Counseling Parents of School-Age Children With Special Needs Christopher Connolly, PhD Most states have mandatory attendance laws which require that a child attend school between the ages of five and sixteen. In recent years there has also been an increase in the number of children between three and five who attend some form of school-related program such as Head Start, nursery school, or Montessori. Thus, for most children, a major commitment of time and energy is expended in school activities during most of their childhood and adolescence. For these children, essential developmental tasks between ages 3-16 involve attending school, relating adequately to a peer group, mastering basic readiness skills, and becoming proficient in core academic subjects such as reading, spelling, written language and mathematics. How a child copes with these developmental tasks, whether or not he is successful, and the type of support and guidance he receives from the adults in his environment have obvious and far-reachingeffects on his overall development. Statistics which document a high correlation between academic failure, early dropout rate from school, and later incidence of juvenile delinquency or criminal activity are convincing in their depiction of the difficult adult life of many individuals who fail in school. Children with special needs have received an increasing amount of attention and public funding over the past ten years. The phrase “special needs” refers to all children who require special education intervention. It is a generic term and includes youngsters with difficulties arising from intellectual, sensory, emotional or physical factors, cerebral dysfunctions, perceptual deficits, or other specific learning disabilities. Remedial and compensatory programs have expanded greatly for this population, and far more younysters today receive special educational services than4reviously. With this trend, many school physicians and nurses have found their roles expanding and growing in directions for which they were not specifically trained. Previously, FEBRUARY 1978

most school health personnel focused on the detection and prevention of physical disorders and the dissemination of health-related information. Today they find themselves dealing with developmental disorders, such as learning disabilities, which do not fall cleanly within a traditional medical context. These are not lifethreatening disorders; and, in this respect, they are different from many of the medical problems encountered by nurses and physicians. However, educational dysfunctions may be chronic; and they often obstruct growth in other areas of development, such as social and emotional relationships. When health personnel become involved in dealing with school problems, they often discover a ripple effect that involves the entire family. The child’s failures in academic work cannot be viewed in insolation because he or she may be perceived as a psychological extension of the parents, the bearers of their genetic traits, and the product of their child-rearing efforts. These are exceedingly important roles, and if a child is not able to function well in school, all the roles become jeopardized. As a result, a child’s learning problems impinge on the goals and aspirations of the parents. If these individuals perceive themselves as failures because of their child’s problems, then a typical reaction pattern is the development of doubt, guilt, and anxiety concerning their adequacy as parents. These emotions translate readily into anger, which is easily displaced onto the school and its representatives. School personnel are in a particularly vulnerable position because they represent the source of the parent’s and child’s problems - that is, they symbolize the setting in which the child’s failures occur. The widespread incidence of school problems (many authorities estimate that approximately 15% of the school population sustains special needs), the critical importance of a child’s school experiences, and the ripple effkct of failure on parents and family clearly THE JOURNAL OF SCHOOL HEALTH

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emphasize the need for effective counseling. This paper takes the viewpoint that within the educational setting, school nurses and physicians are in a unique position to counsel effectively. Medical personnel are not as closely associated with the child’s learning problems as are the instructional personnel and administrators of a school. The principal, teachers, learning disabilities specialist, remedial reading instructors, et cetera, often are seen by parents as too closely linked with their child’s problems. It is these individuals who usually convey the bad news about the academic deficiencies and behavioral irregularities of their children. Because of this link, the instructional and administrative personnel may have a difficult time obtaining the trust and confidence necessary for an effective counseling relationship. Parents are more likely to trust and to respond to the medical personnel who generally are not seen as having any hidden agenda. In addition, the trust many people place in medical professionals is transferred to the school nurse or doctor, even when talking about issues which may not be considered strictly medical. It is felt that many people involved in “counseling” do not prepare themselves adequately, consider their techniques sufficiently, or plan their sessions carefully. It appears that many personnel attempt to counsel without a clear conceptualization of (1) what the problem is, (2) what the parent’s understanding of the situation is, (3) how can the counselor communicate most clearly with the parents, and (4) what do the parents want/need/expect from the session? A counseling session should not be approached haphazardly and left to chance factors such as the level of fatigue of the participants or superficial personality differences. Obviously, it is not possible to plan the exact content of a session since it is necessary to be flexible and to respond to new information that arises. But is it possible to have a general idea about the purpose and goals of the appointment and a feeling about whether these were accomplished. After a session, when the parents are asked to explain the problem in their own words, what the counselor thinks was heard and what the client/patient actually takes away may be two very disparate phenomena. In a counseling relationship, it is what the patient hears that is of prime importance. The counselor’s knowledge and understanding of the situation is secondary. If this knowledge cannot be communicated clearly, then the counselor has failed. Counseling is both an art and a science. It involves not only factual knowledge about complex developmental problems, but also requires effective interpersonal relationships and the ability to communicate clearly upder anxiety-provoking conditions. The physician’s or nurse’s role as a counselor generally contains several elements: 1. To provide factual information (“Is he retard116

