Pediatric School Psychology of the disease is known as Becker muscular dystrophy (BMD).

The symptoms are the

same, such as generalized weakness and wasting first affecting the muscles of the hips,
pelvic area, thighs, and shoulders. Calves are often enlarged. BMD is similar to Duch-
enne’s but often much less severe, although there can be significant heart involvement.
The disease progresses slowly and with variability but can affect all voluntary muscles.
Most with BMD survive well into mid- to late-adulthood. The combined spectrum of
these diseases is referred to as Duchenne/Becker muscular dystrophy (DBMD). DBMD
affects approximately 1 out of every 3,500 to 5,000 boys; girls are rarely affected. With

Neuromuscular Disorders: over 4 million births in the United States each year, about 400 to 600 boys with DBMD
are born every year (Centers for Disease Control and Prevention, 2006; Muscular Dys-
trophy Association, 2006).
A Primer for School Infantile progressive spinal muscular atrophy (SMA) is a genetic disease in which
loss of motor neurons in the spinal cord affects the part of the nervous system that
Psychologists controls voluntary muscle movement. SMA is caused by a deficiency of a motor neuron
protein called SMN, necessary for survival of motor neurons, resulting from a faulty
BY KRISTINE AUGUSTYNIAK & LISA KILANOWSKI-PRESS gene on chromosome five. Onset of the disease is before birth to 18 months of age.
The symptoms of SMA are generalized muscle weakness, weak cry, trouble with swal-
mproved medical care and legislative mandates have increased the degree to lowing as well as sucking, and breathing distress. Babies cannot sit without support.

I which students with neuromuscular disorders (NMD) are educated in general

education environments. However, many practitioners remain largely unaware
of the diverse presentations of disorders and challenges that students with NMD
face. Although the literature is replete with information targeting management
of physical access barriers, information targeted toward the provision of special edu-
cation programming is relatively scant (Strong & Sandoval, 1999). For example, the
lack of knowledge of NMD, combined with the progressive and overt nature of physi-
The condition can progress very rapidly with early childhood death. Physicians, how-
ever, consider SMN-related SMA to be a continuum of severity and prefer not to make
rigid predictions about life expectancy or weakness (MDA, 2006). Approximately 1 in

