OBJECTIVE

Screening for diabetes is typically done using hemoglobin A_1c (HbA_1c) or fasting plasma glucose (FPG). The 2019 Endocrine Society guidelines recommend further testing using an oral glucose tolerance test (OGTT) in older adults with prediabetic HbA_1c or FPG. We evaluated the impact of this recommendation on diabetes prevalence, eligibility for glucose-lowering treatment, and estimated cost of implementation in a nationally representative sample.

OBJECTIVE

To assess the costs and project the potential lifetime cost-effectiveness of the ongoing Autoimmunity Screening for Kids (ASK) program, a large-scale, presymptomatic type 1 diabetes screening program for children and adolescents in the metropolitan Denver region.

OBJECTIVE

To compare the risk of lactic acidosis hospitalization between patients treated with metformin versus sulfonylureas following development of reduced kidney function.

OBJECTIVE

Although blood pressure variability is increasingly appreciated as a risk factor for cardiovascular disease, its relationship with heart failure (HF) is less clear. We examined the relationship between blood pressure variability and risk of HF in two cohorts of type 2 diabetes participating in trials of glucose and/or other risk factor management.

OBJECTIVE

A recent publication questioned the integrity of insulin purchased from U.S. retail pharmacies. We sought to independently validate the method used, isotope dilution solid-phase extraction (SPE) liquid chromatography mass spectrometry (LC-MS), and expand analysis to two U.S. Pharmacopeia (USP) methods (high-performance LC with ultraviolet detection and LC-MS).

OBJECTIVE

To investigate the association of metabolic and lifestyle factors with possible diabetic polyneuropathy (DPN) and neuropathic pain in patients with early type 2 diabetes.

OBJECTIVE

To assess the association between use of glucagon-like peptide 1 (GLP-1) receptor agonists and risk of serious renal events in routine clinical practice.

OBJECTIVE

To assess the efficacy and safety of a 1:1 fixed-ratio combination of insulin glargine and lixisenatide (iGlarLixi) versus lixisenatide (Lixi) in insulin-naive Japanese patients with type 2 diabetes mellitus (T2DM) inadequately controlled on oral antidiabetic drugs (OADs).

OBJECTIVE

Recent studies have highlighted the significance of the microbiome in human health and disease. Changes in the metabolites produced by microbiota have been implicated in several diseases. Our objective was to identify microbiome metabolites that are associated with type 2 diabetes.

OBJECTIVE

The objective of this study was to examine whether altered heart rate variability (HRV) could predict the risk of diabetes in Asians.

OBJECTIVE

To determine the risk of cardiovascular disease (CVD), microvascular complications, and mortality in patients with type 2 diabetes who subsequently develop obstructive sleep apnea (OSA) compared with patients with type 2 diabetes without a diagnosis of OSA.

OBJECTIVE

Type 2 diabetes (T2D) is increasingly diagnosed at younger ages. We investigated the association of adolescent obesity with incident T2D at early adulthood.

OBJECTIVE

Acrylamide exposure from daily-consumed food has raised global concern. We aimed to assess the exposure-response relationships of internal acrylamide exposure with oxidative DNA damage, lipid peroxidation, and fasting plasma glucose (FPG) alteration and investigate the mediating role of oxidative DNA damage and lipid peroxidation in the association of internal acrylamide exposure with FPG.

OBJECTIVE

To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD.

OBJECTIVE

Type 2 diabetes develops for many years before diagnosis. We aimed to reveal early metabolic features characterizing liability to adult disease by examining genetic liability to adult type 2 diabetes in relation to metabolomic traits across early life.

OBJECTIVE

To examine the association between manganese intake and the risk of type 2 diabetes in postmenopausal women and determine whether this association is mediated by circulating markers of inflammation.

OBJECTIVE

This study evaluated the ability of the Building, Relating, Assessing, and Validating Outcomes (BRAVO) risk engine to accurately project cardiovascular outcomes in three major clinical trials—BI 10773 (Empagliflozin) Cardiovascular Outcome Event Trial in Type 2 Diabetes Mellitus Patients (EMPA-REG OUTCOME), Canagliflozin Cardiovascular Assessment Study (CANVAS), and Dapagliflozin Effect on Cardiovascular Events–Thrombolysis in Myocardial Infarction (DECLARE-TIMI 58) trial—on sodium–glucose cotransporter 2 inhibitors (SGLT2is) to treat patients with type 2 diabetes.

OBJECTIVE

We analyzed data from inpatients with diabetes admitted to a large university hospital to predict the risk of hypoglycemia through the use of machine learning algorithms.

OBJECTIVE

Preanalytical processing of blood samples can affect plasma glucose measurement because on-going glycolysis by cells prior to centrifugation can lower its concentration. In June 2017, ACT Pathology changed the processing of oral glucose tolerance test (OGTT) blood samples for pregnant women from a delayed to an early centrifugation protocol. The effect of this change on the rate of gestational diabetes mellitus (GDM) diagnosis was determined.

OBJECTIVE

This study aims to evaluate the association of energy and macronutrient intake at dinner versus breakfast with disease-specific and all-cause mortality in people with diabetes.

OBJECTIVE

In patients with type 2 diabetes (T2D) and critical limb ischemia (CLI), migration of circulating CD34⁺ cells predicted cardiovascular mortality at 18 months after revascularization. This study aimed to provide long-term validation and mechanistic understanding of the biomarker.

