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Sanding Wood Shabby Sheek

One of the most successful activities in my day program is refinishing  furniture and sanding wood. The task is to transform  old wooden furniture into a shabby  sheek piece ready for a boutique shop on Ventura Blvd.

Sanding rewards the worker with the self-esteem and competence of admiring the fruit of one’s labor. The repetitive nature of sanding is also also a good fit for the autistic mind.

Learning Objectives
Learn grades of sandpaper and sanding with the grain.
Enjoy the sensory experience of working with wood.
Build muscle and range-of-motion.
Achieve independence and competence from mastering a creative task.

Social Skills via Tea Party

For many years I have been involved in teaching Social Skills to consumers in my day program. I discovered that a top-down approach of the trainer giving instruction seldom translates into real change in social behavior. 

After a trip to England and drinking lots of tea, I realized the value of Tea Time. The act of drinking tea demands various social skills such as listening, not interrupting, greeting, initiating conversation, and paying attention to nonverbal cues.

When drinking tea with other people, we feel elevated and essential. Respect for others and conversation become enjoyable. So at Life Skills Day Program, we initiated a tea party as a regular activity.

One consumer is responsible for the setup of the tea and snacks. The only rule is no interrupting.

Learning Objectives/Goal

To learn social skills through the natural decorum of a tea party.

Promote competence and self-respect on the part of all participants.

Experience the pleasure and enjoyment of socializing with others.

300 Online Practice Questions and Jeopardy Games

The exam is administered online and is an open book test which means you may reference handouts or Title 22 during the exam. The exam has 75 questions. You must obtain 70% to pass.

Be prepared and study by working through over 300 online practice questions. Each question is followed by the an  excerpt from Title 22 that clarifies and expands on each question.

Practice questions are free when  you enroll in our:

Initial ARF Administrator Certification Training Program 


Check our Jeporday Game Study Guide

People with developmental disabilities overlooked in COVID pandemic.

Research into how COVID affects individuals is critical information for administrators. and staff of Community Care Facilities.

COVID-19 Materials for People with Intellectual and Developmental Disabilities and Care Providers.


Administrator Re Certification Penalty Fee Increase

For existing administrators the ACS section has increased the penalty for submitting your application for recertification from $200.00 to $300.00.

That means on top of the $100.0 to submit your application add a $300.00 penalty. As long as your postmark is on the date of expiration you are good.

Lost your certificate and want to find out when your Administrator Certificate Expires check the ACTIVE CERTIFICATE LIST.
If your not on the list your certificate is not active and most likely expired. To find out your status contact the ACS Section

[email protected]

Autism and Depression

Recognizing depression in individuals with ASD can be challenging as some characteristics of ASD can resemble some of the signs of depression. For example, some individuals with ASD may not interact much with peers or identify many friends, which may also be signs of depression in adolescents. Another challenge is that some of the characteristics of ASD may actually mask signs of depression. Some teens with ASD may not show much emotion, so depression may not be as observable as a look of sadness on the teen’s face. Additionally, the communication difficulties of individuals with ASD may impact one’s ability to recognize depression in this population. Even students with ASD who communicate in full sentences may have difficulty communicating their feelings.

The behavioral examples below illustrate how some of the more common symptoms of depression may look in teens with ASD.

Emotions and mood
Increased moodiness which may include anger, irritability, sadness, and tearfulnessIn the past two weeks, Terri has been crying for her mom and dad to come pick her up from school every
day after lunch.

Feelings of worthlessness or fixation on mistakes
Alex is noticing that he is different from his peers and
this awareness is causing great concern. He often
makes comments that he is “not normal” and “will
never be normal.”

Need for excessive reassurance
Joel is increasingly fearful of black holes and requires
frequent reassurance that he will not disappear.

Loss of interest or pleasure in previously favorite
Rolando always enjoyed swimming at the YMCA but
recently is resisting the pool and does not even want to
put his swimsuit on.

Caleb is not typically aggressive, but in the past month
has hit his younger sister several times and pushed his
mom when he became frustrated.

The choices in the cafeteria suddenly seem
overwhelming for Taneisha, and she has been getting
“stuck” in line.

Noticeable decrease in self-care
Adam has started to move very slowly during his
morning routine and is often leaving for school without
brushing his teeth, washing his face, or combing his hair.

Regression of previously learned skill
Charity, who usually navigates to the cafeteria and back
without assistance, lately is found wandering the halls
telling everyone she is lost.

Changes in autistic symptoms which may include
increased stereotypic behavior or decreased interest in
restricted interests
Kevin used to flap his hands and rock on the floor
when he was young. Since he started high school, he
is rocking again every day after school.

