This study involved families with children from birth to 5; it was a randomized trial in which families received the intervention, called the Video Interaction Project , and the other families served as controls. The V. Participating families received books and toys when they visited the pediatric clinic. Benard Dreyer, a professor of pediatrics at New York University School of Medicine and past president of the American Academy of Pediatrics, who was the senior author on the study. He noted that the critical period for child development starts at birth, which is also a time when there are many pediatric visits.
The Video Interaction Project started as an infant-toddler program, working with low-income urban families in New York during clinic visits from birth to 3 years of age. There I was in the same room with other happy mothers. Pediatricians spoke with them and their children were brought into the room to be breastfed, but it was as if I or my child did not even exist.
Special Needs Children
It is like they immediately wrote my child off. Jasmina explained that medical doctors and nurses tried to convince her and her husband to leave Julija in the maternity ward and to have her placed in an institution:. The social worker also confirmed that professional staff in some hospitals instead may be quick to encourage parents to give up on their child with disability:. Human Rights Watch also documented that the government often does not provide sufficient information to parents and their children about their rights and the services, support, and rehabilitation options available to them, or advice on how to meet the needs of their child with a disability.
If you find out something, it is by pure accident. According to one study in the United States for which parents of children with disabilities were surveyed, the quality of the first information parents receive upon the birth of a child with a disability and the attitude of healthcare workers are key factors that impact the hope parents have for the future of their baby. Parents believe that the child will receive adequate health monitoring and "expert" support in an institution that they cannot provide at home.
The study also found parents often mistakenly believe that taking care of a child with disabilities might impair the development of other children in the family. Human Rights Watch found that families which had children with disabilities did not have access to adequate community services and support, such as health care, psychosocial support, and financial assistance to support children with disabilities and their biological families across Serbia.
One of the key reasons for placement of children with developmental disabilities in institutions is the lack of community-based health care. So, we thought the best solution was to have her stay in Belgrade where she can easily access adequate health care whenever she needed it. But when we go to a regular dentist, he knows nothing about it.
The Serbian government finances foster care and institutions for children and adults from the national budget, while municipalities have the responsibility to develop and finance community-based support services for families. For example in , using EU IPA funds Instrument for Pre-Accession funds , the small group home in Aleksinac had set up a respite service that would give families time off from their caregiver responsibilities and allow their children to socialize with others outside the family unit.
Ana, a single mother of a year-old girl with physical and intellectual disabilities who currently lives five days a week in an institution and spends weekends at home, said that the existence of community-based respite services where her daughter could spend some of her time would allow her as a single and full-time employed mother to raise her daughter at home. According to a representative from the Ministry of Labour, Employment and Social Policy, the Serbian government is committed to develop respite services for children with disabilities and their families.
The absence of day care facilities and inclusive schools also contribute to parents feeling they have no choice but to send their child to an institution. Ana also told Human Rights Watch about her struggle to find a day care center where her daughter could spend time while she works:. Under the Law on Social Welfare, in order for the state to cover these expenses, Ana explained she would have to give up her parental rights.
As long as I keep my parental rights, I must pay for her accommodations. Human Rights Watch research found that where community services do exist, they are limited in scope. For example, the family outreach service, developed by UNICEF in , which provides support to families where there is a risk of the separation of children from their families, is being implemented in only four major cities in Serbia, with limited financial resources and no long-term sustainability. Human Rights Watch found that continuity of services is also a real problem.
According to an analysis by the Network of Organizations for Children of Serbia in , family support prior to separating a child from its family was provided in only 15 percent of the cases. Some parents of children with disabilities as well as foster carers also told Human Rights Watch that they need counseling. Under the Convention on the Rights of Persons with Disabilities, Serbia is obliged to ensure that children with disabilities have equal rights with respect to family life.
With a view to realizing these rights, States parties should provide early and comprehensive information, services and support to children with disabilities and their families. National law protects the right to free and compulsory primary education for all children and the right to free secondary education for all persons. A number of Serbian laws explicitly prohibit discrimination on the basis of disability including the law on education.
However, Human Rights Watch research found that the majority of children and young people with disabilities in Serbia are either segregated in separate schools for children with disabilities or are not given opportunities for education at all. According to the Ministry of Education it is estimated that approximately up to 50 percent of children with disabilities in Serbia are not enrolled in schools. The right to live in the community for children with disabilities, as guaranteed by the Convention on the Rights of Persons with Disabilities, also involves being able to attend school, access healthcare in the community, and enjoy play and leisure activities on an equal basis with other children.
