Finally, a year free of polio

The dream of a polio-free nation has just crossed its biggest ever hurdle. India, which kicked off a mammoth drive in 1995 to make country polio free, will on Friday complete a full year without any polio incident being reported in the country.

The country reported its last case of polio on January 13 last year, from Kolkata in West Bengal. Polio endemic states such as Uttar Pradesh and Bihar too have recorded a constant drop in the polio cases from 2008 — with no case recorded in the two states in 2011.

“UN officials tell me that hopefully by early next year we shall be able to announce that India is finally free of polio,” wrote UNICEF brand ambassador Amitabh Bachhan last month. The milestone has been greeted with a round of applause. Bill Gates, co-chair of the Bill & Melinda Gates Foundation, congratulated Indian government for its efforts in protecting the children against this debilitating disease. But the celebration might have to be muted in view of the long road ahead for declaring India a fully polio free country.

“To be totally polio free, the WHO stipulates that there should be no case of paralytic poliomyelitis by wild polio virus in last three calendar years. So, if there are no polio cases by wild polio virus in 2012 and subsequent years we can call India has eradicated poliomyelitis in 2015,” explains Dr AK Dutta, head of the department of paediatrics at Kalawati SC Hospital, Delhi.

Polio is usually caused by wild polio virus — the virus that is circulating in the environment. And the polio vaccine is prepared by passing the same virus through various culture mediums. In some patients whose immunity is very poor, this vaccine virus passes through their gut and enters the environment. Once in open environment, it transforms into wild virus and infects other people. This is called vaccine derived paralytic poliomyelitis. And this poses a big challenge.

“Once wild polio virus is eradicated from the country, the major issue of concern is that of acute poliomyelitis. The cases are occurring even now and outnumbering wild poliomyelitis cases even in India. Once polio is eradicated there will be a need for injectable polio vaccine in the programme along with Diphtheria Pertussis and Tetanus (DPT) vaccine so that we can control vaccine associated and vaccine derived poliomyelitis,” says Dr Dutta.

Dr AP Dubey, head of the department of paediatrics, Maulana Azad Medical College (MAMC), Delhi, says, “The pulse polio programme has been very effective in minimising the polio cases. We have been able to curtail this menace only because of constant and excellent efforts of the government of India.”

Sounding a caution for young parents, Dr Vandana Kent, senior paediatrician at Rockland Hospital, says, “Once couples become parents, they should be aware about the vaccination schedules and they should get their children immunized on time against this deadly disease.”

Ankita Chakrabarty/ Zee Research Group
New Delhi DNA, Bombay : Jan 13, 2012

This work is licensed under a Creative Commons Attribution Non-commercial No Derivatives license.

Time to inflict pain on the terminally ill

How do YOU suggest we cut the deficit then? You’ll be asked this if you ever oppose a cost-cutting scheme, such as merging the sewer system with the library service or something. So here’s one answer, we could pay a bit less to ATOS, a company that receives £100m a year from the Government for assessing who should be cut off from disability benefit.  The method they choose is to interview each claimant, asking them a series of questions such as, "Do you look after your own pets?" Because clearly if someone can feed a hamster they’re capable of driving a fork-lift truck. Another is "Do you cry?" If you do, you’re probably told it’s all very well being depressed but there’s no reason why you can’t get a job imitating actresses who’ve won an Oscar, or hiring yourself out to appear at funerals to make it seem the deceased knew more people than they did.

During this questioning the interviewer taps the answers into their computer, which makes an automatic calculation as to whether the claimant loses their benefit. This is so much quicker as a method of assessing health than the old-fashioned way of examining someone.  Hospitals should follow this example. Instead of faffing about with X-rays and stethoscopes, the consultant could say, "Which do you prefer, pizza or a curry? Who would you rather have to dinner out of Fearne Cotton and Dermot O’Leary? OK, let’s see what the computer says – aah, you’ve got gallstones."

