a place for participants to sign in.  One’s signature in this location provides a record of attendance at the meeting and does not indicate agreement with any decisions made during the meeting. 

The child’s teacher may next review classroom performance, such as daily work completion, behavior and socialization.  Each of the service providers, i.e., resource teacher, social worker, speech language professional or occupational therapist, gives an update on the progress made toward the goals that had been developed at least year’s Annual Review.  Results of any current testing is shared, including district-wide testing such as MAPS, NWEA or ISAT, which provide data on individual achievement as well as how the child’s skills compare to other same-grade peers in his/her school, district as well as nationally.  Progress monitoring data, such as curriculum-based measurement results often tracked using AIMSweb, may also be shared.  Parents have the opportunity to discuss their child’s successes as well as any concerns.  Also, private providers or advocates can contribute to the discussion at any point during the meeting.

The team then moves to developing annual goals.  The Goal and Objective/Benchmarks form is used for this purpose.  For each goal written, the child’s current academic achievement and functional performance must be documented.  Using this data as a starting point, goals are written for one year.  Goals must be specific, measurable and address the deficits identified in evaluation results in all pertinent domain areas.  Illinois Learning Standards, guidelines for academic instruction applicable to all students in grades kindergarten through high school,  should be used as one of the criteria when writing goals.  For each goal, the child’s current level of performance must be stated and individual benchmarks be developed.  The benchmarks are the steps toward reaching the annual goal.  For each benchmark, evaluation criteria, evaluation procedures, and schedule for determining progress must be recorded.  Goals are reviewed quarterly, usually at each grading period.  Once a goal is met it must be rewritten to reflect continued growth.  A child may only have one goal, or many, depending on his/her areas of need     

The Educational Accommodations and Supports form describes the specific supplementary aids, accommodations and modifications to which the child is entitled.  Accommodations and modifications are specific adjustments made to the regular school curriculum, based on the student’s educational difficulties.  The Assessment form lists the accommodations the child requires for class-based, district-wide and state-academic assessments.  This might include extended time, test in quiet environment and/or test read to student.  Some common classroom accommodations include  books on tape, use of word processor for written assignments, and/or classroom notes provided.

The Educational Services and Placement form explains in what areas the child will participate in the general education curriculum (with and without supplementary aids) and the specific number of minutes for each special education and related service.  Based on the IEP goals generated at the Annual Review, Educational Placement is determined and can include the general education classroom with resource support provided either in the classroom (push-in) or outside of the classroom (pull-out), a self-contained special education classroom, or placement in a special education or therapeutic school.  Parents have the right to have their child attend, to the maximum extent appropriate and with modifications and accommodations, classes with other students who are not special education students, i.e. the “least restrictive environment”.  Placement considerations must always first consider “the least restrictive environment”, which is the general education classroom the child would attend if not disabled.

Transition meetings are routinely held when a child enrolled in a preschool special education classroom reaches the appropriate age to begin kindergarten.  Representatives from the preschool program and the receiving school are both in attendance at this meeting and work collaboratively to decide the appropriate placement and instructional goals for the child.  Transition meetings are also held when a student moves from 8^th grade to high school and often involves two different districts working together to determine programming and establish goals. 

Another section of the IEP pertains to students who are 14 ½ years of age or older.  The Transition Specialist/Counselor becomes another member of the IEP team and there are a number of additional forms that must be completed.  The team must develop appropriate, measurable postsecondary goals based upon age-appropriate transition assessments related to training, education, employment, and, when appropriate, independent living skills.  Students will be asked to complete a variety of formal and informal assessment activities to help identify individual special talents, interests and career aspirations.  In developing the transition goals, the IEP team (including the child) must determine what instruction and educational experiences will help prepare him/her for a successful transition to life after high school.  Transition forms are reviewed at all Annual Review meetings to assure the child is completing the necessary course work to reach expected post-secondary outcomes and has received the documented vocational and independent living skills training

It is important to understand that an IEP is a legal document.  It is governed under IDEA, the Individual with Disabilities Education Act, which assures that services meet state and federal requirements.  A school district is obligated to provide the services, supports, accommodations and number of minutes documented in the IEP.  Progress is to be monitored on a consistent basis through data collection.  If a child is not making gains on his/her goals, these goals need to be reevaluated and possibly revised.  Although IEPs are written for one year, a parent does not have to wait for the Annual Review meeting to share concerns.  IEP Review meeting can be called at any time and changes can be accomplished through IEP revisions.

