(a) A child is classified as health impaired
who has limited strength, vitality or alertness due to a chronic or acute
health problem which adversely affects learning.
(b) The health impairment classification may include, but is not limited to,
cancer, some neurological disorders, rheumatic fever, severe asthma,
uncontrolled seizure disorders, heart conditions, lead poisoning, diabetes,
AIDS, blood disorders, including hemophilia, sickle cell anemia, cystic
fibrosis, heart disease and attention deficit disorder.
(c) This category includes medically fragile children such as ventilator
dependent children who are in need of special education and related
services.
(d) A child may be classified as having an attention deficit disorder under
this category who has chronic and pervasive developmentally inappropriate
inattention, hyperactivity, or impulsivity. To be considered a disorder, this
behavior must affect the child's functioning severely. To avoid overuse of this
category, grantees are cautioned to assure that only the enrolled children who
most severely manifest this behavior must be classified in this category.
(1) The condition must severely affect the performance of a child who is
trying to carry out a developmentally appropriate activity that requires
orienting, focusing, or maintaining attention during classroom instructions
and activities, planning and completing activities, following simple
directions, organizing materials for play or other activities, or
participating in group activities. It also may be manifested in overactivity
or impulsive acts which appear to be or are interpreted as physical
aggression. The disorder must manifest itself in at least two different
settings, one of which must be the Head Start program site.
(2)
Children must not be classified as having attention deficit disorders based
on:
(i) Temporary problems in attention due to events such as a divorce,
death of a family member or post-traumatic stress reactions to events such
as sexual abuse or violence in the neighborhood;
(ii) Problems in
attention which occur suddenly and acutely with psychiatric disorders such
as depression, anxiety and schizophrenia
(iii) Behaviors which may be
caused by frustration stemming from inappropriate programming beyond the
child's ability level or by developmentally inappropriate demands for long
periods of inactive, passive activity;
(iv) Intentional noncompliance
or opposition to reasonable requests that are typical of good preschool
programs; or
(v) Inattention due to cultural or language
differences.
(3) An attention deficit disorder must have had its onset in early
childhood and have persisted through the course of child development when
children normally mature and become able to operate in a socialized preschool
environment. Because many children younger than four have difficulty
orienting, maintaining and focussing attention and are highly active, when
Head Start is responsible for the evaluation, attention deficit disorder
applies to four and five year old children in Head Start but not to three year
olds.
(4) Assessment procedures must include teacher reports which
document the frequency and nature of indications of possible attention deficit
disorders and describe the specific situations and events occurring just
before the problems manifested themselves. Reports must indicate how the
child's functioning was impaired and must be confirmed by independent
information from a second observer.