Maybe the plan is to turn the whole process into a radio panel show called "Fit on the Fiddle", in which claimants answer the questions from a panel including regular captain Gyles Brandreth. One man who might as well have done this was Larry Newman, who attended an ATOS interview with a terminal lung disease, when he could hardly breathe. So he took his medical records and ATOS ignored them, preferring their method of asking questions.  They decided there was nothing wrong with him so his benefit was cut, and a few weeks later, as the hospital attached a ventilator he’d have to wear permanently, with splendid jollity he said to his wife: "Still, at least I’m fit for work." He died a few weeks later, and I expect if his wife took him in again now they’d still say there was nothing wrong with him and send him for an interview to be a town crier.

Still, the cuts have to be made somewhere so I suppose it’s only fair that the brunt of them should fall on the terminally ill. But here’s where it gets complicated. The ATOS system has worked so well that in the past three years 160,000 people have successfully appealed against their decision. So from now on perhaps they’ll use a more reliable method, such as rolling two dice and anyone who gets eight or over loses their money. Or they could still call people in for interviews but do three at a time while the assessor lines them up and goes, "If dip dog shit, you are not it", and the loser has to crawl to the job centre.  The trouble is that these tribunals have cost £30m (and you’ll laugh at this bit), and that money is paid by the Government, out of taxes. So they still get paid the £100m, out of taxes, and all the mistakes are paid for out of more taxes.

It’s like a minicab firm that always takes you in the wrong direction, but you still have to pay them, then they charge you again to bring you back where you started. And to complete the analogy, on the way home they run someone over and shout: "If you can stroke a cat there’s nothing wrong with you", as the victim is carried into the ambulance.  So here’s my suggestion. On live television ATOS are called in for an interview by a panel of disabled people, who ask them to mime looking after their pet, then assess whether they’re entitled to still get £100m or have to go and get a proper job.

Mark Steel, The Independent

Gaming helps treat brain stroke victims

Spanish scientists have created a robotic machine that integrates with a gaming  system to rehabilitate people suffering from neuromuscular disability while making therapy fun

Fifteen million people throughout the world suffer from a stroke every year and 5 million are left with chronic disabilities. Researchers have designed a robotic gaming system for treating neuromuscular disability amongst these patients.  The patient will be able to enhance his or her arm mobility by means of a portable robotic device and a software platform with videogames for tele-rehabilitation, so that the doctor can carry out the online monitoring of these exercises through the quantitative results obtained from the games.

The ArmAssist project is currently testing in a hospital, to find out the degree of satisfaction of patients who have suffered a brain stroke. The project was initiated by FIK, a business initiative focused on research into the field of ageing and disability.

THE DEVICE AND VIDEOGAMES

ArmAssist consists of a mobile-based device that is connected to the user through a hand brace that records and measures the movements of the shoulder and the elbow. This mobile base is connected to a standard computer that links the movements carried out by the arm to comply with the demands of the videogames developed for the rehabilitation of the upper limbs. The exercises proposed for favouring the rehabilitation of the patient are of two kinds: evaluation and training.

The evaluation ones are short and which should be undertaken every day at the beginning and the end of the training session. These videogames train independently the range of motion, force, distance and of precision, so that the therapist can evaluate the progress of the patient.  For their part, the training games last longer. The objective is precisely to motivate the patient, training the arm over a longer period. These games also integrate a cognitive component in order to train also this aspect. Amongst these videogames, there are puzzles, memory games and card solitaire games.

REMOTE THERAPISTS

Using tele-rehabilitation software that this assistive arm includes, a link is also developed between the patient and the therapist, which enables training him or her in their homes, and more independently.  While the doctor can ensure the patient is doing the exercises correctly by using the computer programme with an Internet connection.

Mumbai Mirror Bureau mirrorfeedback@indiatimes.com

Doctors must be trained to communicate with the deaf

An advocate for the hearing impaired community is calling for doctors and health workers to be trained in Jamaican sign language so that they can communicate effectively with their deaf patients.

