Final Week

Ahmad seemed to have it all: he was finally married to the love of his life with two beautiful children. Everything was going great with the work place; Ahmad got a promotion as an assistant manager to the company. The family was living a normal, happy life until Ahmad’s parents’ health started to spiral down out of control. Ahmad knew that someday he would have to make the difficult decision whether or not to move his parents into a nursing home. Ahmad made the difficult decision a couple years later to move his parents into a local nursing home so he and his family could continue to see them each day.
            In order to help pay for the nursing home bill, Ahmad and Taylor worked longer hours and juggled work and their children. Although his parents insisted that they were fine on their own, Ahmad felt that at the age of 55 he could and wanted to provide for his parents, since they did so much for him. The added stress caused Ahmad to struggle with his Lyme’s disease, and he began to focus not on his health, but on his parents’ bills and their family struggles. Eventually the added stress caught up with him and he was hospitalized for a couple days. This did not help with the bills, but it was yet another wake up call that he must care for himself along with his family. Unfortunately a short time after his hospitalization, both of his parents died; first his mother and then his father. Even though he did not have to worry about nursing home costs anymore, he grieved for the loss of his parents.
            Taylor started to worry about Ahmad. He had taken at least one day a week off from work during the past four months as he was still struggling with the death of his parents. He also started to drink daily to try to forget about his parents. On top of this, their twin girls were having difficulties in middle school. The school had to separate the twins to make sure they were not in the same classes because they fought with each other so much. They would lash out at each other by scratching and pulling each other’s hair. Taylor and Ahmad have seen this at home as well, but Ahmad did nothing to stop it. He was in a dark place where all he could think about was how life used to be with his parents. So Taylor was stuck trying to calm the twins down, but they refused to listen to their mother. Taylor insisted that Ahmad go see a counselor to talk about his feelings because now his drinking habits are interfering with home life and work life. She wanted Ahmad to get back on track and contribute to the family, but he just seemed so lost. Ahmad finally agreed to see a counselor and realized that it helped to have someone listen to him. With the help of therapy, Ahmad did not feel the need to drink as often and slowly became a more active and sociable person to be around. This change in Ahmad’s mood reflected on his twin daughters. With Ahmad’s rebound, the twins’ attitude in school also changed as they could now manage to see each other in the hallway or cafeteria without any fights breaking out.

It's hard to believe that almost 8 years have gone by since the death of Ahmad's parents. Ahmad finds it amazing how he managed to pull himself out of such a dark place, but knows Taylor was the glue who held him together and forced Ahmad into therapy.  Kristen and Aubrey have grown so quickly, they are now in their senior year of high school! So much has happened over these past years. Kristen always struggled with her academics, but Aubrey has been top of her classes almost every semester since Ahmad got better.  It wasn't until things settled down in the family that Kristen was given the attention she needed; her teachers spoke with Ahmad and Taylor and recommended Kristen be evaluated for special education services.  The testing revealed that Kristen has ADHD, so medication and an IEP was created right away.  Since services began, Kristen has been able to bring her grades up quite high, but can't seem to get on Aubrey's level.  But her parents were okay with this as they were just happy to see Kristen learning. Now that it is senior year the Nassar twins are looking at colleges and figuring out their next move, while Taylor and Ahmad worry about how they will be able to afford it.  Aubrey will surely get an academic scholarship, and Kristen may spend the first year at the local community college to improve her grades, but time will tell.  

72 years old. Wow. Ahmad and Taylor can hardly believe they have reached the age that one never thinks will actually come.  Where did all the time go? And the girls, well they are out of college and doing just fine.  Aubrey is working in her residency at a hospital in Baltimore, and Kristen is working as a special education teacher at an elementary school in Richmond.  Ahmad and Taylor are so proud of them both.  Ahmad has continued to struggle over the years, and his Lyme mixed with old age has proven to be most difficult.  A few years back, Ahmad was in so much pain while trying to get out of bed that when he stood he fell and broke his leg.  It was a very long recovery, and now he uses a cane to walk, but nonetheless he is alive and that is what matters.  Last winter was also another scare for the family. Ahmad was so sick he had to spend a week in the hospital! The whole family was very nervous, and this was the first time Taylor and Ahmad made a plan as to what will happen if Ahmad did pass.  The couple decided to sell their home for a smaller one-bedroom condo.  Through the sale of the home and their savings, they were able to make this purchase with minimal mortgage left, a great relief to both of them.  Ahmad and Taylor are enjoying their retirement and the time they have left with each other, and watching their children succeed in life is amazing.