Abe usually enjoys reviewing meteorology reports in detail each evening. Lately, however, he has not been able to settle and concentrate in the evenings, and has given up this favorite activity altogether.

Fatigue or loss of energy
Xavier keeps falling asleep in class, even when the class is watching YouTube videos about space, his favorite topic in science.

Sleeping too much or too little
Eli, who is usually the first one up, is having great difficulty getting out of bed in the morning.

 Changes in appetite leading to weight loss or gain
Jackson has stopped eating some of his favorite foods and is coming home with the food in his lunchbox half eaten.

Complaints of unexplained body aches and head aches; increased visits to the school nurse
Sophie has asked more than once this week to go to the school nurse saying that her arm hurts, but the nurse keeps sending her back saying there is nothing wrong with her.

Changes in Behavior
Look for changes in behavior. Since individuals with ASD often have characteristics that can mimic or mask depression, it is important to look for changes in behavior. Pay attention to eating and sleep habits, and look for changes in mood and behavior around the home and community. Look for changes in mood or behaviors during activities and transitions, lunch, or day program.

Youth with Asperger’s syndrome often struggle with anxiety and depression. This causes Asperger’s meltdowns. The video below discusses symptoms, treatments, causes and solutions to relieve these negative effects of Asperger’s syndrome.

Asperger’s: Struggling with Anxiety and Depression
3.37 minutes


Asperger’s: Struggling with Anxiety and Depression.” YouTube , uploaded by Aspergers Guide, 17 Oct. 2009,

Hedges, S., White, T., & Smith, L. (2014, May).
Depression in Adolescents with ASD (Autism at-a-Glance Brief). Chapel Hill: The University of North Carolina, Frank Porter Graham Child Development Institute, CSESA Development Team,


The Center on Secondary Education for Students with Autism Spectrum Disorder (CSESA) is a research and development project funded by the U.S. Department of Education that focuses on developing, adapting, and studying a comprehensive school and community-based education program for high school students on the autism spectrum.

Down Syndrome and Congential Heart Disease

National Association For Child Development

Children with Down syndrome are at a much higher risk for congenital heart disease. As a comparison: the incidence of congenital heart disease in the general population is 0.8 percent. The incidence of congenital heart disease in children with Down syndrome is between 40-60 percent.

Some heart defects can be left alone with careful monitoring while others require surgery to correct the problem.

The following types of heart defects in children with Down syndrome are discussed below.

Atrioventricular Septal Defects (AVSDs) – These are the most common in children with Down syndrome.
Ventricular Septal Defects (VSDs)
Atrial Septal Defects
Patent Ductus Arteriosus
Tetralogy of Fallot
Atrioventricular Septal Defects (AVSDs)

These heart defects are defined by a hole in the wall between the top chambers (atria) and bottom chambers (ventricles) and one common valve between the two areas. In some cases, there might not be a hole between the bottom chambers. Or the valves may not be joined together, but either or both might leak. This is known as valve incompetence.

Because of the high pressure in the left ventricle which is needed to pump the blood around the body, blood is forced through the holes in the central heart wall (septum) when the ventricle contracts. This increases the pressure in the right ventricle. This increased pressure (pulmonary hypertension) results in excess blood flow to the lungs.

Some of the early symptoms seen are difficulty in eating, weight gain, fast irregular breathing and a degree of cyanosis (blueness) particularly noticeable around the mouth, fingers and toes. Clinical examination may show an enlarged heart and liver, and a diagnosis of ‘heart failure’ may be given. This term is used because of the flow of blood from one side to the other; the heart has to work harder than normal causing the heart to fail to work normally.

Not all children will exhibit symptoms early in life, and those that do will not always show all of these.

Early treatment may involve the use of diuretics to control the fluid retention around the body and to reduce the volume of blood in the circulation, thus making the heart’s workload easier. These may be used in conjunction with other drugs that increase the contraction of the heart muscle.

Slow weight gain may indicate the need to use high-calorie formula increase calorie intake. Severe eating problems may warrant using a naso-gastric tube (through the nose and directly into the stomach) to help with proper nutrition.

The majority of cases of AVSD usually require surgical intervention; this generally takes place within the first six months of life.
Ventricular Septal Defects (VSDs)

In this defect there is a hole between the bottom chambers (pumping chambers or ventricles). Because of the higher pressure in the left side of the heart, this allows oxygenated blood to flow through the hole from the left to the right side of the heart, and back to the lungs, in addition to the normal flow.

The amount of blood flow from the left to right ventricle depends on the size of the hole and on the pressure between the ventricles. In other words, the higher the rate of flow means more strain on the heart. The abnormal blood flow is responsible for the murmur that may be heard.

