The Pediatrician’s Role in Development and Implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP)

Several roles for the pediatrician exist under IDEA

If you have already gone through the IEP process and signed off, it isn’t too late! At any time you can “request an IEP meeting to reopen your child’s IEP.” One reason for this could be due to “change in diagnosis.” Another may be new information that has come to light. We have an entire chapter in The Late Talker book with a wealth of valuable information in this area. In fact, I highly recommend you bring a copy of The Late Talker book with you to your IEP meeting and have relevant pages tagged for reading such as the severity intervention matrix which was developed for school based speech language pathologists. Here are a few brief tips to prepare for an IEP meeting…

1. Document everything which in legal terms means to create a paper trail. Keep track of dates of not only each meeting and who you are meeting with, but each phone call and what was said. You can keep track of some notes online but be prepared for lots of paperwork! If you have to get a small file cabinet just for all the paperwork from evaluations and recommendations from private and school professionals look into doing that because it will make it easier to find certain documents quicker. You and your spouse are part of the IEP team so you have to agree and sign off on the IEP as well. The school professionals will document their opinions, but they may or may not document yours, so keep notes and tape record meetings. You have to inform the school you will be recording the IEP meeting as they will then have to have a tape recorder as well. Bring extra batteries and tapes if needed. The reason you can be recording an IEP meeting doesn’t necessarily mean you don’t trust your school’s professionals, it can be because you don’t understand all that is being offered and wish to share the recording with your child’s private SLP (or someone else) who was unable to attend the meeting.

2. Stay professional, calm, and present the facts from your child’s private professionals as well as the published literature on your child’s diagnosis.

3. Have a photocopy of your child for each member of the IEP team, or laminate a photo and put it in the center of the table to bring a face to the IEP. When the meeting starts, say something like “We’re all here for the same reason; to have (your child’s name) schooled in the mainstream as quickly as possible if that is ever possible. It is the opinion of experts in the area of speech and language (or name his diagnosis) that the best possible prognosis of (your child’s name) being mainstreamed from kindergarten on will be by providing him appropriate therapy and placement through his IEP based on his individual needs.”

4. Use correct terminology to describe what you want. You will want to say “best” in regards to your child, but the school does not need to provide the best therapy or placement for your child, only what is appropriate. So each time you catch yourself wanting to say “best” replace the word “best” with “appropriate.” Anytime you catch yourself wanting to say “worst” or “wrong” just replace those words with “inappropriate.” It doesn’t matter how often you use the words appropriate and inappropriate in one sentence as this is the legal language that would hold up in due process if you ever needed to go that route for advocacy for your child, and a language respected by the school professionals.

5. Know the law as best you can. IDEA has very specific guidelines for an IEP meeting, the reporting of it, the conduct of it, the members of it. In addition to reading The Late Talker book, there are various websites that can help such as www.wrightslaw.com. During your crash course in special education law 🙂 learn as best you can the meaning of the words individual, goals, objectives, out of district placement, independent evaluation, IDEA, FAPE, LRE, ESY, and whatever else is relevant for your child’s needs so that you can appropriately use the correct terminology during the IEP meeting.

6. Have copies of your child’s private SLP, MD and other evaluations and letters for each member of the IEP team. Your child’s private SLP, for example, may wish to include short term goals for your child which were missing in the current IEP. Perhaps she added 3 month goals that she believes are appropriate for your son. It’s wise to have short and long-term IEP goals so that you don’t potentially waste a year before learning that goals are not being met. If goals are not being met in the short term another IEP meeting can be scheduled to reevaluate therapies, or even therapist and placement. There are many alternatives for when IEP goals are not being met if the therapist or placement is found to potentially be inappropriate. Bringing in outside experts to train the staff and/or work with the child. Sending the child to private outside therapy paid for by the school. Out of district placement at another public or private school that is paid for by the school. By advocating any of these alternatives and more can be alternatives to the current situation if found and agreed to be appropriate for that child.