Unfortunately, at age 80 Ahmad’s health quickly deteriorated. He was in and out of the hospital for heart issues, and his Lyme’s disease did not help his condition. He was very weak and the family eventually had to hire a full-time nurse to watch him 24 hours a day. At age 81 Ahmad passed away. His wife Taylor died a few years later. Their daughters were devastated but remembered how Ahmad dealt with his parents’ deaths and they decided to go to counseling immediately to help them cope through this difficult time.

Week Thirteen

Ahmad completed his internship with the company he was at and eventually they offered him a job. He often thought about returning to school for medicine, but was always dissuaded when he remembered how difficult college had been for him. He was comfortable in his job because he had been with the company already, so he did well in his position. The company knew that he was a hard worker even though he sometimes had problems with his Lyme. Ahmad was satisfied with his job and over the years built up his reputation within the company. He got promoted and was able to live comfortably on his salary.  It took him a few years after graduating college, but he eventually moved out of his parents’ house and into his own apartment in the same city. He still sees them often, and they are a good support system for him. Ahmad has a few close friends at work and sees them regularly. While Ahmad does still have some issues with social interaction, he was able to bond with his coworkers over their workplace. The people that he made the strongest connection with came to accept Ahmad for who he was.

During college, Ahmad lost touch with his religion. After a talk with his father, he decided to become more involved in the Muslim community around him where he also made some friends. His mother was fine with this as long as it was what Ahmad wanted. After some time, to his father’s delight, he began to date one of the women in this community. After a somewhat lengthy relationship, the couple split up due to mutual lack of love interest. The two remained friends after the breakup.

When Ahmad was well into his 30s, he began to date one of his coworkers that he had known since his internship in college. The two were decent friends before their relationship, and their relationship blossomed because of this. Eventually the two moved in together and became engaged. When Ahmad was 38, the two got married. His wife, Taylor, is very accepting of Ahmad’s Lyme. The two have known each other for so long that she doesn’t even notice his difficulties anymore; she just sees them as a part of him. She also understands his greater risk for degenerative mental disease later in life but is optimistic.

Now 46, Ahmad is still with Taylor. The two have a healthy relationship and twin girls, Kristen and Aubrey. They live in a house in a neighborhood near Ahmad’s parents. Ahmad and Taylor are both still working, and they are able to support their two children. Since Ahmad’s parents are close by, they watch Kristen and Aubrey while Ahmad and Taylor are at work. Ahmad’s parents love their grandchildren, but they are aging and it is becoming increasingly difficult for them to handle the kids. Still, for now, all is well with the Nassar family. 

Week Twelve

Ahmad can scarcely believe that he is about to graduate. After all that he has been through...

Ahmad received special education services to help him cope with the cognitive deficits he encountered owing to his Lyme disease. He was able to finish high school after staying for more than four years, and he attended the University of Florida. His path was not an easy one, and, at 25, he is a good bit older than most other students in his graduating class. Still, he has learned so much about himself and his unique needs. He would have liked to study medicine, but he just couldn't manage the intensity even with supports. His dad often told him that he could have done it if only...

Khalid and Sasha have managed to stay together, and Khalid has come to accept that his son has certain challenges because of the Lyme's disease. Most of these are socio-emotional in nature (Ahmad has a hard time with ordinary social interaction, a bit like Asperger's), but some are cognitive. Ahmad finds it difficult to concentrate for long periods of time, something that has made for several more years of schooling than would be typical for someone like him. Khalid and Ahmad have gotten closer as Khalid has come to accept his son's condition. Khalid has come to terms with his sense of shame and has been able to connect it to his upbringing. He has become more open to Sasha in general and to her worldview, and, as a result, Ahmad has a greater sense of comfort when he comes home.  