Given the numerous

6,000 to 1 in 10,000 infants are born an-
nually worldwide with SMA (SMA Foun-
dation, 2006).
Charcot-Marie-Tooth disease (CMT)
ological dysfunction, has likely furthered the tendency for service providers to directly social, emotional, and is one of the most common inherited
link deterioration in physical condition with decline in overall well-being. However, pain-related challenges neurological disorders, affecting approx-
the relationship between physiological deterioration and cognitive functioning is vari- stemming from imately 1 in 2,500 people in the United
able and inconsistent (Bjornson & McLaughlin, 2001). Although physical atrophy may NMD that negatively States. The neuropathy of CMT pro-
present as the most overt marker of NMD, psychological challenges stemming from gresses gradually, affecting both motor
physical symptoms such as depression, social isolation, and negative body image may
influence educational and sensory nerves. The main problems
serve as the most salient targets for school psychological services. performance, school caused by CMT are weakness and loss of
Despite the fact that school psychologists may lack specific medical knowledge psychologists can sensation mainly in the extremities. Early
regarding NMD’s, they are well positioned to assist students with NMD to access the serve as valuable symptoms typically present as muscle loss
curriculum. Given the numerous social, emotional, and pain-related challenges stem- contributors to in the feet and calves. Tripping, ankle in-
ming from NMD that negatively influence educational performance, school psycholo- juries, and foot deformities such as high
gists can serve as valuable contributors to informal intervention, IEP development,
informal intervention, arches and hammertoes are characteristic
consultation, counseling, and collaboration efforts. In spite of practitioner strengths in IEP development, due to weakness of the small muscles in
this domain, findings of a recent pilot study (Murphy, Augustyniak, & Rinaldo, 2006), consultation, the feet. Complaints of cold legs are com-
building upon the work of McKenzie and colleagues (2000), suggests that school psy- counseling, and mon, as are cramps in the legs, especially
chology service provision to students with NMDs is in need of improvement, particu- collaboration efforts. after exercise. As the disease progresses,
larly as it relates to pain management, intervention planning, meeting psychological weakness and muscle atrophy may occur
needs, and counseling service provision. Delivery of effective services may require that in the hands, resulting in difficulty with
many school psychologists enhance their knowledge of case management, consulta- fine motor skills. Onset of symptoms is
tion, and intervention planning for NMDs. most often in adolescence or early adulthood; however, presentation may be delayed
until mid-adulthood. Pain can range from mild to severe, and some patients may need
NEUROMUSCULAR DISEASES to rely on foot or leg braces or other orthopedic devices to maintain mobility (Babu,
Neuromuscular diseases are a relatively rare, but significantly impairing group of in- 2005; National Institute of Neurological Disorders and Stroke (NINDS), 2007).
herited or acquired conditions typically manifesting during childhood. Most often, Friedreich’s ataxia is the most prevalent inherited ataxia, affecting about 1 in 50,000
NMDs are grouped into two broad categories: muscular diseases and motor neuron people in the United States (NINDS, 2007). Friedreich’s ataxia (FA) is a degenerative
diseases. Muscular disease includes muscular dystrophies and metabolic myopathies, neurological disorder that causes damage to the peripheral nerves, which carry signals
while motor neuron diseases include motor, sensory, and spinal cord neuropathies. from the brain and spinal cord to muscles and relay sensations to the brain and spinal
The NMDs most commonly affecting children are Duchenne muscular dystrophy cord from the rest of the body; damage to the cerebellum, a part of the brain that helps
(DMD), Becker’s muscular dystrophy (BMD), spinal muscular atrophy, and Charcot- coordinate movements; and damage to the heart. Onset usually occurs between 10 and 15
Marie-Tooth syndrome (Sandoval, 2006). All of the NMDs evidence muscular weak- years of age but has been diagnosed in people from ages 2 to 50. Symptoms of FA include
ness and fatigue at early stages, are progressive in nature, and eventually lead to the ataxia, a loss of balance and coordination affecting legs and torso, difficulty with speech
use of a range of health care and technology options to increase lifespan and quality and swallowing, muscle spasms, loss of sensation, skeletal abnormalities, cardiac abnor-
of life (Dawson & Kristjanson, 2003; Sandoval, 2006). malities, and diabetes or glucose intolerance. The sequence and severity of the condition
Duchenne muscular dystrophy (DMD) is one of the types of muscular dystrophy con- varies. However, most sufferers will require wheelchairs and other adaptive equipment
sisting of a group of genetic, degenerative diseases primarily affecting voluntary mus- by late teens or early twenties (Bidichandani, Delatycki, & Ashizawa, 2006).
cles. DMD is caused by an absence of dystrophin, a protein that helps keep muscle cells Acid maltase deficiency (AMD), also called Pompe disease, is one of a group of
intact. Onset occurs during early childhood between the ages of approximately 2 to 6 hereditable muscle diseases that interfere with the processing of carbohydrates needed
years. Symptoms of DMD are generalized weakness and muscle wasting first affecting to draw energy from food. AMD is a metabolic myopathy (less common than the mus-
the muscles of the hips, pelvic area, thighs, and shoulders. Calves are often enlarged. cular dystrophies) caused by a defect in the gene for the acid maltase enzyme (also
DMD eventually affects all voluntary muscles and some involuntary muscles, including known as acid alpha-gluocosidase), which affects the storage and breakdown of gly-
the heart and breathing muscles. Survival is rare beyond the early 30s. DMD is the most cogen. AMD occurs in infancy to adulthood and is characterized by slowly progres-
common form of muscular dystrophy in children. In the absence of newborn screening, sive weakness of respiratory muscles and those of the hips, upper legs, shoulders, and
DMD is usually diagnosed when a child is 3 to 6 years of age. Early signs include delay in upper arms. Cardiac involvement may occur in childhood form and is less common in
walking, frequent falling, and difficulty getting up from a sitting or lying position. Muscle adults. AMD is slowly progressive and less severe in childhood and adult-onset forms;
deterioration continues to progress and, around the time they are 12 years of age, chil- however, the infantile form often leads to death by age 2 (Amato, 2000; MDA, 2006).
dren with DMD become unable to walk. The disease is usually fatal in the teens or early The estimated prevalence for combined infantile and later onset forms of the disease
20s, most commonly due to severe respiratory or heart problems, or both. A milder form is 1 in 40,000 individuals (Martiniuk, et.al, 1998).
Mitochondrial myopathy (MITO) includes a group of diseases affecting the mito-
Kristine Augustyniak, PhD, is an Associate Professor of School Psychology and Director of the
Graduate Program in School Psychology at Niagara University (Lewiston, NY). Lisa Kilanowski-Press chondria that also interferes with the function of muscles. The group is comprised of
is an Assistant Professor of School Psychology at Niagara University. Kearns-Sayre syndrome; Leigh’s syndrome; mitochondrial DNA depletion syndrome

