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Use peer support Peers can help students with autism spectrum disorders develop social skills bipolar depression 60 discount wellbutrin 300mg free shipping. Teachers may need to depression hurts test purchase 300 mg wellbutrin fast delivery interpret nonverbal communication or explain that a specific activity is difficult for a student baseline depression definition buy wellbutrin 300 mg fast delivery, and identify what peers can do to depression nutrition wellbutrin 300mg free shipping help. Young children can be shown how to use specific prompts to initiate and maintain interaction with classmates with autism spectrum disorders. Peers should be reinforced for their role, just as the student with autism spectrum disorders is reinforced for social interactions. It is imperative that Classroom Instruction /75 © Alberta Learning, Alberta, Canada 2003 peers understand the impact that their attitudes, comments and actions have on other students. Peers can help develop strategies to enhance the social competence of students with autism spectrum disorders. This approach involves teaching classmates to use strategies to: • gain attention • give choices to maintain motivation • vary toys • model social behaviour • reinforce attempts • encourage conversation • extend conversation • take turns • narrate play. Provide peers with information on autism spectrum disorders and tips for interacting with students with autism spectrum disorders. It is important that parents be involved in the decision to discuss their children’s autism spectrum disorders. Use social skills training groups Students with autism spectrum disorders may benefit from social skills instruction within a small-group format. Social skills training programs typically include assessments teachers can use to identify skills for instruction. Learning activities generally include: • identifying the skill and skill components, and when it is used • modelling the skill • role-playing • opportunities to practise • strategies for generalization. Although these programs are not developed specifically for students with autism spectrum disorders, they can be used in combination with appropriate adaptations and supports. There may need to be a particular emphasis on strategies for facilitating the generalization of targeted skills. Play groups provide natural situations in which children use language to express wants, practise being near other children and 52 imitate social interactions. Teach self-monitoring skills the ultimate goal for all students, including those with autism spectrum disorders, is to increase independent participation in a variety of environments using effective social skills. One way to increase independence in higher-functioning students is to teach 53 self-monitoring procedures. Self-monitoring involves teaching students to monitor their own behaviours in order to earn positive reinforcement. Studies indicate that in the process of collecting self-monitoring data, desired behaviours increase. The accuracy of self-monitoring may not be as important as the process and awareness it builds in students. Teach students the target behaviours and how to use the self monitoring method to record performance. Increase students’ independence by gradually reducing adult intervention and having students self-manage behaviours. Support friendships Optimally, the aim of developing specific social skills is to enable students with autism spectrum disorders to interact with others in a variety of settings, and facilitate the development of social opportunities and relationships. Students who demonstrate basic social skills may still have difficulty establishing connections with others and maintaining interactions with peers. Teachers may facilitate further social interaction by: For more on facilitating peer friendships, see pages • helping students join school clubs and providing the support 121–123. Teaching Functional Skills One of the fundamental goals of schooling is for all students to acquire the skills they need to function as independently as possible in the world. This is especially important for students with autism spectrum disorders who also have cognitive delays, as they may have significant difficulty acquiring independent functional life skills. The same instructional approaches and strategies used for other areas can be applied to instruction in functional skills. In the field of special education, educators have developed a variety of models for the domains of functional skills. Although these models differ in some ways, they basically include five domains: • domestic or self-care • functional academics • vocational or job skills • social, including leisure skills • community, including travel and using services. Schools and families should coordinate the planning of instruction for functional skills so that instruction at home and school is consistent and efficient. Some of these skills involve personal areas, so sensitivity and care should be used. Address self-care the kinds of instructional strategies used for communication and social skills can be applied to instruction in the areas of self-care. Students with autism spectrum disorders, particularly those with intellectual disabilities, often need direct instruction in personal hygiene, grooming and dressing. Planning meals, food preparation and even eating may be an appropriate part of students’ programs. Identify functional academic skills Being able to apply the basic academic skills of reading, writing and mathematics to real-life situations is another important area of functional skill development for many students with autism spectrum disorders. In the reading domain, it is important for students to: • recognize their names • use simple calendars and schedules • decode common signs. Functional writing skills include: • beingabletosignone’sname • being able to copy from models • having the skills to construct basic lists. There are several functional skills that can be taught within the mathematics domain. Students also need to learn how to communicate personal information, such as their names, birth dates, addresses and telephone numbers. Address vocational skills Students with autism spectrum disorders usually require instruction in the basic skills required for the world of work. Classroom Instruction /79 © Alberta Learning, Alberta, Canada 2003 Independent adults need to be able to: • be punctual and reliable in attendance at work • follow job routines and complete duties as assigned • understand task completion • follow safety procedures • accept direction and correction • respond appropriately to persons in authority • complete a cleanup routine • dress in appropriate work attire and use appropriate grooming • use job site leisure time appropriately. Teaching young students to follow routines and complete activities independently facilitates the development of vocational skills later in life. Consider leisure skills Education programs for students with autism spectrum disorders often include a recreational component, because they may need help developing positive use of their leisure time. For individuals whose disabilities preclude employment, leisure activities constitute a significant part of their daily routines as adults. Families and school staff need to identify and create opportunities for meaningful participation in daily life. Address community skills Refer to Essential and Supportive Skills for Students Safety is a major concern for many students with autism spectrum with Developmental disorders. It is important to consider safety issues in planning for Disabilities (Alberta Learning students as they develop independence in the community. Possible 1995), Book 2 of the areas for consideration include: Programming for Students • using public transportation with Special Needs series, for additional information about • finding community services, such as pools, recreation centres teaching functional life skills. To implement effective instructional activities, it adults with the expectation that may be necessary to first focus on managing student behaviour. It is important that behaviour intervention plans be based on an the purpose of a behaviour understanding of the characteristics of autism spectrum disorders, may be: as well as knowledge of the strengths and needs of individual – to gain attention students. Understanding that all behaviour has a communicative – to escape/avoid function is essential in developing successful intervention plans. Behaviour intervention plans should be developed through a collaborative problem-solving process involving all the significant Durand and Crimmins, 1988 people in students’ lives, including parents, classroom teachers, special educators and teacher assistants. The process may also include others, such as principals, psychologists, behaviour consultants, speech-language pathologists and occupational therapists. It is critical that final plans take into consideration the space, materials and staffing resources available in the classroom. The emphasis in a positive behavioural support plan is prevention, accommodation and teaching appropriate behaviour. Managing Challenging Behaviour /83 © Alberta Learning, Alberta, Canada 2003 Functional behavioural analysis typically involves the following 59 steps. A functional behavioural analysis can be conducted formally over a period of several days or in a less-formal problem-solving or brainstorming process completed in one session. Determine which behaviour to target If students have a variety of challenging or disruptive behaviours, it will be necessary to establish priorities and determine which behaviour to address first. It is also critical to determine whether a specific behaviour is truly problematic.

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Learners should be able to anxiety over ebola order wellbutrin 300 mg on line skilled science and mathematics teachers mood disorder dsm 5 order wellbutrin 300mg on line, choose the vocational pathway before completing technicians and researchers anxiety panic disorder buy cheap wellbutrin 300 mg on line. Objectives Increase average male and female life Higher education expectancy at birth to mood disorder in dsm v discount wellbutrin 300mg without a prescription 70 years. Complete the construction of two new universities in Mpumalanga and the Northern Significantly reduce prevalence of non Cape; new medical schools in Limpopo and a communicable chronic diseases. Provide all students who qualify for the Fill posts with skilled, committed and National Student Financial Aid Scheme with competent individuals. Students who do not qualify should have access Address the social determinants that to bank loans, backed by state sureties. Both the affect health and disease National Student Financial Aid Scheme and bank 68. Prevent and reduce the disease burden All children should enjoy services and benefits and promote health aimed at facilitating access to nutrition, health 70. Implement the scheme in a phased manner, Provide income support to the unemployed focusing on: through various active labour market initiatives ¤ Improving quality of care in public facilities such as public works programmes, training and ¤ Reducing the relative cost of private skills development, and other labour market medical care related incentives. Build human resources in the health sector Social protection systems must respond to 72. Accelerate the production of community the growth of temporary and part-time contracts, health specialist in the five main specialist areas and the increasing importance of self-employment (medicine, surgery, including anaesthetics, and establish mechanisms to cover the risks obstetrics, paediatrics, and psychiatry) and train associated with such. They feel safe at home, at social floor that can be progressively realised school and at work, and they enjoy an active through rising employment, higher earnings and community life free of fear. Increase the supply of four categories of social professional institution staffed by highly skilled service professionals to 55 000, to respond to the officers who value their works, serve the demand for appropriate basic social welfare community, safeguard lives and property without services, i. Identify the main elements of a Actions comprehensive food security and nutrition 82. Create incentives that encourage a culture of individual saving for risks and loss of income due 83. Demilitarise the police force and train all police personnel in professional police ethics and 78. The National Rural Safety Strategy Plan must unemployed to access the labour market. Expand existing public employment initiatives to create opportunities for the unemployed. Mobilise youth for inner city safety to secure safe places and spaces for young people. A judiciary-led independent court implementation, integrated social security administration must be developed. Compulsory community service must be Commission to champion and monitor norms extended to all law graduates to enhance access and standards to ensure that only competent and to