And so Ahmad is ready to get his diploma. He majored in finance and had an internship with a fairly large company. He is hoping for a job with them and hopes he will hear something in the next couple of months. 

* What resources are available for students with disabilities at most major universities? At JMU? What process must a student go through to receive services? Be thorough and specific. How many students with disabilities attend JMU? What kinds of disabilities are present?

* What resources in the community might support Ahmad as he transitions to life on his own? Look at information about Acquired Brain Injury for leads as to what might be helpful for Ahmad.  

* Cite information about the impact of Lyme's disease with regard to cognitive deficits that occur. What are Ahmad's prospects for living independently based on the statistics? You may also consider information on ABI/TBI. 

Week Eleven

Ahmad is now 16 years of age, and life has been challenging for the Nassar family. Since he started receiving treatment for his condition, Ahmad has done better. However, the long-term effects of his health struggles seem to have had an impact on Ahmad's cognitive functioning. In fact, he is currently in the process of being evaluated for special education services after RTI strategies were not effective in helping Ahmad to learn. In spite of everything, Ahmad really wants to get his driver's license and start to drive. His dad has promised him a car if he can keep his grades up, and his dad seems not to want to recognize the challenges that Ahmad now experiences.

Khalid and Sasha have recognized the stress they have been under, and they are considering attending couples counseling. Sasha has not been as comfortable with the couple's differing religious orientations since Ahmad was diagnosed with Lyme's. Khalid is not sure about the process, however, and they have yet to make a final decision.

* Given Ahmad's struggles, what label would he likely carry if he were identified as needing special education services in his school?  Be sure to consider all of his needs in responding to this question.

* From the standpoint of the school and the IEP, what is transition? Describe at least 3 transition goals for Ahmad. When would the IEP team have started to consider and include these?

* Describe the cognitive developmental changes that take place during puberty, and hypothesize how these apply to Ahmad based on this week’s installment.

DECISION POINT ::: Do Khalid and Sasha attend couples counseling? Why or why not? How does the special education eligibility process resolve for Ahmad? What is the outcome?

Week Ten

Life for the Nassar family continued to unravel over the last few years. Due to Ahmad’s growing irritability and seemingly regressive development at 7 years old and continuing till his current age of 12, his parents opted to take him back to the doctor for further evaluation. When Ahmad turned 9, the doctors came to consider that his Lyme disease was not appropriately treated when he was 4 years old, and that his condition may have worsened and spread throughout his body over those 5 years. If Lyme disease is not treated appropriately it can begin to affect the heart and nervous system (KidsHealth, 1995-2012). These individuals can experience “irregular heart rhythm, chest pain, facial paralysis, and arthritic symptoms such as swelling or inflammation of the joints” (KidsHealth, 1995-2012). These symptoms characterize a lot of symptoms Ahmad’s experienced and complained about as a 7 year old. Ahmad’s symptoms were not all physical; he also experienced emotional symptoms of progressive Lyme disease. As a 12 year old, Ahmad is reaching his physically typical developmental milestones, but he is still lacking in his emotional development. Typical 12 to 13 year olds often socialize and interact with their peers, and “become more independent with their own personality and interests” (Centers for Disease Control and Prevention, 2012). However, due to his condition Ahmad finds trouble relating to his peers and begins feeling the effects of social isolation. His frustration with his peers of not being able to understand the severity of his condition, led him to become increasingly irritable and moody.  His overall performance and behavior have declined to the point that he was no longer able to remain at the local Montessori school and has been attending public school for the past 4 years.  Ahmad is now 12 years old but is one grade below his peers having been retained one year due to frequent absences and the sudden drop in grades. Khalid is devastated by this decline in academics which has shown in his dwindling attempts to make sense and time for his son’s new personality and life. 