7. Organize your presentation. If your child’s outside professionals do not agree with the current IEP you and your spouse signed (or you learned more and changed your mind,) list key points of focus in bullet form. Use documentation and letters from your child’s outside professionals as well as pertinent legal documents to cover his entitlement to a “Free and Appropriate Public Education” or FAPE in the “Least Restrictive Environment” or LRE. Your school should also have provided you with a parent’s handbook for the IEP.

8. Ask for documentation for any statements you don’t agree with. If something is said such as “We don’t provide extended school year here” during an IEP meeting, just ask “That’s interesting that you don’t provide extended school year here. I had thought that was part of my son’s FAPE if found appropriate. Would you mind putting that in writing for me and explain why?” Or if you know the issue already they will bring up that you agree with, jot down notes so you can say something at the IEP meeting like one parent suggested “Gosh, the way I read the IDEA document, under section 300.502, page 62, I do have the right to request an independent evaluation at public expense if I disagree with this evaluation. Can you respond in writing as to why that doesn’t apply in this case?”

9. Understand and agree with the IEP before you sign it. Don’t allow them to say things like, “sign this paperwork for now so we can get started and we can make adjustments later if needed.” IEPs should always be adjusted as and when needed, but as it’s a legal contract between you and your child’s school which is what therapy and placement is to be provided you want to make sure it’s appropriate to start. You should share it with your child’s private professionals as well for input prior to signing it.

10. Lastly, follow your gut. If something doesn’t seem right, go home and do some research, ask questions. Nobody is going to care as much about your child’s future success as you and your spouse; his Mom and Dad. You are an important part of the team that is there to help bring him a voice!

About the outside the school evaluations I highly recommended that you seek for your child if there is a communication impairment such as apraxia or autism suspected. While many are aware they can bring evaluations from their child’s private SLP to IEP meetings to help advocate for appropriate therapy and placement, many are not aware that their child’s pediatric medical doctor can also provide advocacy for your child’s rights for appropriate services in school.

Since the question will be “how” your child’s doctor can be relevant in an educational setting to help advocate for appropriate therapy and placement for your child’s IEP in the US, the following is from the American Academy of Pediatrics guidelines in this area. Also even though I use the word “pediatrician” the following applies to any doctor working with your child. Neurologist, developmental pediatrician etc.

The Pediatrician’s Role in Development and Implementation of an Individual Education Plan (IEP) and/or an Individual Family Service Plan (IFSP)

Committee on Children With Disabilities

ABSTRACT

The Individual Education Plan and Individual Family ServicePlan are legally mandated documents developed by a multidisciplinary team assessment that specifies goals and services for each child eligible for special educational services or early intervention services. Pediatricians need to be knowledgeable of federal, state, and local requirements; establish linkages with early intervention, educational professionals, and parent support groups; and collaborate with the team working with individual children.

Abbreviations: IDEA = Individuals With Disabilities Education Act • IEP = Individual Education Plan • IFSP = Individual Family Service Plan • OHI = Other Health Impaired

Special education in each local school district is protected and regulated by strong legislative and judicial safeguards created by the federal Education for All Handicapped ChildrenAct (PL 94–142). This act was reauthorized in the 1991legislation PL 101–476 under the new title, Individuals With Disabilities Education Act (IDEA), which has four key components:1) identification of children with learning-related problems;2) evaluation of the health and developmental status of the child with special needs, determining current and future intervention requirements, and developing a plan to match services to needs;3) provision of services that include educational and related services; and 4) guaranteed due process.¹ These federally legislated safeguards establish that children with disabilities and their parents share the same legal right to a free and appropriate education as children without disabilities.

Federal legislation requires that each child recognized as having a disability that interferes with learning has a written plan of service: an Individual Education Plan (IEP) for children aged 3 through 21 years, an Individual Family Service Plan (IFSP)for infants and toddlers birth through 3 years, and a TransitionalServices Outcome Plan for young adults at 16 years of age. Federal legislation defines transition from school as a coordinated set of activities for a student-designed to promote movement from school to postschool activities, including postsecondary education, vocational training, integrated employment, continuing and adult education, adult services, independent living, and community participation. This transition plan highlights and validates the lifelong needs of individuals with disabilities and is the beginning of an integrated program that enables adults with disabilities to live, work, and play in our towns and cities.² The pediatrician is in a key position to participate in planningservices and to provide care for these children and young adults.