© 2008, N atio nal As s o ciatio n o f S chool Psyc h ologi st s December 2008, Volume 37, Number 4 | Communiqué | 23
(MDS); mitochondrial encephalomyopathy; lactic acidosis and stroke-like episodes
(MELAS); myoclonus epilepsy with ragged red fibers (MERRF); mitochondrial neuro-
gastrointestinal encephalomyopathy (MNGIE); neuropathy, ataxia, and retinitis pig-
mentosa (NARP); and progressive external ophthalmoplegia (PEO). MITO is caused by
defective genes that produce proteins that process food into energy within cells. The pro-
tein affected determines which of the mitochondrial diseases is present. Onset, symp-
toms, and progression of the condition vary according to disease. Mitochondrial myo-
pathies are relatively rare, having an incidence of approximately 6 out of every 100,000
individuals to as high as 16 out of 100,000 individuals (Cobb, 2005; MDA, 2006).
Medical evaluation and diagnosis of NMDs is complex and often complicated by
the vague nature of initial presenting concerns, such as muscle weakness, fatigue, and
double vision, among others, that often overlap with other medical conditions. Dur-
ing the course of evaluation, physicians may rely on diagnostic tools such as electrodi-
agnostic examination (EDX), spinal fluid
analysis, muscle and nerve biopsies, skin
biopsies, and the assessment of the auto- Neglecting the
nomic nervous system (including cardio- importance of pain
vascular and sensory systems, among oth- management leads to
ers; Cleveland Clinic, 2008). Functional
limitations resulting from the NMDs are
critical omissions of
typically assessed by related practitioners service that may be
such as occupational therapists, physical provided to the student,
therapists, and speech therapists. Due to while also reducing the
the progressive nature of most NMD’s, likelihood that proper
youth who have been recently diagnosed
may not demonstrate a strong degree of
accommodations,
functional impairment. Visits to neurolo- modifications, and
gists and other practitioners may initially strategies related
occur infrequently but increase as the dis- to the presence
ease progresses. of chronic pain are
At present, there is no cure for any of
the NMDs, leaving disease management
included in the
and remediation of functional limitations comprehensive IEP.
the primary course of action for physi-
cians. Despite the lack of a cure, many
treatments designed to slow the progres-
sion of the disease, as well as its symptomatic presentation, are regularly employed,
and include gene therapy, use of steroids, intravenous immunoglobulin treatment, and
therapeutic apherisis, among others. Increasing functional skills, improving quality of
life, and working to ensure longevity are the primary aims of medical intervention.
CONSIDERATIONS FOR SCHOOL PSYCHOLOGISTS
Cognitive Functioning. Though cognitive issues related to increased pain and dis-
comfort may affect a child’s academic achievement, current research suggests that
students with neuromuscular diseases most often evidence only a mild degree of im-
pairment in cognitive function (slightly below average cognitive ability). In addition
to mild disruptions in language ability and speech production, decreased sustained
attention, variable memory performance, and slowing of information processing are
the most frequently cited areas of decline (Botez-Maquard & Botez, 1993; Dorman,
Hurley, & D’Avignon, 1988; Flood & Perlman, 1987; Hart, Henry, Kwentus & Leshner,
1986; Zeigler & Wessel, 1996). Consideration of the aforementioned domains is essen-
tial when developing appropriate special education programming, particularly if it is
hoped to continue appropriate cognitive stimulation, communication skill develop-
ment, and educational attainment despite decline in physical functioning (Polakoff,
Morton, Koch, & Rios, 1998).
Pain Management. One of the most frequently overlooked yet critical aspects of
work with students with neuromuscular disorder involves the need to address the in-
fluence that pain exerts on student well-being and educational attainment. Although
school-based professionals are typically inexperienced in this domain, studies by Ze-
bracki and Drotar (2008) and McKenzie et al. (2000) highlight the importance of edu-
cators’ understanding of the relationship between pain management, activity limita-
tions, fatigue, and emotional distress among youth with NMDs. The acute or chronic
presentation of pain yields a variety of implications for educational progress and at-