OBJECTIVE

To examine whether low baseline diastolic blood pressure (DBP) modifies the effects of intensive systolic blood pressure (SBP) lowering on cardiovascular outcomes in type 2 diabetes mellitus (T2DM).

OBJECTIVE

The LEADER trial (ClinicalTrials.gov reg. no. NCT01179048) demonstrated a reduced risk of cardiovascular (CV) events for patients with type 2 diabetes who received the glucagon-like peptide 1 receptor agonist liraglutide versus placebo. The mechanisms behind this CV benefit remain unclear. We aimed to identify potential mediators for the CV benefit observed with liraglutide in the LEADER trial.

OBJECTIVE

To determine the effect of tirzepatide, a dual agonist of glucose-dependent insulinotropic polypeptide and glucagon-like peptide 1 receptors, on biomarkers of nonalcoholic steatohepatitis (NASH) and fibrosis in patients with type 2 diabetes mellitus (T2DM).

OBJECTIVE

Despite evidence of a relationship among obstructive sleep apnea (OSA), metabolic dysregulation, and diabetes, it is uncertain whether OSA treatment can improve metabolic parameters. We sought to determine effects of long-term continuous positive airway pressure (CPAP) treatment on glycemic control and diabetes risk in patients with cardiovascular disease (CVD) and OSA.

OBJECTIVE

The role of U300 glargine insulin for the inpatient management of type 2 diabetes (T2D) has not been determined. We compared the safety and efficacy of glargine U300 versus glargine U100 in noncritically ill patients with T2D.

OBJECTIVE

The aim of this study was to examine the association of circulating retinol-binding protein 4 (RBP4) levels with β-cell function across the spectrum of glucose tolerance from normal to overt type 2 diabetes.

Classroom observations occur to document behaviors and to help provide insight to teachers. Teachers are teaching and are typically focused on the overall learning of the entire class. It is not possible for a teacher to catch all of the details of classroom while teaching. An outside observer, often a School Psychologist, can sit in the classroom and observe a student or the entire class. These insights can be used to help provide better instruction, create behavioral or academic interventions, or to document behaviors.

When do classroom observations occur?

- During a special education evaluation The classroom observation is a required component in a special education evaluation. It provides data and insight to the eligibility committee.

- Before a Behavior Intervention Plan or Functional Behavioral Assessment Classroom observations are important before implementing a Functional Behavioral Assessment or a Behavior Intervention Plan. It helps to clarify the current behaviors, identify possible triggers of the behavior, and determine the frequency of the behaviors.

- When a teacher is worried about a particular student Often a teacher will have a concern about a student and ask the School Psychologist to conduct an observation. After the observation the teacher and psychologist will meet to discuss and brainstorm strategies to assist in instruction.

CNN reports that a study confirms that early autism intervention in toddlers is effective. A study was completed with a program called the Early Start Denver Model (ESDM). This program involves about twenty hours a week in the child's own home. It involves play and parents can easily learn some of the skills that can be applied in other settings. The study compared a group of toddlers that were given ESDM intervention to a group of toddlers receiving typical community interventions. Both groups showed improvement, but the ESDM group improved IQ by 18 points compared to 8 points with traditional interventions. The study is reporting that some of the children "virtually caught up to the typical kids their age." However, they are not claiming it is a cure for autism. According to the article they are working on a replication study to determine if there are similar results. Personally, I'm looking forward to the results of the replication study and want to find out more about this method. From what I understand it is less of a time constraint than ABA therapy.

This study also demonstrated the need for early intervention, which also includes early identification. When children are diagnosed early, they can begin receiving interventions that are proven effective. The study showed that current methods are working, but there may be a new program that can be even more effective on the horizon.

I'd love to hear more from my readers if you have any experience with ESDM or more information about it.

This guest post is written by Angela Peterson who writes on the topic of Online Psychology Degrees and can be emailed at angela_peterson@rediffmail.com

It’s not easy raising a child, and when he or she is affected by a severe disorder or disease, you have a greater challenge ahead of you. You have to put in extra effort, energy and thought into your child’s development and progress, one aspect of which includes their education. Some parents of children with special needs may be tempted to overprotect by keeping them in cloistered environments and limiting their interaction with the outside world. This usually only hampers the child instead of helping them. If you’re a parent with a child who has special needs, here’s some strategies:

* Understand your child: Some children may be able to express themselves while others are limited because of their disability. Whatever the case, understand your child and know that they have a mind of their own even if they are unable to speak it. Instead of forcing your will on them, get to know what they wish to do and cater to their needs as much as possible as long as it does not cause them any harm.

* Be patient: It’s a tough task, but you need to have an enormous amount of patience with your child. You need to condition yourself to be patient through practice and experience, otherwise you and your child will be subject to a great deal of stress.

* Decide on their education: There are many options for providing education to your special needs child, so look for what is available in your area. If you plan to homeschool, you will need to do some research before you’re up to the task. Many feel that it’s better to let the professionals handle this task who are trained and more experienced. Also, your child gets to mingle with other children and interact with them on a regular basis, which is very important to his or her social development.

*Think about inclusive classrooms: Parents often want their special needs children to attend regular schools. Learn about inclusive classrooms and determine if it is a good fit for your child. Consider if your child is up to the task of being educated with general education children and if he/she can cope with the curriculum in such classrooms. Although teachers in inclusive classrooms are trained to deal with children with special needs, there may be times when your child could be bullied or teased by the other kids for not being like them. Take all these facts into consideration before you decide on an inclusive classroom for your child.


