Description of Service Components (alphabetized)
Physical Education (PE)/Recreation: Physical Therapists and/or adaptive PE instructors can help students develop leisure time interests and assist students who experience fatigue or mobility issues. Adaptive options may be necessary for some individuals.
Behavior Intervention Plan (BIP): This individualized plan is designed to address a behavior or set of behaviors that interfere with the student’s ability to learn and/or participate in the school setting. It is based on the results of the Functional Behavior Assessment (FBA). The plan should include positive behavior supports and specific interventions that will be utilized by school personnel. These should be included in the IEP. These techniques and strategies should be evidence-based and monitored by appropriately trained personnel. The BIP, along with the IEP, can also serve as protective documents in case of a manifestation determination review.
Communication/Language: Speech and language pathologists (SLPs) can help students improve both receptive and expressive language through targeted interventions. Augmentative and Alternative Communication (AAC) includes all forms of communication outside of oral speech. AAC methods used for individuals with speech and language disabilities may include gestures, communication boards, pictures/symbols, or the use of an assistive technology device. Pragmatic (social) language interventions may be beneficial for children with FXS. For example, they may need assistance with using language for different purposes, adjusting language to meet the needs of the listener or situation, or following the rules of conversation.
Evacuation Plan: This is a plan written for staff to follow in times of emergency such as weather related disasters, school fires, and acts of violence. Each staff member is directed by this plan to use procedures to evacuate as quickly as possible individuals who are non-ambulatory, nonverbal, hearing and vision impaired, and/or emotionally stressed by the process. This plan should be developed in conjunction with the parents or caregivers and with the appropriate local authorities when possible.
Individualized Education Program (IEP): This is a written, legal document listing the special educational services designed to meet the student’s individual needs. The IEP is developed by a team that includes the student, the parents/caregivers, and school staff (e.g., special education teacher, general education teacher, SLPs, school psychologists). An IEP is based on a psycho-education evaluation conducted by the school team generating a body of evidence to formulate annual goals, accommodations, modifications, supplementary aids, and related services. One important component of the IEP is the Impact of Disability. This allows for the service providers and parents to describe FXS and how the neurobiology impacts a number of learning and behavioral issues described in the educational strategies section. It provides the foundation for the needs and accommodations of the student and helps guide the IEP and possibly the BIP.
Individualized Health Care Plan (IHP): This plan should combine all of the student’s healthcare needs into one document for health management in the school setting. It is developed by the registered school nurse using comprehensive data, including medical information provided by outside medical providers. The nurse will also interview parents regarding medical status and update records accordingly. Whenever possible, the parent should ascertain a comprehensive medical evaluation to be performed by a pediatrician experienced with children with developmental disabilities, specifically FXS. Typically, the IHP includes medication names, dosages and side effects. In addition, treatment strategies for specific medical conditions are listed such as how to deal with a seizure, blood disorders, serious allergies and/or use of EpiPen. A Health Summary should be provided, which consolidates medical records, immunizations, and findings of the health plans (e.g., seizure activity or specific care for any medically fragile student, medication dosage and side effects).
Individualized Transition Plan (ITP): An emphasis on transition issues is formalized through a mandated transition plan by age 16 (IDEA, 2004). Interest inventories, adaptive behaviors, community access, living options, leisure skills, and vocational/post-secondary education skills and placements form the foundation of this plan. The transition plan, like IEPs, must be strengths focused (taking into account the student’s interests and preferences) and outcomes orientated. Specific goals and objectives outlining skills, interventions, and persons responsible for monitoring progress and attainment should be explicitly outlined. Accommodations and modifications necessary for independent living, vocational placement, and/or post-secondary education participation must be considered.
Job Coaching: Job coaching can be provided to the student as they enter the world of work. In addition to vocational instruction and career assessment, coaches may provide support around issues relating to the student’s disability such as need for self-regulation, environmental accommodations or modifications, and communication. Job coaches may be provided by the school district to serve as liaisons between the school and the workplace.
