1.

a) Describe the four key phrases of rehabilitation of adults with Acquired Brain Injury  Emergency/intensive care: First thing is to treat life, and disagreement between parents and medical professionals at this stage. -Check for breathing, then bleeding (want to keep individual alive) -Many patients come in with brain damage ends up in coma (the longer the person is in a coma, the lesser chance of ppl waking up from the coma) -Early signals waking up from coma: finger/eyelid movements -Parents and Medical professionals relationship is most strained in this stage  Hospitalization -may have other health problems aside from brain injury, e.g. rupture spine, -Bring their body back to health/functioning, start with some rehabilitation (not the focus)  Physio/occupational/speech therapy - Occupational therapy: teach them how to use any devices they need (e.g., crutches) - Speech therapy: strokes, relearn to speak - Physio: relearn walking, swimming pool=effective because standing up in the swimming pool is less stressful than standing on ground  Community reintegration through group homes or independent living (growing field in Ontario) Have severe brain damages, personality change ideally you now go back home, but if extent of ABI too severe (e.g. very difficult or violent person) then might be put in group home, not usually apartment (need lots of help but also want to help manage day to day life)

b) Why are behavioral problems so prevalent amongst people with Acquired Brain Injury during community reintegration? Self concept- adjusting goals and expectations of oneself to reduced abilities (career; family life) o Difficult to adjust, a person with cognitive impairment cant think straight o Very difficult because those with ABI often lose ability of extensive rationalization so they cant analyze situations in reality properly o One is a wonderful spouse, community member, parent etc. Cant accept that Frontal brain injury often results in lack of impulse control (injuries when head hits first forward) o Impulse control, personality concept o If the person is an adult and strong strength, and is abusive like a 4 yr old= danger to the society: police gets involved Dynamics of care and control in group homes o Those with ABI dont want to be there, o Revolving staff o Tend to be ~20 graduates from high school, did 2 years college, so they think they know everything about rehabilitation (literature evidence: these ppl have no responsibility/ not ready to help these individuals/ demanding job) o Critics claim bribery and intimidation is used as a mean of control

These difficulties result in severe behavioural problems.

c) What options are available to treat these behavioral problems? Are they controversial? Why? -Combination of drugs (i.e., sedative and/or antidepressants) and Applied Behaviour Analysis (focus on ABCs of behaviour- Antecedents (focus on what came before behaviours, there could be a trigger that caused the behaviour), Behaviour, and Consequences). : Includes what came before the behaviour, because maybe it caused the problem in the first place = more beneficial. If target behaviour is swearing etc, then look at commonalities of what happened before. Its important to focus on antecedents instead of just focusing on the behaviour then consequences. Helens answer: a data oriented method that focuses on figuring out what triggers disruptive behaviour by reducing its antecedents. Yes they are controversial because drug therapy disregards individual dignity. It might be a fast acting treatment which causes submissive behaviour and allows for more manageable control over patients with ABI. But it reduced their activity, which takes away from their personality, character and their abilities. ABA is an empirically sound treatmet. If antecedents are reduced, this would lead to a decrease in disruptive behaviour and thus allow the reduction of medication as a treatmet. However, ABA is controversial in a sense as critics claim it is based on bribery and intimidation (due to candy for reinforcement or physical force, for instance). ABA is not perfect but it is better than alternative methods (e.g. drug sedation in closed psychological hospital ward). -Compared to other methods, ABA is quite successful, but critics claim that it is based upon bribery and intimidation. :ABA is expensive, drug are much cheaper (quicker fix), and its easy to come out to say medication is not the solution, but when an adult has a disruptive behaviour its hard. -Alternative options: Sedation in psychiatric wards of hospitals and institutions.

2. a) What does Autism mean, according to IDEA? A developmental disability significantly affecting verbal and nonverbal communication and social interaction, generally evident before age 3, that adversely affects a childs performance. Other characteristics often associated with autism are engagement in repetitive activities and stereotyped movements, resistance to environmental change or change in daily routines, and unusual responses to sensory experiences. The term does not apply if a childs educational performance is adversely affected primarily because the child has a serious emotional disturbance (IDEA, 1992) b) What are some early signs of Autism? Which DSM-IV category do these typically belong to? Why? Qualitative impairment in reciprocal social interaction. The lack of social-communicative gestures and utterances is apparent during the first few months of life. Emotions such as affection and empathy are rarely displayed. Nonverbal signals (smiling, gestures, physical contact) of social intent tend not to be used. Imaginative play is an activity seldom observed. Eye contact is not initiated or maintained. Friendships with peers fail to develop. Preferred interaction style could be characterized as extreme isolation. Normal attachments to parents, family members, or caregivers do not develop. Cooperative or peer play is rarely observed. They all belong to qualitative impairment in reciprocal social interaction.