Deaf Community Leader, Rian Gayle, who was participating in a panel discussion organised by the Jamaica Association for the Deaf (JAD) on February 17 at the Alhambra Inn in Kingston, said that communication has proven to be a serious barrier between the deaf patient and the health system. She said that a number of deaf persons are avoiding healthcare because of the fear of embarrassment over not being understood. “Deaf people in our community avoid going to health services. They’re having difficulties when they go in (to the doctor), because they feel that the professional does not understand them when they try to communicate and it is not worth going,” Miss Gayle told the audience.

She said that instead of going to the doctor, unfortunately, many deaf persons resort to taking advice from untrained family members and friends, which often puts them at further risk.

She also recommended that other critical service providers, such as lawyers, court workers, and law enforcement personnel receive similar sign language training.

Miss Gayle, who is also a Research Officer at JAD, said that the deaf community is also being side-lined in the media.  “There is no captioning here on the TVs in Jamaica. It is so crucial, because as vital information is coming in from the government, such as hurricane warnings, without captioning, the deaf people are without that information,” she lamented.

Miss Gayle noted that while newspapers may share some positive incites about the deaf, they also help to perpetuate negative perceptions of the community. Citing the use of the word ‘dummy’ in the headline of an article published in a popular Jamaican newspaper, she stated that this is “a totally inappropriate and offensive term to use in describing members of the deaf community.”  Minister of Religion and talk show host, Rev. Garnett Roper, who also participated in discussion, shared Miss Gayle’s concerns over the absence of television captioning for deaf people.

“As a matter of right, not as a privilege, they need to be spoken to. As a minimum, caption use must govern all television presentations. It takes nothing off us,” he said, noting that sign language interpreters should be a permanent fixture on the news.  Legal Officer in the Ministry of Labour and Social Security, Carla Roper, further spoke of the need for the proper training of persons in the legal system so that they can effectively communicate with persons in the deaf community.

He informed that the Justice Training Institute has implemented such a programme, which he said, was a good start. Other maters coming out of the discussion include: the need for quality trained teachers and interpreters; relevant legislation to protect the rights of deaf people; rights-based approach to educational provisions; and the elimination of negative perceptions about the deaf. Other panellists were: Executive Director, Combined Disabilities Association, Gloria Goffe; Director of Family Health Services in the Ministry of Health, Dr. Karen Lewis-Bell; and Head of the Centre for Disability Studies, University of the West Indies, Mona, Floyd Morris.

Deafway Times

Deciding who lives and who dies

QALY (Quality Adjusted Life Score) is the methodology used by the United Kingdom (UK) to determine whether or not an individual is eligible to receive treatment for an illness.  The formula reduces the decision making to a dollars and cents evaluation.  In short, if it costs too much, the patient is denied care.

Fortunately, we have not yet reached the point where our own health care is decided purely on the basis of cost.  Or have we?

As legislators and the public have debated health care reform, claims and counterclaims by each side that the other is trying to scare the public into supporting their position have only served to confuse the issue.  However, comments made by Robert Reich, former Labor Secretary in the Clinton administration, now an Obama economics advisor, are worth noting. While campaigning for the Democratic presidential nomination at the UC Berkeley campus in 2007, he said:

I’m so glad to see you, and I would like to be president. Let me tell you a few things on healthcare. Look, we are we have the only healthcare system in the world that is designed to avoid sick people. That’s true. And what I’m going to do is I am going to try to reorganize it to be more amenable to treating sick people, but that means you, particularly you young people, particularly you young healthy people, you are going to have to pay more.

And by the way, we are going to have to, if you are very old, we’re not going to give you all that technology and all those drugs for the last couple of years of your life to keep you maybe going for another couple of months. It’s too expensive. So we’re going to let you die.

Also I’m going to use the bargaining leverage of the federal government in terms of Medicare, Medicaid—we already have a lot of bargaining leverage—to force drug companies and insurance companies and medical suppliers to reduce their costs. What that means, less innovation and that means less new products and less new drugs on the market which means you are probably not going to live much longer than your parents. Thank you.

