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PLUK News February / March 1998 Volume 12 Number 7/8
	PLUK News is published by Parents, Let's Unite for Kids, a private nonprofit organization founded in 1984 by a group of parents of children with disabilities and chronic health problems. Subscriptions are free to parents in Montana and $15/year for other interested individuals. PLUK News is available in alternative formats. Editor: Katharin A. Kelker PLUK Office 516 N 32nd St Billings MT 59101- 1-800-222-7585 in MT; 406-255-0540 (voice/TT); 406-255-0523 (fax) E-mail: plukinfo@pluk.org
The contents of this newsletter were developed under a grant from the Department of Education. However, those contents do not necessarily represent the policy of the Department of Education and you should not assume endorsement by the Federal Government. Products and services described herein are not endorsed by PLUK, the U.S. Department of Education, or by the Federal Government.

Article Index

Children's Health Insurance: A Political Football Child Care Becomes National Priority Tobacco Agreement May Aid Early Childhood Programs ADA Court Case Federal FY 1999 Budget Process Begins Testimony Before Appropriations Subcommittee Raises Concerns Survey to Report State of Disability in America Saga of Managed Mental Health Care Continues Children's SSI Update Whitefish Woman Makes Business of Social Security Appeals Disability Awareness Poster Contest Winners New IEP Format in Place by July 1998 Child Count Reveals Numbers Served Aversive Treatment Rule Stirs Controversy Community Meetings on Education Profiles Financial Supports for Families

Controversy and Children with Autism Current Autism Treatments in Montana BU Case and Accommodations for LD When is Seizure Surgery Appropriate Freedom Medal for Justin Dart Treating Conduct Disorder Beware of ADHD Look-Alikes Pycnogenol and ADD Genetics Plays Role in ADHD Smoking and ADHD ASK PLUK??? Toll Free Numbers for Information Parent Corner Pros and Cons of Herbal Remedies Trips to the Doctor Parents are Powerful Concerns About Children Promoting Involvement of Fathers Summer Activities Guide Writing Disabilities: Who Has Them & Why? HONOR ROLE

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Children's Health Insurance: A Political Football

In its last session, Congress created Children's Health Insurance program (CHIP) mainly for working families who don't qualify for public assistance but can't afford their own private health insurance. Thus far, only one state, Alabama, has put the program into effect.

Under the CHIP program, the federal government would pitch in $10 million a year toward children's health insurance in Montana, as long as the state provides a 20 percent match, or $ 2 million per year. Such funding would cover more than 20,000 Montana children now without insurance.

State health officials have discussed starting a small experimental run of the program before the 1999 Legislature, to determine whether and how well the project works. But Republican lawmakers have frowned on such a pilot project, saying they don't want to be committed to an expensive program without input.

This is where politics enters the picture. At the federal level, the Children's Health Insurance Program was not politicized in Congress. Debate over the program was notably nonpartisan. In Montana, however, CHIP has become a point of discussion among candidates filing for the 1999 legislature. Democrats filing for legislative seats frequently mention their support for health insurance for children; Republican candidates express concern about getting into a "big government" program whose costs may get out of hand.

Democrats and Republicans in Montana are almost daring one another to deny poverty-stricken children medical attention. As election season for state legislative candidates begins, it is the hottest issue going.

Parents Have Opportunity to Speak Up

For families of children with chronic illnesses or disabilities requiring medical treatment, the CHIP Program offers hope. Many working families find that they are unable to pay for private health insurance, or that the coverage they can afford does not cover the medical services and medications that their children need. Ironically, some families have found that if one parent stops working, the family would be eligible for Medicaid for their children, but the loss of income would not allow the family to meet their other expenses.

For some families, the cost of medications is a bottom-line issue. For example, seizure medications can cost over $200 per month&endash;an expense beyond the means of many working families.

One mother of a young child with autism wrote to PLUK to say: "We are trying to decide what to do. If I continue working, we are just over the income guidelines to qualify for Medicaid. If I don't work, we will not be able to meet our house payment. This proposed health plan would make such a difference for us. We don't want a handout. We are hard-working people, but we cannot earn enough to meet our family's basic needs and pay for our son's special treatments."

This mother's dilemma is not uncommon. Parents who find themselves in this same situation have a golden opportunity right now to inform legislative candidates about why a children's health insurance program would be helpful for their families. Local legislative candidates tend to be very responsive to personal contacts from families in their communities.

Insurance Settlement Could Fund Pilot

State Auditor Mark O'Keefe pledged $21,000 and his staff's time to aide the Racicot administration in developing a pilot of the Children's Health Insurance Program (CHIP). O'Keefe proposes using a settlement with Conseco, Inc., a private insurance company that violated Montana insurance laws, as the state's match for a pilot program to test the effectiveness of CHIP.

Conseco, Inc., recently purchased two insurance companies in trouble for bad business practices in Montana. Washington National and Pioneer Life violated state insurance laws with everything from doubling insurance premiums to not paying claims to harassing doctors over old claims.

If the $210,000 from the Conseco settlement were used for a pilot children's health insurance project, this amount would generate more than $1 million in federal match, enough to show how the program would work.

Sen. Max Baucus has vowed to lean on the Clinton administration to approve Montana's plan quickly.

Once Montana writes a proposal to spend $10 million in federal funds each year, the U.S. Health Care Financing Administration (HCFA) may take months to approve it. This same approval process is needed to start even a small-scale pilot program.

If and when HCFA agrees to Montana's plan, the state will probably have to conduct an open bidding process to find a private insurance company to run the program.

Because of this lengthy start-up process, there is little chance of starting a pilot program until just weeks before the 1999 Legislature begins. The small amount of data that could be gleaned by that point will probably not shed much light on the potential for a more full-scale program.

Even if the pilot project begins, the Legislature will still have to decide whether to commit $2 million a year, as required by the federal match. The Legislature will have to wrestle with questions about where the state will get matching money for the next 10 years and what the state will do to continue the program when federal funds are gone in a decade.

Proponents of CHIP argue that ten years worth of health insurance for 20,000 children is worth whatever risks may be involved. If the $210,000 Mark O'Keefe has pledged for the insurance pilot is not used in that way by the end of this year, the money will go instead to health clinics around the state that serve low-income families.

There is a window of opportunity right now to make health care more available for children of working families. If the state government and the legislature do not seize the opportunity, it will be gone and both state and federal dollars were be deflected to other projects.

Child Care Becomes National Priority

President Clinton's budget proposal contains significant new dollars to subsidize the cost of child care for working families. The original proposal did not contain any specific references to providing child care that would include children with disabilities, but a group of children's advocates led by the National Easter Seal Society met with White House officials in January and were able to get assurances from the Clinton administration that children with disabilities would be included in all of the plans for child care.

Tobacco Agreement May Aid Early Childhood Programs

Head Start and child-care programs would reap significant financial gains through a new Democrat-sponsored plan to increase the national tax on cigarettes by $1.50 per pack.

The tax, sponsored by Sen. Edward Kennedy (D-MA), Frank Lutenberg (D-NJ), Richard Durbin (D-IL), Jack Reed (D-RI), and John Kerry (D-MA), would generate about $10 billion a year for infant-toddler and preschool child care plus special education and child-care training programs.

Congress would include the measure as part of a larger resolution of talks between tobacco manufacturers and states. Lawmakers said the new tax could generate about $20 billion annually, with proceeds split between child development and children's health care.

More than half of the child-development funds, 60 percent, would expand the Child Care and Development Block Grant (CCDBG), with funds earmarked for three initiatives. One-third of new CCDBG funds would go for certificates and grants for low-income families plus new approaches to infant/toddler care.

Another third would create a health and safety fund for states that improve the quality of child care through several means such as: lower child/staff relations; higher reimbursements for accredited programs; consumer education; and training for child-care providers.

The federal government would reserve the remaining third of new CCDBG funds for schools, child-care or youth centers, and community groups to expand before and after-school care and child care on weekends and holidays.

The Act would also reserve 25 percent of new funds to increase enrollment and services at Head Start programs. Early Head Start, the programs' infant/toddler initiative, would receive a separate 10-percent setaside.

Early childhood special education programs would receive 5 percent of new funds, while sponsors designated the remaining 10 percent for child-development research and training.

The training section could provide grants, loans and scholarships for those pursuing careers in early childhood education. Some of these funds also may cover training for staff who work in child-care settings, either through preservice or inservice programs.

The $1.50 per pack increase is more than double the projected cigarette increase in the talks between tobacco manufacturers and states. Both sides had discussed a 65-cent per pack increase as part of a settlement.

The proposed measure will go to the Senate Labor and Human Resources Committee, whose chairman, Sen. James Jeffords (R-VT), already has his own new child-care bill.

His plan, CIDCARE Act, would offer new tax credits to families, provide states with funds for child-care quality activities, and improve distribution of child-care information.

Americans with Disabilities Act Court Case

The U.S. Supreme Court agreed to hear its first case associated with the Americans with Disabilities Act (ADA). The case involves the appeal of a Maine dentist who was found to have discriminated against a woman infected with the HIV virus by refusing to treat her in his office. The court said it would decide whether the dentist violated ADA when he refused to fill a cavity in his office, citing his policy on infectious diseases. One question that must be decided is whether the HIV-infected woman, who was asymptomatic, had a disability under ADA. The patient was successful in the lower courts.

Federal FY 1999 Budget Process Begins

The development of the federal budget is a long process, beginning with the President's proposed budget plan. President Clinton's budget proposal presents a balanced budget for the first time in many years. For most people, this comes as good news. However, there is some concern since the President's proposal proposes level funding for special education, except for an increase in grants for Infants and Families.

This lack of increase in special education funding is disappointing in light of the fact that all of the parties who worked on the reauthorization of IDEA agreed that there should be an increase in federal funding for special education. In the Reauthorization, a new "trigger" mechanism was put in place to help the local school districts. When funding for Part B of the law increases by $1 billion , the formula for funding provides more help for local districts. That is why so many advocates of regular education and special education worked together with appropriations to get the increase of 3/4 of a billion dollars for special education programs. The intention for this year was to advocate for funding to reach the $1 billion mark. Some congressional leaders have indicated they are willing to work to raise the funding levels for IDEA before the federal budget process is completed.