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ed?”, “Does she have a learning disability?”) 2. To dispel unrealistic fears (“Is she having trouble reading because I dropped her when she was a baby?”) 3. To help mobilize school and community resources through support and guidance of the parents. 4. To deal with the residual problems which may arise from the child’s special needs ie, feelings of parental inadequacy, suggestions for home management techniques. The question “How does one counsel?” is analogous to interesting but vague inquiries such as “How do you raise children?” Obviously some techniques and methods are more beneficial than others, and some people seem much more successful at it than others. No one set of answers suffices to cover the wide range of circumstances and individuals involved. In general, good counseling should involve three basic factors: a sharing of factual information, a sharing of feelings, and a plan of positive action for change. Thus there are factual, affective and outcome variables involved. Even though there is no single way to counsel and one must develop his or her own style, there are some general techniques or ideas that many people find helpful: 1. Develop a clear understanding of what kin& of people one is attracted to and repelled by - that is, understand your biases and prejudices. It is naive to believe that we respond the same to all people. If one does not like Bulgarians, whiney children, passive adults or aggressive mothers, then it is important to be aware of these feelings. It is not necessary to change one’s biases, but it is essential to be cognizant of them in order to be alert to their possible intrusion in one’s sessions. 2. Adopt a phenomenological viewpoint - that is, attempt to develop empathy for what the client is experiencing and try to adopt their point of view. How does it feel to be the parent of a hyperactive child or a youngster who has poor impulse control? A phenomenological attitude helps to avoid empty intellectualizing by putting oneself in the client’s position and seeing the world from their vantage point. 3. Avoid using diagnostic labels whenever possible. In medical models, a label may provide useful information concerning etiology and may suggest the best plan for treatment. In educational models, a label more often confuses issues, arouses misunderstanding and anxiety and usually says nothing about how the child should be remediated. Descriptive terms, rather than diagnostic labels, generally are more conducive to understanding, acceptance and growth. This attitude is reflected by the passage of laws such as Chapter 766 in Massachusetts and PL 94-142 of the Federal Laws which support the trend to descriptive terms. 4. Two of the most basic human needs, the need for competence and the need for acceptance, are threatened FEBRUARY 1978

by school failure. We all need to feel masterful in our dealings with the environment and we need to feel that we are an accepted member of our peer group. These drives are critical, especially in the adolescent child. Suggestions for activities which involve woodworking, electricity, cooking and sports are avenues which might increase a child’s self-esteem who has difficulty in language arts areas such as reading and spelling. The general model is to find compensatory areas which bolster a youngster’s self-confidence and to help him avoid overgeneralization of his school difficulties into other areas of life. 5 . Be sure to let the parents respond during the session. Many “counselors” do all the talking and do more lecturing than counseling. Listening to a tape recording of one’s sessions is a helpful tool to see the relative amount of time one spends talking versus listening. Parent’s perceptions of the problem are crucial, and much time and effort can be saved by listening carefully to them. To illustrate, if the parents believe dyslexia is a neurological problem and the counselor believes it is simply delayed reading, communication is unclear and the parties involved are talking on two very different levels. 6. In addition to listening to theparents, it is helpful to look at them for nonverbal cues. Increased restlessness may indicate a sensitive or dangerous topic. Physical changes, such as blushing, dilated pupils and increased activity of the carotid artery may suggest anxiety and discomfort. The projective hypothesis states that many things an individual does - their body language, attire and verbalizations, - disclose their feelings and attitudes. The counselor’s ability to pick up these cues and to deal with their significance increases his or her effectiveness. 7 . Giveparentssomething concrete to do. Help them become involved and feel useful in dealing with their child’s problems. It is very frustrating to be told your child has a problem but to be unable to actively participate in alleviating it. For example, parents may help out with school work if the child requests it. They may help improve language skills by talking with their child or asking what a particular TV show was about. They may be most useful simply by spending additional time with a chikl revolved around non-academic areas of strength such as hobbies, sports, trips. Most parents want to help and want to take on an active role in their child’s treatment program. This role will vary from parent to parent, but concrete suggestions should be offered to them. 8. Help parents not to be overprotective of their child. A delicate balance must be struck between helping the child and, at the same time, avoiding overdependence and passivity. Some parents develop the habit of doing too much for their “handicapped child”, FEBRUARY 1978