Secretary Reich’s honesty is refreshing.  However, since honesty and transparency are hardly hallmarks of the Obama administration and Congress, we are forced to read between the lines in an effort to determine their true intent for reforming America’s health care system. Is it now the prevailing attitude that the government intends to let old people die because caring for them is too costly? The Brits’ QALY system is used to make life and death decisions about which patients will receive care or medicines.  The decision-making process is reduced to a formula for rationing health care based on age and the estimated costs of providing medical treatment and/or services, including prescription drugs.  (see http://www.york.ac.uk/inst/che/pdf/mathprog.pdf).

David Lee, a GE health economist, explained QALY as “…Quality adjusted life year, a year of life adjusted for its quality or its value.  A year in perfect health is considered equal to 1.0 QALY.  The value of a year in ill health would be discounted.  For example, a year bedridden might have a value equal to 0.5 QALY…We try and evaluate benefits and costs.  The way we measure that is a QALY, quality adjusted life year…We try to figure out what the QALY for certain technologies are. Is the gain in QALYs to the gain in costs worth it? The UK has something like £30,000 per QALY.  If the technology can deliver at less than that they’ll pay for it, it it’s more than that they won’t…What it’s telling technology developers is that if you’ve got a high cost with low medical benefit product your chances of getting into market are lower.  If you’re a cancer patient that stands to benefit from an additional three months of life that will cost the NHS (National Health Service) $70k is it worth it or not?”

This places a monetary value on human life. Decisions are made based on life expectancy.  If a particular treatment isn’t determined to be worth the cost, care is denied.  The rationale is that, while these may be difficult decisions to make, they are necessary. The thinking is that there has to be some way to measure costs in order to keep them from getting completely out of control. On the surface, that may make sense, unless, of course, you’re the one who needs the treatment.

Once again, the admonition, “be careful what you wish for,” applies.

In a society that bases life and death decisions on cost, such as the QALY system in Great Britain, it’s easy to see how it’s possible to deny health care to people who have the potential for great accomplishments.

For example, Helen Keller, who was born blind and deaf, through the patience and perseverance of her nurse and companion, ultimately became a world renown figure for her accomplishments in helping the handicapped.  However, my guess is that if she were born at a time when the health care industry was making cost-based decisions about who should live or die, she would not have been spared.  She has been quoted as saying, “I dreamt of heaven the other night, and the pearly gates swung wide. An angel with halo bright, ushered me inside. And there to my astonishment, stood folks I’d judged and labeled as quite ‘unfit,’ of ‘little worth,’  and ‘spiritually disabled.’ Indignant words rose to my lips, but NEVER were set free, for EVERY face showed stunned surprise, not ONE expected Me!”

Another person who probably would not be with us today when the health care system restricts access on the basis of cost is one of world’s greatest physicists, Stephen Hawking (1942-).  Hawking has suffered for approximately 40 years with ALS (amyotrophic lateral sclerosis), more commonly known as Lou Gehrig’s Disease.  The list of his accomplishments is too long to detail here, but he has authored a number of important contributions to the fields of cosmology and quantum gravity, including “black holes.”  Hawking developed ALS in his youth, while attending Cambridge, and has become increasingly paralyzed over the years, to the point that today he is almost completely immobile and can no longer speak. He has been quoted as saying, “It is a waste of time to be angry about my disability. One has to get on with life and I haven’t done badly. People won’t have time for you if you are always angry or complaining.”

If the British QALY system for evaluating the worth of individuals had existed at the time Stephen Hawking first became paralyzed, would he have received the care and support that has kept him alive for the past 40 or 50 years, or would the cost of his care resulted in the conclusion that it was simply too expensive?

There is a long list of people who have made significant contributions to society and who might well have been denied health care on the basis of cost under the British QALY system or a similar policy that could potentially become the method for health care decision-making in America under the type of health care reform that the Obama administration has been pushing.  Following are just some examples:

• Christopher Reeve (1952-2004), actor: Was crippled as a result of a horse-riding injury and dedicated the remaining years of his life attempting to harness the power of medical research to enable people with spinal cord injuries to recover and walk again.
• Ray Charles (1930-2004), musician: Became blind at age seven, learned to play the piano and went on to be one of America’s greatest entertainers.
• Jose Feliciano (1950-), Stevie Wonder (1950-) and Ronnie Milsap (1945-), composers and musicians: Were all born blind and overcame their handicaps to become leading song writers and entertainers.
• Franklin Delano Roosevelt (1882-1945), U.S. President 1933-1945: suffered with Polio, which he contracted in 1921.
• Louis Braille (1809-1852), inventor of the Braille System of reading and writing.  Became blind at age 3 as a result of an accident.
• Anne McDonald (1961-), Australian author and activist for the rights of people with communication disability. She developed cerebral palsy as a result of a birth injury. Diagnosed as having severe intellectual disability at the age of three she was placed in an Australian government institution for people with severe disabilities and lived there without education or therapy for eleven years. Anne wrote her story in Annie’s Coming Out, a book she co-authored with Rosemary Crossley in 1980 (the film Annie’s Coming Out based on the book won several Australian Film Institute awards and was released in the U.S. under the title Test of Love).
• Hubert H. Humphrey (1911-1978), two-term Vice President of the U.S. and U.S. Senator, is credited with saying: “The moral test of government is how it treats those who are in the dawn of life . . . the children; those who are in the twilight of life . . . the elderly; and those who are in the shadow of life . . . the sick . . . the needy . . . and the disabled.”

Important words everyone should keep in mind during the current debate about reforming America’s health care system.  If the changes lead to health care rationing and decision making about who lives and who dies based on monetary considerations, we will not have moved forward but backward in our quest for fairness and equity.

Comments and observations about disabilities that provide us with revealing insights:

• Death is no more than passing from one room into another. But there’s a difference for me, you know. Because in that other room I shall be able to see…No pessimist ever discovered the secret of the stars, or sailed to an uncharted land, or opened a new doorway for the human spirit…”I also dislike people who try to talk down to my understanding. They are like people who when walking with you try to shorten their steps to suit yours; the hypocrisy in both cases is equally exasperating.” – Helen Keller (1880-1968), born blind and deaf.
• “The problems of deafness are deeper and more complex, if not more important, than those of blindness. Deafness is a much worse misfortune. For it means the loss of the most vital stimulus–the sound of the voice that brings language, sets thoughts astir and keeps us in the intellectual company of man.” – Helen Keller
• “Science may have found a cure for most evils; but it has found no remedy for the worst of them all — the apathy of human beings.” – Helen Keller
• “Each handicap is like a hurdle in a steeplechase, and when you ride up to it, if you throw your heart over, the horse will go along, too.” – Lawrence Bixby, author of over 40 books.
• “We all have a disability of some kind; all are lacking in one way or another. Saul has an injury to his leg. What if his personality was deformed? How much worse if his soul was lame? Preachers or teachers look for the good in all of us. (Bless them for doing so.) I don’t see a cripple. I haven’t met anyone yet who isn’t handicapped in some way. So what’s the big deal? Don’t hide your deformity. Wear it like a Purple Heart.” – Georgiann Baldino, author, co-founder of cancer support group.
• “I discovered early that the hardest thing to overcome is not a physical disability but the mental condition which it induces. The world, I found, has a way of taking a man pretty much at his own rating. If he permits his loss to make him embarrassed and apologetic, he will draw embarrassment from others. But if he gains his own respect, the respect of those around him comes easily.” – Alexander de Seversky (1894-1974), aviation pioneer.
• “But pain… seems to me an insufficient reason not to embrace life. Being dead is quite painless. Pain, like time, is going to come on regardless. Question is, what glorious moments can you win from life in addition to the pain?” – Lois McMaster Bujold (1949-), science fiction writer.
  “The healthy and strong individual is the one who asks for help when he needs it. Whether he’s got an abscess on his knee or in his soul.” – Rona Barrett (1936-), Hollywood columnist, author, TV
• “Disability is not a brave struggle or ‘courage in the face of adversity.’ Disability is an art. It’s an ingenious way to live.” – Neil Marcus (1954-), poet, playwright, disabled from age eight.
• “Not only do physically disabled people have experiences which are not available to the able-bodied, they are in a better position to transcend cultural mythologies about the body, because they cannot do things the able-bodied feel they must do in order to be happy, ‘normal,’ and sane….If disabled people were truly heard, an explosion of knowledge of the human body and psyche would take place.” – Susan Wendell, Ph.D., feminist author, suffers with chronic fatigue syndrome.
• “For me, the wheelchair symbolizes disability in a way a cane does not.” – Annette Funicello (1942-), actress, suffers with multiple sclerosis.
• “A true friend knows your weaknesses but shows you your strengths; feels your fears but fortifies your faith; sees your anxieties but frees your spirit; recognizes your disabilities but emphasizes your possibilities.” – William Arthur Ward (1921-1994), author, poet, columnist.
• “It (hepatitis C) will kill four times as many Americans as AIDS will over the next decade. I feel that whatever kind of disability God has given me, as an entertainer and as a public figure, it is so I can be a representative for others.” – Naomi Judd (1946-), singer, entertainer, mother of actress Ashley Judd and singer Wynonna, suffered with hepatitis C.
• “Americans believe that people should work hard and get ahead on their own, but when disaster strikes and they need help with retirement or disability, Americans as a whole should come to their aid.” – Jacob Hacker, Ph.D. (1971-), professor of Political Science, UC Berkeley.
• “Disability is a matter of perception. If you can do just one thing well, you’re needed by someone.” – Martina Navratilova (1956-), world champion tennis player.
• “Congress acknowledged that society’s accumulated myths and fears about disability and disease are as handicapping as are the physical limitations that flow from actual impairment.” – William J. Brennan, Jr. (1906-1997), Associate Justice of U.S. Supreme Court.
• “The only disability in life is a bad attitude.” – Scott Hamilton (1958-), American figure skater, four time Olympic champion.
• “I was slightly brain damaged at birth, and I want people like me to see that they shouldn’t let a disability get in the way. I want to raise awareness – I want to turn my disability into ability.” – Susan Boyle (1961-), Scottish singer.
• “It is a lonely existence to be a child with a disability which no-one can see or understand, you exasperate your teachers, you disappoint your parents, and worst of all you know that you are not just stupid.” – Susan Hampshire (1937-), English actress, TV star. “It was ability that mattered, not disability, which is a word I’m not crazy about using.” – Marlee Matlin (1965-), American actress, deaf (from 18 months of age)