Children with special needs need all the help and support they can get from parents and teachers, and it’s up to you to decide on the best form of education for them.

The eligibility criteria for special education services is black and white. (I'm not talking about the color of skin.) Either the student fits the criteria or does not fit the criteria. The committee comes together with all the test data and then reviews the criteria for each disability. Either the student is eligible or not. They meet the criteria or they do not meet the criteria. Sounds easy, right? The kids who obviously fit the criteria easily qualify for special education services. The kids who clearly do not fit criteria for special education do not qualify for special education services. It should just be that easy. Sometimes it is.

I've been in the field long enough to see that eligibility is not always this magical process that determines special education from regular education. Sometimes eligibility decisions are a nightmare. What about all the gray kids that aren't clearly black or white?! For some kids, determining if they meet the criteria is tough. The black and white criteria makes it difficult to know what to do for the gray kids. The most difficult eligibility meetings are the ones where some members feel the student meets criteria and other members do not. These can lead to heated discussions. There are sometimes different ways to look at data and opinions of how to look at it may vary. Remember that the real issue the student who is cared about by school staff and especially parents which makes the decision emotional. It can be hard to be objective at times. It is not uncommon to hear "but they need it," even when the data does not support it.

There are kids who qualify for special education services at one point, then are found ineligible at another time. Sometimes this happens because the student has made improvements and no longer requires special education services to be successful. Other times this happens because criteria has changed, the criteria is slightly different in a new different school system, or because test data is slightly different after a few years. In my opinion, this is when the system and criteria fails. I'd like to see ways to address the students who at one time fit the criteria, no longer fit criteria, but still require services.

Why is the criteria so rigid? The main reason is because special education is funded by the government and they keep a tight reign on eligibility criteria. School staff is pressured by the administration, who is pressured by the State, who is pressured by the Federal government. There is a call for identification to be accurate to ensure that funds are properly spent. The only way the government can determine if the funds are being used appropriately is to enforce that schools are using clear criteria guidelines for identification.

All that being said, I believe in the process (for the most part). However, it's created by humans meaning there will be errors. If I had a say, I'd make some changes. I do believe there needs to be criteria. No matter who sets the criteria there will always be those gray kids that are just right on the border of eligible or not eligible. The worst mistake that can be made in my opinion is telling a family that the child has a disability when in fact the child does not. The child grows up with the belief that he or she has a disabling condition, when that could have been prevented. Disability identification can be life changing for a person. That is why I believe we need criteria. A strong opinion by a teacher or parent that "she needs it" is not enough data for me to look a child and say they are struggling because of a disability.

Want to learn more about the eligibility process?
Eligibility Process FAQ
What every parent needs to know about the referral process
Ineligible for special education

I will be starting a monthly poll to engage the readers of this blog and start some discussion. Feel free to comment on this topic. I'm sure many of you have a lot to say. At the end of the month, I'll share and discuss results in a blog post. I'm curious to see how the readers of this blog feel about your own schools. You can find the poll in the sidebar. Thanks for participating!

The readers of School Psychologist Blog Files were asked in February to share their own experiences and to vote on a poll "How do you feel about the level of education the school provides your child." It's important to understand that everyone's experience is unique. The readers come from different states, different school systems, and different grade levels. Laws and standards vary somewhat between states. Within any state, there are schools that do a better job suiting the needs of children than others. Within any school system, there are those star schools, and the schools that need more attention. Even within the best schools, there are still going to be individuals who have negative experiences. Within the worst schools, there will be those who have positive experiences. Regardless of your school or your situation, I believe that the readers of this blog care deeply about their child's education and have strong emotions about the education (positive or negative.)

The most popular response was "I generally feel good about the level of education, but have some complaints." I was glad to see that many of you are mostly satisfied. I hope that continues throughout your children's school career. Stay involved, speak up when needed, and compliment those who deserve it.

There was a strong outcry from those who endorsed "I feel as if the school is not supportive and I feel as though I am constantly fighting for his or her rights." This was the second most popular answer. While many feel comfortable with their schools, there are many parents out there who have the unsettling feeling of sending their child to a place they do not feel good about. Many of the readers are feeling that getting appropriate services only comes with a fight. Some of you are not having good experiences. I hope that you are able to find some support and insight here from others.

A few of you feel very thankful for the high level of education that your child is receiving. I am thankful to hear that some of the parents here feel exceptionally good about their child's school. Know this is a blessing that many others do not have.

Feel free to share your comments about experiences and offer some insight to others who may have similar experiences.

Two years into my position in a culturally diverse school system has taught me many things that I never would have learned in my previous position in a school system with much less diversity. I had hoped to be bilingual by now, but I’m not even close to that goal. However, I do have the training to conduct assessments with bilingual students. Thanks to Samuel Ortiz, Ph.D. for his workshops, research, and books that we use so much in our system. Thanks to the other Psychologists in my system for mentoring me and helping me learn this process. It has helped us to better identify which students have a disability and which students only look like they have a disability because of their performance on tests that are not standardized on children with different cultural and linguistic backgrounds. Learning a second language is not a disability. Just because a student is struggling academically, does not mean he should qualify for special education.