tainment, all of which should be considered and addressed in the student’s Individu-
alized Education Plan (IEP). Routine assessment of pain and its sequelae can provide
valuable information to medical professionals as they consider pharmacological and
orthotic options and to mental health professionals as they refine cognitive behavioral
strategies to increase the child’s ability to cope with pain. Neglecting the importance
of pain management leads to critical omissions of service that may be provided to
the student, while also reducing the likelihood that proper accommodations, modi-
fications, and strategies related to the presence of chronic pain are included in the
comprehensive IEP.
Social and Emotional Needs. The social and emotional consequences of NMD may
also have debilitating affects on children and their families. Twenty to thirty percent
of children with chronic illness or disability will experience significant behavioral or
24 | Communiqué | December 2008, Volume 37, Number 4
psychological problems, a rate twice that of nonafflicted peers. The psychosocial diffi-
culties faced by individuals with neuromuscular disorders include depression, negative
body image, social isolation and inhibition, anger, anxiety, and feelings of helplessness
and hopelessness. Caregivers are at increased risk for poorer psychological adjustment
marked by higher stress, less family support, greater intrafamilial conflict, feelings of
isolation, and extended bereavement from multiple losses (Livench & Antonak, 1994;
Polakoff et al., 1998). School psychologists, counselors, and teachers must be diligent
in their evaluation of behavioral or emotional difficulties, particularly in reference to
potential classroom-based challenges such as inattention, lack of motivation, or non-
compliance, which are strongly linked to the effects of pain and fatigue. Furthermore,
although family systems intervention may be outside of the purview of school-based
service delivery in many districts, evaluation of family functioning in terms of the
student’s psychological well-being presents as a relevant consideration. Despite the
availability of counseling and behavioral intervention supports in the schools, parents
surveyed as part of a study of school-based service provision to students with NMDs
rated counseling services least favorably of all service areas assessed. Lack of initial
evaluation for counseling services, lack of clarity about counseling goals and objectives
for IEP counseling, as well as inattention to social and emotional needs by school staff
were reported as areas of concern by respondents (Murphy et al., 2006). Such findings
suggest a need to increase counseling support for students with NMD and to improve
the quality and scope home–school collaboration.
DIRECTIONS FOR SCHOOL PSYCHOLOGISTS
AND ALLIED EDUCATION PROFESSIONALS
Given the low incidence of the disabilities and potentially limited exposure to work-
ing with NMD populations, school psychologists and other school-based service pro-
viders may need additional training to provide effective services. The following serve
as suggestions to increase quality of supports provided to students with neuromus-
cular disorders.
■ School psychologists should seek to conduct comprehensive needs assessments
of any student recently diagnosed with neuromuscular disorder. Such assess-
ments need not be contingent upon special education eligibility determination
procedures and should be designed to identify areas of potential concern and
intervention outside of the realm of special education classification. Needs as-
sessments should include evaluation for informal classroom modifications and
informal counseling supports, if available, as well as referrals to community sup-
port services. Consideration of Section 504 plans for students not in need of for-
mal special education support is critical.
■ When conducting comprehensive psychoeducational evaluations of students
diagnosed with NMD, or in suspected cases of NMD, practitioners involved in
the evaluation process must be sensitive to their own professional limitations.
In cases where any set of presenting concerns extend beyond the expertise of
staff, including school psychologists, counselors, occupational and physical
therapists, and nurses, outside evaluations should be conducted. Recommenda-
tions from outside service providers skilled in working with students with NMD,