The early signs typically belong to this category because it is difficult to tell early in life whether the infant is lacking in verbal/non-verbal communication until later on when language milestone tend to be reached. Also the restricted repertoire of activities and interests, such as stereotypic behaviour that children with autistic spectrum disorder (low functioning) such as self-stimulation (e.g. hand flapping) is not distinguishable in infants because it is a normal behaviour in non-autistic infants as well.

c) What central problem is associated with all treatment methods for Autism and why? What is sensory integration and on what principle should it work? Describe two methods. Do they work? Central problem: we dont know what causes autism. Therefore, we dont know how to treat it. It is a spectrum disorder (and thought to be a grouping of symptoms rather than a disease) so it is not generalizable and therefore we dont have one treatment for autism but many possible treatments to treat different symptoms of autism not the root cause. Sensory integration is a treatment that employs various means to stimulate an individual via different sensory modes (i.e. visually, auditory and kinesthetically.) It works on the principle that we must reach to autistic individuals in different way- through various sensory stimulations, which may stimulate certain parts of the autistic childs brain that were dormant resulting in autistic symptoms because we know brain activity patterns differ in autistic individuals compared to non-autistic individuals. Snoozalen rooms is one method of sensory integration. Focuses on various types of stimulation, included audiovisual in a room built for this purpose. Walls and floors may be carpeted and contain various objects that the child can feel (kinesthetic stimulation) or contain relaxing music. Also Snoozalen rooms contain fibre optic lights. It is a relaxing place for an autistic child to go when they are dealing with secondary symptoms of autism. Effective; good envt for them to enjoy. Very expensive; doesnt cure symptoms. The Tomatis method is focused on auditory stimulation. The autistic children listen to music patterns created by Tomatis himself from a sound system in a relaxing atmosphere. There are listening centers where this method is used in private clinical practices. The only evidence this works is a PHD dissertation by Tomatis so its biased. Works in some cases, no single study peer-reviewed with proper methodology that shows it works; not covered by OHIP cuz not clear empirical evidence, thus like a private business There is no empirical evidence that either works, it does in some cases, but they dont always work. 3. a) Describe the enrichment and acceleration approaches to educating gifted children. What are the major pros and cons associated with each approach? How do these relate to the inclusion and segregation debate?  Enrichment approach the best option for child under inclusive settings. They get to attend school with the same age peers in the neighbouring school. However, they are provided with extra things to do and are taught in depth. The program pairs students with adults who guide them in applaying knowledge to real life situations. Enrichment approach also contains internships, which are programs to allow gifted students, usually in their senior year in high school, to be placed in a job setting that matches their career goals. Pros: inclusive environment, in the same type of school KEY ADVANTAGE: more healthy psychologically, and social, with kids they should be with, Cons: Not at intellectual level, therefore may fall behind  Acceleration approach this approach enables the gifted children to move faster through the curriculum through various different ways, such as, letting them skip grades. - it allows for courses that students take during their high school years to result in college credits. Or, gifted children are simply placed in advanced classes.

Pros: Intellectually stimulated to the point you should be Cons: Educational Disadvantage: more advanced for the education they are receiving. Acceleration: One, is they can skip classes, rather than being in gr8 they are in gr10 (But the price is missing out a childhood), Two , self contained classes, gifted students educated together, maybe in a gr5 peers rather than with gr8

Enrichment is inclusion while acceleration is segregation

b) Why should cutoff scores be avoided when identifying children as gifted? Is this controversial? Explain. Cutoff scores should be avoided because they are the most common way that disadvantaged students are discriminated against. Controversial: (High scores should be used to include students, but if students meet other criteria- through self or parent nominations, for example- then a lower test score should not be used to exclude them. But problem is if parent nominates their kids, then every child would be in the gifted program) - There will be a system that provide these systems that accept students from good family. Using cutoffs perpetuates an elitest like system where only those who are the smartest and brightest get to go into gifted programs and it doesnt matter why (i.e., like medical school). This isnt fair for students who do not come from an advantaged background. On the other hand, the alternative, teacher and parents nominations are subjective and bias and are not reliable. c) What is the Advocacy principle for identifying gifted children? Explain which students are protected by this and how.

Advocacy: Identification should be designed in the best interests of all students. Students should not be harmed by the procedures. Resources from the general program are taken away for gifted students, by spending more time on one group can result in ignoring other group, just by sending labeled gifted children to special classes, will make rest of the students feel inadequate and lowers rest of the class=not a good thing. Make kids that are left behind but still being top of class, might think they are great. Being the star of the class is not really good. Its better to be on the lower end of a better group than being the top of a lower group Once you have the label, the label sticks.

