Strategy 2: Provide Sleep Assistance


Let’s learn the second key strategy, that is so helpful for naptimes, bedtimes, and other rest times. Here are three ways that we can help children regulate their sleep and to develop resting skills that build self-regulation.

  • Support regular sleep-wake cycles by having set times for naps. As much as possible, keep children on a regular nap and sleep cycle. It will pay off in the long run!
  • Provide consistent routines (dim lights, soft music) prior to nap time. Use routines to which the children respond well for sleep. These routines include calming music, soft lights, same location for sleep, pottying, and hand washing before a nap.
  • Allow the child to use a calming device. Let children have a favorite stuffed animal or blanket on their mat, cot, or bed.


💭 Think Spot

Let’s name the sleep assist strategies shown below.

  1. Which sleep strategies are being shown in this picture below? Note on your Handout.

a girl sleeps on a blue cot, a colorful quilt is tucked around her


  1. Which sleep strategy do you see in this picture? Note what is in the child’s lap, and write the strategy on your Handout.

A boy sits on the floor sucking his thumb, surrounded by couch cushions

Did you know that there are generally 2 types of sleepers? They are signalers vs self-soothers.

  1. Signalers:
  • Go to bed without a sleep aid (pacifier, toy, blanket)
  • Often already asleep when put down
  • Cry when they wake up
  1. Self-soothers:
  • Use a sleep aid
  • Are put to bed/nap awake
  • Return to sleep on their own

💭 Think Spot

Let’s consider some more information on sleeper types and calming strategies for each type.

The number of times both types of children wake does not differ, BUT caretakers of poor sleepers FEEL THEY WAKE MORE, because these children need an adult to put them back to sleep!

Which do YOU have? NOTE on your Handout.

Two clip art images, the first is a child sleeping on a crescent moon. The second is a child crying.


Have you observed these other sleep difficulties in your children? Circle them on your Handout.

  • Child is not cuddly.
  • Child cannot screen out noise and wakes easily.
  • Child is easily aroused by movement.
  • Child has trouble getting comfortable and settling in.
  • Child is upset with bed sheets touching his/her body.
  • Child wants body contact of caregiver next to him/her OR wants constant patting, stroking, or massage.
  • Child has specific routines that must occur before falling asleep.

Here are many specific strategies that can help.

These strategies are specific, helpful ways to help children learn to regulate their sleep. They will provide you with a variety of ways to meet your children’s sleep needs.

  • Place mattress or cot on floor away from doors and transition areas
  • Use sleeping bag with 3 to 5 year olds
  • Provide body boundary by placing cot against wall and providing soft item (such as pillow) to hug
  • Use a small tent on floor
  • Provide white noise in background
  • Use Cool Banana’s CD on a regular basis at sleep times (available at )
  • Provide calming objects at rest time, such as stuffed animals or blankets from home
  • Play games that teach comfortable separation such as peek-a-boo and hide-and-seek
  • Avoid active play prior to rest time
  • Darken sleeping room if possible
  • Introduce visually calming activities prior to nap as part of nap routine
  • Before rest times, read books such as Go! Go! Go! Stop! (see below) that are related to self-regulation and teach children about calming their bodies.

A picture of the Cool Bananas CD     A picture of the cover of the book Go! Go! Go! Stop

💭 Think Spot

Now, list two or more of these strategies on your Handout that you will try!


Additional Reading and Videos

For further resources on this topic, please see:

  2. Go! Go! Go! Stop! By Charise Harper

Strategy 1: Expand Pretend Play


This is the first tool we’ll explore to teach children how to control their feelings. Here are some ways to help children expand their pretend play skills, to develop some of the complex social skills that build self-regulation.  Being able to engage in pretend play allows children the chance to practice a variety of feelings in a relaxed setting.