including suggestions regarding classroom modifications and assistive technolo-
gies, should be explored.
■ Parent reports regarding lack of timely identification of NMD symptoms and
functional impairment by school districts is of concern. Such oversights in de-
tection of dysfunction have led to delays in diagnosis of neuromuscular disorder
as well as the assignment of appropriate interventions and supports. As such,
school psychologists may proactively seek to present information relevant to
the diverse presentation of NMD to school faculty and staff via inservice presen-
tations, workshops, or newsletters. Increasing awareness of the various features
of the disorder may lead to increased early detection and intervention efforts.
Urging staff to report any concerns regarding observations of deviations from
normative functioning or changes in student motor functioning may assist in
early diagnosis and treatment. Additionally, given the ability of school psycholo-
gists to research, analyze, synthesize, and disseminate information, practitio-
ners are well positioned to conduct disability awareness trainings for school
professionals already working with children diagnosed with NMD, thus increas-
ing the overall responsiveness of the school community. Within such a forum,
it may also be possible for misconceptions about the disability, including the re-
lationship between physiological function and overall well-being, as well as the
influence of pain on functioning, to be resolved directly and immediately, while
providing opportunities for open discourse regarding the best means to inter-
vene on behalf of the child.
■ School psychologists are well poised to perform roles as liaisons and service
coordinators among home, school, medical, and community environments.
While the school nurse is an invaluable resource in terms of medical manage-
ment, school psychologists are skilled in their ability to synthesize medical and
functional information into meaningful, educationally relevant terms. Desig-
nation of the school psychologist as a critical point of contact, or “case man-
ager,” for students with NMD may serve to ensure greater continuity in care
and intervention between outside service providers and school-based inter-
© 2 0 0 8 , Nat io nal A sso c iat io n o f Sc ho o l P syc ho lo g ist s
 ventionists. Given the breadth of knowledge that school psychologists possess ease Center. Retrieved September 28, 2008, Students with neuromuscular disorders: A sur-
from http://my.clevelandclinic.org/ vey of parental satisfaction with school based
regarding intervention and consultation, practitioners may serve as key contact
neuromuscular_center/default.aspx services. International Journal of Special Educa-
persons responsible for sharing information regarding changes in student func- tion, 12, 68–76.
Cobb, B. R. (2005). Mitochondrial myopathies.
tioning and progress, as well as student needs across home, school, and clini- In S. L. Chamberlin & B. Narins (Eds.), The Muscular Dystrophy Association (2006) Facts
cal domains. Similarly, school psychologists are ideally suited to ensure that Gale encyclopedia of neurological disorders about Duchenne & Becker Muscular Dystrophies.
appropriate referrals to outside agencies (e.g., family support and counseling; (Vol.2), (pp. 534–538). Detroit: Thomson Retrieved September 20, 2008, from http://
Gale. www.mda.org/publications/fa-dmdbmd-what
individual counseling; support groups; community associations well versed in .html
NMDs, respite, assistive technology) occur when necessary, both within and Dawson, S., & Kristjanson, L. J. (2003). Mapping
the journey: Family carers’ perceptions of National Institute of Neurological Disorders and
outside of the initial referral process. issues related to end-stage care of individuals Stroke (2007). Friedreich’s Ataxia fact sheet.
■ Given the variety of social and emotional challenges faced by students with NMD, with muscular dystrophy or motor neuron Retrieved Sep 20, 2008, from http://www
any student with a neuromuscular disorder who is receiving special education disease. Journal of Palliative Care, 19, 36–42. .ninds.nih.gov/disorders/friedreichs_ataxia/
detail_friedreichs_ataxia.htm
supports should be evaluated for counseling services. Service providers engaged Dorman, C., Hurley, A. D., & D’Avignon, J.
in providing IEP-related counseling supports to students with NMD should strive (1988). Language and learning disorders of Polakoff, R. H., Morton, A. A., Koch, K. D., &