He did not make friends at his new school as easily as he once had at the Montessori School. Along with this change and the normal hormone changes that are occurring coupled with the effects of the Lyme disease have caused Ahmad to become rebellious and lose all interest that he had left in school and school activities.  He is difficult to predict and experiences constant mood swings and personality changes.  Ahmad tires easily which has caused him little desire for friends or social activities.  Loneliness has also become a problem which has led to depression and recent suicidal thoughts.

Ahmad’s parents noticed this change in their son, and hoped to improve his quality of life by registering him in a sport he once loved, soccer.

Although a thoughtful gesture, playing soccer was too strenuous on Ahmad’s body. He often felt “fatigued, weakness, and joint aches and pains” (Children’s Hospital Boston, 2005-2011). Ahmad as well as his parents felt discouraged by his condition and situation, but they were also hopeful in discovering a successful treatment plan. Ahmad was taken to the doctor again, but this time doctors suggested that he might be suffering from “post-infectious disease syndrome” (Children’s Hospital Boston, 2005-2011). The doctors suggested several treatment options for Ahmad to try. Some of these options included: “maintaining a sleep schedule, exercising, acupuncture, biofeedback, physical therapy, and anti-inflammatory drugs to help with aches and pains” (Children’s Hospital Boston, 2005-2011). Although some of the treatments that Ahmad’s doctors suggested were expensive, Ahmad’s parents had enough money saved to accommodate their son.

After a few months of treatment, Ahmad finally began showing some improvement. To maintain his improvement another specific behavior plan was established in his school, so Ahmad would have an outlet if he became too overwhelmed with school or his peers.

Even with this slow improvement Khalid and Sasha’s relationship has been strained and they are constantly arguing.  Sasha, in her desperation to make sense of all that has happened, has returned to her Lutheran faith.  The conflict has been exacerbated by Sasha’s anger and guilt as she repeatedly questions herself on why she ever gave in to Khalid to raise Ahmad as a Muslim.

References

KidsHealth. (1995-2012). Lyme Disease. Retrieved March 22, 2012, from http://kidshealth.org/parent/infections/bacterial_viral/lyme.html

Children’s Hospital Boston. (2005-2011). Lyme Disease. Retrieved March 22, 2012, from http://www.childrenshospital.org/az/Site1255/mainpageS1255P4.html

Centers for Disease Control and Prevention. (2012). Child Development. Retrieved March 22, 2012, from http://www.cdc.gov/ncbddd/childdevelopment/positiveparenting/adolescence.html

Week Nine

It has been a difficult several years for the Nassar family. After the diagnosis of Lyme's disease, everything seemed to fall apart for Sasha and Khalid. What was once an easygoing household became tense and hard to recognize from what had been present prior to the Lyme's diagnosis. Khalid was not dealing well with the situation, and Sasha was spending less time at home because of her job. 

For his part, Ahmad had changed significantly from the happy-go-lucky, trilingual boy of earlier years. Now, at age 7, Ahmad was often irritable and sometimes just mean, and he had started to act out in school at the start of his 2nd grade year. For the most part, he was as bright as he had been, but his language skills seemed to have atrophied and did not seem to continue to develop as might have been expected based on his early thriving. Ahmad struggled significantly with peer relationships at school. At one point in the year, a specific behavior plan was set up through which Ahmad could 'earn' time to play the assistant principal's Wii game (which he had in his office). This intervention had a limited effect, however, and Ahmad continued to struggle to get along with other children - he had a couple of incidents of fighting with other boys in his class, and, at one point, threatened to bring a knife to school to cut another child. 

Khalid did not know what to do for and with Khalid. Sasha was just as concerned but equally as discouraged. 

* What services might be available to Ahmad to help him throughout the school day? Explore 'day treatment' services. What kind of insurance would Ahmad need in order to qualify, and is it likely that he would have that type of insurance? What kinds of interventions are typically done by an elementary school counselor? Would any of these be of help to Ahmad? 

