I've been down in Florida visiting family now for a while.  As a New Yorker, I've been through and seen a lot, but let's just say I think a lot of things need major fixing down here in Florida. 
One thing I've been watching very closely as it has been quite disturbing and is near and dear to my heart, is a case involving a 36 year old Developmentally Disabled young man named Aldo Alvarez.  I do not know the extent of his disability nor do I obviously know the exact events that occurred that day as I was not there.  But just as close as we all watched Treyvon Martin and quickly gathered our opinions of George Zimmerman, I promise you'll do the same here.  Luckily this time, lives were spared, at least for now. 
Aldo had lived in that development for a long time along with his mother Ana.  He had been known by others living in the community to take walks around the gated community, often saying hello to people.  Everyone knew who he was, or at the very least recognized him. 
Deputy McGehee was just moving into the community. On a day early in May, Aldo was on one of his walks and saw Deputy McGehee in his garage unpacking.  This is where the rest of the report becomes peculiar and uncharacteristic.  The Deputy states that Alvarez comes up the driveway and starts beating him (or attacking him out of nowhere). The Deputy decides that he has no choice but to shoot him as even though he's off duty, his gun was all he could reach, and Alvarez was unarmed. Although Alvarez was shot 10 times, he was lucky to live. Alvarez is shot, arrested, and now most recently reported, facing a lifetime prison sentence.  The Alvarez shooting was the only one of four involving sheriff’s deputies that did not result in a fatality. Thankfully he is alive, but the following questions remain: why is Mr. Alvarez facing prison? Why a lifetime prison sentence? Why is the Deputy not penalized for shooting an unarmed person?
I am deeply saddened by the above for many reasons.  This kind of thing constantly goes on all over the state. I would love to hear how everyone else feels.  

If you would like to read more about the case, simply google both names, FL, as there are many articles. 

Fact: Schools are punishing kids with disabilities at higher rates than other students.

Now the U.S. Department of Education is doing something about it. They’ve provided guidance for schools to make discipline fairer and decrease suspensions and expulsions:

Read how the new guidelines affect your child - here - http://www.ncld.org/ld-insights/blogs/government-gives-new-guidance-on-school-discipline-but-what-about-students-with-disabilities?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

Get advice from a mother whose child was labeled as “disruptive” here - http://www.ncld.org/learning-disability-resources/special-needs-stories/parent-stories/african-american-mother-be-wary-disruptive-label?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

Fact: President Obama signed the federal budget, but the Individuals with Disabilities Education Act (IDEA) is still not fully funded.

Money isn’t everything, but schools need the right resources so they can provide special education services. To help you understand the stakes, we’ve put together a brief update about which education programs got funded and which didn’t here - http://www.ncld.org/ld-insights/blogs/budget-update-idea-not-fully-funded-but-special-ed-research-increases?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

At the end of the month, President Obama gives his state of the Union. Among the many things needed to be discussed, one vital issue is that the President should promise to fully fund IDEA in the next 10 years and the National Center for Learning Disabilities is asking Congress to sign a letter urging him to do so.

Awareness of the needs of students with learning and attention issues is growing—for proof, check out the new Congressional resolution on dyslexia here http://www.ncld.org/learning-disability-resources/ld-in-the-news?utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

It’s time to turn that awareness into real gains for our kids.

GET INVOLVED!  HELP OUR CHILDREN! Click here:  http://www.ncld.org/disability-advocacy??utm_source=ldaction_jan_23_2014&utm_medium=email&utm_content=text&utm_campaign=ldaction

We have to be mindful that while Applied Behavior Analysis (ABA) is integrated into how first responders; Early Intervention Providers, CPSE, and CSE work within their interventions and disciplines, it does not address the whole of the motivations of a child’s behavioral difficulties.

Behavior is over determined. That is, there are many reasons behaviors come into being. Behavioral issues are not necessarily a function of developmental delays such as sensory, motor, speech, or cognitive delay. While these delays may contribute to the behavioral problems, how much they contribute is an unknown until interventions have had a chance to enable the child to reach their developmental potential.  Interventions might resolve the behavioral difficulties, reduce them, or have no effect. At times, the behavioral difficulties could be so significant that the first responders are not able to clinically intervene as the behaviors interfere with their intervention and the child’s learning.