© 2009 Harris R. Sherline, All Rights Reserved

Read more of Harris Sherline’s commentaries on his blog at “www.opinionfest.com”

The Examiner

From P.S. 176X, kids with autism get joyful launch

By Claudia Wallis
CNN Special Contributor

Editor’s note: Claudia Wallis, a former Time editor at large, completed a yearlong Spencer Fellowship at Columbia’s Graduate School of Journalism in which her reporting focused on the treatment and education of children with autism. To see more of her autism project, visit her Web site.

NEW YORK (CNN) — All parents have hopes and dreams for their children. Parents of kids with serious disabilities are no different. But in their moments of wildest imagination, the parents of Vicki Martinez, Chase Ferguson and Travis Cardona could not have envisioned high school graduation — certainly not in the dark days when they first learned their children had autism.

But last month, in a spacious high school auditorium in the Bronx, New York, Vicki, Chase and Travis marched down the aisle to “Pomp and Circumstance,” resplendent in their caps and gowns, along with 15 classmates at P.S. 176X, a New York City public school with 560 students ranging in age from 3 to 21, all of whom have autism.

“When I came here, I couldn’t talk. I talked gibberish,” the now-voluble Vicki recalls. “I didn’t do my class work; I’d go like this,” and she proceeds to flap her hands — a common symptom of autism known as stereotypy or, self-stimulation.  On graduation day, Vicki beamed from the high school stage as she collected three awards along with a special education diploma, and wowed the hundreds in the audience by singing “Besame Mucho” with the school’s Latin band.  P.S. 176X is the largest school for children with autism in New York City and very likely the largest in the country, if not the world. Because it is so big, explains principal Rima Ritholtz, it can offer an extraordinary range of services: chorus, band, arts, life skills and cooking classes, vocational training at school and in the community, as well as a wide range of academic programs aligned to the wide-ranging abilities and disabilities of the students.