Testimony Before Appropriations Subcommittee Raises Concerns

January 30, 1998, Polly Spare, President of the Voice of the Retarded (VOR), presented her organization's views before the House Subcommittee on Appropriations. She requested investigation of portions of the implementation of the Developmental Disabilities Act and attacked the work of the Protection and Advocacy Systems. Spare claimed that these federally-funded agencies focus their attention solely on class action suits to close institutions. Her complaints also included the following questions:

• Just how much federal money are these groups receiving, and how are they held accountable for use of these funds?
• How does the federal government assure that the money it invests in these groups is used as intended?

Ms. Spare claimed that the major purposes of Developmental Disabilities Councils, Protection and Advocacy Systems, and University Affiliated Programs was to eliminate institutions, sue state governments with federal funds, and to use federal funds to lobby.

Ms. Spare was speaking out against DD programs, partly because the organization she represents is concerned about preserving institutional care for individuals with developmental disabilities. The mission of VOR is to safeguard institutions for the retarded, but this organization is estimated to represent only about .002% of families of individuals with developmental disabilities.

Last year, Ms. Spare co-led an effort funded by the Administration on Developmental Disabilities to bring parents supportive of institutions together with parents supportive of community-based programs. The purpose of this meeting was to search for common ground between these groups with vastly different agendas. By all accounts, the project was successful. All parties signed off on a Statement of Shared Principles.

Ms. Spare's testimony before the House Appropriations Subcommittee seems to be contrary to the spirit and the content of the Statement of Shared Principles. Instead of highlighting the common principles shared by VOR and other disability organizations, she chose instead to attack other groups with differing values and agendas.

The Appropriations Subcommittee will be working on the President's FY 1999 Budget Request and will be considering funding for the Administration on Children and Families (of which the Administration on Developmental Disabilities is a part). The Subcommittee will heard a presentation of the President's budget on the Administration on Children and Families on March 5, 1998 at 2:00 p.m. Those who support the programs funded by the Administration on Developmental Disabilities have the opportunity to make their views known to the Appropriations Subcommittee.

Survey to Report State of Disability in America

The National Organization on Disability (NOD) ha announced the commissioning of public opinion research firm Louis Harris and Associates to survey the attitudes, opinions and life-styles of Americans with disabilities. The research, which will be available in May, 1998, is made possible in part through a $25,000 grant from the Christopher Reeve Foundation.

The survey follows similar research conducted for NOD by Harris in 1994 that found significant participation gaps between people with and without disabilities in many aspects of life, including education, employment, socializing, voting and worship. Most significant was a serious gap in employment that showed two-thirds of working-age people with disabilities out of the work force, compared with only 10% of the general population. In addition, the poverty rate of people with disabilities was more than double the national average.

The 1994 survey is still widely cited by government and business and will serve as a benchmark against the 1998 survey to monitor and measure advances and changes in participation levels and societal attitudes.

NOD, along with public and private businesses and organizations, will use the new survey results to build strategies and programs designed to close persisting participation gaps and continue improving the attitudes that keep people with disabilities from fully participating in American life.

The Christopher Reeve Foundation was founded in 1996 to raise funds for medical research for effective treatment and, ultimately, a cure for spinal cord injury paralysis. CRF serves as a source of information and a voice for all people with disabilities.

NOD was founded in 1982 as an outgrowth of the United Nations International Year of Disabled persons. NOD is the only national network organization concerned with all disabilities, all age groups and all disability issues. NOD involves people with and without disabilities in carrying out its programs. NOD is supported by private sector donations from individuals, corporations and foundations and does not receive government funds.

Saga of Managed Mental Health Care Continues

Magellan Health Services of Atlanta completed its acquisition of Merit Behavioral Care during February, putting this giant company in control of Montana's program of mental health care for low-income people.

Once again the managing company for Montana's fledging program has been taken over&endash;this time by a still larger national company. This latest merger comes at a time when the first significant improvements in the turbulent program came after Merit took over the $400 million contract from CMG Health of Owings Mills, Maryland, last September.

Merit has recently put into place a number of management improvements of the managed care program that have speeded up eligibility and claims processing. Many problems, however, still remain&endash;especially the lack of quality care in rural areas and the limited range of services in most Montana communities.

Though significant problems remain, mental health care providers, advocates and state officials agree that things are better since Merit executives took over. State officials have made it clear that canceling the contract is no longer an option. Instead, the state will hold Merit/Magellan accountable for meeting performance standards and will withhold payment on the contract if performance standards are not met.

Merit officials have assured that their company will continue to manage the Montana contract. Merit claims that the takeover by Magellan will simply make more resources available to providing services in Montana.

Magellan has received all necessary federal approval for its merger with Merit. Some state regulatory issues remain, but not in Montana.

Magellan has offered to take over Merit's debts and buy all Merit stock for about $460 million.

Merit operates in all 50 states, providing mental health, substance abuse and employee assistance services that cover more than 21 million people. The company has 36,000 employees and has its headquarters in Park Ridge, New Jersey.

With other merger deals in process, analysts have estimated the acquisition of Merit will give Magellan a 26 percent share of the behavioral managed care market, making it the largest player in this new and rapidly growing field.

The merger is expected to create a company with $1.5 billion in annual revenue and managed care contracts covering 60 million people.

Merit was one of three unsuccessful bidders for the Montana contract in November 1996. The original successful bidder was Community Partners, a nonprofit company created by CMG Health and the Care Coalition of Montana, a group of nonprofit mental health care providers.

The state's managed care program began in April 1997 and in July Merit announced it was buying CMG. The merger was completed in September 1997. Just a few weeks later, on October 24, Magellan and Merit signed a merger agreement.

Children's SSI Update

The Children's Supplemental Security Income (SSI) Program has been undergoing change for the last year or so, with stricter regulations and a review of the eligibility of certain children. About one million children who are poor and have serious disabilities were receiving SSI benefits before this "redetermination" process began. As a result of new SSI rules, about 263,000 children have been reviewed over the last several months. More than 50% (135,800) of them have lost their eligibility. Families and some policymakers have raised concerns about this. In December, Ken Apfel, the Commissioner of the Social Security Administration (SSA), issued a report about the SSI redetermination process, admitting that there were some problems and promising to address them.

Thousands of children were denied SSI eligibility after undergoing the redetermination process. Many families did not appeal those denials. Commissioner Apfel decided to give those families another chance to appeal. SSA will send letters to the families with instructions about how to appeal. The letters should go out to the families in early February.

If a family whose child was denied SSI eligibility during redetermination did not appeal, the chid's SSI benefits stopped. However, benefits can continue during the appeal if the family asks for continuation of benefits. If a child loses the appeal, the family will NOT have to pay back the benefits if they appealed in good faith.

Because the SSI eligibility, redetermination, and appeals processes are so complicated, it is important for families to have good information and legal assistance. In Montana, contact legal aid at 1-800-666-6899 (Western Montana) and 1-800-999-4941 (Eastern Montana).

Whitefish Woman Makes Business of Social Security Appeals

Stephanie Dalerio of Whitefish operates Dalerio Disability Services, a business that offers to help people find their way through the Social Security system. Ms. Dalerio got into the idea of disability consulting a few years ago when her husband, Greg, a registered nurse at Kalispell Regional Medical Center, came across a program that trained people in the legal requirements and time tables used by the Social Security Administration. This course fit with Stephanie's background that includes biological sciences, medical terminology and an internship with the Disabled and the Law program at Chico State University.

Dalerio handles all the paperwork for clients, attends meetings and appeals, and keeps the client informed about progress toward resolution of the case. Delario does her work on a contingency basis, collecting only a percentage of back benefits owed her clients. If nothing is recovered, she charges no fee.

Poster Contest Winners

The Developmental Disabilities Planning and Advisory Council (DDPAC) annual Disability Awareness Poster Contest has concluded and fifteen winners were selected from among 420 entries.

Grades K-2

First Place&endash;Kathryn Schmitz, Bozeman

Second Place&endash;Hallie Ricketts, Helena

Third Place&endash;Fiona McNeil, Kalispell

Grades 3-6

First Place&endash;Elizabeth Harball, Kalispell

Second Place&endash;Wesley Hilton, Kalispell

Third Place&endash;Liz Richmond, Kalispell

Grades 7-9

First Place&endash;Katie Vaughn, Anaconda

Second Place&endash;Stephanie Hamel, Eureka

Third Place&endash;Tamara Mills, Eureka

Grades 10-12

First Place&endash;Andrea Graa, Anaconda

Second Place&endash;Ben Ryan, Anaconda

Third Place&endash;Lisa Cortright, Anaconda

Adult

First Place&endash;Robert Nichols, Eureka

Second Place&endash;Melissa Clark, Great Falls

Third Place&endash;Keith Stokes, Great Falls.

From this group of participants, the overall winner was determined to be the poster created by Robert Nichols. Robert, along with the four other first place winners (and their parents, if appropriate), were brought to Helena during the first week of March when they met Governor Marc Racicot. The Governor presented Robert with a $300 savings bond and each of the other first place winners with a $150 savings bond. The $75 savings bonds for the second place winners and the $50 savings bonds for the third place winners will be mailed to each of them before the end of March.

The first prize posters make up the poster that has been printed as the 1998 Developmental Disabilities Awareness Month poster for the state. Approximately 1,200 copies were mailed to numerous agencies, schools, classes, and individuals throughout the state. Each winner will also receive a copy of this poster.

New IEP Format to be in Place by July 1998

Tom Hehir, Director of the Office of Special Education Programs (OSEP) says the proposed IDEA regulations leave no room for doubt when it comes to new IEP requirements: July 1, 1998, is the deadline to have all IEPs in compliance with the law.

Even though the regulations are under review and are not expected to be finalized until April, Hehir says, "The proper thing to do is get the IEPs in line with the new regulations before July 1, 1998."

Many school officials across the country have suggested that it is logistically impossible for school districts to redo all of the IEPs to conform to the new requirements of IDEA '97. Instead school districts would prefer to bring IEPs into line with the new rules as they come due for annual reviews in 1998. In this way, the review of IEPs would occur gradually, giving special education staff time to receive training in the new requirements and to develop new forms that comply with the law.