Generally patients with a small VSD will not exhibit symptoms (they are asymptomatic) and the problem may only be found when a murmur is detected upon routine examination. Patients with a moderate VSD may breathe quickly, exhibit poor weight gain, and be slower at eating. These children are also much more prone to chest infections. This tends to be more pronounced when the hole is large.

As with ASVDs, patients with moderate or large holes usually require treatment with diuretics to control fluid retention and to reduce the volume of blood in the circulation may be used. Also, high-calorie formula or tube feedings might be necessary.

Many VSDs will close spontaneously or get much smaller, so it is normal practice to leave a child with a small or moderate VSD and monitor their progress before deciding to operate. Surgery may be needed if there is failure to thrive despite medication, or concern about pulmonary hypertension. If a large VSD is present, surgery is almost always recommended.
Atrial Septal Defects (ASDs)

In this defect there is a hole between the top chambers (receiving chambers or atria). Because of the higher pressure in the left side of the heart, oxygenated blood flows through the hole from the left to the right side of the heart, and back to the lungs, in addition to the normal flow.

There are three types of Atrial Septal Defect; the most common is when there is a hole in the middle of the central heart wall. Holes in the lower part of the septum, called the primum defect (partial atrioventricular septal defect), are often associated with a problem of the mitral valve that often results in a leak. Less common are sinus venosus defects or holes in the top of the septum. These are associated with an abnormality of the right upper lung vein.


Generally patients with an ASD defect will exhibit no symptoms and the problem is only found when a routine clinical examination detects a heart murmur. Occasionally children with this problem will exhibit poor weight gain and a failure to thrive, and if there is mitral valve leakage there may be early symptoms of breathlessness.


Small holes which allow little blood flow from left to right generally cause no problems. If they are located in the middle portion of the central heart wall, they may even close on their own.

However, moderate and large holes do not close, and the extra work over the years places a strain on the right side of the heart causing an enlargement of both pumping chambers. Therefore, treatment (surgery) is usually recommended in the first few years of life for larger holes, before excessive strain has been placed on the heart.
Patent Ductus Arteriosus (PDA)

This defect is the continuance of a direct connection between the aorta and the lung (pulmonary) artery, which normally closes shortly after birth.

A baby in the womb is supplied oxygen by the placenta via the umbilical cord. The baby’s lungs are not expanded and require only a small amount of blood for them to grow. The ductus is a blood vessel that allows blood to bypass the baby’s lungs.

Generally, the ductus closes within a few days of birth, and the connections between the two sides of the heart no longer exist. The resistance to blood flow quickly falls with the onset of breathing. In some babies, with Down syndrome, the ductus fails to close. This causes higher pressure in the left side of the heart and increases the amount of blood flowing into the lungs.

If the ductus has partially closed and only a narrow connection remains, the baby won’t show symptoms. If the connection is larger, the baby may be breathless and tired and show poor weight gain.

If the ductus remains open for more than three months, it is unlikely to close on its own and surgical closure is recommended.
Tetralogy of Fallot

A small percentage of babies with Down syndrome have this complex heart condition which combines the most common defect associated with Down syndrome, AVSD, with Tetralogy of Fallot.

This anomaly includes four different heart problems:

a hole between the top chambers and a hole between the bottom chambers
combined mitral and tricuspid valves (common atrioventricular valve)
narrowed pulmonary artery (from heart to lungs) or the area under or above the valve, or all three
thickening of the right bottom chamber (ventricle)

The combination of these defects early in life almost seems to balance out such that the child may be rather blue, but not too breathless. There can, of course, be too much blueness or too much breathlessness, depending on the severity of the different conditions.


The type of surgery depends on the severity of the AVSD or the Fallots. Usually, the children are quite blue and require a BT shunt to increase the amount of blue going to the lungs. Then another operation is performed later – usually at 1-2 years of age – so that the holes can be closed, the valves repaired, and the way out to the lung artery widened.

Other Heart Related Problems in Down Syndrome

In addition to the heart defects associated with Down syndrome, high blood pressure in the lungs (pulmonary hypertension) is more common in people with Down syndrome. This high blood pressure may be a result of malformation of the lung tissue, but the exact cause is not known.

Higher blood pressure may limit the amount of blood flow to the lungs and therefore decrease the likelihood of symptoms of congestive heart failure seen in babies with complete AV canals or large ventricular septal defects. This then causes the problem of delaying a possible needed surgery to close holes in the heart. These babies must be watched carefully in order to determine the best time for surgery.

Tests to Diagnose Congenital Heart Disease in Babies with Down Syndrome

The majority of cardiologists agree that all babies diagnosed with Down syndrome should have a cardiology evaluation. This is because of the high incidence of associated congenital heart defects. A good history and physical examination should be performed by an experienced cardiologist to rule out any obvious heart defect.