* What recommendations would you have for Khalid and Sasha? What would/should the school be doing from the standpoint of the Special Education process? Should Ahmad be evaluated for Special Education services? Why or why not? How would this process begin? If the process continued, with what "category" of disability would Ahmad likely be identified? 

* Are there community-based resourced that you think would be helpful for Ahmad? Which ones?

DECISION POINT ::: Is Ahmad evaluated for Special Education services?

Week Eight

Spring Break

Week Seven

Individual assignment

Week Six

Ahmad is now four years of age, and he has met every developmental milestone and then some. Khalid and Sasha are thrilled to be with one another and with Ahmad whenever they are able to be. Ahmad has been attending a local Montessori school since he was 2 1/2, and he has been thriving in that environment. More incredibly, Ahmad signs with ease, and he speaks Arabic and English. 

Ahmad has friends at his Montessori school that he gets along with well. His parents decided to sign him up for soccer with the local health club, something that he seemed to enjoy at his young age. It was a hot summer, and the Saturday mornings out on the tennis-court-converted-to-soccer-field were often long. Ahmad loved it, though, and the Fall came quickly that year. It was in September during a bath that Sasha noticed the large, bullseye-like mark on Ahmad's leg. She had never seen such a thing before and called Khalid in to take a look. Khalid had never seen anything like it, and the two decided to take Ahmad to the pediatrician the next day. 

Ahmad was diagnosed with Lyme disease. Khalid and Sasha made it a point to check Ahmad for ticks throughout the summer, but they missed the tick that infected Ahmad. Deeply concerned, they were somewhat comforted by the pediatrician who told them that Ahmad should be fine after treatment with antibiotics. Ahmad was strong all the way through the blood test and into the time that he had to take the antibiotic. He experienced some flu-like symptoms during the time he was taken the medication, but those went away after several days. Khalid and Sasha thought that everything was OK, and they went back to their busy Fall schedule. 

It was around November that Ahmad began to act differently than he had before. They couldn't put their finger quite on it, but he seemed more irritable than he had in the past. He started complaining about pain in what they thought were his muscles, and they weren't sure what was happening with him. They also noticed that his Arabic wasn't as fluent as it had been, and he seemed to struggle to remember words that he had formerly used for some time. They began to worry and wondered what to do next.

* What are the possible effects of Lyme disease if treatment has been inadequate?

* What kind of testing might be appropriate for Ahmad at this point to rule out any cognitive deficits?

In addition to the questions above, please also answer the following questions posed to you by the other groups (not all questions are included from all groups) :::

From the Lisa Yoo group :::

1) Ahmad has been able to master three languages before some children can even master one. What does advanced language development predict for Ahmad’s later cognitive development? Find research that ties early language abilities to maturing cognitive growth.

From the Thomas Mahoney group :::

1) Has the Khalid’s hearing impairment affected his relationship with his son in any way? Does Admad understand why he was being taught sign?

From the Wendy Marianna group :::

1) Do you think Ahmad’s use of three different languages will make it difficult for him to communicate effectively with his peers once he is old enough to attend school? Do you think his attachment style to his parents will make it difficult to use anything but Arabic and sign language when communicating outside of the family? Why or why not?

2) Ahmad’s parents had heated discussions about which religion should the family practice while raising children. What do you think are the advantages and disadvantages to be raised in a multiple religion household? Should Ahmad’s parents wait until he is old enough to decide which religion to practice? Why or why not?

Week Five

Individual assignments.

Week Four

Ahmad is thriving at 2 1/2 years of age. His parents continue to be thrilled and are thinking about sending him to a Montessori school.

Ahmad seems to have a particular interest in anything that has a ball associated with it. Football, baseball, soccer - you name it, and Ahmad enjoys it. This, of course, pleases his father to no end, and Khalid can't help but see himself in his son. Ahmad also likes anything having to do with trucks. He seems to be "all boy" as his mother says.

* Describe Ahmad as a typically-developing 2 1/2 year old. Attend carefully to his language skills, and indicate the extent to which he is able to communicate in the three languages around him. What would we expect to see if we met Ahmad given his secure attachment to his parents?