  • Pretend play helps build working memory. Children must think of their own role and those of their peers while playing. By remembering their and others’ roles in play, children practice showing their emotions and responding to others in a relaxed setting.
  • Pretend play helps build inhibitory control. Children must stop actions that are out of character or that stop the flow of play. During pretend play, action changes often. Children get to practice stopping their actions and responding in new ways as the play changes.
  • Pretend play increases flexibility. Children must adjust to changing twists and turns in the flow of play. Pretend play includes changes in props, stories, people, and location. Children have a safe place to practice handling frequent changes.
  • Pretend play increases attention span. Encourage children to stay within their chosen roles and not leave after a few moments. Children can be encouraged to stay with play sessions even when they don’t go as they wish. They learn that play doesn’t always go their way, and that it can still be lots of fun.


💭 Think Spot

Now let’s consider some examples:

  1. In the first picture, which one of the strategies for extending pretend play do you see the teacher using? Hint: many of the children are wearing costumes. Reread the definitions for the strategies carefully. Note your response in your handout.

Circle time for a group of 4 year olds. Many of the children are dressed in costume. The teacher sits on a rocking chair reading, her lap covered by a blanket. A child sits beside her on another chair. Behind the chairs is a hanging tent.



  1. In the picture below, do you see a variety of pretend play areas where children can practice various roles?  Can you suggest any changes to this space? Note them in your handout.

A play kitchen is set up in the corner of the classroom. The wall is lined with a continuous self with several pieces of artwork. Below are several cabinets and a refrigerator with play food and kitchen supplies. In the center of the space is a table covered with various play food things and surrounded by four brightly colored chairs.


  1. Which one of the strategies does the picture below show for building play skills? Note in your handout.

A core board with spaces for Go Almost Done and Stop on the left. The section on the right has the various activities within the classroom (breakfast, circle time, free play, etc)


  1. Watch the following video, Kids Learning Through Play, and decide which pretend play strategies are being demonstrated. Note them in your Handout.

Additional Reading and Videos

For further reading on this topic, please see:

What is Self-Regulation?


To introduce this topic, watch a brief video by TVO Parents: Why is Self-Regulation in Kids Important?  It describes why self-regulation is so important for children.  While watching, you may replace the word “caregivers” for “parents,” as the message applies well to both.


Some of the main points of this video are that self-regulation:

  • Affects a child’s ability to learn
  • Helps a child manage school rules such as sitting for circle time
  • Helps avoid later problems that may result from problem behaviors
  • Helps children learn ways to play with peers and to deal with conflict

Gillespie and Siebel (2006) wrote an article on the relationship between child and adult behaviors and self-regulation (see resource below).  They recommend six important tools for helping children learn to self-regulate, including:

  • Watch children closely. Watch what their actions tell you about how they are feeling.
  • Respond appropriately to children’s behavior. Respond with gentle guidance. Let them know that you see their needs.
  • Provide structure and routine. Children need consistent structure and people in their lives.
  • Arrange settings for each child’s age and abilities. Arrange safe environments for children at differing ages, with challenges that are not too difficult.
  • Define safe limits based on each child’s age. Keep safe yet challenging environments for children at each age, that allow them to explore safely. Children feel secure when they have clear (not punishing) limits.
  • Show empathy and caring. Let children know, above all, that you truly care about them.

💭 Think Spot

ADD an example from your experience for each of these tools. WRITE them in the Handout. We’ll see each of them again!

  • Watch children closely. How have you practiced this tool?
  • Respond appropriately to children’s behavior. How have you practiced this tool?
  • Define safe limits based on each child’s age. How have you practiced this tool?
  • Provide structure and routine. How have you practiced this tool?
  • Arrange settings for each child’s age and abilities. How have you practiced this tool?
  • Show empathy and caring. How have you practiced this tool?
Self-regulation is NOT the same as following the rules or being compliant. A self-regulated child behaves the same way whether or not an adult is watching.

Most children can calm down on their own; children with regulatory difficulties cannot.