justice and provide work opportunities for suitably experienced people are appointed to graduate lawyers. Objectives Make the public service and local A state that is capable of playing a government careers of choice developmental and transformative role. Establish a formal graduate recruitment scheme for the public service with provision for A public service immersed in the mentoring, training and reflection. Formulate development agenda but insulated from undue long-term skills development strategies for senior political interference. Use placements and secondments to enable proactive approach to managing the staff to develop experience of working in other intergovernmental system. Use differentiation to ensure a better fit between the capacity and responsibilities of Actions provinces and municipalities. Take a more Stabilise the political-administrative proactive approach to resolving coordination interface problems and a more long-term approach to 91. Develop regional utilities to deliver some local a hybrid approach to top appointments that government services on an agency basis, where municipalities or districts lack capacity. An accountability framework should be coordination so that routine issues can be dealt developed linking the liability of individual public with on a day-to-day basis between mid-level servants to their responsibilities in proportion to officials. Corruption in the private sector is reported state-owned enterprises on and monitored by an agency similar to the 100. Improve coordination between policy and shareholder ministries by making them jointly 108. Restraint-of-trade agreements for senior civil responsible for appointing the board. Target Our vision is a society where opportunity is not Actions determined by race or birthright; where citizens 101. The capacity of corruption fighting agencies accept that they have both rights and should be enhanced and public education should responsibilities. Most critically, we seek a united, be part of the mandate of the anti-corruption prosperous, non-racial, non-sexist and agencies. At school assembly the Preamble of the Constitution to be read in language of choice. Expand the scope of whistle-blower protection to include disclosure to bodies other 111. Bill of responsibilities to be used at schools than the Public Protector and the Auditor and prominently displayed in each work place. Incentivising the production and distribution legislation and develop joint targets, indicators and of all art forms that facilitate healing, nation timelines for monitoring and evaluating progress building and dialogue. Promote citizen participation in forums such enhancing predictability for economic actors. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Treatment in the acute phase includes intravenous steroids and plasma exchange therapy. Imagem por ressonancia magnetica demonstra lesao medular que se estende tres ou mais segmentos vertebrais. Corticosteroide venoso em altas doses e plasmaferese sao usados no tratamento das fases agudas, enquanto os imunossupressores devem ser usados na profilaxia das recorrencias. In 1882 Chisholm recorded a case in and transverse myelitis occurring concomitantly or with which death occurred only 12 days after the onset drawing in a short interval, and no evidence of disease outside the attention to the severity of the disease. These observations led Japanese and myelitis were both the result of a common cause. Patients who had a relapsing-remit Lyon because of intractable headache and depression in ting course with involvement of the optic nerves and spi addition to general asthenia. One month later she devel nal cord and no clinical evidence of disease either in the oped urinary retention, complete paraplegia and blind cerebrum or the cerebellum were considered to have op ness, and died few weeks later. Those with minor brainstem signs, such as demyelinating and necrotic lesions extending for 4-5 cm nystagmus and diplopia in addition to the opticospinal in length in the lower thoracic and lumbar spinal cord. Patients with signs the lesions involved both the white and gray matter of multiple involvement of the central nervous system, in and were associated with cellular infltrates and thicken cluding the cerebrum and cerebellum were considered to ing of the vessels walls. Devic22 presented this case at the First Congress 3 of a spectrum of the same condition. The eponym “Devic’s co-occurrence of optic nerve disease and transverse my disease” was suggested by Acchiote24 in 1907. Stansbury in 1949, based upon re the association between acute myelitis and optic view of over 200 cases and analysis of 20 autopsied cases, 15 nerve disorder was frst described by Albutt in 1870. The patient ultimately made nerves and the spinal cord; that the severe binocular loss a complete recovery from the myelitis and a practically of vision is a characteristic of the disease, although the vi 17 complete recovery of visual function. Other cases disease outcome is extremely poor as patients in his anal 121 Devic’s neuromyelitis optica Lana-Peixoto Arq Neuropsiquiatr 2008;66(1) ysis usually died few months after onset of the disease. Additionally to the occurrence and necrosis ensue to coalesce into larger lesions with ax of optic neuritis and myelitis, which could be coinciden onal damage. The spinal cord gray matter may be distinc tal or separated by an interval of months to years, pa tively affected or may be involved by extension of the ad tients should not have signs of involvement beyond the jacent white matter lesions. Finally, glial scars are formed although scarring signs of cavitation in the spinal cord. Scott in 1952, commenting on Stanbury’s synthesis and usually absent oligoclonal bands. Patholog review, disagreed over his conclusion about the inexora ical features included necrosis and cavitation of the spinal bly poor outcome of the disease and drew attention to cord with absent or scant infammatory infltrates. He described cases should be signs of demyelination in the optic nerves, with with visual loss associated with minimal spinal cord dys or without cavitation whereas no lesions were to be found function and even the occurrence of “abortive types” with in the brain, brainstem and cerebellum. The frst patient was a 21-year-old mulattoe female disease could follow a monophasic or relapsing course. One patient had systemic lupus erythematosus, old white woman who presented acute transverse myeli another mixed connective tissue disease, and a third pul this followed a month later by bilateral optic neuritis.