An electrocardiogram should be performed. This can be very helpful in making the diagnosis of AV canal, even when physical symptoms are absent.

Some doctors also choose to perform at least one echocardiogram to rule out other subtle heart problems.

If the diagnosis of congenital heart disease is made, the cardiologist normally follows up with the child through routine office visits. Most patients can be watched clinically to determine if the child is having difficulty because of the heart defect.

Occasionally, a repeat electrocardiogram, chest X-ray, or echocardiogram is performed to further evaluate clinical changes. These tests are likely to be repeated before surgical repair is recommended.

Rarely, a cardiac catheterization is required for complete evaluation prior to corrective surgery, especially in children where elevated pressures in the lungs are a concern.

Parents of a child with Down syndrome need to work closely with their child’s doctor(s) to determine what route (surgical or medical) will best serve their child.

HIV and Drug Use

National Institute of Drug Abuse
Drug abuse and addiction have been inextricably linked with HIV/AIDS since the beginning of the epidemic.  While intravenous drug use is well known in this regard, less recognized is the role that drug abuse plays more generally in the spread of HIV by increasing the likelihood of high-risk sex with infected partners.

The intoxicating effects of many drugs can alter judgment and inhibition and lead people to engage in impulsive and unsafe behaviors.  Also, people who are abusing or addicted to drugs may engage in sexually risky behaviors to obtain drugs or money for drugs.  Nearly one-quarter of AIDS cases stem from intravenous drug use, and one in four people living with HIV/AIDS in the period of 2005–2009 reported use of alcohol or drugs to an extent that required treatment.

Drug abuse and addiction can also worsen the progression of HIV and its consequences, especially in the brain. For example, in animal studies, methamphetamine increased the amount of HIV virus present in the brain; and in human studies, HIV caused greater neuronal injury and cognitive impairment in methamphetamine abusers compared to non-drug users.

The Centers for Disease Control and Prevention (CDC) estimates that 1.2 million people are infected with HIV in the United States and that 1 in 5 (20 percent) are unaware that they are infected. In 2010, over 47,000 people were newly diagnosed with HIV, the majority of whom were men. HIV infection is over-represented in the African-American community: African-Americans make up almost one-half of the newly diagnosed cases, followed by Whites and Hispanics.

Effective treatments have dramatically decreased the number of deaths from AIDS since the peak years of the epidemic (1993–1998); however, more than 17,000 people still died from AIDS-related illnesses in 2009. In fact, even among those diagnosed with HIV, a substantial proportion do not receive proper care or remain in treatment (see figure).  Additionally, the trend of people living longer with HIV presents new, long-term healthcare challenges for this population.

Epilepsy in the Elderly

It’s common for older adults in their seventies and eighties, and even in their sixties, to feel confused and  forgetful.  But that’s not a normal part of aging. Often, it can be a sign of epilepsy.

Epilepsy affects some 300,000 elderly people in the United States.  Older adults are the fastest growing population group with epilepsy. By 75 years of age, three percent of the population will likely be diagnosed with epilepsy; 10 percent will have had a seizure of some type.  In contrast, only 1 percent will have developed epilepsy by age 20.

This increase in prevalence of epilepsy among older adults may be due to other health problems associated with aging .  Elderly people are at an increased risk of stroke and heart attack, both of which can damage the brain and cause epilepsy.  Stroke is the most common cause of seizures in older adults, causing about 33 percent of all cases of senior epilepsy. Elderly people are likely to fall and have a head injury that could cause seizures.

Seniors are also at risk for dementia, including Alzheimer’s disease, which is the second most common cause of epilepsy in older adults. These degenerative diseases damage the brain and, very often, result in seizures. Other diseases common in seniors that increase the risk of epilepsy include:

Liver disease
Kidney disease
High blood pressure
Tumors in the brain
Heart disease

Warning Signs of Epilepsy in Older Adults
Seizure symptoms in older adults aren’t  different from seizure symptoms in any other age group.  It may seem strange for a 20-year-old to blank out for a few minutes  an elderly person  might dismiss it as a normal part of aging. Some of these seizure symptoms may be confused with signs of mental illness or dementia.

Signs of seizure in older adults include:
hearing voices or  seeing people who aren’t  there
repetitive actions e.g. chewing, mumbling
wildly moving arms and legs
staring into space
unaware or out of it for a period of time
temporary problems with language

Seizure Prevention Challenges in Older Adults
Prescribing medications to treat epilepsy in the elderly is more complex that with younger people. Older adults often have a number of other health conditions and are taking other  medications, which can increase the risk of drug interactions.

Seizure medications need to be taken consistently to prevent seizures.  For some elderly people  it may be a challenge to take their medication regularly.