Let’s learn some ways to help children calm down!

Additional Reading and Videos

  1. Rice’s (2012) Understanding the importance of self-regulation for preschoolers at
  2. Gillespie & Siebel’s (2006) Self-Regulation:  A cornerstone of early childhood development in the journal Young Children, 61(4).
  3. A videotaped seminar by the course authors, Gooden and Kraska, entitled Emotional Health and Self-Regulation in Young Children.  This seminar is a discussion of critical factors for children’s emotional health and self-regulation strategies that is available at


Course Overview

This overview gives you an idea of the content we will cover in this one-hour online course. You may go at your own pace, and return to any areas of interest or need. PRINT any documents that will help your learning; give them TIME to open! Use a computer connection that allows you to watch videos. There is a HANDOUT to guide your learning; print it and follow along as you take the course. Each section gives you more information in areas of interest or need.

Do you have children in your classroom or home who have any of these behaviors?

  • Aggression: physical or verbal (biting, hitting, kicking, screaming)
  • Under-developed play skills: needs one-to-one help to play, only plays in one area or room, “rough” with toys and peers
  • Sleep difficulties: won’t nap, wakes frequently, hard to get to sleep, often tired or cranky
  • Difficulty managing energy level: moody, seek or avoids movement, slow-moving, very active

If so, this course may be right for YOU!


Why is self-regulation important?

Young children who have developed self-regulation skills find it easier to:

  • Take turns
  • Make friends
  • Adapt to school and home routines
  • Be ready for school
  • Follow classroom rules
  • Solve problems

And their relationships with teachers, families, and other children are improved!

🎯 Goals of this Course

To help young children learn to self-regulate, we will consider:

  1. What is self-regulation?
  2. What problem areas are most often seen in children with self-regulation problems?
  3. What tools can I use to help children control their moods, calm down, wait, and handle change?


Think Spots

Throughout this module, you will find this symbol.

  • đź’­ Think Spot:Think spots are a place for you to think about the ideas on the slide and to apply your own experience. Use the spaces in the Handout to note your reflections.


Ready? Let’s begin with a course overview from Julie Kraska, OTR/L Kraska and Associates, Lexington, KY.


Topic 3.1 – LCI Questions

Learner Characteristics Inventory (LCI) –

Kearns, Kleinert, Kleinert, & Towles-Reeves (2006)

The ARC is required to complete each item on the Learner Characteristics Inventory as a tool to discuss the characteristics of the student when considering the eligibility of the student participating in the alternate assessment.

The LCI is to be completed after reviewing the participation criteria. The LCI is not to be used as an evaluation tool. The purpose and use of the Learner Characteristics Inventory (LCI) is to describe the population of students who take alternate assessments on alternate achievement standards and to assist in designing assessments that consider the unique characteristics of the population.

The Learner Characteristics Inventory (LCI) has two primary purposes:

  1. to describe the range of the characteristics of learners who participate in the alternate assessment
  2.  to describe the extent to which patterns of those characteristics emerged within and across states and local districts

Overview of the LCI

There are twelve questions (or indicators) that must be answered about the student in the LCI. The teacher or team member with knowledge of the student simply chooses the response under each indicator that best describes the student or the services the student currently receives.

  • Indicator responses are subject to change as interventions, supports and services are implemented to promote progress.
  • All items on the LCI will be completed annually as the student is found eligible to participate in an alternate assessment.
  • When completing all items on the LCI, select the response that BEST describes the student and/or services the student is receiving for each indicator

Disability Category

This is the start of the Learner Characteristics Inventory:

Select the student’s primary disability noted on the eligibility determination form and IEP.

Available data confirm that most students with significant cognitive disabilities are in the categories of intellectual disabilities, autism, and multiple disabilities. Although these are not the only disability categories reflected in the population of students with the most significant cognitive disabilities, they are the most prevalent. Even though disability category or EL status cannot determine whether a student is one with a significant cognitive disability, districts may want to study those cases in which students with learning disabilities, other health impairments, and speech-language impairments are participating in the state alternate assessment to confirm that it is the most appropriate assessment for each student.

