What's New/News:                                             Vol. 2, Issue 1

ADVOCACY NEWS

HEARING IMPAIRMENTS AND INTERPRETERS

Sign language is by no means a uniform language and many, many individuals with hearing impairments do not use sign language. In fact, with an aging population, the majority of individuals with a hearing impairment have lost their hearing gradually as they aged. These people understand auditory language and generally do well with their hearing aids or writing. The percentage of people who do use sign language have variable abilities and comprehension levels. Therefore, any interpreting to a group must be geared toward a diverse audience. Interpreting should include sign language as well as other visual means of communication and the written word. The auditory message should be delivered with the highest quality sound possible in an acoustically agreeable environment i.e. if one must choose between a wood floor or a carpeted floor in which to make a presentation, the acoustically preferable environment would be the one with a carpeted floor all other factors being equal.

If the communication is made to individuals by telephone then the written word is often the best method. Most individuals with hearing impairments have a device they can use to communicate by typing/reading. In Texas, we have a system called Texas Relay. A hearing individual can call a "middle man" who relays the spoken message by way of a TTY or TDD that has a visual, typed display. Or, a deaf individual can call a person with average hearing and a "middle man" will accept the message that is typed and use his voice to relay the message.

One more thought regarding deafness -- Be sure to have an interpreter who meets the needs of the audience. For a general audience, a general interpreter will do. For medical interpreting, one needs an interpreter with specific skills. For legal interpreting, one needs a highly specialized interpreter. Interpreters are certified by State and National organizations that determine the skill level of the interpreter. For more information, contact the Texas State Interpreters for the Deaf or a similar organization in your State.

BIPOLAR DISORDER IN CHILDREN

As a result of a child with whom I am working, I have been introduced to a new medical/diagnostic debate. That debate can be boiled down to two questions. Does bipolar disorder in children manifest itself differently than it does in adults? And, is bipolar disorder in prepubertal children mistakenly diagnosed as ADHD? Both questions are being hotly debated at this time, and both sides have excellent arguments.

First, let's define the disorders. Bipolar disorder involves "very rapid alternation (over days) between manic symptoms and depressive symptoms" according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) written by the American Psychiatric Association. DSM-IV states that the manic (euphoria, irritability, high activity) symptoms can occur without the depressive symptoms. Generally, the individual has enormous mood swings that are quite noticeable.

ADHD is Attention Deficit Hyperactivity Disorder, which is much more common in children. ADHD consists of difficulty paying attention combined with a high activity level that often interferes with learning. These children have a hard time concentrating. They tend to be fidgety. They also tend to drive teachers up a wall because they are so active. These are children who were not meant to sit in a classroom desk for long periods of time (defined, by me, as over a few minutes). They can be maddening. However, they do respond to medications (like Ritalin) that help them concentrate.

The argument, advanced by Joseph Biederman, M.D., Professor of Psychology at Harvard Medical School and Chief, Joint Clinical Research Program in Pediatric Psycho-pharmacology, Massachusetts General Hospital and McLean Hospital, is that doctors mistake childhood bipolar disorder with ADHD. He claims that one fourth of children with ADHD have bipolar symptoms as adults.  Therefore, he states, the ADHD diagnosis is incorrect. The children had prepubertal bipolar disorder but that disorder is manifested differently than the adult bipolar disorder. As children, these individuals tend to be basically manic. They are highly irritable with affective "storms" or tantrums. The depressive symptoms are minimal. Biederman concludes that people who had serious or "bad" ADHD symptoms as children and later became adults with bipolar disorder actually had bipolar disorder from childhood (misdiagnosed as ADHD). These individuals were, and remain, bipolar. Since the manifestation of both disorders is so similar, Biederman claims that the ADHD diagnosis is an understandable error. He believes that the treatment should be for bipolar disorder early in life.

His opponents disagree. They argue that ADHD is co-morbid with (combined with, in addition to) bipolar disorder in children who later are diagnosed with bipolar disorder. They also argue that since the DSM-IV diagnosis is not met by the child, the child develops the bipolar disorder later in life.

The arguments are both well explored and researched. It will be interesting to see which side comes out on top. In the meantime, I am working with real people with real needs -- a mother and child. The child is diagnosed with bipolar disorder. The child meets Dr. Biederman's criteria for bipolar while manifesting features of ADHD, Oppositional-Defiant Disorder, Separation Anxiety Disorder and Dysthymic Disorder.

The child's psychiatrist does not agree with the school's diagnosis, which does not label the child bipolar. They are arguing vocabulary. As a teacher and administrator, I have always looked at the child. How do we help her? What methodologies work with the individual child? What does she need from us to help her learn? More importantly, what does she need from us to lead a "normal", productive life? That is where the argument needs to concentrate. Anything else is merely words.

The psychiatrist recommends small group or individual instruction. He recommends a quiet, structured environment. He knows the child. His opinion should be valued. After all, a school runs most smoothly when the children’s' needs are being met--when children are learning and progressing in a positive environment. Expert advice should be considered and, with few exceptions, followed in order to facilitate the goal of meeting the needs of the children or, in this case, a child.

The school personnel, however, have their own goals and concerns. They must meet the needs of the children, the school and the district. The district cannot focus all of its resources on only a small number of children. Therefore, school personnel are very reluctant to make recommendations that are costly. Individual and small group instruction is expensive. On the other hand, school personnel must consider the individual needs of the child. Together with the parent, school professionals must develop an individualized education plan (I.E.P.) that addresses the educational and social needs of the child. That I.E.P. must also be based on the assessment -- not so much the diagnosis, but rather, on the recommendations of the professionals.

In the case of this one child, we will face the task of taking the recommendations of the school professionals and the professionals that work with the child outside of the school to develop an I.E.P. that will make the child successful in school and begin the transition of the child from school to a productive adult life. If we can focus on what has worked (at home and at school) and what is recommended by professionals (both in the school and outside of the school) who interact regularly with the child, then an appropriate education plan can be achieved regardless of a very interesting psychological debate over the actual diagnosis.

WHAT HAPPENS NOW?

I met some old friends this month who have an unusual problem. They have a nine-year-old child who is severely disabled. The child has lived with this couple since she was an infant; however, they do not have legal custody of the little girl. The biological parents abandoned the child in a hospital, signed and notarized documents relinquishing their parental rights and have never contacted the child again. Unfortunately, they neglected to file the relinquishment documents with the court leaving the child, and this couple, in an odd legal position. This couple definitely wants to adopt the child. The child has never been in the government system (in Texas, the Department of Protective and Regulatory Services) nor in a private placement system. The couple has contacted two local attorneys who have not been able to help. The child seems to be in the position of a square peg that needs to fit into a round hole.

I wish I could tell you the ending to this story. It covers both the legal and disability areas so you can bet I will be very involved in solving this problem. I'll let you know how it all turns out. Watch for an answer in my February newsletter. (I will accept advice on this one if anyone has any.)

Take care,

Karen

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