Multi-Tiered Systems of Support (MTSS): This is an evidence-based framework for effectively integrating multiple systems and services to simultaneously address students’ academic achievement, behavior functioning, and social-emotional well-being. MTSS allows for varying levels of support, instructional and behavioral screenings, progress-monitoring of instructional strategies, and data-driven decision making. The use of a tiered approach to academic and behavioral interventions coupled with significant data collection requirements is beneficial for children with FXS and should be explored even when an IEP is in place. Encompassed within MTSS is Response to Intervention (RTI). RTI is used to determine eligibility for specific learning disability (SLD). With the reauthorization of IDEA (2004), or Public Law 108-446, educators must now use RTI as a key indicator for SLD eligibility. Although males with FXS typically do not qualify for services via a SLD diagnosis, this change is very important for females. First, RTI allows children to receive interventions to support their learning when there is a suspicion of academic difficulties. Second, children no longer need to demonstrate an IQ-achievement discrepancy gap to qualify for SLD services. RTI has implications for assessment and diagnosis issues and intervention and behavioral applications.
Occupational Therapy (OT): This therapy may be recommended to address fine motor, handwriting, and self-help difficulties. This may serve to reduce anxiety and frustration related to academic and vocational tasks. OT may be utilized to address adaptive functioning or self-help skills such as dressing, grooming, or feeding. It may also be used to help determine the need for compensatory tools (e.g., use of the computer and keyboarding skills) to optimize functioning. Occupational therapy also supports self-regulation, to include coping skills to support academic and social participation.
Sensory Processing: Occupational therapy may include sensory integrative and sensory processing approaches that may help address or reduce behavioral symptoms of children that experience hypersensitivity to a number of environmental stimuli. Sensory integrative interventions are often used to reduce hyperarousal and manage the biological antecedents to behavior, and are most typically paired to self-regulation strategies. Many students with FXS have hypersensitivity to smells, tastes, textures and sounds. Anecdotal observations have indicated that sensory processing issues often make it difficult for children with FXSX to participate in large group activities, eat certain foods, and tolerate certain clothing. Sensory processing issues may also be addressed through environmental accommodations in the school environment (e.g., adjusting the lighting in classrooms, reducing noise level, taking breaks, using fidgets).
Sexuality and Personal Safety: Sexual/Human Growth and Development instruction includes discussion of public and private behavior, nonverbal behaviors (e.g., staring, touching, personal space), issues around sexual maturation and safety (e.g., consent, sexually transmitted infections), and social behaviors (e.g., initiating and extending conversations, flirting). Such instruction increases the rate of successful integration in college, work and social settings. Classes on these topics are often offered by local ARC organizations, local universities and law enforcement organizations.
Social Skills Training: This training supports topics around social, communication, and nonverbal skills. Instruction may include modeling behaviors, repeated practice (e.g., turn-taking with an adult), or structured peer group activities (e.g., lunch buddies). Young adults and adults may benefit from discussions and role playing related to dealing with situations involving substances (e.g., drugs, alcohol) and relationships (e.g., platonic, sexual). In addition to improving social skills for improved social participation, it is critical to support social skills that include self-advocacy and limit setting to ensure reduced social vulnerability. Social skills require interdisciplinary supports.
Speech/Language Therapy: This therapy may aid in the development of functional communication skills and improve a child’s pragmatic use of language, as well as articulation. Continued speech/language therapy in middle and high school is important to improve ongoing communication skills that facilitate the building of peer relationships and functional communication for employment.
Transition Program: This stage of the educational process begins at age 18 after high school programming has been completed. These programs include more of a college and career readiness focus—skills related to vocational training, daily living experiences, and independent travel are emphasized. The focus is no longer academic content, but real life context and experiences.
Transportation: IDEA (2004) requires that schools provide transportation from door to school, with specialized equipment as needed, for children in special education.