The meeting begins with an introduction of all in attendance and the Student Identification Information and Parent/Guardian Information form is reviewed.  Parents should carefully check over this page to make sure all the information is correct, i.e., address, telephone numbers, date of birth.  On the bottom of this page is a place for participants to sign in.  One’s signature in this location provides a record of attendance at the meeting and does not indicate agreement with any decisions made during the meeting. 

The child’s teacher may next review classroom performance, such as daily work completion, behavior and socialization.  Each of the service providers, i.e., resource teacher, social worker, speech language professional or occupational therapist, gives an update on the progress made toward the goals that had been developed at least year’s Annual Review.  Results of any current testing is shared, including district-wide testing such as MAPS, NWEA or ISAT, which provide data on individual achievement as well as how the child’s skills compare to other same-grade peers in his/her school, district as well as nationally.  Progress monitoring data, such as curriculum-based measurement results often tracked using AIMSweb, may also be shared.  Parents have the opportunity to discuss their child’s successes as well as any concerns.  Also, private providers or advocates can contribute to the discussion at any point during the meeting.

The team then moves to developing annual goals.  The Goal and Objective/Benchmarks form is used for this purpose.  For each goal written, the child’s current academic achievement and functional performance must be documented.  Using this data as a starting point, goals are written for one year.  Goals must be specific, measurable and address the deficits identified in evaluation results in all pertinent domain areas.  Illinois Learning Standards, guidelines for academic instruction applicable to all students in grades kindergarten through high school,  should be used as one of the criteria when writing goals.  For each goal, the child’s current level of performance must be stated and individual benchmarks be developed.  The benchmarks are the steps toward reaching the annual goal.  For each benchmark, evaluation criteria, evaluation procedures, and schedule for determining progress must be recorded.  Goals are reviewed quarterly, usually at each grading period.  Once a goal is met it must be rewritten to reflect continued growth.  A child may only have one goal, or many, depending on his/her areas of need     

The Educational Accommodations and Supports form describes the specific supplementary aids, accommodations and modifications to which the child is entitled.  Accommodations and modifications are specific adjustments made to the regular school curriculum, based on the student’s educational difficulties.  The Assessment form lists the accommodations the child requires for class-based, district-wide and state-academic assessments.  This might include extended time, test in quiet environment and/or test read to student.  Some common classroom accommodations include  books on tape, use of word processor for written assignments, and/or classroom notes provided.

The Educational Services and Placement form explains in what areas the child will participate in the general education curriculum (with and without supplementary aids) and the specific number of minutes for each special education and related service.  Based on the IEP goals generated at the Annual Review, Educational Placement is determined and can include the general education classroom with resource support provided either in the classroom (push-in) or outside of the classroom (pull-out), a self-contained special education classroom, or placement in a special education or therapeutic school.  Parents have the right to have their child attend, to the maximum extent appropriate and with modifications and accommodations, classes with other students who are not special education students, i.e. the “least restrictive environment”.  Placement considerations must always first consider “the least restrictive environment”, which is the general education classroom the child would attend if not disabled.

Transition meetings are routinely held when a child enrolled in a preschool special education classroom reaches the appropriate age to begin kindergarten.  Representatives from the preschool program and the receiving school are both in attendance at this meeting and work collaboratively to decide the appropriate placement and instructional goals for the child.  Transition meetings are also held when a student moves from 8^th grade to high school and often involves two different districts working together to determine programming and establish goals. 

Another section of the IEP pertains to students who are 14 ½ years of age or older.  The Transition Specialist/Counselor becomes another member of the IEP team and there are a number of additional forms that must be completed.  The team must develop appropriate, measurable postsecondary goals based upon age-appropriate transition assessments related to training, education, employment, and, when appropriate, independent living skills.  Students will be asked to complete a variety of formal and informal assessment activities to help identify individual special talents, interests and career aspirations.  In developing the transition goals, the IEP team (including the child) must determine what instruction and educational experiences will help prepare him/her for a successful transition to life after high school.  Transition forms are reviewed at all Annual Review meetings to assure the child is completing the necessary course work to reach expected post-secondary outcomes and has received the documented vocational and independent living skills training

It is important to understand that an IEP is a legal document.  It is governed under IDEA, the Individual with Disabilities Education Act, which assures that services meet state and federal requirements.  A school district is obligated to provide the services, supports, accommodations and number of minutes documented in the IEP.  Progress is to be monitored on a consistent basis through data collection.  If a child is not making gains on his/her goals, these goals need to be reevaluated and possibly revised.  Although IEPs are written for one year, a parent does not have to wait for the Annual Review meeting to share concerns.  IEP Review meeting can be called at any time and changes can be accomplished through IEP revisions.