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The cardiovascular risk age can be automatically calculated using HeartScore ( These various (from uncomplicated through to mood disorder home remedy buy wellbutrin 300 mg with visa asymptomatic or estab limitations should be kept in mind when estimating cardio lished disease) depression websites wellbutrin 300mg low price, according to depression quest discount 300mg wellbutrin different grades of hyperten vascular risk in clinical practice depression scientific definition order 300 mg wellbutrin otc. The cardiovascular risk does not necessarily correspond to the actual risk at different ages. Two measurements should be taken at each disturbance, obstructive sleep apnoea, obesity, high salt measurement session, performed 1–2 min apart [57]. Definitions of hypertension according to office, substantially increase in risk [74]. A significant white-coat effect can be seen at all grades of hypertension (including resistant hypertension), but the 4. This is true also for people in whom masked normal in white-coat hypertension, they tend to be hypertension is detected. This approach can provide important sup greater than that of sustained hypertension [68,93–96]. When ments are also indicated in specific circumstances (see structured population screening programmes have been Section 4. Nevertheless, exercise testing values before and during high altitude (>2500 m) exposure. Clinical indications for home blood pressure monitoring or ambulatory blood pressure monitoring Conditions in which white-coat hypertension is more common, for example: 4. Time of the first diagnosis of hypertension, includ measurements should be performed if ing records of any previous medical screening, the rst two readings differ by > 10 hospitalization, etc. Lifestyle evaluation, including exercise levels, body these measurements are logistically and weight changes, diet history, smoking history, alco economically feasible. History of any concomitant cardiovascular risk clinical indications, such as identifying white factors coat and masked hypertension, quantifying I A 8. Details and symptoms of past and present comor bidities the effects of treatment, and identifying pos 9. Specific history of potential secondary causes of sible causes of side effects [17,54,62,68,72] hypertension (see Section 8. History of past pregnancies and oral contraceptive use Journal of Hypertension Details of the requirements for a comprehensive clinical examination are outlined in Table 13, and this should be adapted according to the severity of hypertension and 5. Suggested routine clinical investiga investigations tions are outlined in Table 14. Physical examination provides important indications of potential causes of secondary hypertension, signs of 5. Whether addi tional parameters other than evidence of increased left ventricular mass and left atrial dilatation are useful to help 5. Stenotic carotid plaques have a strong predictive reduced renal function and/or the detection of albuminuria. One negative urinary ical determinant of isolated systolic hypertension and age dipstick test does not rule out albuminuria, in contrast to dependent increase in pulse pressure [148]. The increasing indicative of advanced atherosclerosis [152], and has pre emergence of new techniques to visualize the fundus through dictive value for cardiovascular events [153], being associ smartphone technologies should increase the feasibility of ated with an almost two-fold greater 10-year cardiovascular more routine fundoscopy [165]. White matter hyperintensities and silent infarcts are associated with an increased risk of stroke and 5. An alter butwhitematterhyperintensityandsilentbraininfarctsshould ation of renal function is most commonly detected by an be sought in all hypertensive patients with neurological dis increase in serum creatinine. This is an insensitive marker of turbances, cognitive decline, and, particularly, memory loss renal impairment because a major reduction in renal func [168,169]. A family history of cerebral haemorrhage at middle tion is needed before serum creatinine rises. Younger patients (<40 years) with grade 2 or more disease has been reported with a treatment-induced reduc severe hypertension in whom secondary hyperten tion in urinary protein excretion in both diabetic and sion should be excluded nondiabetic patients, especially for microalbuminuria 3. Patients with treatment-resistant hypertension (see [174], but results are discordant [175–179]. Other clinical circumstances in which the referring dence on the predictive power of treatment-induced doctor feels more specialist evaluation is required. I B Measurement of urine