older boys with Duchenne muscular dystro- Rios, C. M. (1998). The psychosocial and cog-
to identify clear goals and objectives within the counseling arena and should seek phy. Developmental Medicine and Child nitive impact of Duchenne’s muscular dystro-
to share information regarding student functioning and progress with parents. Neurology, 30, 316–327. phy. Seminars in Pediatric Neurology, 5, 116–123.
Domains of social and emotional functioning that may warrant exploration during Flood, M. K., & Perlman, S. L. (1987). The men- Sandoval, J. (2006). Neuromuscular diseases.
counseling sessions include depression, anxiety, peer relationships, body image, tal status of patients with Friedreich’s ataxia. In L. Phelps (Ed.), Health-related disorders in
Journal of Neuroscience Nursing, 19, 251–255. children and adolescents: A guidebook for under-
changes in physical functioning, changes in academic performance, stigma, fear standing and educating (pp. 193–211). Washing-
of the future, perceived needs at school, and family relationships in the face of de- Hart, R. P., Henry, G. K., Kwentus, J. A., & Leshner,
ton, DC: American Psychological Association.
R.T. (1986). Information processing speed of
generative functioning (Livench & Antonak, 1994; Polakoff, et al., 1998). Although children with Friedreich’s ataxia. Developmental SMA Foundation (2006). Retrieved Sep 20,
school districts may not provide family based counseling supports, consideration Medicine & Child Neurology, 28, 310-313. 2008, from http://www.smafoundation.org/
of familial challenges from a family-systems perspective may prove helpful when index.php?option=com_faq&Itemid=32&
Livench, H., & Antonak, R. F. (1994). Review of
Itemid=32#answer3
serving as a consultant between home and school. Referrals to community family research on psychosocial adaptation to neuro-
counseling centers and support groups, if available, may benefit families experi- muscular disorders: I. Cerebral palsy, muscu- Strong, K., & Sandoval, J. (1999). Mainstreaming
lar dystrophy and Parkinson’s disease. Journal children with a neuromuscular disease: A map
encing acute and prolonged illness-related distress. ■ of Social Behavior and Personality, 9, 201–230. of concerns. Exceptional Children, 65, 353–366.
References Martiniuk, F., Chen, A., Mack, A., Arvanitopou- Tinkle, B. T., & Leslie, N. (2008). Glyco-
los, E., Chen, Y., Rom. W. N., et al. (1998). gen Storage Disease Type II (Pompe Dis-
Amato, A. A. (2000). Acid maltase deficiency measurement of health related quality of life
Carrier frequency for glycogen storage dis- ease). Gene Reviews. National Institute of
and related myopathies. Neurologic Clinics, 18 (HRQL) in children with Cerebral Palsy.
ease type II in New York and estimates of Health. Retreived August 30, 2008, from
(1), 151–65. European Journal of Neurology, 8(5), 183–193.
affected individuals born with the disease. http://www.ncbi.nlm.nih.gov/bookshelf/
Babu, D. (2005). Charcot-Marie-Tooth Disease. Botez-Marquard, T., & Botez, M. I. (1993). Cog- American Journal of Medical Genetics, 79, br.fcgi?book=gene&part=gsd2
In S. L. Chamberlin & B. Narins (Eds.), The nitive behavior in heterodegenerative ataxias. 69–72.
Zebracki, K., & Drotar, D. (2008). Pain and ac-
Gale encyclopedia of neurological disorders (Vol. European Neurology, 33, 351–357.
McKenzie, K., Matheson, E., McKenzie, S., Don- tivity limitations in children with Duchenne
1), (pp. 224–227). Detroit: Thomson Gale.
Centers for Disease Control and Prevention ald, S. M., Loan, G., & Shannon, H. (2000). or Becker muscular Dystrophy. Developmental
Bidichandani, S. I., Delatycki, M.B., & Ashizawa, (2006). What is Duchenne/Becker Muscular An examination of the role of clinical psychol- Medicine and Child Neurology, 50, 546–552.
T. (2006). Friedriech Ataxia. GeneClinics. Re- Dystrophy (DBMD)? Retrieved September 20, ogy in meeting the needs of young disabled
Zeigler, W., & Wessel, K. (1996). Speech Tim-
trieved August 26, 2008, from http://www 2008, from http://www.cdc.gov/ncbddd/ clients and their families/careers.
ing in ataxic disorders: Sentence production
.geneclinics.org/profiles/friedreich/details.html duchenne/what.htm Health Bulletin, 59, 372–379.
and rapid repetitive articulation. Neurology, 47,
Bjornson, K. F., & McLaughlin, J. F. (2001). The Cleveland Clinic (2008). Neuromuscular Dis- Murphy, J., Augustyniak, K., & Rinaldo, V. (2006). 208–214.