Mr. Hehir does not appear willing to provide this much slack. He has said that all IEPs must be in compliance with the new regulations by July 1, 1998.

The new provisions that affect the IEP include the following:

• Inclusion of regular educators as required members of IEP teams;
• Reference to the general education curriculum in the development of IEP goals and objectives;
• Inclusion in the IEP of functional behavioral assessment data and a positive behavior plan for students with behavior problems;
• Consideration of communication needs for students with hearing and speech problems;
• Consideration of Braille instruction for students who are blind;
• Addressing how the student will participate in state and district achievement testing.

Since these provisions were not required by previous law, existing IEPs are unlikely to contain this newly required information. School districts wishing to be in complete compliance with IDEA '97 would, therefore, have to review every active IEP to determine what changes would be needed to meet the requirements of the law. In most cases, an IEP Team meeting would need to be held to revise the existing IEP. Conducting this many meetings between now and the end of the school year certainly would be difficult, if not impossible, for most school districts.

Child Count Reveals Numbers Served

Each December 1 the Office of Public Instruction (OPI) assembles the figures from all the public schools to determine how many children are being served in special education. The participants in special education are listed according to the disability categories designated in the Individuals with Disabilities Education Act (IDEA). Here are the figures by category from December 1, 1996:

Children Served from 3-21

CD = cognitive delay............1,368

HI = hearing impairment...........149

DE = deafness......................76

SL = speech/language impairment.3,441

VI = visual impairment.............82

ED = emotional disturbance......1,130

OI = orthopedic impairment.........69

OH = other health impaired........662

LD = learning disabled..........9,574

DB = deaf-blind....................19

MD = multiple disabilities........151

CW = child with disabilities....1,731

AU = autism........................90

TB = traumatic brain injury........64

Total..........................18,606

A quick look at the figures shows that students with learning disabilities make up 51% of the children served in special education. The next largest category is children with speech/language disorders (18%). Students with cognitive delays represent 7% of the total, and children with emotional disorders 6%. Young children (under the age of six) with the generic label of "child with disabilities" account for 9% of those served. On the other hand, students with sensory or orthopedic impairments are very small groups within the population of special education students.

Overall, the numbers of students in special education have been increasing at a slightly faster rate than the total number of students in public education. Montana is, however, continuing to identify roughly 9.5% to 10% of its student population as needing special education.

Aversive Treatment Rule Stirs Controversy

Over the past 18 months, the Office of Public Instruction (OPI) has been reviewing possible revisions to the Administrative Rule on Aversive Treatment. This effort has sparked considerable interest from school administrators, parents, advocates and directors of special education. Almost all who have offered advice are in agreement that the current rules, which have not changed for over 20 years, are in need of revision. However, there are strong differences of opinion on what the rules should say.

"Aversive treatment" means any procedure used to manage behavior that involves restraint, removal from reinforcement, or use of noxious odors or tastes. Aversive procedures may include physical restraint, mechanical restraint (e.g., use of a harness or seat belt), seclusion time out (e.g., isolation room), or mists, aromatics or tastes (e.g., lemon juice, water spray). Aversive treatments may be used in modifying behavior only for the benefit of the student and may never be used as punishment, or for the convenience of staff, or as a substitute for a nonaversive program. Any procedure which is intended to cause physical pain or denies necessary nutrition or care is strictly forbidden.

Because of the differences of opinion in the educational community about the aversive rule, the Office of Public Instruction is continuing to seek input on an informal basis from all interested parties. The process of seeking input so far has included surveying other state's rules governing aversives, surveying selected Montana professional groups and surveying parents, and the development and distribution of two drafts of rules on aversive treatment with each version requesting comments. Hearings on the second draft held January 14 at the Southeast Montana Association of School Superintendents meeting in the Miles City School Administration Building and an informal discussion in Helena on January 15 in the State Capitol, Room 312, drew severe criticism from some school administrators.

Comments on the second draft have come primarily from school administrators and directors of special education. In general, these comments have expressed concern that the language in the draft would result in burdensome paperwork and limitations on administrators' ability to discipline students.

Parents, on the other hand, have been generally pleased to see spelled out in administrative rule how and when aversive treatment can be used.

OPI will continue to accept comments on the proposed Aversive Treatment Rule throughout March. A blue ribbon panel is being established to re-work the drafts of the aversive rule. The panel is to include a parent of a regular education student, an advocate for students with disabilities, a school administrator, an elementary and a high school teacher experienced in the use of aversive treatment procedures, a regular education teacher, a school psychologist, a principal, a special education director, a mental health professional, a parent of a child who has received aversive treatment and a person with disabilities.

The professional members of the panel will be appointed by their respective professional groups. The panel is expected to meet in April and will start by selecting one of three drafts of the rules from which to begin their deliberations. Draft one is the rule as currently written. Draft two is the rule which has generated criticism, and draft three is a revised text. The group will further revise the draft it selects as a text for any rule proposed by OPI.

Before any new rule is adopted, the administrative procedures act requires formal notice and a formal hearing. It is anticipated that a formal proposal for rule revision will be published in the Administrative Register in May or June. A formal hearing on the proposed rules will then be held.

To receive copies of the draft of the proposed rules or information on opportunities to comment on the draft, contact Doug Doty at 406-444-0907.

Community Meetings on Education Profiles

The 1997 Legislature passed a School Improvement Program which, among other things, required that the Office of Public Instruction provide an Education Profile&endash;a description of how Montana's students are doing in terms of achievement in mathematics, reading, and other subjects.

As part of its process of developing an Education Profile, OPI is holding community meetings in cooperation with the Montana PTA to discuss the types of information Montanans believe would be useful when evaluating and improving Montana's statewide education system and local schools.

Overall, an education profile may include such topics as program and course offerings, student environment, student achievement, services, finances, staffing, school facilities, and community demographic characteristics. A draft document for discussion purposes may be obtained from Dori Nielson at 406/444-3656.

The following is a tentative schedule of Education Profile town meetings for the Spring of 1998:

March 19 Great Falls

April 2 Billings

April 6 Forsyth/Colstrip

April 7 Glendive

April 8 Glasgow

April 9 Havre

April 14 Seeley Swan/Condon

April 21 Pablo/Ronan

April 22 Missoula

April 23 Hamilton

April 28 Kalispell

April 30 Butte.

Watch for details of location and time in local newspapers.

Financial Supports for Families

Often when parents are faced with raising a child with disabilities or chronic illnesses, they find themselves overwhelmed by bills for special treatments, therapies, or medications. The sources for financial support are not immediately obvious. Sometimes it takes parents months or even years to learn about the resources that may be of help to them. Here is a list of the basic resources for financial assistance.

Supplemental Security Income (SSI) is a federally funded income maintenance program designed to provide monthly cash benefits to support individuals of any age who have disabilities. Eligibility depends on a disability severity criterion for the individuals and an income and asset criterion for the family. SSI criteria and benefits have been changing dramatically over the past few years. The newest version of the law requires a child to have a "medically determinable physical or mental impairment which results in marked and severe functional limitations." The requirement for a "marked and severe" limitation has eliminated many children who met previous criteria. Currently, many children, especially those with attention deficit hyperactivity disorder, have been flagged for reevaluation or for cessation of benefits.

Medical Assistance (Medicaid) provides broad coverage for medically necessary services, including home care services, to individuals with financial need. The child who is eligible for SSI benefits is automatically eligible for Medicaid. For most children, losing SSI benefits based on the new law will also mean losing Medicaid.

The Tax Equity and Fiscal Responsibility Act (TEFRA) provides a mechanism for children with disabilities to qualify for medical assistance based on their own income and assets, not those of their parents. This program is sometimes known as the Katie Becket Waiver because it was Katie Becket's parents who lobbied the Reagan administration to allow an income waiver to provide assistance to families choosing to care for their children at home instead of institutionalizing them.

In Montana, the waiver program is administered through Child and Family Service Agencies (e.g., CDC, STEP, DEAP, HI-Line Homes, Family Outreach). There are only a limited number of "slots" for children to be on the waiver and there is a waiting list for this service.

Title V Children with Special Health Care Needs programs offer care to some families who are financially ineligible for Medicaid yet lack adequate health insurance coverage to cover their children's medical needs. To apply for assistance through this program, contact Sharon Wagner at 406/444-3617.

Long-Term Financial Planning may be necessary to protect the welfare of a child with special health care needs. The usual will leaving property or cash to a child may encumber the child with assets that disqualify him or her from receiving federal support for services. When a child with a disability receives an inheritance, government agencies providing benefits to the child may charge the child for services rendered&endash;current and past services. An inheritance could be quickly exhausted. If a trust has been established for the siblings as well, their shares may be equally at risk.

In Montana, the Legislature created the Self Sufficiency Trust to help parents of children with special needs to set aside funds to supplement the financial supports the children can receive through government programs. PLUK helps with the administration of this trust. For more information, contact the PLUK office at 1-800-222-7585.

Controversy Heats Up on Intervention for Children with Autism

Debate is vigorous among proponents of various early intervention programs for children with autism. Several intensive home-based programs, some involving up to 40 hours of intensive therapy per week, make claims to provide encouraging results in ameliorating the symptoms of autism. School districts, on the other hand, have shown reluctance to provide or pay for these intensive programs, despite their claims to success. Parents caught between the schools and private special education programs struggle with how to achieve the best results for their children and how to pay for private programs if school districts will not provide the intensive therapy that may be needed.

All over the United States parents have sought due process to assist them in obtaining appropriate programs for their children with autism. From these cases a pattern of decisions is beginning to emerge.

New York

A New York preschool student was identified with autistic symptoms and his parents enrolled him in a home-based program in which he received 40 hours per week of one-on-one instruction using the applied behavioral analysis (ABA) method. His parents applied to their school district of residence for public preschool educational services. Following an evaluation and assessment by a multi-disciplinary team, the school district recommended placement in a private nursery school for children with autism. The placement called for 25 hours of applied behavioral analysis instruction, which the parents believed would be contingent on funding. The school district relied on evaluators who believed that the home-based program, in which the student was showing remarkable progress, was impossible under state law. The student's father requested a due process hearing at which he alleged that the proposed placement violated state and federal law. The hearing officer upheld the proposed IEP, and a state review officer affirmed the decision. The father appealed to the U.S. District Court for the Southern District of New York.