I often find that parents who have children who have special needs, may have been good enough parents with a typical child.  However, because the child has special needs, parents are not sure how to adjust their parenting to meet the needs of the child.  In some cases, the parents have significant internal conflicts and don’t use the best approach as they draw on their experience from their parents.  A parent of a special needs child has to be a better parent then most as they constantly have to adjust their expectations to the reality of their child’s abilities.  This is no easy process.  A parent’s ability to adjust their parenting style is pretty limited in most cases.  A parent’s ability to adjust to their child’s needs, will depend in large part how traumatic the parent’s childhood was.  In extreme cases, where Grandparents were emotionally or physically abusive; emotionally disturbed, and/or a grandparent may have been physically and/or emotionally absent, among many other potential issues, the now parent is not likely to be able to adjust to the emotions and developmental abilities of their special needs child.

In typical children with parents who have had a poor parenting experience, the child calls for help by acting out either physically, socially, or verbally. When the child has special needs, the call for help can be masked by his/her other developmental issues. There is the notion that the interventions are going to resolve, not only the developmental issues, but the behavioral issues as well. However, there is a larger context that must be considered when addressing behavioral difficulties in children. For example:


Consider the impact on a special needs child where a parent;

• is suffering from depression
• grew up being physically and emotionally abuse
• grew up in a home where their parents were constantly yelling at and/or beating on each other
• is disorganized and fails to back up their words with actions?
• does not establish regular sleeping and eating routines?

The interventions of speech, OT, PT, and ABA would not necessarily be addressing this child’s emotional development and needs.


Consider the possibility of a child in preschool who is constantly disrupting the classroom routines, is always in motion, and not attending. Ah, ha! ADD/ADHD, I knew it! But consider the possibility at that within this child’s first 4 years of life a sibling is born with cancer.

• What if the mother and father are consumed with this newborn child’s survival?
• What if one or the other parent were absent for prolonged periods of time getting help for the sibling?
• What impact does this have on our thinking of our now “diagnosed child” with
• ADD/ADHD?

Are behavioral interventions going to stop the demonstrated behaviors? If applied expertly, they can and should. Are we ready to move on without addressing the emotional communications of the behavior?

When clinicians are presented with a child exhibiting behaviors they set up positive contingencies to get the child to cooperate, engage, and learn. If they are on target the treatment outcome will be a success.   If a clinician to able to gain the attention and work successfully with a child a parent would be well advised to watch the interaction and ask; “Why their child works with the clinician and does not act out?”  Alternatively a parent can ask the clinician; “Why they think the child acts out at home?”  The parent can ask themselves the last question as well.   If they are able to both listen to the response and learn to respond differently than the acting out behaviors might diminish. 

Another potentially helpful tactic for the Parent is to ask the clinician if they can watch and then practice working with their child in the treatment session.  Ask the clinician to tell you honestly what you are doing right and wrong and provide suggestions how to do things differently. 

When behaviors don’t stop we can assume there is a problem behind the identified need(s). In conversations with other clinicians and parents, I’ve heard statements, “The child is still acting out.” Or, “His mother gets into fights with him in the waiting room.” An honest dialogue with your child’s clinician could go a long way in resolving a child’s acting out.  

By looking at the larger context (the parents’ parenting and the parents’ feelings about their own parents, as well as their feelings, attitudes, and thoughts about their child) the emotional communication(s) and needs of the whole family can be addressed.

It is my hope that in working with parents and first responders we can look beyond ABA and while behaviorally addressing the acting out, address these other motivators for a child’s difficult behavior(s). We can discuss how to emotionally intervene to resolve the behavioral issues from the inside at the same time we are addressing the manifest behaviors on the outside.

I am always available to work with parents and first responders to privately discuss concerns about a child. I find great joy in talking with parents and my colleagues, learning about their lives and work, and supporting them to help their children.

Adam J. Holstein, P.D., L.P.
Psychoanalyst/Behavior Therapist
Cell:  516.297.5705
www.BehaviorTherapists.org
Adam@BehaviorTherapists.org

Wada, S., Tohara, H., Iida, T., Inoue, M., Sato, M., & Ueda, K. (2012). Jaw-Opening exercise for insufficient opening of upper esophageal sphincter. Archives of Physical Medicine and Rehabilitation, 93(11), 1995-1999.

The outcome of this no named new Dysphagia exercise is increasing hyoid elevation, Upper Esophageal Sphincter (UES) opening, pharynx passage time, and decreasing pharyngeal residue after swallowing at preexercise and postexercise evidenced by VFSS.