What everyone involved in school needs to know:
It takes many years for a person learning a language to develop academic use of language to the same level as monolingual individuals. It does not always seem that way when a person has excellent conversational skills in English. However, social use of language is not as sophisticated as academic use of language. Students can appear to be fluent, when in actuality the language and vocabulary is not on grade level. If a student’s comprehension and expression of language is below grade level, academics will naturally be below grade level as well. This is not the same as having a disabling condition.

A child with good social use of language, but developing academic use of language often looks to teachers like a student with a disability, when in reality the student may be a typically developing second language learner. Special education is not the answer for this student; the answer comes through hard work, patience, and instruction through a high quality English as a Second Language Program. In the past (and currently in many systems) this child would be misidentified as a student with a disability and inappropriately put into special education programs.

What Parents need to know:
Traditional assessments are not standardized for use with culturally and linguistically diverse students, so typical interpretation of scores on these assessments are inappropriate. When school systems try to use these assessments in the traditional way and then apply the unreliable scores into eligibility criteria, it’s frankly scary.

If you are a parent of an English Language learner, insist that a bilingual assessment be administered. I recognize that the irony of this statement is that many parents of bilingual students are not reading this blog as it is in English only. I don’t really have a good answer for that at this time.

What Teachers need to know:
If you are a teacher, recognize that academic language competency takes time and it requires additional assessment tools to tease out if the difficulties are primarily the result of language and cultural differences or if it is the result of a disability.

What School Psychologists need to know:
If you are a School Psychologist and not using the Cattell-Horn-Carroll Cross-Battery Assessment, I strongly encourage you to take a look. Here is an article from the National Association of School Psychologists Website by Samuel Ortiz, Ph.D. on resources for cultural competency. http://www.nasponline.org/resources/culturalcompetence/ortiz.pdf Advocate that all School Psychologists in your system be trained to administer bilingual assessments or at least have someone competent on hand for these assessments. You can’t hire a School Psychologist in every possible language you might need, so it only makes sense for all School Psychologists to be trained to assess all students. It takes more time to do the assessment, interpret data, and write a report and it requires the use of hiring an interpreter for portions of the assessment, but it is well worth the time and money to properly identify these students. If your school system does not see it this way, bring it up as a solution to disproportionality.

Everyday Health is gathering the responses of several professionals of the top 5 questions they get regarding ADHD. They asked me to participate. The following are the questions and my answers. Check in with Everyday Health next week to see the compilation of responses.

1. Why are there so many theories about the causes of ADHD? What are the most common?

2. How can you explain the value of treatment to resistant parents? For example, “I survived my childhood with ADHD --and I was never diagnosed or treated. Why does my child need ADHD treatment?”

Often children with ADHD have gaps in their education. As they are in and out of focus each day, they miss key points in instruction. As new skills build upon old skills, it can be more and more difficult to learn new tasks where there are gaps in the foundation. This difficulty can make focusing even more difficult, further compounding the problem. Treatment can help reduce or prevent this cycle.

3. What role does a child’s school have in helping him or her with ADHD?

4. Are the medications recommended for ADHD safe for children? What are the potential dangers?

By Guest Blogger, Penny Williams of {a mom’s view of ADHD}

ADHD children do better with routine. It’s a proven fact. In a brain characteristically in chaos, the order routine provides is soothing. They need to know what to expect in advance and have time to make the mental transition as well.

Everything goes more smoothly for my son when he knows what’s coming and when, and everything falls apart when our schedule changes unexpectedly. As parents of neurologically different children, we make their world more comfortable by publicizing the family schedule and sticking to a routine as much as a family can. We have a routine for getting up and ready for school in the morning. We have a bedtime routine. We even have an {unpopular} dinnertime routine. Why should homework time be any different?

It has taken me two years to establish a fairly comfortable homework routine for Luke, my 8-year-old, third grade son who has ADHD and sensory integration issues. Two years of a lot of trial and error. And we aren’t set yet, nor do I predict we will be for many years. As the full extent of Luke’s written expression disorder has been revealed this year, the homework routine has changed quite a bit, but for the better.

Like Clockwork

I’ve experimented quite a bit with the time of day that we do homework. It was quickly apparent that waiting until after dinner (and after medications had worn off) was not going to work for Luke (or for me). We then tried right after school and at 4 pm, which is about 30 minutes after we arrive home from school. I liked the idea of some free time for Luke to unwind and a break from schoolwork that the 4 pm schedule offered. However, it hasn’t always worked out. In 30 minutes time he can get engrossed in something fun and then it’s a battle to get him to stop and do homework. I feel a little like a schoolmarm making him do homework the minute we get home, but he does his best work at that time.

Now sure we don’t always come straight home from school. Sometimes I’m working and grandma picks him up. Sometimes we have afterschool activities or just need to run to the grocery store. But Luke knows that we do homework when we return home from school, whatever time that may read on the clock. He has come to expect it.

Even Homework Needs a Home

Give homework papers and supplies a home and keep them in the same spot. When I say, “time to do homework,” Luke immediately goes to his homework spot. Well, not immediately. Even the best laid plan will not cure the typical resistance to homework. We keep Luke’s homework folder, pencils, etc. on his end of the snack bar. Up until a month or so ago, he sat there or just behind at the dining table to do his homework. We kept all needs there so he wouldn’t have the distraction of getting up to fetch something.