albumin:creatinine ratio is recommended in all hypertensivepatients [43,180]. I B Renal ultrasound and Doppler examination shouldbe considered in patients withimpairedrenal function, albuminuria, or for suspectedsecondary hypertension. However, Genetic testing and hypertension hypertension is a highly heterogeneous disorder with a Recommendations Classa Levelb multifactorial aetiology. Device-based hypertension should receive antihypertensive drug therapy is also emerging, but is not yet proven as an treatment alongside lifestyle interventions [208]. Thus, the benefits of antihypertensive treatment hypertension at low-moderate cardiovascular risk have not been attenuated by the widespread concomitant Recent meta-analyses show significant treatment-induced prescription of lipid-lowering and antiplatelet therapies in reductions in cardiovascular events and mortality in contemporary medicine. These findings have been supported by increase statistical power, and over a relatively short dura the results of a subgroup analysis of the Heart Outcomes tion of follow-up, rarely beyond 5 years. Chronological dence: age is often a poor surrogate for biological age, with consideration of frailty and independence influencing 1. In vascular risk factors in hypertensive patients, and to these patients, monotherapy may be sufficient. Antihypertensivetreatment may alsobe consideredinfrail older patients if tolerated [215]. For the purposes of these Guide not <140 mmHg) [231], other large meta-analyses lines, ‘older’ patients are defined as those aged at least have confirmed that in type 2 diabetes, lowering 65 years. Further details on the there is increasingly wide variation between a patient’s approach to treatment of the frail older patient are dis chronological age and their functional status, ranging cussed in Section 8. This convergence has also been confirmed in treated vegetables and fruits, weight reduction and maintaining an patients [243] in whom the difference between office ideal body weight, and regular physical activity [17]. A recent Recommendations Class Level meta-analysis of these trials showed that a reduction of 1. The effect of reduced dietary sodium on cardiovascular In older patients (aged > 65 years) receiving events remains unclear [252–255]. Increased cLess evidence is available for this target in low–moderate-risk patients. The con day (which corresponds to 9–12 g of salt per day), with sumption of these drinks should be discouraged [35]. Excessive weight gain is associated with hypertension, and Effective salt reduction is not easy and there is often poor reducing weight towards an ideal body weight decreases appreciation of which foods contain high salt levels. A reductions associated with an average weight loss of reduction in population salt intake remains a public health 5. Both priority but requires a combined effort between the food overweight and obesity are associated with an increased industry, governments, and the public in general, as 80% of risk of cardiovascular death and all-cause mortality. Binge drinking can have a 2 25 kg/m, whereas a more recent meta-analysis concluded strong pressor effect [17]. Hypertensive men who drink alcohol efficacy of antihypertensive medications and the cardiovas should be advised to limit their consumption to 14 and cular risk profile. Weight loss should employ a multidisci women to 8 units per week (1 unit is equal to 125 ml of wine plinary approach that includes dietary advice, regular or 250 ml of beer). Alcohol-free days during the week and exercise, and motivational counselling [35,275]. Recommendations Classa Levelb For additional benefit in healthy adults, a gradual increase in aerobic physical activity to 300 min a week of moderate Salt restriction to < 5 g per day is intensity or 150 min a week of vigorous-intensity aerobic I A recommended [248,250,255,258]. There is also evidence suggesting ill-health fruits, sh, nuts, and unsaturated fatty acids effects of passive smoking [282]. Brief advice from a physician has a small but significant Regular aerobic exercise. This can be improved by the use of pharmaco I A logical measures, with varenicline and combination nico days per week) is recommended tine replacement therapy being superior to bupropion or [262,278,279]. In comparison Smoking cessation, supportive care, and with placebo, nicotine replacement therapy or treatment referral to smoking cessation programs are I B with buproprion doubles the chance of quitting, while recommended [286,288,291]. Compelling and possible contraindications to the use of specific antihypertensive drugs Contraindications Drug Compelling Possible Diuretics (thiazides/thiazide-like, Gout Metabolic syndrome.