Prior to the conference, find a few minutes to talk to your child about his/her school year. Begin by asking which aspects of school are enjoyable. What are some favorite school activities? What assignment or project is he/she especially proud? Then discuss those things that your child perceives as difficult. Ask what he/she does not like about the school day. Learn what he/she might like to change. Inquire about assignments that may have been challenging or boring. With or without your child, look over the previous report card or semester grades. Reread teacher comments. Check your child’s assignment notebook and returned work to gain a better understanding of classroom expectations and how your child is meeting these demands.

It may be helpful to prepare a list of questions to help guide the time spent with your child’s classroom teacher(s). Below are some suggestions.

• How is my child doing academically? Is he/she finding learning pleasurable or is it a struggle? What subjects appear to be easy? Which are problematic?
• What are you seeing behaviorally? Is my child on task, using time well, following class instructions, understanding classroom expectations?
• Does my child appear happy, comfortable, tired, sad, anxious? Are my child’s needs understood?
• How does my child relate to peers? Does he/she work well with a partner or in a group? Is my child involved with peers during both structured and unstructured times? With whom does my child play? Is this other student a good fit for my child? Who might you recommend I encourage my child to play with?
• What appear to be my child’s passions or talents? What enrichment opportunities focusing on these areas might you recommend? What is available in the school or the community?
• What is my child’s level of independence? How can we foster more independence at home? How can we foster more independence at school?
• What is the nightly homework expectation? How long should students spend doing homework? Should I support my child more or less with homework completion?

It is important to trust your child’s perception and your instincts. If there are specific issues you would like to discuss, the parent/teacher conference is a good place to begin. Depending upon what you learn, these items can be followed up by a meeting with the Principal or the school’s Problem Solving Team. If your child presents with academic struggles inquire about what type of supports are available in reading, math or writing through Response to Intervention (RtI). He/she may already be receiving Tier I interventions within the classroom. You may share incidents your child has relayed to you that have made him/her anxious or sad, such as making or maintaining friends, a sense of social isolation, being bullied, or feelings of inadequacy. You might request that your child meet with the school counselor or social worker. Communicate any current stressors at home that might impact day-to-day functioning. Inquire on ways you might support the teachers or school as they work with your child.

If your child already receives services through RtI, a 504 Plan or an IEP, it is important that the teacher understands any classroom accommodations to which he/she is entitled. Discuss the types of interventions used and/or the individual goals that have been developed. Be sure to meet with all professionals with whom your child works. This might include the Resource Teacher, Reading Specialist, Speech/Language Pathologist, Social Worker or Occupational Therapist. Ask the classroom teacher to invite these professionals to your conference or schedule separate meetings with each individual. IEP goal updates often are due around conference time. Use this as an opportunity to review progress towards goals and discuss next steps if changes need to be made.

Additionally, the February/March conference is a good time to begin planning for next year. What teacher(s) or team would be a good fit for my child? Request an observation of the classrooms at the next grade level if your school allows this opportunity. What friends should be placed in his/her class? How does the curriculum demand increase? How can I help my child be prepared for this change? What summer programs would benefit my child, either at the school or in the community?

If you feel your conference will take more time than allotted, ask to schedule it at an alternative day or time. Teachers view conferences as an opportunity to touch base with parents, but would prefer to conduct a lengthier discussion when more time is available. The parent/teacher conference is an excellent opportunity to learn a great deal about your child and can be beneficial to both the parent and the school.