The court found substantial evidence that the 40-hour intensive one-on-one applied behavioral analysis program was appropriate since it was supported by a psychological and behavioral evaluation and neuropsychological evaluation of the student. There was also evidence that the 25 hours of instruction proposed by the school district would not be intensive and would therefore be inappropriate. The court rejected the school district's assertion that the home-based placement violated the IDEA, saying "Some students with disabilities must be educated in segregated facilities because of their disruptive behavior or because the gains from inclusive instruction may be marginal." The court reversed the administrative decisions, ruling that the IEP proposed by the district was calculated to provide educational benefits to the student.

IMPORTANT IDEAS

• The child was making progress in the intensive 40 hour program so it was providing benefit;
• The lesser program was proved not to provide enough benefit;
• The child could be placed in a more restrictive environment because this environment was where he could make progress.

Massachusetts

Because the proposed IEP for a 3-year-old child with autism was procedurally and substantively flawed, a hearing officer ordered the district to provide the child with compensatory education. The district was also ordered to furnish in-home applied behavioral analysis training to the child, as the evidence clearly demonstrated he required an ABA program to make educational progress.

The parents of a 3-year-old child with autism arranged for him to participate in an in-home applied behavior analysis training program for two hours a day twice a week and to receive private occupational therapy. The school district proposed an IEP calling for the child's diagnostic placement in a specific school. The parents agreed with the proposed school placement but requested the district also assume funding the child's in-home ABA program. When the district refused, the parents requested a due process hearing.

When the hearing officer reviewed the child's IEP, the officer concluded that the district had made several procedural errors:

• Failed to evaluate the child before his third birthday and refused to consider valid, timely evaluations done privately;
• Disregarded or ignored recommendations of individuals who worked with and evaluated the child;
• The diagnosis of autism was undisputed so the child did not require a diagnostic placement;
• The IEP failed to state the specific services to be provided.

The hearing officer concluded the child required in-home ABA training in order to benefit from his education. The evidence demonstrated that the child made significant advances while participating in the ABA program, and ABA instruction was recommended by the child's early intervention service providers and current classroom teacher.

The hearing officer ordered the district to provide the child with in-home ABA training for 10 to 15 hours a week in addition to his district placement. The district was also ordered to provide the child with compensatory education.

IMPORTANT IDEAS

• The district was ordered by the hearing officer to pay for a specific program because the program was working for the child and the district had offered nothing specific as an alternative;
• The hearing officer ordered the district to provide compensatory education because the district had failed to meet its legal requirements of doing a timely evaluation and using the diagnostic information that was available on the child.

Nevada

Under special education law, school districts have the right to choose the specific teaching methodologies to be used with a child. It is assumed that the licensed special educators have the training and background necessary to make appropriate decisions about methodologies. Even though parents may prefer a different methodology, the choice of methodology is not up to the parents alone.

In a Nevada case, a school district was not required to offer a 4-year-old student with autism an ABA/Lovaas program when the district proposed an appropriate program which used the TEACCH method of instruction.

The parent objected to the proposed IEP and requested due process, seeking reimbursement for the costs of an in-home, ABA/Lovaas program the parent arranged for the student. At the time of the hearing, the student had not attended the proposed district program for over one year. The hearing officer determined the proposed IEP was appropriate, as it offered the student a free, appropriate education (FAPE) in the least restrictive environment (LRE).

The officer said the parties appeared to be disputing the appropriate instructional methodology. Since methodology decisions are left to school district, the district was not required to use ABA/Lovaas. The IEP offered by the district was appropriate, in that it allowed the student to make educational progress, included a communication system, involved the parent, and addressed the student's behaviors.

IMPORTANT IDEAS

• This parent was not successful in making a case for the district to provide ABA training because the parent did not allow the district to try its plan. On paper the IEP met legal requirements and the TEACCH methodology is an accepted method for educating children with autism. If the parent had allowed the school district to implement its plan and the child made little or no progress, then the parent might have had a claim that some other method should be tried;
• The parent's unilateral choice of ABA is not binding on the school district because choice of methodology is a district responsibility under the law.

Current Autism Treatments in Montana

The Autism Society of Montana reports the following contacts in the Billings/Bozeman area for specialized autism treatments:

For more information about the Autism Society of Montana, call 406-651-9260. Mike Maxwell is starting a Missoula ASM chapter. For more information about this, contact him at 404 Whitaker Dr., Missoula 59803; 406-728-4120.

The PLUK Library houses the ASM collection of materials on autism. To borrow books or articles on autism, call 1-800-222-7585 or 406/657-2074.

The Boston University Case and Accommodations for LD

Boston University has long had the reputation for being a leader in providing appropriate accommodations for students with learning disabilities. At one time, the university offered a wide array of accommodations, including note takers, readers, assistive technology, test modifications, and course substitutions (e.g., substitutions for foreign language requirement). Then a new administrator, Jon Westling, reversed these long standing practices and required retesting of many students to determine if they were really learning disabled and in need of accommodations.

BU President, Jon Westling publicly referred to students with learning disabilities as "draft dodgers" and had, by his own admission, fabricated a story about Somnolent Samantha who represented Westling's belief that students with learning disabilities were often fakers who undercut academic rigor.

Outraged by their treatment by BU, a group of students filed a discrimination case in favor of the students against the university. The U.S. District Court issued a decision in the case of Guckenberger et al. v. Boston University et al.

At issue in the case were practices of BU that allegedly violated the civil rights of students with learning disabilities and ADHD. The court concluded that BU's practices violated the civil rights of the students. Specifically, BU violated the Americans with Disabilities Act of 1990 (ADA), the Rehabilitation Act of 1973 and provisions of Massachusetts law. The Court also concluded that BU breached its contract with certain student plaintiffs.

At the outset, BU did not dispute that the students in the case were individuals with disabilities who were otherwise qualified within the meaning of the law. Further, prior to the trial, BU had changed some of its practices on retesting. For example, in 1995, BU had imposed a new requirement that students with learning disabilities be retested every three years. After the commencement of the litigation, BU changed its policy to permit waiver of the retesting if the student's evaluator deemed such retesting not medically necessary.

In its over 100-page opinion the Court set forth findings of fact, conclusions of law, and an order of judgment. The Court reviewed considerable expert testimony concerning the disabilities.

The court ordered that:

• BU end its policy of requiring that, to be eligible for accommodations, students with learning disabilities, who have current evaluations by trained professionals with at least masters degrees and sufficient experience, be retested by professionals with Ph.D. or MD credentials.
• BU propose within 30 days a deliberative procedure for considering whether the foreign language requirement is part of the fundamental nature of the liberal arts program. If the requirement is not fundamental, then students with the requisite documentation of their disabilities and need for accommodations would be able to have a course substitution for foreign language.
• Judgment be given in the amount of over $29,000 to a total of six students.

The Court applied a different standard for evaluation of students with ADHD. The Court concluded that requiring current documentation based on reevaluations in adulthood is a reasonable requirement and that a doctorate level of training for the evaluator is necessary.

The Court concluded that BU had no obligation to consider whether its mathematics requirement must be altered. The Court referred to a lack of scientific evidence that any learning disability in mathematics is sufficiently severe to preclude meeting mathematics requirements.

The Court also concluded that BU failed to engage in the interactive process required under the ADA and Section 504 in fashioning accommodations for students with learning disabilities. The Court further concluded that BU breached its contract with three of the named plaintiff students by failing to honor the express representations of its representatives about the students' ability to document their disabilities and to receive accommodations from the university.

This case is instructive in indicating what kinds of accommodations the courts may require of universities. Clearly, this case indicates legal support for the concept of accommodations for college students with learning disabilities.

When Is Seizure Surgery Appropriate?

Brain surgery to control seizures is usually considered a last resort when all other methods of control are unsuccessful. For individuals who are good candidates for surgery, the risk of death is almost nonexistent. The rate of significant complications with standard lobectomy is 1 to 2%. In contrast, not having surgery and continuing to live with uncontrolled seizures can have serious and debilitating consequences; including, decreased vocational status, increased emotional and psychiatric disability, worsening memory, and mortality that is two to four times greater than that in the general population.

Who Is a Candidate for Epilepsy Surgery?

Epilepsy surgery is indicated when (1) seizures are disabling and not controlled by medication, (2) seizures emerge from a single discrete region in the brain; and (3) that region is not critical for normal function.

How Many Medications Should Be Tried Before Considering Surgery?

The best evidence indicates that only about 20% of individuals not responding to aggressive treatment with a single antiepileptic medication will respond to treatment with another antiepileptic medication. Only about 10% of the individuals failing two trials of drug therapy will respond to a third AED or two AEDs used together. Further manipulations are even less likely to help. Thus, epilepsy surgery probably should be seriously considered in individuals failing two trials of drug therapy and a trial of two drugs taken at once. These types of trials can usually be completed in less than two years.

What Can Be Expected from Epilepsy Surgery?

Seizure surgery usually stops seizures or significantly decreases seizure frequency. Recent studies confirm that after seizure surgery individuals experience better employment outcomes and improved psychological well-being. Studies have also confirmed that individuals who have the surgery utilize fewer medical resources and feel more confident socially after surgery.

However, thorough education before surgery and further support after surgery are important to maximize benefit. It is important to set realistic goals before surgery. For example, cessation of seizures may allow the individual to resume driving, but improvement of memory may or may not be a realistic expectation depending on location of seizures, baseline memory function, and presence or absence of psychiatric disorders. Use of antiepileptic medications may be reduced, but only about half of the individuals receiving surgery are able to stop medications altogether for long periods of time.

Source: Minnesota Comprehensive Epilepsy Program, 5775 Wayzata Blvd, Minneapolis MN 55416; 612-525-2400.