As per Dr. James Coyle this exercise is also designed to increase UES opening by using strengthening the anterior muscles of the floor of the mouth (submandibular suprahyoid) muscles. It exercises these muscles by depressing the mandible. We do it with gentle resistance and use the same schedule that is published in the studies on tongue strengthening. Coyle


During a swallow, the UES is open, and works closely b/c of the location of the cricopharyngeal muscle. The cricopharyngeal muscle is attached to the cricoid cartilage and is relaxed upon swallowing as it is pulled by the hyoid laryingeal structures. "The UES does not open automatically. Successful opening of the UES requires an anterior-superior traction of the hyoid and larynx and further UES relaxation and hyoid traction on the larynx precedes UES opening" Wade.   Further described, when the hyoid decreases laryngeal elevation can cause dysphagia resulting from UES opening.


This exercise involves jaw opening and multiple muscles therefore during ones' Oral Periphieral Exam Jaw as well as Labial muscles must be assessed for this exercise. It doesn't mean they have to have within normal limits, but it must be documented. The suprahyoid muscle group including mylohiyoid muscle, the anterior belly of the digastric muscles and the geniohyoid muscles are also involved in hyoid elevation and some in jaw opening. These muscles include the mylohyoid muscle, the anterior belly of the digastric muscles, and the geniohyoid muscle.

Given the above mechanisms, the authors performed a jaw-opening/strenghening exercise among patients with UES dysfunction and assessed the effect of this exercise on swallowing function with a videofluorographic swallowing study (VFSS).

Evidence has shown that there was significant improvements when you compare swallow functions pre-exercise and post-exercise.  Advances were demonstrated in the extent of upward movement of the hyoid bone, the amount of UES opening, and the timing of pharyeal passage.  Four (4) weeks after initiating the exercise. Some subjects evidenced decreased pharyngeal residue. No increases were noted in any subjects.

The conclusion demonstrated that this jaw-opening exercise is an effective treatment for dysphagia; caused by dysfunction of hyoid elevation and UES opening.

Parents often ask us: how can we stimulate the development of speech in our children? We present you with a great program, Land of Sounds, which will appeal to younger children, who are just learning to speak, as well as to already speaking preschool, who are just beginning to know their the world around them. It is also a perfect tool to stimulate speech for children with the delayed speech development. The Land of Sounds program may be also used as the supplement to the speech therapy.

The program is available on-line at www.landofsounds.com Without registration you can play with several games and exercises. After a quick registration the users can use all resources of the program. You can find hundreds of animations and games supporting the development of children’s speech.

And here’s more good news: until the end of October you can use the program completely for free! You just need to register.

After registering on the website and logging in you can use the resources of several major sections: “exercises”, “games”, “exercises with a guide” and “knowledge library”.

You will find a lot of animations with sounds made by animals, vehicles, devices and sounds associated with every day activities and situations. In next scenes there are presented different sources of sounds in the form of images and onomatopoeic words. The child by watching the cinematographic animations, listens to the onomatopoeic sounds of the speech. He can also try to repeat the expressions during the exercise.

Using onomatopoeic words is an important stage in the development of child’s speech. In this way he replaces too difficult words with those that are easier to say. Because of that in a simplified way he names the surrounding world and achieves his first success in communication. As a result, he more likely establishes the language contact with the environment!

For children, who move from the stage of onomatopoeic speech to the stage of words and sentences there are animations, in which they get to know the names of objects and activities.

Games in this section will definitely interest the youngest children learning to speak and developing speech. They will also be great while working with children with the delayed speech development.

The Land of Sounds program has a very large base of animations that is bound to find something to keep their interest. Doing the exercises – tests you can check how the child recognizes and associates the sounds with the sources making them.

Using games and activities in this section, the children perpetuate the sounds of onomatopoeic words learned in the section “Exercises”. To use the games you just need basic skills of using the mouse and keyboard. The level of difficulty of games is adjusted to the age of the children. You can find labyrinths, memory games, tasks involving collecting objects and many others!

Apart from access to hundreds of animations, you can use the aid of the virtual advisor, who will tell you how to preferably begin the work with the Land of Sounds program. You just need to fill in a short survey, and the virtual advisor will direct you towards the best place to start work and will look after your progress. At any time you can cancel the virtual advisor and move to the selected exercises and games.

In the library you can find interesting articles in the field of speech therapy, as well as those from which the parents can learn how to stimulate the proper development of speech of their child.

Exercises in the program are selected with great care, appropriately to the age of children and their cognitive areas. The Land of Sounds program is worth recommending for one more reason: it has a beautiful, calm, uncluttered with excessive number of elements graphics and beautifully recorded sounds. We can fully recommend this program as the tool to stimulate the development of the child’s speech! We recommend it!  

Service landofsounds.com was created from the EU funds grant (Innovative Economy Operational Program, activity 8.1)