Veda: Good Evening. Welcome to the Georgia Center's Live CHAT. The CHAT will begin at 9:00 p.m. and end at 10:00 p.m.

  Veda: Welcome. I will be your CHAT Moderator this evening.

  Veda: This evening we are pleased to have with us Dr. Amy Pakula, M.D. and Jackie Haar, LCSW. Both professionals are employed by the Marcus Institute in Atlanta. Tonight our topic will be " Parenting The Child With Developmental Issues. Let me introduce our guests...

  Veda: Dr. Amy Pakula is a Developmental Pediatrician. She runs the International Adoption Evaluation clinic at the Marcus Institute. Dr. Pakula screens, evaluates, diagnoses and treats children with a variety of developmental issues/disabilities. Dr. Pakula has been on the Marcus Institute staff since 1993. Jackie Haar is a Licensed Clinical Social Worker who works with Dr. Pakula in the International Adoption Clinic and also assists children and their families while they are being treated at the Marcus Institute. Jackie has been a social worker at The Marcus Institute since 2000.

  Veda: It is after 9 p.m. so we will begin our CHAT. I'm certain others will join us shortly. Amy and Jackie would you like to add more about what you do at The Marcus Institute to get us started?

  amyp: Certainly...

  amyp: I am a Developmental Pediatrician.

  Catherine Da: - has joined the chat -

  jackie: I am a clinical social worker.

  Veda: To begin, Dr. Pakula, when do you usually first see children at the Marcus Institute?

  jackie: Part of work includes providing pre-adoption and post-adoption services.

  amyp: The ages range from newborn to about 18 years...

  amyp: We often evaluate children in the preadoption process.

  Veda: Dr. Pakula when would you recommend a parent seek a developmental screening or evaluation for a child?

  amyp: Others we see later, if parents have concerns about development or behavior

  karen: r. Pakula, do parents need to be referred to you?

  amyp: Anytime a parent has concerns about a child being on target developmentally or behaviorally

  amyp: No... parents can call themselves for an appointment, however

  amyp: we may ask that they obtain a doctor's referral if their insurance co requires this.

  Veda: Would one or both of you describe what takes place during a developmental assessment for the child/family.

  amyp: Jackie...would you like to start ?

  jackie: We first try to get a history of the child medically, developmentally and behaviorally.

  amyp: This is very important because often behaviors and other skills the child has are not displayed fully in the doctor's office.

  karen: for parents from out of the area, is this done in one visit?

  jackie: If families have just adopted their child the first goal is to make sure that the child has had all the proper labs ordered

  amyp: yes it is.

  amyp: We try to accomodate famlies from distant locations.

  karen: excellent

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  amyp: So the evaluation may entail a meeting with a social worker followed by the physician

  jackie: I focus more on the social/emotional and behavioral issues.

  amyp: We request that families bring any pertinent medical records for me to review...

  amyp: such as birth records, reports from specialists involved in the child's care, psychological evaluations, etc.

  amyp: The examination includes comprehensive physical exam, neurological examination and neuromotor examination.

  jackie: We also request bringing any other history you have regarding the child prior to the adoption. This may include translated documents if you have adopted internationally.

  Veda: What seems to be the most frequent concerns that parents have?

  amyp: The degree and extent of developmental evaluation depends on the child's age

  Parent 5: - has joined the chat -

  amyp: That would depend on the age of the child, I think.

  Veda: For those of you just joining our CHAT, Welcome. Please review the log and join us.

  amyp: In younger children, parents are often concerned with medical problems, or delays in skills such as walking, talking, etc.

  jackie: ...as well as how long they have had the child.

  amyp: In older children parents may express concerns about learning, school performance or behavior.

  jackie: If a parent has just adopted a child we realize that there is an adjustment period.

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  Veda: How do the two of you assist parents in "parenting" a child with say developmental delays in speech/language...that seems to be a fairly common developmental concern.

  cindy: hi everyone

  karen: Does all follow up happen at Marcus or do you have resources available throughout the state?

  amyp: At this point follow up is at Marcus...we are not yet statewide.

  amyp: Veda... I think initially I try to determine if the child's language "delays" are simply delays or represent a more complex language disorder.

  jackie: For speech/language services we refer outside of Marcus. We do have occupational and physical therapy.

  amyp: If the child has a Language Disorder, we assist with directing the family to the appropriate intervention services.

  amyp: Then I monitor progress and ongoing service needs.

  jackie: Often children with speech/language delays display frustration.

  Kim: My son is failing the eighth grade at the moment andI know he can do the work but I also know he has some delays do you pin point the problems so that parents can take the information directly back to the school

  jackie: This frustration comes from the child's difficulties in communicating with others. Some children will act out due to this frustration. We try and help parents find strategies to use with their child. Often we see that the child's behavior improves once they can communicate more.

  karen: how do you balance the child's developmental needs with their emotional issues?

  jackie: It is very important to pin point the problem and to share this information with the school.

  Kim: we

  amyp: Kim, we have a very talented psychological staff well versed into evaluating school problems...

  jackie: Once it is determined what the specific problem is the school may be able to provide additional services.

  Kim: We had a Neuro-Psych done on our son but it did not translate well to us or the school system

  amyp: our psychologists often assist the school in understanding the issues.