  • Red flag – any disability no including cognitive in the disability eligibility determinations.

English Learner

-The indicator asks specifically if the student’s primary language is a language other than English? (These may be students who also don’t use oral speech but this refers to the language they hear at home regardless of whether they “speak” the language or not)

Guiding Questions for ARC

If the answer to the indicator question is Yes, a team member with knowledge of EL should review and discuss these guiding questions with all ARC members:

  1. What is the student’s primary social language?
  2. What is the student’s primary academic language?
  3. Does the student qualify as an English Learner with a significant cognitive disability as described in the KDE definition of a EL student with a significant cognitive disability?
  4. What is the student’s individual ACCESS/Alternate ACCESS scores and what do they mean?

This information can be gathered through communication with parents, present levels of communication or from evaluation reports. If the parent’s native language is anything other than English, it is important that an interpreter be present to communicate with the ARC.

  • red flag: student communicates at home but not school.
  • red flag: the student is achieving elp at a moderate rate. (progress)

Classroom Setting

The student’s primary classroom setting is the student’s least restrictive environment as noted on the IEP. The primary classroom setting is where the students spends the highest percentage of their school day. Special School can include home/hospital setting.

  • red flags: options 4 and 5


Expressive Communication Skills

What is the students primary mode of expressive communication as noted on the IEP?

Expressive Communication Indicators

A communication plan should be in place for any student with pre-symbolic and emerging symbolic communication skills. With intensive intervention, it is likely that a communication system can be identified for many students at the pre-symbolic and emerging symbolic levels.Information on the students current communication skills can be found in the present levels of the IEP, in the most recent evaluation report and/or from parent or teacher observations.

  • symbolic language – could be oral speech, single words, repeating words, use of picture symbols, textures, or augmentative communication device, pointing, gesturing, etc.
  • emerging symbolic language –  Uses intentional communication, but not at a symbolic language level: Student uses understandable communication through such modes as gestures, pictures, objects/textures, points, etc., to clearly express a variety of intentions.
  • pre-symbolic language – communicates primarily through cries, facial expressions, change in muscle tone, etc., but no clear use of objects/textures, regularized gestures, pictures, signs, etc., to communicate.


  • red flag: uses symbolic language consistently in addition to other red flag indicators

Communication System

5. Does the student use oral speech to communicate?

This item refers to the student’s use of oral speech. Does the student use oral speech through words to communicate? – indicate yes or no.

Information on the student’s current communication skills can be found in the present levels of the IEP, in the most recent evaluation report and/or from parent or teacher observations.

6. Does the student use an augmentative communication system in addition to or in place of oral speech? If yes, the ARC should discuss how consistently the student uses the device and if an appropriate communication plan is in place on the IEP.


Receptive Language

7. What is the student’s primary mode of receptive language as noted in the IEP?

Students with the most significant cognitive disabilities who are likely to participate in the alternate assessment include students with diverse receptive communication skills.

If the best description of the student’s receptive language skills is an uncertain response to sensory stimuli, then it is absolutely essential to seek intervention for that student and identify AAC options and develop an appropriate communication plan on the IEP.

  • Red flag: The top two description of this indicator are the most often identified. A high percentage of independent direction followers may indicate over identification of student with mild intellectual (mental) disabilities

Motor and Engagement

8. Motor: Select the best description of the individual student’s current motor functioning.

Many students with motor disabilities may have trouble crossing the midline or indicating a choice.  This is also an indicator that helps identify supports.

This information can be found in the student present levels on the IEP.

9. Engagement: Select the best description of the individual student current engagement level.

Even students who communicate may not engage in social communication.  Select the best indicator of how the student engages with others.  Information regarding the student’s current level of engagement can be obtained through observations or through the most current evaluation report.