____________________________________________

Consider a Homework Toolkit: The toolkit will be some sort of box or desktop organizer, even an actual toolbox, with every single item necessary to complete homework, prepped and ready to go:

• pencils (sharpened -- sharpening pencils is a favorite procrastination technique of children),

• pencil sharpener (in case it breaks),

• pencil grips (if used),

• markers,

• colored pencils (sharpened),

• appropriate scissors,

• notebook paper,

• construction paper or blank copy paper,

• calculator,

• ruler,

• dictionary,

• index cards,

• highlighter,

• tape,

• glue stick,

• post-it notes,

• clip board (if not working at a table or desktop),

• anything else your child may use for homework

____________________________________________

Now that Luke has some technological accommodations for his written expression disability, he does his spelling homework on the computer. When I announce “homework time,” he gets his folder off the snack bar and brings it to my desk to work on my computer. (I am looking for a good place in my office to create a new homework spot now that things have changed.) He’s great with technology, and typing is so much easier for him than hand writing assignments was, so this change has actually allowed me to stop standing over him, constantly nagging, during homework for the first time since he started school. It’s wonderful!

He finishes his spelling assignment and then takes his book to the sofa and I set the timer for reading. If you don’t have a timer or don’t use one with your ADHD child, I super-strongly recommend its implementation. My favorite is the Time Timer, but any household timer will work. When the timer sounds at the end of his 15 minutes, he jumps up, completes his homework log, and then puts the homework folder back in its home on the snack back (with a little prodding and a lot of reminders).

Don’t Make Them Bite Off More Than They can Chew

Homework is designed to prove to a teacher that a child has mastered the subject matter and is sometimes an exercise in repetition for knowledge retention. Every child in the class is given the same homework, regardless of their differences, unless there’s already an IEP or 504 Plan to the contrary. It’s your duty as your child’s advocate and #1 cheerleader to be sure the homework is appropriate for your child. Yes, this is negotiable, either through teamwork with the teacher or through a formal IEP or 504 Plan.

Scaling the amount of homework to your child’s differences and needs is a crucial element in the success of the homework routine. For example, Luke reads for 15 minutes each day while the original 3^rd grade homework structure called for 20 minutes. There was a lot of resistance and inability to finish 20 minutes of reading but 15 minutes is just the right amount for Luke. While he is above grade level in reading, he is allowed to have me read aloud to him if that’s what it takes to get the assignment finished. I have found that he often asks me to read to him just to have time together. I agree, but on the condition that we take turns reading aloud by alternating paragraphs. He usually ends up reading most of it himself anyway, just with me alongside him.

Spelling is also a regular homework task. He has 15 words each week and his teacher suggests a list of activities from which to complete three. We alter these activities to accommodate his handwriting issues. He types all activities which means there are some that don’t apply to him (like writing each word in cursive three times). Sometimes there aren’t three on the list that can be typed so I let him pick from activities he’s done previous weeks.

Also, get creative and tailor homework to the way your child learns. Luke is a visual and tactile learner so we make homework visual and hands-on as much as we can – it was easier to do so in the younger grades. Use dried macaroni for math or even spelling. Does your child love to paint? Let them paint their spelling words or their illustration for their writing assignments. Painting letters is actually a common therapy tool for children that struggle with handwriting. What about play dough? I purchased a box of cookie cutters with all the letters and numbers for play dough play. You could do spelling and math with these. It will take longer but make homework more interesting and fun.

Luke’s teacher is perfectly content with our customization of the homework plan. Since they don’t get a grade on homework in third grade, it’s easy to make this change. Similar alterations can be made for middle school and high school homework too though. For instance, a student should be allowed to complete a percentage of the problems on a math worksheet to show they have mastered the content when the entire assignment will take too long or is overwhelming. Shortening the assignments will reduce their anxiety too, making it easier to work and study in the first place.

Don’t Forget Good Study Habits

Good study habits are even more crucial for children with ADHD and learning disabilities. There are some general ground rules that should always be followed:

1. TV and other distractions must be turned off. However, music in the background actually helps some children focus. It is a distraction for me, but Luke and his sister both do homework better with music on, especially when listening with headphones. Experiment with this and see what is best for your child.

2. Praise and reward often (typically more often than feels natural).

3. Take breaks as needed. Who says you have to finish homework in one sitting? Allow your child to get up and stretch, get a snack, jump on the trampoline, etc. Just don’t allow them any screen time during breaks because you won’t likely get back to the homework amicably.

There is so much more than the few ideas I've covered here, especially for older children. Take a look at these other resources on the subject of homework with ADHD children:

• Family Education, full of amazing homework tips, tricks, helps, templates, checklists, and how to's. Here's the Family Education homework section. They even have a section on ADHD.

• Homework Help! A system that works for ADHD children, AdditudeMag.com article

• ADHD and Homework Time from 4ADHD.com

• Help a child with ADHD do homework

• How to Help Children with ADHD End Homework Hassles

Penny Williams is the creator and editor of {a mom's view of ADHD}, where she writes candidly about the everyday experiences of parenting her young ADHD son. In her immersion in all things ADHD since her son's diagnosis, Penny has published, My ADHD Story: Love Notes, Blah, Blah, Blah!, and Teachers We Love: Learning for All in ADDitude Magazine, the #1 national publication dedicated to ADHD. She has been quoted in Parenting.com's Family Health Guide on ADHD and The High Desert Pulse, Summer/Fall 2010, When Ritalin Works.