BACKGROUND

The Individual Education Plan (IEP)
In 1975 Congress enacted PL 94–142, the Education for All Handicapped Children Act, as an educational bill of rights to assure children with disabilities a free and appropriate education in the least restrictive environment. In 1977 implementation of services was extended to children 3 to 21 years old, although services for children aged 3 to 5 years remained optional. States were also requested to identify children who had not previously received services.

PL 94–142 (currently Part B) allowed children with mental retardation, hearing deficiencies, speech and language impairments, specific learning disabilities, visual impairments, emotional disturbances, orthopedic impairments, and a variety of medical conditions that may interfere with education (categorized as Other Health Impaired [OHI]) to receive special education services.To meet the eligibility criteria, a child’s disability must interfere with the educational process and normal school performance to the extent that special education assistance is needed.

Other portions of the law provide the following:

Every child must have a multidisciplinary evaluation by a team.This team, working in collaboration with the family, is responsible for designing an IEP that has specific education and therapeutic strategies and objectives. Each plan must be reviewed annually.
Every child must be educated in the least restrictive environment.This criterion supports the concept of integrating children with and without disabilities as much as possible and with extra supports and services when necessary to facilitate inclusion.
The evaluation team may recommend the following related services:transportation; developmental, corrective, and other supportive servicess (including speech pathology, audiology, psychologicalservices, and physical and occupational therapy); recreation(including therapeutic recreation); and social work services(including rehabilitative counseling) and medical services (fordiagnostic and evaluative purposes only). These services maybe required to assist a child to benefit from special educationand include early identification and assessment of disablingconditions.³ If the parents approve the IEP, they sign a documentand the school is committed to providing these outlined services.
The rights of the parents and child to “due process” shallbeprotected. This ensures the parents’ rights to be involvedindeveloping the educational plan and for the meeting to beconductedin their native language or other mode of communicationif itis not a written language understandable to the generalpublic.The IEP/IFSP team leader is responsible for arrangingand payingfor an interpreter if English is not the native languageofthe home or if the parent has a hearing impairment. Furthermore, parents have the right to appeal when they view the team’s decisionas inappropriate or harmful.

The Individual Family Service Plan (IFSP)
In 1986 Congress enacted the Education of the Handicapped ActAmendments, PL 99–457.⁴ It was reauthorized in PL 105–17in 1997. Part C of this reauthorization legislation, formerlyknown as Part H, called for the creation of statewide, coordinated, multidisciplinary, interagency programs for the provision ofearly intervention services for all infants and toddlers withdisabilities. Although the law did not mandate these services, partial reimbursement of costs was made readily available tostates that wished to participate. All states have establishedprograms for children birth to 3 years. These developmentalservices are designed to meet needs in the areas of physical, cognitive, communicative, and psychological development, andin self-help skills. The purpose of these services is to enhancethe development of the infant and toddlers with disabilities; to minimize their potential for developmental delay; and tooptimize the abilities of the families to meet the special needsof their children. It was also hoped that this would minimizethe cost over time of special education services when youngstersattained school age, decrease the need for institutionalization and enhance the potential for independent living.

The law requires each state to create its own definition ofdevelopmental delay as a basis for determining eligibility forservices. Pediatricians played a significant role in determiningthis eligibility by advocating for a broad definition of developmentaldelay. Services are provided for children with developmentaldelay, as well as for those whose biological conditions havea high probability of having a delay. In addition, states havethe option to provide services to those children who are atrisk of manifesting developmental delays attributable to environmentalfactors.

A major difference between Part C of PL105–17 and PartB of PL94–142 is that Part C focuses on the involvementof the family and supports for the family. Under this law, theevaluation, assessment, and planning take place with familyparticipation and approval. Early intervention services areall optional, subject to family approval, and are provided innatural settings such as the parents’ home and child care settingsas well as more formal child development programs. The currentdiscussions about early brain development center around childrenfrom birth to 3 years. It is during this period that the growthand organization of the brain is most influenced by environmentalfactors that Part C strives to make optimal.