Freedom Medal for Justin Dart

On Martin Luther King's birthday, January 15, President Clinton awarded the Medal of Freedom&endash;the United States' highest civilian award&endash;to Justin Dart. Mr. Dart was the Director of Vocational Rehabilitation during the Bush administration and he has been a lifelong advocate for people with disabilities.

In presenting the Medal of Freedom to Mr. Dart, President Clinton said:

"Justin Dart literally opened the doors of opportunities to millions of our citizens by securing passage of one of the nation's landmark civil rights laws: The Americans with Disabilities Act. Throughout his career, he has worn many hats, and he's wearing one of them today.

At the University of Houston, he lead bold efforts to promote integration. He went on to become, in his own words, 'a full-time soldier in the trenches of justice,' touring every state in the nation to elevate disability rights to the mainstream of political discourse.

He once said, 'Life is not a game that requires losers.' He has given millions a chance to win. He has also been my guide in understanding the needs of disabled Americans. And every time I see him, he reminds me of the power of heart and will. I don't know that I've ever known a braver person."

After coming down from the stage where he received his medal, Justin took the Medal from around his neck and placed it on his wife, Yoshiko, who has shared fully every contribution he has made.

Other recipients of the Medal of Freedom included civil rights hero James Farmer, four-time cabinet secretary Elliot Richardson, and philanthropist David Rockefeller.

Treating Conduct Disorder

Symptoms of conduct disorder responded to short-term treatment with Ritalin in a study of 83 children with the disorder. Those who received Ritalin exhibited a decrease in such behaviors as attacking others, stealing, and cruelty, compared with those on a placebo. The authors speculated that a key trait of conduct disorder is impulsivity, which is ameliorated by treatment with a stimulant.

Source: Arch. Gen. Psychiatry 54 (12): 1073-80, 1997.

Beware of ADHD Look-Alikes

ADHD is an "in-vogue" diagnosis that is perhaps being made too often. Medical research suggests that approximately 3%-5% of the general population of children may have ADHD; however, in some communities and some schools as many at 10%-15% of students are being diagnosed with ADHD.

One reason for over-diagnosis may be that there other conditions which mimic some of the symptoms of ADHD. It is very important that children who display symptoms of hyperactivity, inattentiveness or impulsiveness receive a comprehensive assessment that would rule out other causes for the symptoms they display. The conditions that can mimic some or all of ADHD symptoms include the following:

Vision and Hearing Impairment. A child who does not see or hear properly may be inattentive.

Sleep Disorders. Sleep disorders are fairly common in young children and can manifest as night terrors or insomnia. They can cause several ADHD-like symptoms.

Seizure Disorder. Absence seizures are often misdiagnosed as ADHD because the seizure may not be obvious. Seizures can cause a student to appear inattentive or to not respond to questions.

Drug Abuse. Use of marijuana and other drugs can cause lethargy and memory problems&endash;symptoms also common in ADHD.

Depression. Diminished abilities, decreased interest in normal activities, and irritability are among the many symptoms of depression that are similar to ADHD symptoms.

Bipolar Disorder. Hyperactivity and irritability during manic episodes can mimic ADHD. Bipolar disorder is not uncommon in children, especially those with a family history of the disorder. In children treated unsuccessfully for ADHD, the possibility of bipolar disorder should be considered.

Obsessive-Compulsive Disorder. A child with obsessive-compulsive disorder may appear to have difficulty concentrating because the child is focusing on compulsive mental acts or obsessions.

Anxiety Disorder. Anxiety Disorder, like ADHD, can cause restlessness and irritability. It is not uncommon in children and can last 6 months, which is one of the criteria for the diagnosis of ADHD.

Adjustment Disorder. The marked stress that can occur in a child whose parents have divorced, who has moved, or who has faced some other major adjustment, can also mimic that seen in children with ADHD.

Asperger's Disorder. This social interaction disorder is characterized by symptoms such as impaired use of nonverbal behaviors, failure to develop peer relationships, and lack of social reciprocity. The inappropriate social behavior seen with Asperger's can sometimes be mistaken for ADHD-like impulsiveness.

Language Disorder. Children with problems understanding language or expressing themselves through language can be easily frustrated, excitable, impulsive, and inattentive.

Common Tests for ADHD

Besides the usual achievement and intelligence tests used to evaluate children with learning and behavior problems, there are some commonly used assessment tools which are meant to identify characteristics of ADHD.

Conner's Parent and Teacher Rating Scales. These measure learning and attentional problems, conduct, impulsivity, anxiety, and hyperactivity.

ADD-H Comprehensive Teacher's Rating Scale (ACTeRS). This scale measures inattention, hyperactivity, social skills, and oppositional behavior. It provides separate ratings of attention and hyperactivity.

Continuous Performance Task (CPT). This computerized assessment measures inattention and impulsivity.

Peabody Picture Vocabulary Test. This measures receptive vocabulary (words that the child understands).

A battery of these tests, plus a physical examination, and a careful medical and educational history can be used to differentiate ADHD from the many disorders that mimic ADHD.

Pycnogenol and ADD

Pycnogenol is a water processed extract from the bark of the French Maritime Pine tree. Maritime Pine Pycnogenol is a patented and trademarked naturally occurring compound that is produced in its basic, generic form by Horphag Research Ltd. in France.

The generic form of Pycnogenol is available without prescription in many health food stores.

Pycnogenol is currently being touted as a replacement for stimulant medications (e.g., Ritalin, Dexedrine, Cylert) that are used to treat the hyperactive/inattentive symptoms of attention deficit disorder.

Pycnogenol, however, has not been tested in the United States for its effectiveness in treating any medical condition. Proponents of its use claim that Pycnogenol is effective not only for reducing ADD symptoms but also for treating Alzheimer's disease, immune system dysfunctions and other conditions. These claims have not been substantiated by any published research.

One of the appeals of Pycnogenol use is that the compound is supposed to be cheaper than the medications that are typically prescribed by physicians. Medications like Ritalin, Dexedrine, and Cylert are expensive, but they do have the advantages of having been widely studied, their side effects well known, and all three medications have been demonstrated to be effective for many individuals in treating the symptoms of ADD and ADHD.

Genetics Plays Role in ADHD

The American Academy of Child and Adolescent Psychiatry reports that ADHD is an inherited condition and that shared genetic influences probably explain its association with oppositional defiant disorder, language difficulties, and other disorders.

Dr. Florence Levy, Director of the Avoca Clinic, Prince of Wales Hospital, Sydney, Australia, reported the results of a study of nearly 2,000 pairs of twins from the Australia twin registry, aged 4-14 years when the research began. The prevalence of attention-deficit hyperactivity disorder (ADHD) was 11%-12% among the twins compared with 8% among other siblings.

Among identical twins, the presence of ADHD in both twins was 83%&endash;about twice as high as among fraternal twins&endash;suggesting again a genetic pattern. In other words, if one identical twin had ADHD, there was an 83% chance the other twin would have ADHD.

Data collected in 1994 divided subjects with ADHD into the three subtypes of ADHD defined in DSM-IV: hyperactive-impulsive, inattentive, and combined. Among the identical twins, both twins were highly likely to have the same subtype of ADHD, again suggesting a genetic component to the presence of the condition. Also among identical twins the presence of a speech problem in one twin was highly predictive of the other twin having a speech problem.

Dr. Levy also noted that language and reading difficulties were far more common in children with the inattentive or combined subtype of ADHD than in children with the hyperactive-impulsive subtype. According to Dr. Levy, the association between language and reading problems and the inattentive and combined subtypes of ADHD is probably genetic, although shared family environment probably also plays a role.

Preliminary data analysis suggests that the overlap of conduct disorder and oppositional defiant disorder with ADHD is also largely accounted for by common genetic influences.

Source: Sherman, C. (Feb. 1998). Genetics plays major role in ADHD, comorbidity. Pediatric News, p. 30.

Smoking is Cause and Consequence of ADHD

Maternal smoking during pregnancy is a risk factor for attention deficit hyperactivity disorder in offspring, and adolescents and adults with ADHD are more likely than peers to smoke.

Dr. Sharon Milberger of Massachusetts General Hospital, Boston, reports these findings from a study she did with 140 individuals with ADHD, aged 6-17 years; 120 normal controls; and their families. Twenty-two percent of the mothers of youth with ADHD reported smoking at least a pack a day for at least 3 months during pregnancy, compared with 8% of the mothers of normal controls. The difference remained significant after controlling for socioeconomic status, IQ, and maternal and paternal ADHD.

In ADHD children and siblings alike, maternal smoking was associated with significantly lower IQ in offspring.

These findings are consistent with other research studies linking maternal smoking with neurologic and cognitive deficits in children. Although the causes of ADHD are complex and uncertain, it appears chronic exposure to nicotine is damaging to the fetus and that the human fetus is exposed to higher nicotine concentrations than the cigarette-smoking mother herself.

A 4-year follow-up of 128 ADHD children and 109 controls found that nearly twice as many adolescents with ADHD were cigarette smokers (19% compared with 10%). The difference remained significant after controlling for major depression, conduct disorder, anxiety disorders, socioeconomic status, and IQ.

Smoking onset was 2 years earlier among the ADHD group: 15.5 years, compared with 17.5 years for controls.

If an adolescent had both ADHD and conduct disorder, the adolescent was much more likely than controls to smoke.

Also siblings of children with ADHD were at higher risk of smoking than siblings of normal controls (17% compared with 7%). ADHD, conduct disorder, and major depression were associated with higher risk of smoking in high-risk siblings.

In adolescents with ADHD and their siblings, smoking was associated with five times the risk of substance-use. In ADHD groups but not controls, smoking risk followed a familial pattern. High-risk siblings were three times more likely to smoke if the ADHD child did. In control families, smoking by one sibling did not predict smoking by others.

Source: Sherman, C. (Feb. 1998). Genetics plays major role in ADHD, comorbidity. Pediatric News, p. 31.

ASK PLUK

Q: I read in the newspaper about a special education case that reached the Montana Supreme Court. The family alleged that their child had been humiliated in school by a teacher and excluded from a school ski trip. The parents thought their child had been discriminated against because of his disability and went to court with their claim. The Supreme Court rejected the claim, saying the family hadn't exhausted "administrative remedies." This doesn't seem fair. All too often kids with disabilities are discriminated against in subtle and not so subtle ways. Isn't there any redress?

