Monterey Bay Forum

Hearing loss in babies has huge effects on their general development: hearing loss impacts language acquisition, speech, psycho-social well being and overall learning.

Research shows that the critical time to stimulate the auditory and brain pathways is during the first six (6) months of your child’s life. So pay particular attention during your child’s first six months that he or she continues to hear normally.

The good news is that children with all degrees of hearing loss — who receive appropriate interventions prior to 6 months of age– can obtain speech and language skills comparable to their normal hearing peers when age 3 years.

What parents can do:
Check and re-check that your baby’s hearing remains normal. Visit your pediatrician for screenings as your doctor recommends. Research recommends hearing screening every 2 months until age one year — and every three months until age two.

Keep this in mind:
Even mild hearing loss can significantly interfere with the reception of spoken language and educational performance. Research shows that children with one ear hearing loss are ten (10) times as likely to be held back at least one year compared to children with normal hearing.

Many children are affected with ear infections: Chronic otis media (ear infections) affects 5 – 30% of children age 6 to 11 years and can persist 4 – 5 months with or without medical interventions.

Watch for possible symptoms of hearing and ear problems. Does your child: Tug at his/her ear; turn side of head towards parent; appear inattentive; strain when listening; make frequent mistakes following directions; day dreams; tend to isolate; tire easily; talk too loudly or too softly; have a speech problem; appear passive.

Does your child appear to have pain in their ear? Do you see redness or drainage from the ear?

Methods to assess for hearing loss in young children:

Otoacoustic Emissions Technology (OAE)

Otoacoustic Emissions is a hearing test that uses a small probe inserted into the external ear to introduce a sound stimulus (series of beeps) and measures the response sound, like an echo, emitted by the inner ear (cochlea) of a normal hearing person. The cochlea of a person with a hearing loss greater than 25-30 dB does not emit a sound in response to a sound stimulus.

Many studies have shown that screening children 0 – 3 years of age may be beneficial with OAEs. The OAE technology is very good for children who are unable to respond to a sound by raising their hand or dropping a toy in a bucket to indicate a response to the stimulus.

Children with developmental delays [possible autistic spectrum issues, possible intellectual disability] may not understand or often refuse to follow simple directions. OAE may be a useful screening for children with developmental delays.

Note that OAE may not detect mild hearing loss (20 dB to 40 dB) which may affect performance in school. The gold standard for screening children over age three is with a pure tone audiometer conducted by properly trained personnel.

To summarize: Parents can greatly reduce possible hearing loss in babies and young children with appropriate interventions. Know why its so important that children hear normally. Get medical attention immediately when young children appear to have difficulties with hearing normally.

Take children for routine screenings every 2 months during first year or as your pediatrician recommends. Watch for signs of possible ear infection and behaviors that indicate difficulties with hearing. Knowledge, parent involvement and appropriate medical interventions to improve hearing are particularly crucial during your child’s first six months. Parents can do a lot to reduce hearing loss in babies and young children.

In CA, children with developmental delays are typically referred for Early Start services. Early Start services are provided through the government from birth until the child turns three years old.

Roughly 70% of the children referred for Early Start services in CA are due to speech delays.

And, a very important medical questions is: Can this child hear normally? If a child applying for Early Start services cannot hear normally different medical interventions are needed to address hearing loss.

In Santa Cruz County assessment for Early Start services is done via various vendors. These vendors provide assessment reports concerning the overall development of the child/ applicant for Early Start services.

Whether or not the applicant for Early Start services can hear normally is vital to determining the appropriate kind of services to provide to the child.

Any parent who applies for Early Start services in Santa Cruz County should check with the vendor and whoever receives the assessment report and inquire about their child’s hearing abilities. Was the child’s hearing abilities screened? Can the child hear normally? And if the child does not hear normally, what appropriate medical services are recommended?

Remember the first sentences of this post: Hearing loss in young babies has profound effects on the general development of a child. And, parents can help in many ways so that their child hears and develops normally.

written by DrCameronJackson@gmail.com

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The overall goal is to get everyone on the same page: you as parent, MD, therapist, regular ed and special education teacher(s), school nurse, school psychologist, and any government agencies that are involved (e.g., County Mental Health, Child Protective Service for children in foster care).