1. Be proactive — Ask questions

Before making a final selection on a camp, you should be prepared to ask very specific questions about how the camp is run. Find out who will be working with your child, how old they are, what kind of training they have had and how behavior problems are handled.  The following questions also are helpful to ask: How much structure does the camp provide? What is their daily routine? What is the adult: child ratio? How many children share a cabin together? Has the camp worked successfully in the past with children who have had similar difficulties?  What kinds of options exist for a one-on-one aide?  What is the camp’s philosophy? Is it competitive?  If camp personnel are unable to answer these questions to your satisfaction, it is probably not the best place for your child.

2.  Define the problem

Most good camps will want to know as much as possible about your child’s strengths and vulnerabilities.  Generally speaking, knowledge is empowering.  Give the staff a true and honest account of your child’s special needs (e.g., level of inattention/hyperactivity; motor problems; language problems; trouble with peers; sensory issues; previous experience with camp, medications). Make sure they know this is something you consider to be important. You can help educate the staff by spending time with them and answering and asking questions before you drop off your child.  Rather than simple giving a label that is open to interpretation, it is often more helpful to provide specific behaviors that your child is likely to exhibit.  For instance, instead of just saying “My child has ADHD,” it may be more helpful to say, “My child has ADHD, which means that his ability to pay attention for extended periods is not as strong as others his age.”

3. Offer ideas

When discussing your child’s special needs, offer some easy to implement strategies that you have found to be helpful.  Enlist help from your child’s teachers and other specialists (e.g., speech/language, therapist, psychologist, occupational therapist).  At the same time, provide some predictions about what types of activities at camp may be the most challenging for your child (e.g., unstructured time, overstimulating activities, getting dressed after swimming, lunch) so that the counselor can take a proactive stance.  Remind the counselor about the importance of positive reinforcement, close supervision, and appropriate boundaries and consequences. 

4. Provide references

Don’t assume that camp staff will understand exactly what your child’s neurobehavioral disorder entails. Provide some simple and direct printed information stating what the problem is and how it may manifest at camp. (Staff at RNBC can help you with this information.) It is considerably more likely that teenage counselors will read a one-page summary than a book and a mountain of papers.  If your child is taking medication and will be attending sleep-away camp, be sure to provide the phone number of the child’s prescribing physician.  In addition, provide the staff with a list of emergency phone numbers and email addresses, and make sure they know how to reach you at all times during your child’s camp stay. You may even want to sign a release for your child’s specialist to speak with particular camp staff, such as his/her therapist.

5. Keep in touch

Check in with your child’s counselor on a regular basis to see how things are going. Give them permission to tell you about any problems right away, and work collaboratively with them to resolve the situation. If counselors are willing, send a report form that lists desirable behaviors that can be checked off and returned to you each day. Be sure to read any information sent home from camp and respond promptly with questions.

The following list includes some camps that offer specialized programs for children with neurobehavioral difficulties:

Camp STAR  www.jcys.org/campstar

Camp Hug the Bear (autism spectrum disorders-NSSRA)

Cove/Hyde Park Day School-summer reading and math programs

Camp Neeka (Josselyn Center, IL)

Julie Herr & Associates www.julieherr.com (Chicago, IL)

Camp Firefly www.campfireflyjcfs.com

Hidden Valley Camp (Maine) www.hiddenvalleycamp.com

The Learning Camp (www.learningcamp.com) Vail, CO

Camp Buckskin (www.campbuckskin.com)

Wolfeboro: The Summer Boarding School www.wolfeboro.org

Summit Camp www.summitcamp.com

Rush University Medical Center also maintains a web-based resource which includes camp information.  The direct link to the summer camps is http://www.rush.edu/rumc/page-1234554460333.html

Disclaimer
There may be camps other than those identified in this article that would be suitable for this patient population. None of the camps identified in this article are owned by, affiliated with, related to or agents of Rush University Medical Center.

The Educational Services Department at RNBC in Skokie, provides one-to-one tutoring in executive function skills for children, teens and young adults that is individualized to meet the specific needs of each student.  During the summer, EF student workshops are offered for those entering middle school, high school or college, preparing students for these crucial academic transitions.  These workshops develop essential organizational, time management and critical thinking skills in a small group environment.  Competence in executive function skills builds independence in students and capacity for them to take responsibility for their own success in school. 

Teachers are encouraged to participate in RNBC EF workshops designed with professional development in mind.  Through these workshops, the importance of EF skills is reinforced and the teachers are provided with an EF curriculum developed by RNBC Educational Team Members to help them with strategies to support the EF skills of their students. 