  Parent 5: Kim, what is a Neuro-Psych...I think I know, but am not sure?

  jackie: I also often contact the school and help intervene, depending on the issue.

  amyp: I understand... special educators often have to translate neuropsychological information into a practical action plan.

  Parent 5: Amyp, would the psychologists go to the school with the parent, if the school was local?

  jackie: Our psychologist is able to help determine the child's learning style.

  jackie: As well as cognitive and academic ability.

  Kim: Neurological and Psychological evaluation

  amyp: Yes, they sometimes go to schools and attend IEP meetings.

  Parent 5: Switching gears...FAS seems to have come up often lately, what should parents look for to be concerned?

  jackie: In certain situations the psychologist will attend IEP meetings

  jackie: In certain situations the psychologist will attend IEP meetings

  Parent 5: parents need that kind of support at the school meetings, that's great!

  amyp: Children with FAS are often small, and can have certain physical features

  amyp: early on they may be slow in meeting thier milestones...

  amyp: Some with FAS are hyperactive...

  jackie: In addition they may also have behavioral and attentional issues.

  jackie: Later on they may have learning difficulties.

  amyp: Persons with FAS may have learning differences as well.

  Parent 5: As a parent of a toddler, it's hard to know what is typical toddler behavior and what could be warning sings of hyperactivity.

  amyp: I feel that if there are concerns about FAS a parent should first speak to the child's pediatrician, and consider consultation with a specialist who has experience with this diagnosis.

  amyp: Yes, It is very difficult to recognize hyperactivity in a toddler...

  Veda: If needed, is supportive counseling available for parents at MI to assist them in their parenting of a child with a disability? Often parents find a child with FAS, dual diagnoses to be a challenge...

  jackie: Yes, supportive counseling is definitely available.

  jackie: We also try to encourage parents to get support from other parents who have children with similiar diagnoses.

  amyp: A variety of counseling and therapeutic services are available ... in addition to the varied medical services.

  jackie: Part of my role is helping parents find additional resources in the community for support.

  Parent 5: Jackie, you are right about support from other parents in similiar situations.

  Veda: We are quickly coming up on 10 p.m., would you briefly tell us how you assist parents adopting Internationally in regards to possibly parenting a child with developmental challenges.

  jackie: Having a child with special needs can be very isolating.

  karen: For the families who haven't the ability to travel to MI, is there a transportation service?

  amyp: first... we provide peadoptive consultations and review of medical records, videos, etc.

  amyp: We see the children shortly after adoption to address acute medical problems and infectious diseases, etc.

  jackie: That depends on the families insurance. Medicaid does provide medical transportation.

  amyp: I like to get baseline developmental assessments

  Parent 5: Preadoptive consultations sounds great, but I do not think insurance would pay for something like that. Is it expensive?

  amyp: Then monitor very carefully for intervention needs based on how they progress after international adoption.

  Parent 5: Preadoptive consultations sounds great, but I do not think insurance would pay for something like that. Is it expensive?

  amyp: For international adoptions, insurance does not pay for preadopts.

  karen: ould the evaluation be covered by the one time cost

  amyp: We try to keep the cost down as much as possible.

  jackie: As Amy mentioned before, some families wait to bring in their child until there is a problem. Our recommendation is to bring the child in as soon as possible after the adoption..

  cindy: do you offer some form of payment plan for those in real need?

  amyp: Yes we do, cindy.

  Parent 5: Jackie, do you suggest this for older "special needs" children or all adopted children?

  jackie: I usually speak to parents on the telephone to discuss payment.

  jackie: I also discuss our services and any concerns. I then have our intake coordinator call to schedule an appointment. If you are requesting pre-adopt medical and video review, we do have paper work to be filled-out in advance.

  jackie: Parents can call me at 404-321-0393 ext. 111.

  jackie: You can also e-mail me at jackie.haar@marcus.org

  karen: Thank you both so much. This evening was very informative.

  amyp: Thank you Karen.

  Parent 5: Jackie & Amy, Thanks for a an informative chat. Wish I had gotten here sooner.

  Veda: Parent 5 asked a good question a moment ago do you have time to respond to that one?

  amyp: yes, I do... but I missed the question

  cindy: I really enjoyed the information you gave us. thank you I have several families I think this will help

  Parent 5: Do you suggest an evaluation for all adopted children or just older "special needs?"

  Veda: Dr. Pakula and Ms. Haar, Thank you both for sharing so much beneficial information with us this evening. We certainly appreciate your being with us on our CHAT...

  amyp: Parent 5... I am thinking about your question...

  Kim: Thanks for all the information , the chat was very helpful

  amyp: I feel that at the time of adoption parents should have as much information about there child's developmental needs as possible..

  amyp: If there are any specific concerns, then yes and assessment is called for.

  rosalief: joined late, but this information will help many of the families we serve. Thanks for helping us to be more informed.

  amyp: International adoptees are a bit different because of the high incidence of developmental dalays and I think they should be evaluated.

  jackie: If you are unsure, you can always call me. I often help parents sort this ? out.

  Veda: Thank you both again, and have a good evening.

  amyp: thank you.

  Parent 5: Yes, thanks again.

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  Veda: The CHAT has officially ended. Goodnight everyone. Thanks for being with us.

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  Parent 5: Night all.

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