Inclusive education focuses on ensuring the whole school environment is designed to foster inclusion, not segregation. In Serbia, most mainstream kindergartens and schools continue to be inaccessible for children with disabilities, particularly children with developmental or intellectual disabilities. Many schools also refuse to admit children with disabilities on the basis that they do not have the resources or skills to educate them.
When the school finally enrolled the child, it was a struggle to keep her in school. In principle, the development of day care centers is a positive step in providing support and accommodation during the working hours of parents, and as a support service to schools. Day care centers, however, should not become a substitute for enrollment in school. Children who live in small group homes in Belgrade and Aleksinac are included in the education system.
However, even in this case, all children go to special schools exclusively for children with disabilities rather than in mainstream schools for all children. Of the 48 children and families interviewed for this report, Human Rights Watch met only two children, a year-old girl with an intellectual disability and a year-old boy with psychosocial disabilities, who live with their birth and foster families and attend mainstream schools. According to Serbian law, parents or legal guardians of children with disabilities make the decision on whether a child will attend mainstream or special school.
Four birth and foster parents told Human Rights Watch they decided to enroll their child with a disability in a special school out of fear that the child will be neglected and will not receive quality education in a mainstream school. It is literally impossible to have an individual approach with every child.
I would rather have my daughter get the attention and support she needs to thrive in special school than to languish in a general school. In the letter to Human Rights Watch, the Ministry of Education said it does not have information on the number of children with disabilities who are enrolled in schools in their communities. The ministry recognized the need to improve data collection, and provided information on concrete steps taken to improve data collection on children with disabilities and their right to access education.
According to the Ministry of Education, parents usually have questions on how to access personal escorts and access to education such as the process of enrollment in mainstream and special schools and how to move children from special to mainstream schools.
Serbia is developing and promoting foster care through Centers for Family Placement as an alternative to institutionalization. As of November , children with disabilities lived in foster care. Ongoing work includes broadening foster care services for children with disabilities across Serbia. Each foster family is supported by a foster family associate, who is responsible for supporting and counseling the families as well as supervising foster parents.
Human Rights Watch visited and interviewed three foster families in Belgrade and Nis, each of whom is fostering one child with a disability.
Two of the children previously lived in institutions and one child had lived with her birth family. Human Rights Watch also interviewed one of the children currently placed in foster care and one foster family associate. It took me eight months to get him to smile. Suzana, a foster parent to Marina, a four-year old girl with developmental disabilities, told Human Rights Watch how it was impossible to touch the girl when she first came to their home from an institution three years earlier:.
However, according to local experts, children with disabilities are more likely to be put in alternative care arrangements than receive support in their birth families. Instead the state should provide parents access to social and economic support in order to safeguard and protect their family and the rights of the child. Human Rights Watch interviewed five young people with disabilities placed in foster care five to six years prior to the Human Rights Watch visits, who reported experiencing physical abuse, including one case of sexual abuse, while in foster care.
Foster care in Serbia is also currently provided as the main option for relocating children out of institutions. There is insufficient effort to reunite children with disabilities with their birth families and support birth families in raising children with disabilities. In addition, the Rulebook on Foster Placement obliges the centers for social work to support birth families with the aim of rehabilitating and supporting parents so they can care for their child. Human Rights Watch research found that a parent of a child with high support needs who lives in the community often stays at home to care for the child, forfeiting paid employment and placing financial strain on the family.
At the same time, a parent in Serbia cannot be recognized as the caregiver of their child with disabilities in the same way as a foster parent, meaning that a parent cannot be compensated for taking care of a child with disability.
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This also often means that the family has difficulty paying for the necessary therapeutic services, medication, or transport to appointments. The lack of these services and supports can compel some parents to reluctantly place their child in an institution. Based on interviews with children and young people with disabilities, institution staff, and activists, as well as visits to five institutions, Human Rights Watch found that children and young persons with disabilities experience a range of situations in Serbian institutions in which their human rights are violated.
These include segregation and seclusion, neglect, lack of privacy, insufficient safeguards, involuntary and potentially inappropriate medical treatment, lack of education and play, denial of legal capacity upon reaching adulthood, and limited freedom of movement. In both the Stamnica Home for Children and Adults with Disabilities and the Veternik Institution for children and adults with disabilities, children were confined to cribs in the same room and wards as adults.
In the Kolevka Home for children with disabilities, up to 30 children with developmental and intellectual disabilities, including newborn babies, were confined to cribs in rooms without natural light or fresh air. There were no windows in the rooms, no space for children to play, and apart from the cribs there was no other furniture in the room. Up to 11 children lived together in one room, with one caregiver responsible for all of them.