Children referred as potentially eligible receive a comprehensivemultidisciplinary assessment. The assessment describes the abilitiesand needs of the child and family. Following assessment, anIFSP is created, to include the following:

the child’s presentattainments,
family strengths,
how to enhance developmentof the child,
major outcomes expected, including the outcomemeasures andcriteria, and time lines to achieve specific goals,
specific early intervention services that the child and familywill receive,
projected dates for initiating services andtheir duration,
name of the service coordinator responsiblefor coordinatingand helping the family implement the plan,
steps to help the child and family with the transition toschoolservices at an appropriate time.

The statute specifies a wide array of other services, but theonly health services included are those that are “necessaryfor the infant or toddler to benefit from other early interventionservices.” Diagnostic and consultative medical services arealso included, but the extent to which these services are fundedby the early intervention program varies.

Pediatricians can be a powerful member of the IEP team

Several roles for the pediatrician exist under IDEA. All pediatriciansshould ensure that in their practices, every child with a disabilityhas access to the following services:

A medical home.⁵^,6 A medical home provides care that is accessible, continuous, comprehensive, family-centered, coordinated, andcompassionate. For children with special health care needs, many of whom have an IEP or an IFSP, the pediatrician’s centralrole as the provider of primary care means that he or she wouldparticipate in the plan development. In addition, the pediatricianshould collaborate with community resources in treatment planningand in promoting early intervention programs that work.
Screening, surveillance, and diagnosis.⁷^,8The pediatrician shouldscreenall children from the first encounter, checking for riskorexistence of a disability or developmental delay. Pediatriciansare in key positions to identify at the earliest possible agethose children who may benefit from services under IDEA. Pediatriciansshould provide screening and surveillance using a combinationof methods best designed to take advantage of multiple sourcesof information.
Referral. The pediatrician should be knowledgeableabout thereferral process to early intervention programs inhis or hercommunity and knowledgeable about the parents’ rightfor multidisciplinaryteam evaluation by the school- or state-designatedagency ifa disabling condition may be present. In addition, some of thebest support of parents comes from other parentswho are ableto offer emotional and social support and practicaladvice.Many communities have programs in which parents supporteachother and help parents new to the system better navigatethesystem.⁹Family Voices, a nationwide grassroots network offamiliesand friends speaking on behalf of children with specialhealthcare needs, is a creditable organization that can assistparentsand pediatricians and is accessible by telephone andthe Internet(1–888-835–5669;www.familyvoices. org).
Diagnosis and eligibility. For early intervention, the pediatricianhas an important role in the identification of children withestablished delays and in the diagnosis of conditions with ahigh probability of developmental delay, which will qualifya child for this program. Each state has developed a definitionof these conditions, which should be obtained from the state’slead agency for this infant and toddler program. In addition, some states include “at risk” conditions as defined by the stateas eligible for services. Further information about these issuescan be obtained from the single point of entry into Part C locallyor the state’s lead agency. A list of lead agencies for stateearly intervention services can be obtained from the NationalChildhood Technical Assistance System (919/962-2001;www.nectas.unc.edu/).
Participation in assessment. A child identified through screeningor observation as meeting the definition for developmental delayshould receive a comprehensive multidisciplinary assessment.The pediatrician has an important role as a referral sourceor, if more extensive participation is elected, as a memberof the multidisciplinary team. Few pediatricians have the flexibilityin their schedules to participate in person in lengthy teammeetings. Usually, these meetings are scheduled with a shortlead time and at the convenience of the educators arrangingthem. However, all pediatricians should offer to be availableby written communication or participate by conference call orother means to offer input to and receive feedback from theassessment team. Ideally, the pediatrician should be a memberof the team and attend the IEP/IFSP meeting.
Counsel and advice.During the assessment process, familieswill need a knowledgeableperson for medical advice and counsel.Pediatricians can alertparents to the benefits of a pre-IFSPor pre-IEP conference; of their right to sign the IFSP or IEPonly when they are comfortablewith the recommendations; andtheir right to have a friend orother advocate at the IFSP andIEP conference. Although a parentmay bring their personal attorneyto the conference, most parentsdo not. If an attorney is goingto attend on behalf of the family, the family should notifythe school agency of that fact beforethe meeting to give theschool an opportunity to have theirlegal counsel or top administratorscheduled for the conference.The appeal process begins at thedistrict school board wherethe child resides. The presidentof the school board and superintendentof schools should receivethe written appeal document. If appealat the district levelfails to satisfy the family’s concerns, their next appeal isto the State Board of Education. Rarelydoes an appeal by eitherthe school district or family go tostate or federal supremecourts. Each district school boardhas a published documentthat advises parents of proceduralsafeguards, which can beobtained at no cost to the family.Most assessment teams nominatea member as service coordinatorto work with the families. Astrong link should be developedbetween the assessment teamand the primary care pediatrician, as well as an open sharingof concerns between parents, thepediatrician, and the assessmentteam.
Creation of the IEPand IFSP. Pediatricians who participatein the assessment processshould be consulted by the assessmentteam when these documentsare created. Such consultation isvital to preparing an appropriateand effective plan. The pediatricianshould review the plandeveloped, counsel the family, and commenton health-relatedissues as needed. The pediatrician shoulddetermine if the health-relatedservices proposed are appropriateand sufficiently comprehensiveand assist parents in performingtheir advocacy tasks when thereis evidence of inappropriateplanning. Ideally, when schoolsor educational agencies aredeveloping the IEP or IFSP, a pediatricianshould serve as amember of the assessment team.
Coordinatedmedical services. When medical services are partof the IEPor IFSP, they should be conducted by the primarycare pediatricianor an appropriate pediatric subspecialist.Medical servicesand communication should be coordinated bythe primary carepediatrician or his or her designee in thosecases in whichthe children have complex medical needs involvingseveral physiciansor centers. Special education personnel shouldbe made awareof the restrictions of health care insurance includinglimitedreferral options and the role of the primary physicianas “thegatekeeper” in some programs.
Advocacy. Pediatricians havemany local and state opportunitiesto serve as knowledgeable, thoughtful advocates for improvedcommunity and educationalservices for children with disabilities.Pediatricians who selectthis role need to be aware of the structureof services in thecommunity and the key persons who implementthem. Examples ofadvocacy roles for pediatricians include participationin thelocal or state early intervention interagency council,consultingwith the local school system or state departmentof education, or becoming a school board member.