Health and Attendance

10. Health Issues/Attendance: Select the best description of the individual student’s health and attendance description.

Students with significant cognitive disabilities may often be absent from school because of medical conditions.  Missing school is also missing instruction. A student can not be found eligible to participate in the alternate assessment based on their attendance and health issues.

The ARC must discuss the impact of the attendance if it impacts the student’s progress. The student’s attendance can not be the primary reason for the ARC decision for a student to participate in the alternate assessment.

This information can be obtained through school attendance records and through communicating with the parents about current health issues and/or reasons for absences.

Reading and Mathematics Skills

11. Reading: select the indicator that best describes the student’s current performance in reading.

Information regarding the student’s current level of reading can be found in the student’s present levels of performance on the IEP, through observations, and/or through current evaluation reports.

12.  Mathematics: select the indicator that best describes the student’s performance.

Information regarding the student’s current level of mathematics can be found in the student’s present levels of performance on the IEP, through observations and work samples, and/or through current evaluation reports.

  • Red flag: completes math computations with minimal prompts etc. reads fluently with understanding

LCI Guiding Questions for the ARC

Here are some questions members of the ARC can contemplate after completing the Learner Characteristics Inventory for a student.

  • Do the indicators selected for the student support that the student has a significant cognitive disability?
  • How does the student’s characteristics compare to the definition of a student with a significant cognitive disabilities?
  • How does the student’s characteristics compare to those reflected in the population of students who typically participate in an alternate assessment?


If you have any questions regarding the training document, contact the Kentucky Department of Education at 502-564-4970 or

Topic 2.1 – Participation Guideline Overview


Participation Guidelines Overview

ARCs will review, discuss and complete the Participation Guidelines Documentation form to determine whether a student is eligible to participate in the Alternate Assessment (Alternate K-Prep). All ARC decisions based on the discussion must be documented in the conference summary or on the participation guidelines supporting evidence or notes section.

For example: The ARC should document that they explained the difference between the courses of study for the regular and alternate diploma to the ARC members, including the parents so that they are given the opportunity to ask questions.

Checking the box for the criteria on the guidelines form does not document the ARC decision. The ARC must document statements of their decisions based on their review and analysis of information.

The Alternate K-Prep is administered each year to students in grades 3-12 who meet the required criteria.

More information regarding administration of the alternate assessments and subjects tested, is available on the Alternate K-PREP page on the KDE website.

A student must meet all of the following criteria to participate:

  • Receives special education services and has an Individual Education Program (IEP)
  • Has a significant cognitive disability
  • Requires extensive direct individualized instruction and substantial supports to achieve measurable gains in the grade and age-appropriate curriculum
  • Participation is not primarily the result of the exclusionary factors listed on the guidelines

For an EL student to participate, he/she must meet all of the following criteria:

  • Meets all of the definition of a student with the most significant cognitive disability and
  • Meets the Kentucky Department of Education (KDE) Definition of English Learners (EL) on the English Learners page of the KDE website.

Note: If an EL is participating in the Alternate K-Prep, the student will be or already is participating in the Alternate ACCESS

Red Flag Considerations

Red flags will be identified throughout the module. These red flags may indicate that an ARC should further discuss and analyze the information. Additionally, the red flags may prompt ARCs to consider if the student is being assessed with the most appropriate assessment.

Kentucky Alternate Assessment Participation Guidelines Resources

The following include snapshots of each section of the Kentucky Alternate Assessment Participation Guidelines Documentation form to be completed as an ARC.

Recommendation: It may be helpful to print or download a copy of the Kentucky Alternate Assessment Participation Guidelines Documentation form to refer to during the module. The form is available on the Alternate K-Prep Instructional Resources page and under Course Resources with Lesson 1 of the Module.