A: The Individuals with Disabilities Education Act (IDEA) does provide parents and students with an avenue for settling disputes with school districts, but IDEA does not allow parents to claim compensatory damages. In the case to which you refer, the parents were seeking compensatory damages (financial compensation) and the Supreme Court said they had chosen the wrong route to make their claim and should pursue due process under IDEA.

In a broader sense, the courts are not a good place to settle disputes between families and school personnel. When a case gets to court, the lines are drawn very specifically, and there are clear winners and losers. This kind of settlement does not help much in mending working relationships, nor does it prevent future problems between the same family and the school district.

When PLUK becomes involved with a family that alleges discrimination, we always urge using conflict resolution techniques first to see if we can get the parties talking and allow hurt feelings to be acknowledged and dealt with.

When there are actual legal claims involved, PLUK staff can assist parents in understanding their options under IDEA, beginning with formal mediation. In our experience, formal mediation can be very helpful when informal negotiations have broken down. The mediators in Montana are skillful at listening to all points of view and suggesting alternatives for resolution. Often having a neutral third party listen to the concerns of all allows a true airing of the issues and makes repair of broken relationships possible.

If mediation is not successful, parents always have the option of asking for a due process hearing before a hearing officer. This procedure is more like a court hearing. In this case, the hearing officer makes the final decision to resolve the dispute.

Again, if the parents are not satisfied, they can continue to seek resolution through the courts.

In our experience, informal negotiation resolves more than 90% of conflicts; another 5% are resolved in mediation; very few disputes need to go any further.

The IDEA due process procedures are not designed to provide parents with financial compensation for "harm" they may feel has been done to their child. This may be a frustration for some. Overall, however, we find that what most parents want is a more positive relationship with school personnel and educational programs that are designed to benefit their children. It is the educational program which is of greatest importance and usually the achievement of a good program requires the good will and patience of both parents and school personnel.

Q: Is time-out a legal behavior management procedure for students with disabilities?

A: Time-out is used commonly by both parents and educators as a means for managing children's behavior. If used correctly, time-out can be useful as part of an overall behavior management plan for a student in special education.

Time-out is a procedure in which the child is removed from the social situation to an unstimulating environment. During time-out the child is supposed to regain control. As soon as the child is exhibiting appropriate behavior, the child can return to the group.

Time-out can be an effective procedure, particularly when a child has escalated beyond the point where the child can be controlled verbally by an adult. But time-out must be administered in a safe and humane way. The basic safeguards for implementation of time-out include:

• Used in accordance with state and local policies.
• Incorporated specifically in the IEP.
• Used only when less intrusive procedures have proven ineffective.
• Limited to short durations of time, typically 2-10 minutes.
• Provided in an unlocked, monitored and otherwise physically safe place.

If time-out is a procedure that has been recommended for your child, its use should be discussed by the IEP team. Time-out procedures should be spelled out in the IEP, and you as the parent will have to agree to the IEP before time-out procedures can be implemented.

Q: Our 14-year-old son is an eighth grader who has severe learning disabilities in reading and writing. Since he has been in junior high school, he has become very sensitive about his learning disabilities and about being in special education. Many times he refuses to do his school work. The teachers view this behavior as "being defiant." We have been told that if our son continues to be noncompliant and not do his work, he will be expelled from school. If our son is expelled from school does this mean an end to his education?

A: From your description, it sounds as though there should be further investigation into why your son is not doing his work. There may be any number of reasons why he is not performing. Some possibilities might be: (a) he is afraid of making mistakes and being ridiculed by classmates, (b) he would rather fail than reveal how much difficulty he is having in doing the assignments, (c) written expression is very difficult for him so he avoids writing tasks, (d) he is overwhelmed by the task and does not know how to begin, or (e) he has experienced so much failure that he is discouraged and does not even want to try.

Many LD students in junior high reach a point when the volume and pace of work overwhelms them. At the same time, as adolescents these young people do not want to be different or singled out. They are very reluctant to ask for help, particularly in front of their peers.

Your son certainly should not be expelled for behavior which may be related to his disability. At this point, ask for an observation of your son by the school psychologist or someone who is well versed in learning disabilities. If the school district does not want to do the evaluation, then ask for an independent evaluation. It is important to determine if the assignments your son is expected to do are really within his grasp. There may be a need to reduce the amount of writing, allow him to do oral testing, provide him with instruction in learning strategies. There are any number of interventions which may be helpful.

Also, please note that because your son is a special education student, even if he were expelled, the school district would still have to provide him with an education.

The important point is that expulsion is not a good tool for encouraging your son to do his school work. It would be far more effective to (a) provide him with assignments he can do, and (b) give him the tools and the encouragement he needs to compensate for his learning disabilities.

Q: Our 17-year-old son who has a learning disability in math is interested in a health career. We are concerned that this may be an unrealistic ambition for him because he cannot do the kinds of math necessary to become a doctor or nurse. Should we discourage him from looking into the health field?

A: It is true that a good grasp of mathematics is basic to becoming a physician or a nurse. There are, however, many other types of careers in the health field which do not require as much math and may be suited to your son's abilities and interests.

It may be helpful at this point to have your son tested for aptitudes and career preferences. Some school counselors provide this service. If aptitude testing is not available in your son's high school, you might consider private testing from a private rehabilitation or career counseling firm.

If your son has his heart set on a medical career, there certainly should be some aspect of the medical field where his learning disability will not be a hindrance.

Q: Our daughter has been accused of "sexual harassment" because she wrote a note with explicit sexual language in it to a boy in her eighth grade class. The school district says that they are considering expelling our daughter because of this conduct but, because she is a special education student, they will have to have a manifestation determination review first. What is a manifestation determination review? Should we have a lawyer present for this?

A: A manifestation determination review is a meeting of the IEP Team in which the facts of your child's misconduct are reviewed and the participants determine whether or not your child's disability caused her misconduct. In other words, is there something about her disability which would cause her to be unaware of appropriate social behavior with a male classmate? Did she understand the language she was using and did she intend to do harm when she wrote the note?

Your daughter cannot be expelled if the manifestation determination review shows that she had impaired ability to understand the impact and consequences of the inappropriate behavior or that she had an impaired ability to control the behavior.

There is no need to have an attorney at the manifestation determination review. It is important, however, that the team consider evaluation and diagnostic results, observations of your daughter, and her current IEP. The team should consider whether or not the IEP has been implemented appropriately and whether the behavior intervention strategies, if any, in the IEP were provided consistently.

If the team determines that the misbehavior was related to your daughter's disability, then the team should discuss how to help your daughter to understand the problems caused by the note she wrote. Her IEP may need to be revised to include a positive behavior plan designed to teach your daughter new skills for interacting appropriately with male peers.

If the Team agrees that your daughter's misbehavior was not related to her disability, then she will be subject to whatever the usual discipline is in the school. If you find yourselves in this situation, be sure that you obtain a copy of the school district's policies on discipline and on sexual harassment. If there is an expulsion hearing before the school trustees, you may want to have an attorney present.

Q: My son's fifth grade teacher has repeatedly told him that ADHD is not a "real" disability. The teacher has implied that my son could control his inattentiveness if he wanted to do so. Now my son is very confused. He wants to please his teacher, but he cannot meet the teacher's standards for behavior. How can I get this teacher to work with me and be more understanding of my son's ADHD symptoms?

A: Start by arranging for a private conference with your son's teacher. Before the conference, provide the teacher with information concerning your son's evaluations for ADHD. You may also want to include some medical or scholarly articles that describe ADHD and ways to manage students with ADHD in the classroom. (The PLUK Library has lots of this information.)

At the conference discuss with the teacher his or her understanding of the materials you have provided. Brainstorm with the teacher strategies which may help to manage your son's behaviors. Try to enlist the teacher's commitment to follow through on a good behavior management plan.

If your meeting with the teacher is not productive, then contact the principal and ask him or her to help you communicate with the teacher.

Q: Our son is in a day treatment program within his high school. So far this program does not seem to be of much help to our son who has been diagnosed with schizophrenic tendencies and an anxiety disorder. It is all we can do to get our son up in the morning and off to school. Most of the time, he does not want to leave his bedroom. He is very fearful about going to school and does everything he can to avoid getting ready. We are working with a psychiatrist and a psychologist. Both of them feel that our son's needs are not being met in the school program. They are recommending residential treatment. Under what conditions would a school district agree to a residential placement? When do school districts have to pay for part or all of the cost of such a placement?

A: The question of when a residential placement is necessary is a difficult one to answer. In general, the special education law favors placement of students in the most normal educational setting (e.g., the regular classroom) and in a situation where contact with peers is possible. A residential placement is considered the most restrictive environment, so the need for such a placement would have to be very well documented. The following questions are the ones that the courts have been asking when settling disputes over residential placements:

1. Has the district attempted to include the student to the maximum extent possible? Has inclusion proved not to be beneficial to the student?
2. What are the educational benefits of a school district placement versus those in a residential placement? The benefits would have to be greater in the residential placement in order for that placement to be considered.
3. What effect has the inclusion of this student had on the education of classmates? If the student has been extremely disruptive, then this is proof that inclusion is not a successful option for this student.
4. Does the student have physical or mental conditions which prevent him from learning in a school district placement?
5. Does the student's behavior limit his ability to learn in a school district placement or has the student been regressing to the point where he cannot learn in the district placement?
6. Has any professional working with the student recommended a residential placement for educational purposes?
7. Is a residential placement the only way that the student can realize his potential?
8. Has past experience led to the conclusion that a residential placement is necessary?
9. Is the residential placement required for the student to make educational progress?

If you think your son requires a residential placement, then you should be prepared to answer the nine questions above and support your answers with documentation. If the IEP Team agrees that your son needs a residential placement in order to make educational progress and that he cannot make educational progress in the school setting, the school district will be obligated to pay for residential placement.

If a residential placement is made for reasons other than education (e.g., for therapeutic reasons), then the school district is under no obligation to pay for the placement.