CONCLUSION

Participation in interdisciplinary efforts for children withdisabilities can help the pediatrician focus on the needs ofthe child with disabilities or developmental delay and improvethe coordination of all forms of service and care for the childand the child’s family.¹⁰ The pediatrician’s role in IEP andIFSP development and implementation includes knowledge of federalstatutes and state and local mandates and regulations; establishinglinkages with local early intervention and education professionalsand parental support groups; and collaborating with the teamserving the individual child. Collaboration among parents, pediatricians, and educators can lead to better quality of care and paves theway for a better quality of life for the child and young adultwith a disability.

PhilipR. Ziring, MD, Chairperson
Dana Brazdziunas, MD
W. CarlCooley, MD
Theodore A. Kastner, MD
Marian E. Kummer, MD
Lilliam González de Pijem, MD
Richard D. Quint, MD,MPH
Elizabeth S. Ruppert, MD
Adrian D. Sandler, MD

William C. Anderson
Social SecurityAdministration
Polly Arango
Family Voices
Paul Burgan,MD, PhD
Social Security Administration
Connie Garner,RN, MSN, EdD
US Department of Education
Merle McPherson,MD
Maternal and Child Health Bureau
Linda Michaud,MD
American Academy of Physical Medicine and Rehabilitation
Marshalyn Yeargin-Allsopp, MD
Centers for DiseaseControl and Prevention

Lani S. M. Wheeler, MD
Section on SchoolHealth
Chris P. Johnson, MEd, MD
Section on ChildrenWith Disabilities

FOOTNOTES

The recommendations in this statement do not indicate an exclusivecourse of treatment or serve as a standard of medical care.Variations, taking into account individual circumstances, maybe appropriate.