None of these children attends school. In the same ward, but in a separate room, Human Rights Watch met a seven-year-old Roma boy with intellectual and physical disabilities, who is also HIV positive. We worried they could scratch each other. In two institutions visited, Human Rights Watch found that staff put children in isolation rooms. The staff explained that the purpose of isolation is to ensure that children do not carry contagious illnesses into the institution or to help them adapt to the institution. The isolation room had a small twin size bed with white sheets, there were no personal belongings, toys, or any other furniture, and the boy was dressed in a white hospital gown.
The toilet inside of the room was separated from the sleeping area. There was no space for the boy to play or run around. According to the director of the institution, a medical nurse is present in the room with the child and a child usually stays in an isolation room up to five days.
The biggest problem is lack of staff. We have 4 special education therapists, 10 rehabilitation therapists, and 4 work instructors for plus people. One caregiver is responsible for 20 people. Lack of individualized attention from caregivers is a significant problem documented in all large institutions Human Rights Watch visited, in many cases leading to neglect.
The lack of individualized attention is likely due in part to the lack of personnel to care for large numbers of children and adults with disabilities. Other than taking care of basic needs such as bathing, diaper changes and feeding, there is little time for individual care or interaction with the children.
For example, staff in Kolevka Home for children with disabilities explained that the primary role of the scarce caregivers in the institution is to provide nursing and physical care. In one of the rooms, Human Rights Watch found a year-old boy with untreated hydrocephalus, lying motionless on a bed on his back. Institution staff recognized the lack of individual time they can provide to children with disabilities.
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In what way can we devote individualized work? In addition to overall low numbers of staff, in all institutions visited the staff complained about the lack of qualified personnel for much-needed services including, variously, child psychiatrists, psychologists, speech therapists, and physical therapists. Human Rights Watch found that many children and young people with disabilities in Veternik, Stamnica, and Kolevka institutions wear diapers and are not toilet trained.
Toilet training any child requires patience and individualized support and can be a challenging and time consuming task for overwhelmed caregivers in Serbian institutions. However, just as with learning to feed and dress oneself, becoming toilet trained is an important step in personal independence for children. Human Rights Watch research revealed that in the complex of the Stamnica institution where children and young people with disabilities live there were no doors or means of privacy separating the toilets in the bathroom.
There were also no showers and the institution staff and the children told Human Rights Watch that they use water hoses to bath the children. Two institution staff explained that the reason why there are no showers is because residents broke them. In two other large institutions visited, there were no doors or curtains separating the showers in the bathing facility.
In the Veternik Institution for children and adults with disabilities, a Human Rights Watch researcher observed that in addition to no separation in the bathing and toilet facility, there were no doors on several rooms where children with disabilities live, giving residents very limited privacy. In Stamnica, several beds—sometimes up to three—were pushed together, and some beds had thin mattresses even though residents who lived in this ward could not walk and spent the majority of their days lying down.
Human Rights Watch did not document any evidence of regular or widespread physical or psychological violence by staff against children with disabilities in institutions, nor evidence of the resorting to abusive use of physical restraints on children. The rules further prohibit exploitation of residents, abuse of trust or power that institution staff enjoy in relation to residents, and any other practices that distort the health, dignity, and development of residents. This document stresses the need for the protection of children.
However Human Rights Watch is concerned that given the conditions observed in several institutions and the absence of effective safeguards — including no confidential complaint mechanism for people with disabilities in institutions, and a lack of independent and periodic monitoring of institutions - creates a risk that such abuses could still occur with impunity despite the rulebook.
Interviewees told Human Rights Watch about seven instances of various forms of psychological or physical violence by staff that are alleged to have occurred between three and five years prior to the visit of Human Rights Watch, as well as two recent alleged cases. It was awful. Made me extremely sad. I was tied like that for an entire day. Two women told Human Rights Watch they witnessed staff using physical restraints on other residents.
Human Rights Watch requested to see the relevant rulebooks during each visit to the various institutions, but was never shown any. Human Rights Watch also observed that some institution staff used derogatory language when speaking to children and young people with disabilities. For example, some staff who spoke to Human Rights Watch stated that the children have no potential to learn or go to school.
The UN special rapporteur on torture has held that both seclusion and restraint can amount to torture or cruel, inhuman, or degrading treatment when used against people with disabilities in certain circumstances. Under the CRC, States parties should ensure that children enjoy safe and effective means of reporting maltreatment.