If the school district participants on the IEP Team do not agree that a residential placement is necessary and you still feel that residential placement is required, you can take the issue to due process and ask for mediation. Before you consider due process, be sure that you have the evidence necessary to prove your case that residential placement is the only setting where your son is going to be able to make educational progress. Remember that the school district is under no obligation to ensure that your son makes therapeutic progress.

Q: We live at the end of a mile long country lane. Our daughter, who is nine, has cerebral palsy and cognitive delays. She cannot walk unaccompanied to the bus stop on the county road. Usually I would drive her to the bus stop, but for the next few months, I will not be able to take her. We have twin babies who were born prematurely and I need to be at home with them. My husband cannot drive our daughter because he goes to work very early&endash;long before our daughter should be at the bus stop. Our lane is muddy and unpaved. The school bus coordinator says it would be dangerous to bring a school bus down the lane. Is there anyway that we can ask the school district to pick up our child at our house&endash;at least during this time when I am caring for the twins?

A: Transportation is a related service that can be written into a special education student's IEP. If your daughter's IEP says that she requires transportation to and from school, the school district is obligated to provide that transportation.

If your school district has determined that it cannot safely drive its regular bus down your lane, the school district must arrange for a different vehicle to pick up your child.

Since you are not going to be able in the foreseeable future to transport your daughter to the bus stop, it does become the school district's responsibility to devise some other way to get your child to school. For example, the district may want to contract with another family that is traveling to the bus stop, or the district may have a smaller vehicle (e.g., four-wheel drive car) that can be used to pick up your daughter.

If the district seems reluctant to discuss this issue with you, suggest the following options:

• The issue could be discussed at an IEP Team meeting;
• The district could get some technical assistance concerning this issue by calling the Office of Public Instruction, Special Services Division (406-444-4429).

If the school district flatly refuses to work with you on this issue, you can file a complaint with OPI, saying that the district is not providing the transportation services outlined in the IEP.

Toll Free Numbers for Information

• The US Department of Justice operates a toll free Americans with Disabilities Act Information Line (1-800-514-0301) that provides information on and answers questions about the ADA, free ADA materials, and guidance on how to file an ADA complaint. The Department of Justice Information Line also provides information on the Rehabilitation Act of 1973 (Section 504) and guidance on how to file a complaint on issues other than those related to education.
• The US Department of Education, Office of Civil Rights, operates a toll free line (1-800-421-3481) providing information on Section 504 and guidance on how to file a Section 504 complaint involving educational issues.
• The Job Accommodation Network (JAN) operates a toll free line (1-800-232-9675) provides information about job accommodations and employment issues for persons with learning disabilities and their employers.

Parent Corner--Items of interest to parents

Medicating Infants

The Medicine Pacifier makes giving babies their medicine easier. The syringe-concealing sucker allows either active or passive administration of medicine and is safe enough to be used as a normal pacifier. These pacifiers are available from:

Ulster Scientific Inc.

P.O. Box 819

New Paltz NY 12561-0819.

National Education Standards for Involving Families

Family involvement in schools is supposed to be a major component in school reform. A useful new resource for parents groups is the National PTAs publication, "National Standards for Parent/Family Involvement Programs."

This user-friendly tool is designed for school districts, schools, and parents to increase meaningful involvement of families in schools. The goal is to develop dynamic programs to improve student achievement and improve schools through parent involvement.

The six areas for which national PTA has developed standards for involving families actively are: Communicating; Parenting; Student Learning; Volunteering; School Decision Making and Advocacy; and Collaborating with Community.

To obtain a copy of the National Standards for Involving Families, contact:

National PTA

33 North Wabash, Suite 2100

Chicago IL 60611-3690

Telephone: 312-670-6782.

The cost is $2.00 per copy plus $5.00 shipping and handling.

Free Flights

Delta Air Lines is partnering with United Way of America to sponsor the SkyWish program. SkyWish offers individuals with life-threatening illnesses free flights to where they can get the medical treatment they need. Since June 1995, travelers have donated more than 9 million of their frequent flyer miles through Delta to United Way of America, which converts the miles into free tickets and donates them to people who need to travel to get medical treatment. More than 160 families across the country have benefited from the United Way SkyWish program partnership.

Delta travelers may donate their frequent flyer miles in increments of 5,000 miles. To help boost the value of the gift, Delta adds one mile for every five miles contributed.

Donors should use the Delta award request form on their monthly Delta mileage summary to indicate the number of miles they wish to donate. For more information, contact Loretta Herbert at 800-892-2757 ext. 285.

Songs for AAC Users

Music from the Heart is a computer disk containing 13 songs (in both male and female voice pitch range) about living effectively with disability and seeing disability in the healthy context of human diversity. With this augmentative communication disk, AAC users are able to sing with their classes, perform solo works, and generally participate in the common experience of sharing music.

The songs are those contained in We're People First, Jeff Moyer's popular collection. Kevin Thomas of Fort Wayne, Indiana, took these songs and recorded them on an augmentative communication disk using several male and female voices. Kevin's daughter, Angie, is a teenager with cerebral palsy who uses an augmentative communication system.

For more information, contact Jeff Moyer at Music from the Heart; 888-323-0626; 440-449-4652 (fax); on the web at http://www.jeffmoyer.com.

Help with Hard Decisions

Even though Montana does not place children in institutional settings, some families still struggle with whether or not such a placement is in their child's best interests. Crotched Mountain Foundation of Greenfield, New Hampshire, has published a new guide for parents of children with severe physical disabilities. Titled Choosing Home or Residential Care, authors Marilyn Lash and Paul Kahn describe the benefits and drawbacks of home and residential care for the child and other family members. The benefits and drawbacks of residential care are frankly discussed and illustrated with many quotes from families.

The book includes a special section to help families choose a residential program with checklists for evaluation, and there is a final resource section to help families locate local, regional and national services and clearinghouses for information.

Available to families at no charge, except shipping and handling of $3.50, it can be ordered from:

Crotched Mountain Foundation

One Verney Drive

Greenfield NH 03047.

Contributors for New Chicken Soup Book

New York Times best selling authors, Mark Victor Hansen and Jack Canfield, creators of the phenomenally successful Chicken Soup for the Soul books, have teamed up with realtor, Ralph Roberts, to create the latest addition to their series. The new book will focus on people with disabilities. The authors are seeking contributors with stories.

The authors are looking for inspiring stories to encourage self-esteem and promote a feeling of self worth among individuals with disabilities. They need stories, poems and quotations by people with disabilities or by anyone who has had their life touched by a person with a disability.

A portion of the book sales will be donated directly to organizations that serve people with disabilities. Submissions can be mailed to Ralph R. Roberts Real Estate, Inc., Attn: Chicken Soup, 30521 Schoenherr, Warren, Michigan 48093. Contributors can also submit stories or receive more information by phone, 810-558-5369, by fax at 810-573-9845 and e-mail at ralphsworld@voyager.net.

Saturday Learning Strategies Sessions

The Montana Center on Disabilities is offering learning strategy sessions to students and adults who would like to increase their skills in test taking, reading comprehension, writing, and memorizing. Each session can be taken separately or in a series and is limited to 12 participants. The lessons include instruction, practice, and feedback. A $10 per session fee is payable upon registration and includes lunch. Students must register one week before each session. All Saturday sessions will held at the Montana Center on Disabilities, MSU-Billings, Special Education Building, Room 103 from 9:00 a.m. to 2:00 p.m.. Session topics are Writing Skills (March 14), and Memory Skills (April 18). For more information, contact Linda Wham at 406/657-2312 or 888-866-3822.

Job Corps, an Alternative

Job Corps is a U.S. Department of Labor program providing free vocational, educational, and social skills training for qualified youth aged 16-24. Students participating in the program can earn a GED and learn a trade at the same time. Centers serving Montana include: Anaconda, Missoula, Rapid City, Minot, and Salt Lake City. For more information, call Lisa Baus at 406/259-2322 or 1-800-544-5627.

Strategies for All

A new free resource, TeachEach: Classroom Strategies to Reach All Learners, is now available from the Charles and Helen Schwab Foundation. This booklet shares five teachers' innovative classroom practices that have succeeded in teaching&endash;and reaching&endash;each student in their classrooms.

To receive a free copy, call 1-800-471-9545.

DD Conference

The 1998 Montana Conference on Developmental Disabilities will be in Butte at the Copper King Inn on October 14-16 (same dates as MEA). The three keynote areas are: (1) self-determination, futures planning and transition, (2) parent perspectives, and (3) self-advocacy. For more information, contact Perry Jones at 406/444-5662 or pjones@mt.gov.

Spring Monitoring Conference

On May 11, 1998, the Division of Special Education will be offering a spring monitoring conference for those school districts which will monitored during the 1998-99 school year. This will be a METNET conference with two sessions, one from 8:00am to 12:00pm in Billings, Bozeman, Great Falls, Missoula, and Helena; and another from 1pm to 5pm in Bozeman, Glasgow, Glendive, Havre, and Kalispell. The materials packet for the conference will be mailed on or about March 20, 1998. The schools and cooperatives that will be monitored in 1998-99 include: Bear Paw Cooperative, Blue Sky High School, Chester, Dodson, Hays-Lodge Pole, Hinsdale, Malta, Whitewater, Central Montana Learning Resource Center, Geyser, Stanford, Plevna, Medicine Lake, Lockwood, Columbia Falls, Evergreen, Smith Valley Elementary, Swan Lake, Salmon, Trego, West Glacier, West Valley, Bozeman, West Yellowstone, Boulder, Montana City, Prickly Pear Cooperative, Townsend, Clinton, Frenchtown, Missoula Area Cooperative, Potomac, Ronan, St. Ignatius, Belt, Simms High School, Sun River Valley Elementary, Ulm Elementary, Park City, Rapelje, Fromberg Elementary, Red Lodge, Brady, Cut Bank, Glasgow, Lustre, Opheim, Geraldine, and Deer Lodge Elementary.