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It’s incumbent upon the individual—the learner—to determine the value of that information and how it connects to anxiety chat rooms cheap wellbutrin 300mg amex other data or experiences depression short definition cheap wellbutrin 300mg online. The speed and diversion of information in our modern world im pacts our abilities to anxiety groups generic 300 mg wellbutrin fast delivery synthesize useful knowledge vapor pressure depression definition chemistry 300 mg wellbutrin with visa, effectively retrieve it, and translate or apply it in practice. Information overload is a signifcant and growing issue; volumes of data are bombarding people at faster and never-ending rates. When exposed to too much data, the human brain will tend to focus on the clearest, easiest to un 3 derstand, most familiar elements—and discard the rest. It’s the body’s nat ural way of functioning in a focused and emotionally stable state. However, in today’s data-rich climate, this sometimes means retention of false or mis leading information, which can lead to poor decisions at both individual and collective levels. Thus, as the world continues to become increasingly vola tile, uncertain, complex, and ambiguous, we need educational practices that ensure people are prepared, not only for today’s classroom but for tomorrow’s global landscape. With in creasing average lifespans and worldwide pace of change, continuous lifelong4 64 | Modernizing Learning learning has become a necessity. All this means that many people will change careers—not just jobs—multiple times within their lives. Thus, we need to expand the time-5 frame of learning beyond K–12 and even beyond traditional higher education and vocational schools. While these forms of formal, developmental educa tion are likely to persist for some time, we can expect more learning to occur later in life—in the 30 to 65 age range. It’s time to change course by moving away from incremental improvements to our existing education system and instead, reimagining how foundational scientifc principles can inform a new model of learning—one that spans the lifetime. It happens all the time and everywhere, in the classroom, online, at home, and through lived experience. Learning is per sonal, changing in form based on the unique personality, interests, skills, at tributes, circumstances, and beliefs of each individual. Various subjects don’t exist in distinct and disconnected packages; instead, diverse concepts that can be learned together. People can achieve success in countless ways via individualized learning trajectories that max imize their unique potential, rather than boxing them into a fnite set of “ac cepted” developmental boxes. Education will be designed to help cultivate people who can thrive in a complex and chaotic future, rather than simply ushering them through the linear, K–12 milestones we have today. First, as its name implies, it considers learning a continuous, lifelong experience. Today, we tend to view learning in discrete developmental phases—early childhood, then K–12, and, fnally, higher education or workforce training. In the future, we’ll view learning as an ongoing process, where information is constantly synthesized, all the time and from copious sources. The second tenet of this model is that learning isn’t constrained to cognitive development. Rather, we must recognize learning as an interplay among cognitive, social, emotional, and physical skills, attributes, and capabilities. Today, we primarily measure and accredit knowledge and skills acquired in formal settings and assessed within similar structures. However, in the future, life experience and indepen dent, informal learning will also be measured and recognized as much as— or, in some cases, more than—formal learning. As our capacity to measure learning and experience improves, we’ll also be able to examine individuals’ experiences more systematically, to better understand what they know, com prehend, and are capable of achieving. This means learners of all ages are viewed through a lens that considers where they are today and where they’ll grow to tomorrow. Still a work-in-progress, the framework is being developed by a community of experts, school networks, teachers, students, youth groups, parents, universities, local organizations, and social partners. Its vision is to help every learner develop as a whole person, able to fulfill his or her potential and contribute to worldwide wellbeing. The current version of the framework emphasizes: • New solutions for a rapidly changing world with diverse global challenges • New transformative competencies for innovation, responsibility, and awareness • Learner agency—the responsibility for one’s own education throughout life • A new, broad set of desired knowledge, skills, attitudes, and values • Individual and collective educational goals for wellbeing • Design principles for eco-systemic change 1. Learning is lifelong Although 90% of brain volume is attained by age 6, learning occurs across the lifetime and continues to affect the brain’s capabilities. Certainly, early childhood experiences impact individuals’ ability to compensate effective ly as they age. Although cortical thickness, mass, and connectivity seem to8 decrease with age, adults can compensate by activating interdependent neural mechanisms gained from life experience. In other words, although the brain develops most rapidly in childhood, learning can effectively occur throughout 68 | Modernizing Learning life and is shaped by individuals’ behaviors. What and how much individuals9 learn depend on a variety of micro and macro-level factors. Micro-level fac tors include individual choices, motivations, and the ability to self-regulate, particularly outside of formal education settings. Clar ity of interests and goals, and greater self-awareness make this time-frame conducive to personal growth and often encourage a greater motivation to learn. Adults also have a greater wealth of experiences to draw upon, which 10 How can help them synthesize new information more deeply and effciently. Otherwise, we risk having deep experts embedded within stovepiped knowl edge communities who lack a general understanding of how the pieces ft together to work within a holistic, effcient system. Lifelong learning must encompass whole-person development the ability to effectively participate in life is not exclusively determined by one’s cognitive abilities or educational attainment. Rather, resilience, motiva tion, circumstance, exposure, metacognition, self-regulation, and other per sonal attributes contribute to a person’s ability to