The school operates within five school buildings: three elementary schools, a middle school and high school. P.S. 176X students have full-spectrum autism, not milder forms. About 10 percent of the students attend regular classes at those schools, with an aide to help them, but 90 percent are in special classes, with student-teacher ratios as small as 1-to-1 and as large as eight students with two aides and one teacher.  Nationally, there is much debate over how best to educate the nation’s rapidly growing and diverse population of youngsters with autism, the prevalence of which has increased tenfold over the past 25 years. The quality of services offered by public schools varies enormously from place to place. Some parents relocate to school districts that offer good autism services. Some persuade or even sue their district to pay for private school placement, which can cost $70,000 a year or more. Video: see Vicki sing and other highlights from the graduation ceremony »  The right to seek private school placement for kids with disabilities was strengthened in June by a Supreme Court ruling in a closely watched case from Oregon. Under the federal Individuals with Disabilities Education Act, children with autism and other disabilities are guaranteed the right to a “a free appropriate public education” in the “least restrictive environment.”

“People have preconceived notions about public school; they think private is better,” says Ritholtz, who’s wrapping up her 12th year as principal of P.S. 176X and is, herself, the daughter of a special education principal. But Ritholtz would happily match her program with almost any of the high-priced private schools. “I say, let me see their chorus,” she jokes. While the school cannot necessarily serve children who have multiple handicaps in addition to autism, she allows, “We will walk a mile before we say we can’t accommodate a kid.”  The school offers a mix of educational approaches. Some classrooms follow a fairly strict applied behavioral analysis methodology, which tends to put a strong emphasis on one-on-one instruction, using rewards and punishments to spur learning and measuring incremental progress. Other classes use a variety of methods.  The school will weigh parental preferences along with what they feel will work best for the child. “Half the battle is winning the trust of the parents,” says Ritholtz. “We understand they are up against a very baffling disability.”

While the school does a lot of testing and evaluation, the staff never seems to lose sight of larger questions about the quality of life for its students. Says Ritholtz, “My father told me not everything that is important can be measured, and not everything you can measure is important.”  After watching her son Chase graduate, Teresa Ferguson ticked off the many things he learned at P.S. 176X. “They taught him so many things I never thought would be possible,” she says. “He learned how to make friends, joke, socialize. He learned how to sit still in the classroom. He learned how to read, write, sing, play a musical instrument, stand on a stage and say a speech. These are things I never knew would be possible when he was a toddler.”  Planning for graduation and the transition out of school begins when a student is 14, seven years before he or she must, by law, leave the public school system. Terri Giampapa, the transition coordinator and job developer, works closely with families to help them find job placements, adult day programs, sports and recreational activities that will suit the graduate. As part of that preparation, students visit work sites, spend time learning vocational skills and get used to being in larger groups. Some learn to travel and navigate public transportation.

Surprisingly, it can be harder to place the more capable graduates who seek job opportunities than those who are more severely disabled and directed to adult “day hab” programs. “Employment is extremely challenging,” says Giampapa, and it’s been made even harder by the recession. Only two of this year’s 18 graduates — Vicki and Chase — appear to be headed for work. They plan to go to “supported employment” situations, meaning that they will be closely trained and supervised.  Often such jobs are just 20 hours a week, so the school helps families plan ways to flesh out the week. For those who swim, there may be weekly visits to the YMCA or, in the case of one graduate, weekly appointments at a nail salon for a manicure and a dose of salon community. The goal is to construct a full and satisfying life, explains Rosemary Petrovich, a former assistant principal who still works at the school a few day a week: “Where are the places to go, people to see, things to do?”  The family of 176X graduate Travis Cardona couldn’t be more pleased with his post-graduation plans. Travis, who can read and write but doesn’t speak and relies on an electronic communicator, is headed for a day hab program called Quality Services for Autistic Citizens. “They had no space, and then they made space for him,” says Travis’ aunt and guardian, Ivette Ithier.

Ithier says she wept with joy watching her nephew graduate. “It was unbelievable. A big accomplishment.”

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