Open House and Dedication

CDC in Missoula will hold a special event on March 20, 1998 from 3pm to 7pm to dedicate a new building addition named in honor of Michael Morris. Michael was Executive Director for CDC from August of 1977 to September of 1985. Prior to his death, he was Justice of the Peace for Missoula County. Michael was instrumental in developing community-based programs for individuals with developmental disabilities. Ann Mary Dussault will offer the dedication speech. There will be an open house for CDC's new Respite House and CDC office. For more information, contact CDC at 406/549-6413.

SAMS (Sensory and Motor Stimulation) Riders

SAMS Riders, Inc. of Kalispell (therapeutic horseback riding program), announces that they are now taking applications through the Human Therapy on Horseback (HTH) program. HTH is a nonprofit fundraising group. The applications are to help fund a portion of each therapeutic riding session.

If you are interested in receiving an application, contact CDC's Kalispell office (406/755-2425) or:

HTH

P.O. Box 1541

Whitefish MT 59937

Telephone: 406/881-4192.

If you would like more information on therapeutic horseback riding and the positive effect it can have on your child, contact Bob or Timi Burmood at SAMS Riders, 406/752-6716.

Part C Focus Group Needed

Lizabeth Vincent, special education researcher, has received a grant from the Harbor Center in California to develop a set of learning materials which would help families who are entering Part C, Infant Toddler Services. Jan Spiegle Stinger, Coordinator for Part C services in Montana, and Ms. Vincent invite parents, as well as service providers, to share their expertise and experiences in helping to design these materials for new families. Lizabeth and Jan are planning both in-person and teleconference focus groups. There may be funding to help with travel reimbursement. If you are interested in helping, please call Jan at 406/444-2995.

OT Call-In

On Monday, April 6, 1998, between 8am and 5pm, EDST, occupational therapy professionals will be on the line to answer your questions and direct you to resources to meet your needs. Call the American Occupational Therapy Association toll-free number (1-800-668-8255) for information on dealing with health problems that interfere with daily living.

Families Learning with Families

The Montana School for the Deaf and Blind is sponsoring an educational weekend for families of children with hearing impairments on June 5, 6, and 7. Topic areas to be covered include:

• Parent rights and responsibilities under IDEA
• Information about the CST/IEP process
• Up-to-date information about deafness
• Forum for parents to discuss their concerns
• Introduction to assistive technology
• Information for siblings
• Opportunities to interact and share ideas with deaf adults
• Sex education for the deaf child
• Community involvement for families.

For more information, call 406/771-6000 or contact:

Sarah Eyer, Outreach Coordinator

P.O. Box 724

Boulder MT 59632

Telephone: 406/225-4373 (V or TDD).

New Book for Siblings

Views from Our Shoes is a new book for siblings of children with disabilities. Forty-five siblings share their experience as the brother or sister of someone with special needs&endash;the good and bad aspects, as well as many thoughtful observations. The children whose essays are featured in the book range in age from four to eighteen and are the siblings of youngsters with a variety of special needs including autism, cerebral palsy, developmental delays, chronic health conditions, attention deficit disorder, hydrocephalus, visual and hearing impairments, Down syndrome, and Tourette's syndrome.

Views from Our Shoes: Growing Up with a Brother or Sister with Special Needs was edited by Donald J. Meyer of the Sibling Project. The book is 114 pages long and is written at a reading level for grades 3 through 7. To order, send $14.95, plus $4.00 shipping and handling to:

Woodbine House

6510 Bells Mill Road

Bethesda, MD 20817

or call 800-843-7323 and pay by VISA or MasterCard.

Pros and Cons of Herbal Remedies

The use of herbs as an alternative to drugs or medications has become a $1.6 million industry in the United States. Among the herbs which have become popular alternative remedies are:

Aloe Vera. Long noted for its effectiveness for burns, aloe has more recently been used for canker sores, though evidence of its effectiveness is largely anecdotal.

Aloe Vera is recommended to be used only externally until more research has been done on its use for more serious conditions.

Evening Primrose Oil. This oil has been shown in some small studies to be useful for arthritis, inflammatory bowel disease, chronic fatigue syndrome, and multiple sclerosis; however, it is used most often for eczema.

Dermatologists disagree about its effectiveness but several studies suggest that 4-6 grams taken by mouth daily improves the condition in adults. It is unknown whether this dose of the oil is safe or effective in children. Reported side effects include upset stomach, diarrhea, and headaches, but these have been minor and uncommon.

Tea Tree Oil. The antibacterial and antifungal qualities of this oil make it a popular topical acne treatment; one study showed that it is comparable to 5% benzoyl peroxide for acne treatment.

As an antifungal agent, tea tree oil has been shown in several studies to be as effective against the symptoms of ring worm, athlete's foot, jock itch, and yeast infections as most medications. However, the herb has not been shown to be as effective in eradicating the fungi.

Tea tree oil should be diluted when it is used on the skin to avoid irritation, and it should not be used internally, as little as 1 teaspoon has been known to cause coma in children.

Ginger. This herb is most often used for nausea, for warming, and as an anti-inflammatory. Toxicity is very rare with ginger, although there is some potential for the herb to cause allergies and stomach irritation.

Chamomile. Historical anecdotal evidence suggests this is effective as a calming or sleeping aid, for upset stomach, and for colic.

Side effects seem to be extremely rare and solid evidence exits to show that it is safe as a mild sedative.

Goldenseal. Numerous randomized, controlled trials have shown goldenseal to be potent in treating diarrhea, including bacterial diarrhea from cholera and Esherichia coli. However, there are not comparisons with the effectiveness of traditional antibiotics.

Goldenseal should not be used in newborns because it can cause jaundice.

Feverfew. This herb has been used effectively for migraine prevention. Daily dosages of dried preparation must be taken for 4-6 weeks before effects are seen, so it is recommended only for those willing to use it long term; discontinuance can cause rebound headaches. Feverfew can cause oral ulcers.

Lavender. This mild sedative has a pleasant smell and low toxicity&endash;except when taken internally&endash;that make it especially useful for calming children.

The difficulty with using herbal remedies is that it is difficult to determine what an appropriate dose might be for a particular individual. Herbal remedies purchased in health food stores are not regulated for dosage, potency, and purity the way that standard medicines are. The use of herbs, therefore, requires experience and knowledge in order to be done safely.

Making the Most of Trips to the Doctor

Many parents of children with special needs express frustration concerning their interactions with physicians. They complain of being kept waiting, doctors ignoring their concerns, or doctors showing a lack of interest in their child's special needs. When parents have so many appointments to keep and so many professionals with whom they must interact, it is annoying to have an unsuccessful visit to the doctor.

There are ways, however, that parents can be more certain that a doctor visit will be productive. Some advance preparation can make all the difference. Here are some suggestions from other parents who feel that have good relationships with their children's doctors:

Get Acquainted. If your child is seeing a new doctor, schedule a "get-acquainted" visit first. Take this time to ask the doctor questions about his or her views on immunizations, discipline, alternative medicine, medications, children with disabilities, or any other issues or concerns. Also, take this time to ask questions such as: What are the office hours? What do I do when my child needs care on weekends or during the night? Make a list of your questions and take it with you to your appointment.

Extra Care. Children with disabilities often require extra care from a physician. Make sure you choose a doctor who will help you network with other families and one who will consult with the variety of specialists your child may need.

Call Ahead. Anytime you need to see a specialist, have your doctor call or write ahead to discuss your child's case. Also, keep all records in one easy-to-find place. Then, ask the specialist to review a copy of the records prior to your visit. The result will be a more productive appointment, and it saves you from having to repeat your child's history.

Routine Visits. When calling to schedule an appointment, ask for extra time to talk about issues of concern. Let the staff know the purpose of the visit and why you need extra time. This will allow them to schedule an appropriate amount of time, and you will not feel like you are being rushed.

Write Out Questions. Write down questions you may have prior to your visit and ask your doctor to review them before you arrive. Send the questions in the mail, or send a fax to your doctor's office. If your child is sick, bring your list of questions but address the immediate problem first. Then, as time permits, refer to your list of other concerns.

Side Effects. If your child's doctor prescribes medication, ask the doctor about possible side effects and how new medications may interact with current medications. Don't forget herbs are drugs too. Make sure to tell your doctor if your child is taking herbs (or any other substance) on a regular basis.

Know Your Child. It is important to obtain knowledge regarding your child's disability. Know what treatments, therapies and medications might be available. This will aid in asking informed questions of your doctor and can ultimately provide your child with the best possible care.

The Internet is a great source of information on disabilities. If you don't have personal access to the Internet, call the PLUK Library and Janice, the librarian, will do a search for you.

Speak Up. Don't be afraid to speak up if you don't understand your doctor's instructions or terminology. If you have concerns with the doctor's recommendations, voice them at the time of the visit. Remember, although a professional diagnosis is important, you know your child best.

Be honest. If you feel your questions are not being answered, or you are having problems with the staff, let your physician know.

Make a Change. If you have tried your best with a particular doctor and things are not working, don't hesitate to try another physician.

Parents Are Powerful

Parents are Powerful is a new resource from the Center for Law and Education. It provides parents with user-friendly information on how to get involved in their children's education and explains how programs such as Title 1, School-to-Work and IDEA can promote academic achievement. For more information, write to:

The Center for Law and Education

1875 Connecticut Avenue, NW, Suite 510

Washington DC 20009.

Concerns About Children

Public concerns about the most important problems facing America's children don't match up with expert opinion, a survey by Harvard University, the Robert Wood Johnson Foundation, and the University of Maryland found. Of 1,501 adults surveyed, 56% listed "drugs" as the biggest problem for children 24% named "crime," and 22% cited "home life breakdown and related problems." Neither child poverty nor health care ranked in the top 10, even though many experts in the medical and educational realms feels those are the biggest problems facing children.

Promoting Involvement of Fathers in Educational Programs

Family roles have changed. It used to be that mothers had almost the exclusive responsibility for caring for young children and interacting with child care and educational programs. But this pattern is changing. Today's dads often express a desire to be more intimately involved in their children's lives. Many fathers share responsibilities with mothers for basic child care and nurturing. Yet even though more fathers are involving themselves more in their children's lives, over half of all fathers in two-parent families have no significant involvement in their child's school life. That number rises to 82% when discussing fathers who do not live with their children.

Couple that fa