navigate life. This position is strengthened by the fnding that “brain development and cognition (and the connectivity between cortical areas) are infuenced and organized by cultural, social, emotional, and variability in learning. Lifelong Learning | 69 We’re training people for jobs that aren’t going to exist anymore. It recognizes that people learn throughout their work lives—and often beyond, into retirement. It’s just a subset of the larger territory that we’re looking at; it’s an under appreciated subset but important for our economy and civic health. We need to recognize that the world is changing and that we don’t leave people out to dry because their first career fizzled out and dried, and we didn’t have a mechanism to help them out. Under the spotlight, we have K–12, higher education, and retirement, but when you have a career change and the world isn’t helping you, it’s murky. We asked, “How do we make that a different span of life during which people feel supported For example, what if I’m really struggling and I don’t know if I want to be a researcher or a designer Wirth Professor in Learning Technologies Harvard Graduate School of Education 70 | Modernizing Learning We will need new models of learning and theories of development to effec tively address the “whole-person” learning paradigm. To date, much of the human-development has focused on the early stages of life (prior to adult hood). As we move away from a front-loaded notion of education and towards a lifelong learning concept, we’ll need to expand this body of research to incorporate adult learning, changing societal conditions, and the goal of de veloping more holistic capabilities across time and space. Discussions of cognitive development usually point back to 12 the foundations built by Jean Piaget (1936) and Lev Vygotsky (1978). Piag et’s theory of cognitive development defned four critical periods in which a young child develops sensorimotor intelligence, preoperational thought, con crete operations, and, fnally, formal operations. People who reach this fnal stage (and not all do, according to Piaget) are able to think abstractly. Since we now know that learning occurs throughout an entire lifetime, what happens after reaching this stage Vygotsky’s sociocultural theory of cognitive development offers some answers; it focuses on a person’s journey to individualized thinking through a co-constructed process of social and cultural interaction. Though both Piaget’s and Vygotsky’s theories recognize the interplay between self-development and di rected learning, they take some opposing views; neither accounts for develop ment across the lifetime, and neither consider how a person can achieve a set of meta-skills across disciplines, experiences, and formal and nonformal learning. We can now offoad data storage and “lower-order” cognitive tasks to computers, aggre Lifelong Learning | 71 gate and analyze large sums of in formation as never before possible, and access content ubiquitously. These affordances create the oppor Key hurdles in developing tunity to exponentially accelerate today’s students to be ready human cognitive development, both for life include a lack of early childhood experiences and in time and scale. For example, if foundational language that human brains have fnite working can serve as a springboard 13 memory capacities, then comput for later learning opportuni ers can expand this—to not only ties. Expectations are not enable humans to work with more always where they need to information (without task shedding) be, from teachers or leaders; but to also better digest and com consistently higher expecta prehend wider amounts of infor tions are needed. As another Nathan Oakley example, since humans are highly Chief Academic Officer, Mississippi infuenced by life experiences and a Department of Education computer can provide opportunities to experience simulated situations, we can expand our store of experiences in signifcantly shorter amounts of time, benefting from what might be called “unlived experiences.

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These other methods consisted of talking to great depression test answer key order wellbutrin 300mg overnight delivery professionals severe depression quit smoking 300mg wellbutrin, attending autism conferences depression symptoms and medication buy wellbutrin 300mg otc, and networking with families of children with autism depression test calm clinic discount 300 mg wellbutrin with amex. Twenty parents mentioned that their child was already receiving services before the diagnosis was given. It should be noted that none of the parents mentioned that they did not seek services for their child because they thought he/she would outgrow the problem. After seeking information, one hundred twenty-five parents recounted the next step after the diagnosis. Time Spent by Professional During the Feedback Session of Diagnosis Parent stress may be correlated with the amount of time the professional spent in the interpretive conference while breaking the diagnosis. Thus parents were asked to state how much time the professional spent on initial discussions about the disorder, discussions about their reactions and the possibilities of seeking interventions. Out of these 121 parents, 71% reported that the professional spent half a session, more than half a session or one full session with them. While 92 (73%) parents reported that the professional spent time with them discussing their reactions, only 45% of these reported that the professional spent half a session, more than half a session or one full session discussing these reactions. To further explore parents’ perceptions about the time spent by the professional during the interpretive conference, parents were asked to rate the following statement, “It would have been helpful if the professional making the diagnosis would have spent time in discussing the prognosis and the future recommendations for my child. Intervention Services As mentioned before, the mean age at which children received services after the diagnosis was 2. All parents (N = 126) reported the nature of first services received after the diagnosis. In the “other services,” parents reported the type of programs that were followed. These other programs included adaptive music, auditory training, cranio-sacral therapy, Reiki, nutritional/diet therapy, Relationship Development Intervention, cognitive behavior therapy, naturopathy, Floor time, social skills training, melatonin, Communicating Partners, incidental teaching, sensory integration and Picture Exchange Communication System. Next, parents were asked to describe the type of