* Outline Montessori education. Children can start at 2 1/2. Why so young? How does Montessori differ from traditional schooling? How could Ahmad benefit from going to school at such a young age? The highly motivated will pay a visit to Woodland Montessori School in Harrisonburg to observe the classrooms there.

* Describe Ahmad in terms of the various systems of which he is a part (see reading). What is his microsystem, mesosystem, etc.?

DECISION POINT ::: Does Ahmad attend Montessori school?

Week Three

Ahmad has developed into a capable and competent 18 month old child who is flourishing. The day care he has been attending provides significant interaction with other adult as well as other children. 

Khalid and Sasha have been teaching Ahmad sign language, and he has gotten quite proficient with it. It was important for Khalid since it is another way for him to communicate, and he wanted to make sure that Ahmad had a chance to know his father as much as possible. Khalid felt conflicted in that he didn't have a chance to conduct many of the rituals at birth that he knew had been done when he was born - Khalid wanted to preserve as many of his family's customs and traditions as he could. 

Ahmad also had some knowledge of Arabic, but it was hard to keep speaking Arabic in the home - particularly when Sasha was only somewhat familiar with the language. He was as cute as he could be when he spoke in either language. Khalid often thought of going back to Iraq to visit, but Sasha had deep reservations about a trip given the instability and the risks. 

* Describe typical developmental milestones for an 18 month old child. Be sure to include physical, cognitive, social and emotional domains. Describe Ahmad as a securely-attached, typically-developing 18 month old child who is able to sign and has an emerging sense of both English and Arabic.

* Present evidence for and against the practice of teaching children sign language at an early age. Some have indicated that such a practice might delay language development while other have indicated that teaching sign is helpful. Weigh in. What influence might the presence of 3 languages have on Ahmad's development? 

Week Two

Khalid and Sasha have decided that Ahmad will be raised as a Muslim. Sasha feels strongly about environmental issues, and she and Khalid have agreed to use natural products as much as possible with Ahmad. This will include using cloth diapers instead of disposables. Sasha also feels strongly about breastfeeding and plans to do so for as long possible.   

Ahmad was born without complication or incident, and mother and child returned home shortly after birth. Sasha took on the bulk of the caregiving, although Khalid supported the two by cooking and making sure all of the household needs were well-managed. In fact, Sasha and Khalid enjoyed significant time together with Ahmad, and he developed a secure attachment with each parent.

As Ahmad grew and flourished, it came time for Sasha to return to work. Khalid and Sasha were uncertain about putting Ahmad in day care, and they debated about it for some time. Khalid was able to stay home with Ahmad, but Sasha thought that interacting with other children would also be important, even at his young age.

* Why might someone choose to use cloth diapers instead of disposable diapers?

* Given that Sasha does not practice Islam, what challenges are likely to be associated with their decision to raise Ahmad as a Muslim? Do you foresee any conflicts between Khalid and Sasha? Provide research data regarding child rearing in households where religion differs between partners.

* Are there specific religious rituals and/or expectations that pertain to the birth process, the newborn, and then the infant in the religion of Islam? Other religions, for example, delineate specific practices regarding the newborn: in Judaism, circumcision takes place for the male child, and the Judeo-Christian tradition (most “mainstream” Christianity in the United States including Catholicism and mainstream Protestant denominations including Lutheranism, Presbyterianism, and Methodism) follows this practice.

* Outline the typical developmental milestones for newborns and infants in their first year.

* What are the recommended immunizations for newborns? What immunizations are typically provided just after birth? Which ones in the first year? How frequently should the newborn visit the pediatrician in terms of what is recommended? What is the CHAT and when is it given to parents? Outline Ahmad’s first year in terms of doctor visits. Provide rough information as to the fees associated with these visits.

* What is a “secure attachment?” What does such an attachment style predict with regard to later life outcomes?

DECISION POINT ::: How do Khalid and Sasha resolve the issue of whether to put Ahmad in day care?