and the child remains immature and dependent. The concept of functional autonomy is relevant to this point. Functional autonomy exists when a behavior which was appropriate at an earlier age continues at the present time, even though it is no longer appropriate or needed. For example, when a child of age five is sickly and frail, it is natural for the parents to be very involved, protective and concerned. Ten years later, when the child weighs 200 pounds and plays linebacker on the high school football team, such attitudes and behaviors are no longer needed. Unfortunately, in some instances, the earlier attitudes become functionally autonomous; and in these cases, the counselor should help the family to realize these patterns and help break the habits. 9. Share test results and evaluation data with parents. If we have an abdominal pain which concerns us enough to have an X-ray taken we are very interested in the results and want an explanation of them. Similarly, if a child’s psyche and soma have been probed and tested, the parents (and child) should have a clear presentation and interpretation of results. The Buckley Admendment adds legal weight to the obvious ethical responsibility of the school to explain test results clearly. Such data also can be effectively utilized to dispel fears of mental retardation or other severe disorders which the family may secretly fear is the cause of their child’s problems. 10. Try to show parents the relationship between problems at school and at home. For instance, difficulties with spatial relationships and fine motor control may cause writing problems in class and clumsiness in the kitchen. The child’s learning problems at school may manifest themselves at home by spilling things, bumping into objects, being excessively sloppy and so forth. It is helpful if parents can see that several behaviors which might concern them have the same cause. Tying together many concerns into a meaningful theme helps to reduce anxiety and makes problems more understandable and possibly easier to deal with. In conclusion, school physicians and nurses often find themselves in counseling relationships with parents of school-age children. The parents frequently have significant concerns about their adequacy as childrearers, and their sense of security and self-confidence is in jeopardy due to their child’s special needs. In addition, they may feel anxious, confused and angry toward their child and toward the school system. Medical personnel are felt to be in an excellent position to be effective counselors in these situations, and it is suggested that they use their role consciously to improve their techniques and effectiveness.

Christopher Connolly, PhD, is Psychologist-Educator, The Children’s Hospital Medical Center, 300 Longwood Avenue, Boston, M A 02115. THE JOURNAL OF SCHOOL HEALTH

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CALL FOR NOMINATIONS FOR ASHA AWARDS Members of the Association are invited to nominate candidates for the William A. Howe Award and ASHA Distinguished Service Awards which will be presented during the annual convention in October. Nominations should be sent to E. J. McClendon, EdD, Chairman, ASHA Awards Committee, American School Health Association, Box 708, Kent, OH 44240. Nominations and supportive information should be forwarded by March 15, 1978. ASHA OFFICES Nominations are now open for the following ASHA offices: Vice President, Coordinator of Study Committees, and five positions on the Governing Council. Nominations should be sent to Warren E. Schaller, HSD, Chairman, Nominations Committee, American School Health Association, Kent, OH 44240. The deadline for nominations is MaFh 15, 1978.

RESEARCH PAPERS The Research Council of the American School Health Association invites papers for consideration by a review committee for presentation at the 52nd Annual Convention, October 11-15, 1978, in Dearborn, Michigan. The research must be relevant to some aspect of the school health program and must be now completed or expected to be completed before the date of the annual meeting. All applications must be received no later than May 1, 1978. Each must state the name of the author@),the author’s institutional affiliation, address, and the title of the paper as it is to be listed in the program. A minimum of four copies (three of which should not bear the author’s name and address) of a 500 word abstract should state the purpose of the investigation, establish its significance to health education, describe the procedures which were employed, and summarize the principal findings or conclusions. The Research Council would like to add a special session for Research Methodology. We encourage papers to be submitted dealing with such aspects as: needs for research, problems in research, types of research, philosophical and methodological considerations, common research errors, et cetera. The paper must be presented by the investigator(s) and must not have been previously presented or published elsewhere. It should be understood if the paper is selected, THE JOURNAL OF SCHOOL HEALTH will have first option for publication. All applicants will be notified of their paper’s acceptance or rejection. Send all abstracts and other necessary information by May 1, 1978, to the Research Council Program Chairman, John A. Conley, PhD, Chairman, Department of Health and Safety Education, Division of Health, Physical Education and Recreation, University of Georgia, Athens, GA 30602. RESOLUTIONS Annually the American School Health Association addresses itself to significant problems in the field of child health and school health education. The full span of the discussion on many of these problems is made known through a series of Resolutions passed by the Governing Council. The membership is invited to suggest problems which might serve as the basis for action of this sort. Such suggestions should be transmitted to the Chairman of the Resolutions Committee, American School Health Association, Kent, OH 44240.

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Counseling parents of school-age children with special needs.

Counseling Parents of School-Age Children With Special Needs Christopher Connolly, PhD Most states have mandatory attendance laws which require that a...
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