REFERENCES

Palfrey JS. Community Child Health. Westport, CT: Praeger Publishers; 1994:93–131
The National Information Center for Children and Youth With Disabilities. Transition Summary. New York, NY: NICHCY; 1993
Individuals With Disabilities Education Act (PL 102–119)
Education of the Handicapped Act Amendments of 1986 (PL 99–457)
American Academy of Pediatrics, Ad Hoc Task Force on Definition of the Medical Home, The medical home.Pediatrics.90, 1992, 774[Abstract/Free Full Text]
American Academy of Pediatrics. The Medical Home and Early Intervention: Linking Services for Children With Special Needs. Elk Grove Village, IL: American Academy of Pediatrics; 1995
American Academy of Pediatrics, Committee on Children With Disabilities, Pediatric services for infants and children with special health care needs.Pediatrics.92, 1993, 163, 165[Abstract/Free Full Text]
Levy SE, Hyman SL, Pediatric assessment of the child with developmental delay.Pediatr Clin North Am.40, 1993, 465, 477[Medline]
Salembier GB, Furney KS. Speaking up for your child’s future. Exceptional Parent. July 1998;62–64
Blackman JA, PL 99–457: advance or albatross?Contemp Pediatr8, 1991, 81, 95

Also check the AAP council on school health website

From The Late Talker book written by Lisa Geng, Dr. Marilyn Agin and Malcolm Nicholl

Sample letter from a pediatric medical doctor for an IEP meeting:

EVALUATION FOR THE SCHOOL SYSTEM

The following is the “assessment and plan” section from a neurodevelopmental evaluation of a child with apraxia (and oral apraxia) designed to get the best possible services from the school system.

Matthew is an almost three-year-old boy who has a history of being a quiet, serious-looking baby with oral-buccal hypotonia and significant feeding problems, which is consistent with a diagnosis of severe oral apraxia. He continued to have difficulties with non-speech movements, including puckering his lips, licking his lips, and blowing bubbles, until recently. In addition, Matthew has a history of being a “late talker” with a speech pattern that includes groping behaviors, vowel distortions, omissions of syllables, dropped endings, inconsistency in speech productions, and difficulty imitating speech sounds other than the bilabial sounds: /p, b, m/ and /t, d, n, f, sh and ch/. He has generic words that he uses for a number of other words, because of his difficulty in coordinating the movements of the oral musculature.

Matthew has signs of a verbal apraxia which is a neurologic speech disorder affecting the motor planning and sequencing of speech sounds, which becomes even more difficult to understand with the increasing length and complexity of the sentence. His speech is so severely unintelligible to the unfamiliar listener, that, out of context, it would be almost impossible to understand what he is saying. Even in context, his speech is just a series of approximations, and his grammar and syntax is also disordered. His cognitive skills and receptive language, however, are within normal limits. Associated with Matthew’s verbal apraxia, is an expressive language impairment, with deficits in grammar and syntax as well as a limited lexicon (vocabulary) for age. Research has shown that early speech and language problems are correlated with later reading and academic problems in school-aged children. Matthew also has a coordination difficulty and sensory motor integration deficits. He trips and falls and has poor spatial awareness, running into things. His dyspraxic symptoms carry over to the motor planning involved in gross motor activities and overall coordination, e.g., riding a tricycle. He is “heavy footed,” and fixes his right arm when he runs. He also has issues with sensory motor integration which involves processing of proprioceptive and vestibular stimuli along with difficulties with balance, equilibrium reactions and postural stability.