4. a) Using a utilitarian argument, Marks claims that most people feel that the lives of people with disabilities are less worthy than those of "normal" people. State the main points of this argument in sequence. - According to the Utilitarian argument of western society, the quality of lives of people are low if they do not have utility (contributing to society, i.e by raising kids, paying taxes, making an income. Thus, ppl with disabilities must have a lower quality of life and their lives are less worthy according to this argument. Evidence for this way of thinking is reflected in the fact that human rights do not protect all minorities eg. If a person murders a person with a disability, their jail sentence is different from murdering a non-disabled person. Also, social class and financial resources gives certain individual better services. E.g healthcare- Paul Martin received healthcare from the U.S.A (jumped in line) This suggests that there is a prevalent belief in society that some lives are worth more than others. Lives of people with disabilities are less worthy: None of us: 1. Cannot imagine coping with a severe disability because of this lives of those with disabilities are socially interpreted as tragic (if I cant imagine how I would cope then it was tragic + ppl with disabilities must be suffering) This view is reflected by the language society uses (eg suffering from a disability. 2. Disabilities are tragic and people with disabilities are suffering: it is incomprehensible how a person with disabilities copes/lives their lives fulfillingly and therefore this gives us the right to mercy kill them. b) How are the medical and social models of disability related to the debate about who's responsibility it is to accommodate people with disabilities? Explain Medical Model: -Advocates the notion that impairment leads to disability therefore we need to fix the broken body (likes its a machine) -The medical model views impairments as internal and requires that the person with the impairment solve the problem on their own by paying for services therefore in the medical model, responsibility is held by the individual to accommodate themselves if they have an impairment. scientific eradication of disability objectifying gaze playing god eugenics amniocentesis medicine as a gate keeper of public funds

Social Model: -Impairment doesnt necessarily lead to disability. E.g: If a person confined to a wheelchair cannot make it to work, the social model regards this as an external problem (the fact there is no ramp). Thus, the social model

views impairment as external + advocates that society is responsible for accommodating for environmental and individual for accommodating for environmental and individuals changes and ppl with disabilities. where is disability located? must impairment lead to disability? industrialization the built environment responsibility to accommodate wheelchair users or everyone?

c) Who is more dependent? A quadriplegic who is a self- made millionaire who requires assistance from a full time attendance or a healthy individual who receives social assistance. Why? - Neither are more dependent. Human societies are based upon human interdependence. If an individual is identified as dependent, this is because society organization and distribution of resources has made them this way as needs are socially constructed. In both cases, they are discriminated as dependent abused on socially constructed needs. For the quadriplegic individual, the key expectation of society across all culture that has not been met in their lives is the ability to take care of themselves. In this way, they are dependent. For the healthy individual, the socially constructed need of utility or contributing to society is not met because they are depending on societys pool of resources which are limited.

5. a) Why is the use of charities to elicit donations for disability causes (as well as others) controversial? Charity-pity-donations: -People donate the money to make themselves feel better and sometimes thats all they do because they feel that they done their part -Great for paying for programs today, but does not help for the future, ie. Africa the image comes in mind are a dark child who is poor, this is the product of charities. What about companies, they want to invest, they wont want to go develop in Africa because its all negative images. Hence, Africa will never become rich. b) What are the old and new stereotypes of giftedness? Are they correct? Neither of them are correct nor true. OLD STEREOTYPE- Gifted child is weak, socially inept, narrow in interests, and emotionally unstable. y INCORRECT: Therefore if someone gets more of something, the other person will get less of the something, if a person is very smart, then they must be emotionally unstable etc. (No one can have everything) Stems from the idea that God created everyone equally. NEW STEREOTYPE- Gifted child is superior in everyway - intelligence, physique, sociability, etc. y INCORRECT: Thinking that they have everyone, the all American Child = White upper, middle class, gorgeous looks, usually boy, blonde hair blue eyes, small American town, athlete, very intelligent, excellent family member, older brother and come from tragic past events etc. This image comes from Hollywood. Both are problematic because it sets expectations of individual that they wont be able to meet. Lead to low selfesteem. c) ) If you had an Autistic child would you try a gluten and casein free diet as treatment? Why/why not? What considerations would you use to make this decision? Diet - gluten (wheat protein)-free, casein (dairy protein)-free foods - may drug the brain Yes: Because it has proven to work in few cases. No: Because personally I would not choose it, because the evidence show there are only a few cases that actually worked. Autistic is not identified at birth but when the child is 2 or 3 years old, by the time they already formed patterns of behaviour its hard to change their eating behaviour. Also todays children eat many products that contain milk and wheat. So its hard to get them to eat gluten free and casein free food. Why put up with their anger tantrum when this strategy might not even work. Its an inexpensive treatment, but highly difficult to implement, hence a last resort if all other treatment fails.