Additionally, schools can take advantage of on-site educational programming to develop executive function skills in students.  RNBC team members consult with school personnel to familiarize them with the Executive Function Curriculum so that these educators can extend the training to others in their school.  This can be accomplished through a team approach, specific grade level training, or a school-wide initiative.  The Executive Function School Curriculum has been designed to correspond with RTI provisions, Tiers 1 and 2. 

Research shows that

• Students who performed well in the Executive Function Curriculum have a higher rate of homework completion and earned higher grades, as measured in the subjects of math and reading
• Students who demonstrated greater adherence to the Executive Function Curriculum throughout the school year performed significantly better on the spring Learning First reading assessment and on the ISAT reading tests, even after controlling for demographic variables and prior years’ scores

 Responding to parent requests, the RNBC Educational Services Department offers an EF Parent Seminar Series.  This three session seminar series explores areas of the RNBC EF Curriculum especially relative to parents, including organizational skills, time management, study strategies, goal setting and decision making.  These small parent groups allow the participants ample opportunity to interact with each other and the instructor.  This experience is conducive to gaining insight into how executive function skills impact students and what parents can do to facilitate good habits that promote a lifetime of success.

The Educational Specialists also offer presentations to parent and/or community groups, featuring the latest information on executive function research and ways to help students on the home front. 

Time management is one aspect of executive functions skills.  Why is time management so important for students?  Students lead very busy lives.  They spend six hours daily in school, are involved in all types of after-school activities, have family responsibilities, in addition to the requirement of completing nightly homework assignments.  Helping students become aware of how they spend their time, as well as giving them strategies to efficiently manage their time, will facilitate independence and a sense of control. Refer to our “Planning My Time” log for an activity to help students become aware of how they spend their time. 

Interventions developed through RtI are generally delivered in a hierarchy of intensity, referred to as Tier I, Tier II, and Tier III. Although this may vary, typically each level of intervention lasts from six to eight weeks with data collection completed weekly using progress monitoring tools. Tier I intervention is provided by the classroom teacher, who is asked to modify instruction by implementing the suggested strategies, and then carefully monitor progress.  If the child’s skills improve, the intervention is considered successful. If the intervention is not yielding the desired results, the team would recommend the child receive the next level of support: Tier II.

Tier II support can be provided through an inclusive model within the classroom or in a small group. This level of support is often facilitated by the reading specialist or someone trained in delivering a specific type of scientific, research-based intervention. If this level of intervention is not yielding the desired results for the students, then the team moves to the highest level: Tier III.

Tier III intervention is often delivered outside the classroom, individually or in a small group. A special education teacher provides support through Tier III. It is often within this level of intervention that any concerns about specific learning disabilities are addressed. When this is the case, students are eligible for an Individual Education Plan (IEP), for which the child’s school is responsible.

As RNBC’s Educational Specialist, Ms. Resnick’s primary role is to assist families as they work with their school systems to secure these (and other) services for their children. “To better assist families, I have familiarized myself with RtI models that are used in various school districts,” explains Ms. Resnick. “When I attend school meetings, I ask about the type of scientific, research-based intervention being used, the amount of time devoted to the intervention and who is providing the service. This enables me to better understand if the intervention is appropriate to meet the child’s needs.” 

In addition to helping families better understand their child’s school’s RtI policies and process, Ms. Resnick supports parents by reviewing their children’s evaluations, generating ideas for 504 Plans, reviewing Response to Intervention data, and assessing Individual Education Plans. She also observes children at school, meets with teachers, special service providers, principals, and special education administrators. She is a strong student advocate as she is knowledgeable of special education rights and law. Parents have indicated that Ms. Resnick has been very helpful, not only with current school planning and decision making, but in deciding whether their child’s school is the best fit for him or her. “I am familiar with many of the programs, materials, and interventions used by schools to support children with deficits in reading, math, and written expression.  I also visit many of the therapeutic, special education, gifted and private schools in the Chicago area, to assist parents in making an informed choice when considering an alternative placement for their child. I find it very satisfying when I can see positive changes in children. Each child has his or her individual strengths and needs, so once an appropriate intervention is in place, the child begins to thrive.” 

To schedule a consultation appointment with Ms. Resnick, call 847–933-9339. You may also email Ms. Resnick directly at Barbara_Resnick@rush.edu.