DIAGNOSES:

1. (#784.69) Oral/verbal apraxia

2. (#784.6) Expressive language disorder

3 (#781.3) Hypotonia, coordination disorder, sensory integration dysfunction

RECOMMENDATIONS:

1. Matthew should be placed in an integrated language-based preschool classroom, with both typically-developing children and children who have developmental difficulties, where there is typically a small student to teacher ratio. The original recommendation of the CPSE evaluation team, to place Matthew in a classroom with typically developing children, would do him a tremendous disservice; he is already feeling the frustration of not being able to communicate with peers and adults, and not being understood, which has caused him to be reserved and generally non-communicative with unfamiliar people. The only person who truly understands him the majority of the time is his mother. If Matthew is placed in a class with typically developing children who may make fun of him or not understand him, this could cause self-esteem issues that could last for years to come. He also would not get the extra attention and expertise of a special education teacher who would understand his needs.

2. Matthew will need intensive speech therapy by an experienced speech pathologist knowledgeable about working with children with verbal apraxia and oral hypotonia. He will need individual therapy at least 3 to 4 times per week for 30 minute sessions. Children with verbal apraxia do not benefit from group therapy. Speech pathologists who work with this population use touch-cue techniques like PROMPT. The therapist must be trained in a multi-sensory approach using auditory, visual, and tactile cues to facilitate speech productions. One of the significant values in correctly diagnosing a child with verbal apraxia is that the diagnosis alternatively changes the direction of the therapeutic management of these children. Traditional methods of speech therapy do not work. Matthew has had a focus on oral motor, oral sensory training, and touch-cue prompting up until now in Early Intervention.

3. Matthew will need a 12-month program, [an extended school year (ESY)], as he regresses when he is not in therapy.

4. Matthew will require occupational therapy two to three times per week for 45 minute sessions to improve sensory motor integration.

5. It is recommended that Matthew receive physical therapy once to twice weekly for 30 minute sessions to improve higher level gross motor functioning, balance reactions and postural responses.

6. A trial of essential fatty acid (EFAs) supplements is recommended as anecdotal evidence has shown an improvement in apraxic symptoms. The LCP Solution by Stordy and Nicholl is recommended reading for background information. I would be happy to offer advice in administration of the supplements as needed.

7. Re-evaluation is recommended in six months.

Ida Care, MD, FAAP

Contemporary Pediatrics article “The Late Talker;

When Silence Isn’t Golden” Contemporary Pediatrics Guide for Parents written by Lisa Geng

The Late Talker book includes a chapter on fish oils. Please be sure to share information with your child’s pediatrician on the preclinical research for NV as well. Here is more information to share with your child’s doctor.

Other articles:

Pediatricians should advocate for patients with learning disabilities and help foster their self-esteem: Accentuate the positive Deborah Johnson

PARTNERSHIP IN CARE FOR YOUNG CHILDREN WITH SPECIAL NEEDS: THE
PEDIATRICIAN AND THE EARLY INTERVENTIONIST
by Dorothy Johnson, M.S., Co-Director of SKI•HI Institute

Six Simple Steps to Building a Medical andEarly Intervention Transitional Coalition By Denise Merrill

MAKING THE CONNECTION BETWEENMEDICINE AND EARLY INTERVENTION:A FAMILY’S STORY By Denise Merrill

Collaboration Between Two Schools Produces Innovative Early Intervention Program by Susan Poltarak, Marjorie Zimmerman, and Phyllis Rizzi

LISA GENG

Author and Executive Director at The Cherab Foundation

Lisa Geng got her start as a designer, patented inventor, and creator in the fashion, toy, and film industries, but after the early diagnosis of her young children, he entered the world of nonprofit, pilot studies, and advocacy. As the mother of two “late talkers,” she is the founder and president of the nonprofit CHERAB Foundation,c o-author of the acclaimed book, The Late Talker, (St Martin’s Press 2003), and is instrumental in the development of IQed, a whole food nutrition meal replacement. Lisacurrently serves as a parent advocate on an AAN board for vaccines, and is a member of CUE through Cochrane US. Lisa is currently working on a second book, The Late Talker Grows Up and serves as a Late Talkers, Silent Voices executive producer. She lives on the Treasure Coast of Florida.

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