Confession time. I tend to write this blog with my professional hat on, keeping my personal life, personal. Today, I am writing as a mother of two very dear, but very spirited children. People tend to think since I am a School Psychologist, that I know exactly what to do in my own family, and that I should have it all together. The reality is that I have struggles just like everyone else. Sometimes, my kids just don't listen. Sometimes, I feel overwhelmed too. Sometimes, I don't respond in the most positive manner.

Sometimes it can be very difficult to be positive. I know this from experience. While I'm usually an optimistic person, who tends to find good in situations (at least eventually), I sometimes struggle in the heat of the moment. Especially, when I am running late or stressed about something, I have much less tolerance for resistance and disobedience from my children.

In the last few weeks I've really been having a difficult time with the morning routine. There are a lot of procedures that need to occur efficiently in order for everyone to get to work and school on time. I do not like that I have turned into a Drill Sargent with very little patience for any deviation from the schedule. There are mornings that I tell my children to get dressed multiple times and am ignored multiple times. As the clock ticks and it's time to rush out the door with two children (age 5 and 3) who haven't gotten dressed yet, I become more and more negative. By the time we get to the daily "Yes you are wearing a coat- it's 25 degrees outside!" argument with the second child, I have lost all patience. When they walk to the car, I'm behind carrying everything and making sure the door shuts, and have been known to yell "RUN!, RUN TO THE CAR, RUN!" and eventually pick up the meandering child and put her in the car at my own pace. How's that for a start to one's day? I don't feel very good about those days.

Thankfully, not every morning is like that. There are also days that everyone is calm and everyone got ready (although hurriedly), but we got to school/work on time and in good spirits. Specifically I think of a day earlier this week that I handed all the clothes to my five year old and asked him to get himself dressed and see if he could help his little sister a little bit. He helped her step by step, and was extremely proud of himself. I enthusiastically praised him for his help and everyone went to school and work happy that day.

So what is the difference between the crazy mornings and the relatively calm mornings? I want to say- "my kids." I want to say "some mornings they choose to focus on getting dressed and I don't have to argue with them, so we are happy." And while they do play a small part, the biggest factor is ME. I'm the difference. When I am more calm, I have the mindset to be more positive and encouraging, which the children actually respond to. When I am frantic, I think they retreat and are much more prone to act out or start throwing their own fits (about coats or shoes). Yes, there are days that my kids don't listen the first time. However, they are 3 and 5 years old. Also, they don't care if I am late, it means nothing to them. So, what is the main thing I can do to change our crazy mornings. It's not a magic cure to make my kids get ready in a hurried and frantic manner that will get everyone out the door on time. The answer is getting myself up earlier, so I am not stressing about my tardiness and I can focus on helping everyone else get ready.

So here's the challenge to all parents- Take a look at a part of your day that is prone to go poorly with your kids. Think about what you can do yourself to help change the situation. I don't mean what your children could or should do or what you need to do to change your child. Let's take a hard look at yourself first, and see what you can do to yourself to make a positive change in a situation. For my mornings- it's pretty obvious- like it or not, I need to wake up earlier. I'm always saying I should wake up earlier, but that snooze button is quite tempting every morning. Since I'm blogging about it, I now have many people out there to keep me accountable. I'm thinking that if I were not rushed and frantic, then I would be more patient with my kids and able to start using more positive methods for getting them to get ready. While there is an issue that I'm being ignored sometimes- right now I'm just going to focus on making a change to myself. I'm guessing it will spill into everyone else.

Let's all find one small thing we can do ourselves that will help be a blessing for our entire family.

Penny Williams from A Mom's view of ADHD and I decided to join forces this month in an attempt to reach more people through our blogs. I believe that many of my readers would find her blog helpful and I also felt that I could offer some insight into the school perspective to her readers. Penny wrote Make Homework Routine a few weeks ago. If you found that helpful, check out her blog full of more strategies! A Mom's View of ADHD is an excellent resource for parents of children with ADHD. It's written from by a parent going through it and provides excellent insight and strategies. I highly recommend it as a place for parents to go to connect and gain support.

Be sure to check out my article, Support for ADHD in the Schools. I discussed the options available for receiving support in the schools for ADHD such as an IEP or a 504 Plan.

As a School Psychologist- I attend numerous Special Education Meetings weekly. There are Child Study Meetings, where we discuss interventions and may decide to complete an evaluation. There are eligibility meetings, where we determine if a student is eligible for special education services. There are IEP meetings where we develop a plan for a student who is eligible for special education. Additionally, there are Manifestation Determination meetings, Functional Behavioral Assessments, Behavior Intervention Plans, and 504 Meetings.

Parents are asked to sign paperwork when services begin, when changes are made, and if services end. Let's not stop there. Parents must sign before any assessments begin. Parents must sign that they attended meetings. Parents sign that they received a copy of special education rights. The reasoning is to protect everyone involved. It gives documentation to show who attended the meetings, shows parental consent for what is outlined in the plan, and documents what has occurred at the meeting.

Do you understand the scores from cognitive assessments, academic assessments, and behavior rating scales? Understanding the basics of these assessments and what the test scores mean is extremely important when your child has been evaluated for special education. If you are like most parents and have lots of questions, I've written up the basics and compiled them onto one page. Read all about Understanding Test Scores at School Psychologist Files.