Unfortunately, what often happens is that the left hand does not know what the right hand is doing. You as parent need to get in the driver’s seat and see that all the “horses” – school, professionals, hospitals, government agencies — move ahead in the right direction.

And that should include that everyone knows what the others have learned. So, make sure that Releases to share information are signed so everybody can communicate, receive records and communicate.


Here’s an example. An elementary school child is in foster care and receives services through Child Protective Service and County Mental Health. To clarify diagnosis the County wants the child to go to nearby Stanford Hospital (LPCH). So what needs to happen? Hopefully, CPS and County Mental Health will see that their mental health records together with the the child’s pediatric MD records and appropriate school records accompany the referral.

Another example: You as parent have concerns and go to your pediatrician. The pediatrician thinks that your child needs additional assessment and your doctor refers to a large, near by hospital complex (UC-SF, Stanford Hospital, Kaisier Permanente). Be sure that you as parent take along with you all relevant school assessments, school grades, and medical records. Get all the players on the same page. And be sure that all the players can talk to each other and exchange information.

Here’s some general ‘how to’ directions for parents of a child with ADHD or Autistic Spectrum Disorder (ASD):

Start with a physical exam by your pediatrician to make sure there are no physical reasons for child’s problems with concentration, attention, focus and organizational problems.

Next, get appropriate assessment of your child for symptoms of ADHD and Executive Functioning abilities. Some pediatricians and psychologists are trained to do appropriate assessment.

Have your MD or psychiatrist write a brief letter to child’s school.
The letter needs to state that the child is under the care of ____ doctor (MD) or psychologist (Ph.D.) and that it is the professional opinion of _____ that the child’s educational performance is significantly impacted by ____ and ____.

Take several copies of the letter from your doctor to your child’s school. Be sure that copies go to: school nurse, teacher, school psychologist & principal.

Make sure that the letter from MD or psychologist including diagnosis of ADHD or Autistic Spectrum is part of your child’s regular education CUM file. That way the school nurse can monitor as needed.

In a separate letter addressed to Special Education at your child’s school (include child’s date of birth, complete name of child, address, telephone number, email address,) ask that your child be identified as Other Health Impaired student. Ask for appropriate assessment by the school. Also ask for a 504 Plan available under the Americans with Disabilities Act. Be sure to date that letter and keep original in your file.

If you do not hear back in two weeks send another copy (with a Second Copy in red) to the school principal and child’s teacher. Typically the second letter gets a quick response.

Of course, be polite and understanding and remember that in these times of substantial change in the economy every school dollar is stretched more than it was.

Your child with ADHD and Autistic Spectrum issues needs your guidance to successfully learn at school.
Questions?

Contact Dr. Cameron Jackson DrCameronJackson@gmail.com

Some simple techniques can assist children with attention deficit hyperactivity disorder (ADHD) and/ or autistic spectrum disorder (ASD)to be happier and achieve appropriate goals. These techniques are easy for parents and teachers to implement.

Of course a child is not a car but think of the following analogy:

Every car to get to a destination needs a driver. Parents can assist children to get into the driver’s seat and drive their ‘car’ to appropriate ‘destinations’.

Here’s how to assist children who have difficulties with focus, attention, concentration, ‘executive functioning’ or ‘working memory’ difficulties. Executive functioning and working memory are words used by school psychologists. What the parent sees is a child who can’t seem to figure out what comes first and appear disorganized.

What to do: Get a pad of 8 by 12 inch lined paper.

On one per sheet of paper —
1) Write at the top, a Goal that parents/teachers want the child to achieve.
2) Write out all the Steps required to accomplish the Goal.
3) Order the steps from first to last using KISS (Keep It Simple, Simple)
4) Figure out an appropriate Reward for child accomplishing the steps.
Set it up so child can get partial reward for partial completion.
5) Decide the number of Days child needs to complete the Goal.
6) Draw up a Graph with Days across Top of Page and Goals listed on left.

Here’s an example of a Behavior Plan for a child who shows symptoms of both ADHD and ASD:

Gina is 8 years old and was exposed in utero to illegal drugs and alcohol. Her biological mother lost parental rights and Gina has been in foster care since age two. Since age four, Gina has received County Mental Health therapy and medication to assist with focus, attention and concentration. The therapy provided by County Mental Health focuses only on helping Gina to label emotions and better express her emotions appropriately.