services and number of hours spent in each of the areas (namely speech therapy, occupational therapy and special education) received for the first time after diagnosis. It should ne noted that the outliers (16, 25, 26, and 43 hours) were excluded while calculating the mean for speech therapy because they were more than 3 standard deviations away from the mean (M = 1. Similarly, the outliers (15, 25, and 60 hours) were excluded while calculating the mean for occupational therapy because they were also more than 3 standard deviations from the mean (M = 1. The mean number of hours for special education did not seem to represent the data well and therefore the percentages in each of the categories were reported. Therefore, it was necessary to explore the nature of current services being received by children. Since it was supposed that children receive a variety of services, parents were expected to check more than one option on this question. One hundred twenty parents reported the nature of current services being received. Fourteen percent of the parents reported that they did not know the type of therapy that was followed, 19. These other programs included adaptive physical education, point system, hippotherapy, dietary interventions, neurofeedback, biomedical regimes, cognitive behavior therapy, floor time, social skills training, Communicating Partners, incidental teaching, and sensory integration. Furthermore, parents described the nature of services being currently received in each of the areas (namely speech therapy, occupational therapy and special education). A summary of the nature of services alongwith the numbers of hours spent in each therapy per week are presented in Table 7. Similarly for the mean of occupational therapy hours, the outlier (60 hours) was excluded since it was also more than 3 standard deviations away from the mean (M = 1. Time and Money Spent in Diagnosis and Intervention Resources that parents spent during diagnosis and interventions, in terms of money and time, were explored. It was noteworthy that one parent reported spending $100,000 on the diagnosis of his/her child. When asked how much money was spent on the first intervention services, 80 parents (78. When asked to state how much money they are currently spending each year on intervention services, 94 (65. In order to understand the nature of stress that parents face, it was necessary to explore how much time parents spent every week on intervention services (immediate post diagnosis as well as current) for their child. Out of 103 parents who reported the number of hours they spent on intervention each week, 10. Out of 114 parents who reported the number of hours that they spent on current intervention each week, 9. Geographical Location In order to examine the accessibility of services, parents were asked how many miles they have to travel to get intervention services every week. Parents were asked the geographical location (city, state and population) where the most recent diagnosis was received. The population that parents reported about the city that they received the diagnosis in, was verified using the 2006 population estimates from the U. Urbanized area consists of contiguous, densely settled census block groups and census blocks (at least 500 people per square mile) that together encompass a population of more than 50,000. Urban cluster consists of contiguous, densely settled block groups and census blocks (500 people per square mile) that together encompass a population of at least 2,500 people but less than 50,000 people. Rural area is defined as all population and territory that is not an urbanized area or urbanized cluster. Therefore, the locations that parents provided were converted to urbanized areas or urban cluster/rural areas based on the above criteria. Thirty-four parents reported being from rural and urban cluster areas (population less 57 than 50,000). The percentages of parents from each of the geographical locations are described in Table 9. Parent Stress Information about parent stress was tapped using a variety of questions along with the stress measures. Parents were asked to report the level of stress they experienced when their child was diagnosed, on a 7-point Likert scale. Current levels of stress were explored with the help of the stress measures such as the Parent Stress Scale and the Perceived Stress Scale. Satisfaction of services Parents’ satisfaction with the services may provide us with valuable information about how professionals can make changes to the existent services. Therefore, parents were asked to rate certain statements related to their satisfaction about the diagnostic services. One hundred twenty-five parents rated this statement on a 7-point Likert scale (1 = Strongly disagree, and 7 = Strongly agree). Furthermore, it was necessary to know the level of difficulty that parents experienced in finding resources to get a diagnostic assessment. Overall satisfaction with the current services was reflected in the item which asked parents to rate their satisfaction on a 7-point Likert scale (1 = Not at all satisfied, and 7 = fully satisfied). Additionally, parents were asked to rate their satisfaction in each of the therapies that they were receiving. In order to tap further into parent satisfaction with intervention services, parents were asked to rate the statement, “I wish my child would have started receiving intervention at an earlier age,” on a 7-point (1 = Strongly disagree, and 7 = Strongly agree) Likert rating scale. Finally, parents were asked if they were satisfied with the way therapy was working for their child. Therapy Model Preferences Parent’s preferences about the model of therapy were assessed. Out of 125 parents who responded, 59 28% preferred the therapist-child direct intervention model, 12% preferred the therapist parent consultative model, 67. Parents’ suggestions of other models included therapist and peers model, and parents being able to train themselves. One parent suggested that he/she would prefer a “social therapist,” who would be responsible for helping their child apply the behavior learned in the classroom to generalize in the real world. Parents’ preferences about these therapy models were further evaluated by asking them to respond on a 7-point Likert scale (1 = Strongly disagree, and 7 = Strongly agree). Current status of the child Parents were asked to mark the level of progress that their child has made since they were first concerned. Parent report of progress of their child was measured on a 7-point Likert scale (1 = No progress; 7 = Excellent progress).

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