Over the last few years I have been very busy working with teachers to create individualized behavior plans for several different elementary school students. There have been amazingly successful plans where some of the most significant behavior problems in the school have turned it around. Children who made daily trips to the office are only there now to receive praise from the administration. Teachers previously brought to tears from the behaviors have stopped me in the hall to say "Oh my goodness, he's like a different kid!" Students who were close to being sent to a day placement school are now succeeding in a regular classroom. It's very encouraging if I focus on those students. However, there have also been some plans that have been revised and revised and revised and the student is still struggling and the teacher is still severely frustrated. I have been reflecting on why some behavior plans work and others don't. Of course one of the biggest factors is the student. All students are different and the motivation for the misbehavior or lacking skill is different in each student. While this is important to consider, this particular article does not focus on this. I'm going to focus today on the teacher's role in making the behavior plan successful.

• Focus on the Positive!!! The behavior plans that have had the most dramatic success are plans that allow the teacher to focus on the positive. Classroom consequences are still in place, but are not connected to the plan. Here is an example: Johnny's teachers will offer positive reinforcement frequently in the classroom by giving Johnny a “warm fuzzy” pom pom when he is caught engaging in a desired behavior. Johnny will chose the bag to keep the “warm fuzzies” in and carry the bag with him to every class. Once the bag is full, he receives an immediate reward. There is no limit to how many “warm fuzzies” he can earn in a day. He does not loose “warm fuzzies” that he has already earned. All teachers and staff who work with Johnny can give him “warm fuzzies” for his bag. This plan works because Johnny who was used to receiving a lot of negative feedback, is now getting positive attention frequently throughout the day. He receives something tangible (the warm fuzzy) that he can put into his bag. This begins to change his perception of himself, which changes his behavior, which changes his teacher's perception of him, which can potentially change his future. Plans that offer positive rewards completely separate from the classroom consequences seem to have the most significant effects.




• Be Consistent. Teachers who are able to be consistent and are able to follow through every time have the most success with the plan. Oppositional children are excellent at pushing limits to see how far they can push. Consistent teachers have more success because they don't offer the wiggle room.




• Be Flexible. This is not the opposite of being consistent. This is having flexibility in your expectations and stating them upfront. If the student was able to behave like everyone else in the class she would be. She may need some flexibility in some areas. For example you may need to have area for her to work in the classroom for times she needs to cool down and get away from a stimulus. The teacher may need to allow her extra time to finish projects if it is the transition that sets her off. Being flexible and willing to make acceptable changes for the student sets everyone up for success.




• Remember that all students are different. The behaviors may be exactly the same as a student you had two years ago. However, that doesn't mean that the motivation for the behavior or the lacking skills are the same. What works for one student may not work for the next. That is the reason for the individualized plan. I strongly recommend doing a formal Functional Behavioral Assessment and a Behavior Intervention Plan.

Teachers have a HUGE part in making the Behavior Plan sucessful. It is the teacher who has to follow through and implement it consistently every day. It is the teacher who has to push forward even when it appears it isn't working at first. It is the teacher who has a tremendous positive impact on the student when the behavior starts turning around. It is the teacher who does the work to change lives!

Stay connected with School Psychologist Files by joining the School Psychologist Files Facebook Page.  You can be one of the first to know about new articles on the School Psychologist Files website such as the brand new FAQ Parents ask about the IEP that I finished this weekend. 

Dedicated to the lady at Walmart with the screaming kid and all of us "good parents" who have been that lady at Walmart.

One of the most difficult behaviors for parents or teachers to address is explosive behavior, a child who has little control over emotions and "melts down" in the classroom or at home.  It is frustrating, it is embarrassing, it is anxiety producing, it causes intense emotions in ourselves.  Parents agonize over why it happens or what they did wrong?  Often the parents are blamed or judged by bystanders in stores, family members, friends, or school staff.  However, I have seen parents with a variety of parenting styles have kids with poor emotional control, including those who are strict, those who are quick to give in, those who spank, those who use time out, those who take away privileges, and a whole lot of parents who feel like they have tried everything.  I know children with very little emotional control from homes that are falling apart, from homes that are loving and supportive, from poor families, from affluent families, from parents who have no clue how to parent, from parents with excellent skills, even from School Psychologists.  This is not to say that parenting styles do not have a role in this, but there IS more to it.  We have to stop judging each other and get to the root of the problem.  

What is the Root of the Problem?

The problem, the reason some children "explode" or act out with little emotional control, is because he or she is lacking a skill.  Emotional control is a skill.  Most kids will learn this skill through consistent discipline strategies, but some do not. 

Another way to look at it.

We don't tell our kids how to read and then expect them to do it.  We show them step by step.  Some kids will pick it up easy, others will need to be taught and retaught and retaught and will need extensive help in doing so.  Do we blame ourselves?  Do we look at our friends judgementally and think to ourselves "look at the book she is using, it's all wrong?"  No, we assume the child has a problem learning to read and we find a way to teach him.  WE HAVE TO START LOOKING AT BEHAVIOR IN THE SAME WAY.  When a child is exploding, the first step should not be to label the child or blame the parent.  Lets start looking for the skill that is lacking.  When we find that skill, lets teach it.

It's NOT always a control issue.  Sometimes kids act out because they have not been taught to obey and respect authority, but sometimes they act out in spite of good training at home.  The explosions lead to self esteem problems in the child and the child feeling like a "bad kid," which in turn makes explosions bigger and more frequent.  Have you ever looked at a screaming child and demanded he control himself right now or "act your age."  It's a common thing to do.  Have you ever looked at a child with a Learning Disability and said "read on your grade level, now!" or "I have told you and told you how to read, why aren't you reading?"  Of course you haven't.  We work with the reader at his level and patiently try different strategies to improve reading.  We can't demand them to be good readers and we can't demand that a child who does not have the skills to control his emotions "act his age."  These explosive kids need skills and truth be told, we who work with these kids need skills. 