Gina’s foster mother and her teacher agree that Gina’s adaptive functioning abilities are considerably below what they expect for her age. Her foster mother wants Gina to 1) wash her face & brush her teeth; 2) make her bed; 3) put toys in basket in her room; 4) set the table with utensils and plates before dinner.

Goals:

Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Wash face & clean teeth
Make bed
Put toys in basket
Set table with utensils & plates

Spiritual/ religious beliefs need to be integral to a successful Behavioral Plan.
For example, Gina’s foster mother goes to church and rests on Sunday. Therefore the behavior plan is for six days a week and no work on Sunday, their day of rest. Six days a week time four goals = 24 Goals for Gina to achieve. For each Goal achieved she earns one (1) dime. During the week she puts stickers on the sheet and gets her motivators (dimes) which she puts into a plastic, clear jar. That way she can see exactly what she has earned towards a new toy on the weekend. Her foster mother believes Gina can find age appropriate toys for around $2.50 to $3.00 a toy.

What makes a Behavioral Plan successful?
The answer is simple: practice and more practice so the Steps are as simple as possible and the child gets rewarded for partial and then complete finishing the Goal.

For example, Gina when we started could not make her bed said her foster mom. Well, the cover was too big and too heavy for a thin, small 8 year old to move around. Thus, by simplifying and making a bed simply tossing a light duvet (down comforter) on a twin bed and putting the pillow in place — then making a bed by an 8 year old is simple and possible.

A second example:
Gina has never set the table for dinner. Part of the reason is that the plates are too high for her to reach and they are china easily breakable. Also, the utensils are not easy to get to. This is easily solved by moving plastic plates and smaller folks and spoons to one drawer that the child can reach. The point is to set it up so the child can successfully achieve the Goals.

Overall point: Parents can set simple ‘destinations’ for their child to drive their ‘car’ towards and by keeping the steps simple and practising the steps again and again their child can achieve those destinations to goals that parents set.

Very important: the hugs and ‘You did great!’ and ‘Keep trying!’ are as important and at times more important than any reward system. Parents – whether biological parents or foster parents – are the fire to ignite important, life long change in children.
Send comments to DrCameronJackson@gmail.com

[youtube]http://www.youtube.com/watch?v=flRvsO8m_KI[/youtube]

Cerebral palsy is overcome by this family’s commitment.

Unions sue state for more school funds
By Sharon Noguchi, Mercury News

“To secure billions of dollars in additional funding for education, two school employee unions filed a lawsuit against the state of California on Thursday.

“The lawsuit argues that the state must repay schools the amount it’s taking away — and sooner than other funding schemes would allow.

“Faced with a state budget crisis, Sacramento has taken $8.6 billion from K-12 and higher education over two years. The lawsuit argues that the state must repay much of that, and cites a 1988 voter initiative that guaranteed minimum funding for education.

This week, the state Department of Finance suggested that schools may lose an additional $3.6 billion.

That threatened reduction “made it imperative to file” the suit, said Marty Hittelman, president of the California Federation of Teachers, which filed the suit in San Francisco Superior Court. It was joined by the Service Employees International Union Local 99, in Southern California, which represents janitors, secretaries and other support staff. The CFT represents about 100,000 teachers, librarians and other credentialed school employees, and is the smaller of two unions representing public school teachers in California.

Hittelman denied that the CFT filed the suit after polls showed most of the six propositions on the May 19 ballot badly trailing. Two of those, Propositions 1A and 1B, are key to funding education. Prop. 1B sets how much the state owes education and outlines a repayment schedule.

Even if 1B passes, the teachers union argues that schools would be shortchanged by freezing the repayment amount at $7.9 billion and deferring repayments until 2011-12.

The lawsuit argues that the state uses the wrong formula to determine whether schools will be reimbursed in the future for reduced funding.

H.D. Palmer, deputy director of the state Department of Finance, said the state owes school districts money for 2007-08, but not the current school year. “The Constitution is straightforward in this regard.”

Contact Sharon Noguchi at snoguchi@mercurynews.com or 408-271-