In its concluding observations from April 21, , The UN Committee on the Rights of Persons with Disabilities called on the Serbian government to protect persons with disabilities in all institutional settings from violence, abuse, and ill-treatment of any kind. They force me to take pills every day, during breakfast, lunch, and for dinner. In case I resist, they open my mouth with their hands and put in pills. Some of them are orange; others are white. They never said what they are for. Maybe they are for insanity. Why do I have to take these now?
My head hurts from these pills. In all of the institutions visited, Human Rights Watch documented numerous cases of potentially inappropriate or forced medical treatment and intervention given to children and adults with disabilities. Human Rights Watch documented that several medications, including psychotropic medications, are used on children with disabilities in Serbian institutions and small group homes, apparently as a means of dealing with behavioral issues, without the oversight or review to ensure the treatment is necessary and administered in line with the rights of children with disabilities to the highest attainable standards of health.
Staff at all five institutions visited told Human Rights Watch that the majority of children and young people with disabilities in their institutions are prescribed psychotropic medications. In three institutions, Human Rights Watch documented that many children were given combinations of the following medications: Largactil an antipsychotic , Rivotril a benzodiazepine , Mendilex an anti-cholinergic , Rissar atypical antipsychotic , Lorazepam a benzodiazepine , Diazepam sedative , and Amitriptyline antidepressant. According to Serbian website lekovi. According to the American Academy of Child and Adolescent Psychiatry, the use of psychotropic medications in children and adolescents may lead to adverse effects on neurological development, personality and character, including weight gain or movement disorder.
Staff in institutions, including medical staff, stated that psychiatric drugs are in many cases prescribed to prevent children from harming themselves or from being aggressive to others, and also to control the behavior of children. The Ministry of Health told Human Rights Watch, in response to its concerns about the overreliance on the use of psychotropic medication to control the behavior of children, that:.
Our research, however, suggests that quick resort to medication to control behavior may be more common in the institutions we visited. For example, a year-old woman with psychosocial disability told Human Rights Watch that she had observed that staff were quick to use medication to address aggressive behavior in the institution where she lives:.
We regulate this [self-harm or aggressive behavior] by medication, not restraints. We do have those challenges.
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That we need to pay more attention to the child. Staff in two institutions visited stated that the lack of staff contributed to overreliance on high dosages of psychotropic medication for children, as a means for small numbers of staff to manage a large number of children and adults. It is impossible to devote [time to each child]. An individual approach is simply not possible. Autonomous learner model: Optimizing ability. Cash, A. A profile of gifted individuals with autism: The twice-exceptional learner. Roeper Review, 22 , Autism: The silent mask.
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Social stories and comic strip conversations with students with Asperger Syndrome and high functioning autism. Schopler, G. Kunce Eds. Guevremont, D. Social skills and peer relationship training. Barkley Ed. New York: The Guilford Press. Henderson, L. Gifted individuals with Asperger Syndrome. Hollingworth, L. Hurlburt, R. Sampling the form of inner experience of three adults with Asperger's Syndrome. Psychological Medicine, 24 , Klin, A. Asperger Syndrome. Guidelines for parents: Assessment, diagnosis, and intervention of Asperger Syndrome.
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Psychological Medicine, 11 , The relationship between Asperger's Syndrome and Kanner's Autism. Manifestations of social problems in high-functioning autistic people. Severe impairments of social interaction and associated abnormalities in children: Epidemiology and classification. Journal of Autism and Developmental Disorders, 9 , This material may not be reproduced without permission from NAGC. This article is provided as a service of the Davidson Institute for Talent Development, a c 3 nonprofit dedicated to supporting profoundly gifted young people 18 and under. The appearance of any information in the Davidson Institute's Database does not imply an endorsement by, or any affiliation with, the Davidson Institute.
All information presented is for informational purposes only and is solely the opinion of and the responsibility of the author. Although reasonable effort is made to present accurate information, the Davidson Institute makes no guarantees of any kind, including as to accuracy or completeness. Use of such information is at the sole risk of the reader. How to Apply Davidson Fellows Past Fellows Overview Student Profiles Staff. Eligibility Tips for Applying Tuition and Fees. Instructors Past Courses. Living on Campus Activities. Ed Guild eNews. Search Database. Gifted children with Asperger's Syndrome This article by Maureen Niehart suggests approaches for the teacher who works with young people with Asperger's Syndrome.
AS is a disorder in the autism spectrum that is observed in some gifted children. Gifted children may be very difficult to diagnose with AS because the disorder may resemble other problems such as a learning disability or simply just similar traits of a gifted child.