If you are a parent with a child who acts "out of control" stop blaming yourself.  It isn't necessarily because you spanked or didn't spank or were too strict or too lenient.  Your child is lacking the skills she needs to control her emotions.  Also, realize you are going to need to learn new skills to help your child learn the lacking skills.  You are no longer in the Parenting 101 class, you need to move on to the Advanced skill- teaching parenting class. 

The BEST book I have read on this topic is The Explosive Child by Ross Greene.  He addresses the skills these children might be lacking and he has great strategies to address the issue. (see Amazon link below)

If you are a teacher and have an "explosive child" in your class, rethink your perspective of the student.  The child needs to learn skills, so lets focus on teaching the skills and being patient with the children who are slower to learn emotional control.  We as school staff can not make excuses or blame the parents.  We have to reach the child at her level.  We teach a child to read at her level.  We must teach a child to control emotions at her level as well. 

Challenge for Everyone
Let us stop labeling these kids with emotional skill deficits as "bad kids" and stop judging the parents.  Let's be honest with ourselves and recognize we all have shortcomings and could use skills in certain areas.  Maybe our kids need skills in emotional control, maybe we do, maybe we need skills in teaching emotional control, or maybe we need skills in some other area all together.  Let's be patient with our children and our peers and ourselves. Let's stop criticizing ourselves and others and start learning and teaching new skills.   We don't live in a world with bad kids, we live in a world will kids who need skills, so let's teach.

I spend most days of my life working with various students who are at different parts in the sped referral process. I attend Child Study Meetings where we decide if we are going to evaluate a student. I observe and screen children and talk with parents and teachers to help the committee make a good decision about whether we should do a special education evaluation.   I evaluate those students (this includes Psychological testing, observations, talking with student/teacher/parent, doing rating scales, etc.). I attend eligibility meetings where we determine if the student is eligible for for special education services. All of this is second nature to me and sometimes I need to stop and remember when a parent comes in, that this is NEW.

When I talk to parents, I find that many parents do not fully understand the special education referral process, even when they nod and act like they do. We as school staff need to do a better job of helping the parents understand the process. Parents also need to speak up and ask questions when there is not understanding.

This is a guide for parents to understand the process of special education testing, the testing components, and some of the test data. It is important to note that schools systems and states will vary to some degree. If you have any questions about the process in your school system, ask your school psychologist, teacher, or principal. Parents have every right to ask questions and usually school personnel are happy to help make this process less anxiety-provoking for you. It is important for parents to understand their rights during the special education process.


Special Education Process

After data shows that interventions have been attempted and if a student is suspected of having a disability, a referral is made to evaluate him or her for special education testing. Once the parents sign the Permission for Testing Forms, timelines begin and the schools have 65 business days to complete the assessments and hold the eligibility meeting. Some states may have a different timeline.

During these 65 days, several testing components will be completed with you and your child. The evaluators will write reports and a copy will be given to parents at the eligibility meeting. However, schools are required to have a copy available for parents to pick up two days before the eligibility meeting. It is advised, that parents take advantage of this and read reports before the meeting to help get familiar with the information and to formulate questions. The reports hold a lot of information that can be overwhelming if you are not familiar with this type of testing. Read Understanding Test Scores to understand the types of tests used and what the scores mean.

Additionally, the meeting is likely to bring forth strong emotions as your child’s difficulties are discussed openly. It can be overwhelming for parents, especially when not prepared. When parents do not read the reports prior to the eligibility meeting, they are the only people at the table who come to the meeting not knowing what to expect.


What if My Child is Found ELIGIBLE for Special Education Services?

Once a child is eligible for special education services, the schools have 30 days to develop an Individualized Education Plan (IEP) for the student. This will consist of accommodations, goals, and describe the services offered. Parents are part of a committee to help create this document. Once it is signed, schools are legally required to follow it. It is reviewed once a year, unless parents or teachers feel that changes are necessary. Every three years, the committee will determine if the student should be reevaluated. This is called a triennial evaluation. Sometimes another full evaluation will be conducted, other times a review of records and updated teacher information is used.


What if My Child is Found INELIGIBLE for Special Education Services?

If your child was found ineligible for special education services and you agree with the eligibility findings, then your child will not receive special education. He or she was evaluated because of a problem that still needs to be addressed within regular education. Ask for a separate meeting with your teacher or a team to determine what accommodations or strategies can be used to help.

If you believe that your child requires special education services and has a disability, but was found ineligible for services, make an appointment to meet with the special education director. If an agreement cannot be reached, you may be able to have an Independent Evaluation at the expense of the school. The results of that testing will be brought back to an eligibility meeting. A child MUST have 2 things before they can receive special education services: They must have a disability and there must be a documented educational impact that the student requires special education services to be successful.

Do you wonder if your child might have ADHD?

As the numbers of Central American migrants crossing into Mexico and the United States rises—putting migration front and center in the U.S.-Mexico relationship again—this event examines the opportunities for cooperation between the two countries, along with ways to improve U.S. and Mexican asylum systems, create new approaches to labor migration, address smuggling networks, and modernize border management.