   
     
& C B0 <  .A 6"?*  6& 0(*(<C
C.? <. ),.A *. 4$0* *,* 2. ), %$2*0! ,* .$$!, .$
!$. 42$* ,% $#.#. # !,, ."(
A&< A.6)74  >$:8
 77((*(<C
*$" #4 , .$% #42* ,"%!4 !$ $# .$ .


2,. 0,# 4$0* ""* %,,2$* # ,*(
 +06.@   7(%,
.*"!# # #. ), 0%. #.* $*, 

 
!# #2 !$$ # ! .$ $%."5 4$0* 0,* 3%*#(
7C <. 7
*# $* *,* , #1* # ., ,4( ),
#.0.1 .0*, %0. 4$0 # $#.*$! 2! ,1# 1!0! ."

 
# #*4(
0'<.'<  ( , '7  .,< ,<
! ,0* # 4$0* %*. #$2# 4$0 * ,,# .

 
"$,. 0**#. !*!. *,* # 1#,
%*., 1!!(
 ?+ 6.?7 ?**' B<
6<(* 7 ..)7 6(%(,* 7 ,
+.6 444

  

  
 
  


 
 4

,, .$ . !.,. !*!. *,* # 1#, %*., , ,,#.! .$    
%*$1# $##. # ."!4 !1*4 $ ,$$!, ,*1,( ), %$2*0! ,*   

%!., # .*. .,, 1 4$0 $# %! .$ # . "$,. 0**#. *,* # , 7@ /D3 ."" <& 6 %?*6 $- ,,?*
,.*., .$ $ 4$0* $(
6< 4  < /> +.,<&7  77 ".6 .,*C $$4


 $!!.$# $#,,., $ .$0,#, $ %**12 $0*#!, # "$* .# $#
"!!$# 0!!.3. *.!, # $$ %.*, *$" ,3 $"%*#,1 .,, 

  
&.,  1!992 ==/'
  1=D/2 9#8'D>8D

" */ *"*
 *$,,$#! 1!$%"#. $!!.$#/
 ,4$!$4  1$*! #, $!!.$#/
 
+ 2. 0!!3.
  + &0.$# ,$0*, #$*".$# #.*' .7< ".6 C.?6
  ,*(, (66C5
 $
/
!# 0 6 A )4
,.A(,% A&< A.6)75 .? % < (<4

© 2008, N atio nal As s o ciatio n o f S chool Psyc h ologi st s December 2008, Volume 37, Number 4 | Communiqué | 25
Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.