Topic 1.2: How students with disabilities participate in Kentucky assessments

This section lays out the steps an ARC should take when considering how a student will participate in Kentucky assessments.

There are multiple options for inclusion in the state assessment. These options should be considered in this order:

  1. Participating in the general assessment WITHOUT accommodations
  2. Participating in the general assessment WITH accommodations
  3. Participating in the Alternate Assessment with accommodations

An ARC determines a student’s eligibility to participate in the alternate assessment annually and on an individual basis. Student must have a CURRENT education plan (IEP, 504, Program Service Plan) to participate. Decisions based on student’s present levels, evaluation information (progress monitoring) and work samples.

Discuss the General Assessment

An ARC should discuss the possible participation in the general assessment for a student first. Then review student information and decisions for considering the student for alternate assessment only if the ARC agree that the student is unable to participate in the general assessment with accommodations and modifications.

Questions the ARC should ask:

1.Can the student participate in the general assessment without accommodations?

2.Can the student participate in the general assessment with accommodations? The ARC should review and discuss all accommodations available for the general assessment.

3.If the student can participate in the general assessment with accommodations, has documentation of accommodations determination been reviewed and documented?

4.If the student can NOT participate in the general assessment with or without accommodations, then the ARC needs to document that decision and begin review and documentation of the Kentucky Alternate Assessment Participation Guidelines.

Students demonstrating mild to moderate cognitive disabilities may be more appropriately placed in the general assessment with accommodations. Anticipated or past low achievement on the general assessment, other assessments or poor classroom performance does not mean the student should be taking the Alternate K-Prep.

As with all assessments, the alternate assessments are a snapshot of student performance based on grade-level expectations, but they are just one data point to help understand a student’s progress academically. The student’s IEP goals, alternate assessment score, and a variety of other progress monitoring tools should be used throughout the school year to help the ARC plan for the most appropriate instructional program to ensure the student is provided with the most post-secondary opportunities.


Topic 1.4: ACES and their Impact on Brain Functioning

Researchers have identified multiple ways ACES exposure changes children’s brain development and functioning.  Repeated exposure to stressful situations in the developmental period or in adolescence causes the body to remain in a heightened state or response in ways that impact how genes operate, well into adulthood.  In a process called gene methylation, chemical changes occur that modify how genes work.  This chemical-induced genetic change, or epigenetic shift, overrides genes’ ability to function and force them to behave differently.  Where long-term exposure to ACES occurs, epigenetic shifts occur in the genes associated with the body’s ability to regulate stress responses, forcing those genes to respond as if the individual were under constant threat.  That is, the body remains in a state of high stress.  This causes a person to remain in a heightened state of the fight or flight response at the biochemical level which can affect not just behavior but also the body’s general health by increasing inflammation and risk for diseases such as cancer, heart disease, depression, and others.  Further, emerging research found similar epigenetic changes in genes that are not associated with stress regulation as well.  This research suggests that children exposed to long-term toxic stress are at higher risk for a broad range of diseases in adulthood.  Consequently, children living in this heightened state of tension are not just more likely to over-react to stress and exhibit challenging behavior, they are also likely to suffer substantial long-term health impacts.  The research has significant implications for reframing our previous understanding of what has historically been viewed as physical, mental, or emotional aspects of human development (Nakazawa, 2016).

Exposure to ACES can also impact the size and shape of the brain by increasing productions of hormones that reduce the size of the hippocampus.  This part of the brain has been associated with regulating emotion, memory and managing stress.  Long-term and repeated exposure to ACES have also been associated with size reduction in the prefrontal cortex, which is related to the capacity for decision-making and impulse control.  Similar changes have also been found in the amygdala, which is associated with our ability to process fear.  Consequently, children experiencing ACES are also at-risk for over-reacting to stress into their adult years. This can occur in situations that others might perceive as only mildly stressful (Nakazawa, 2016).

Another way ACES impact brain development is neural pruning, or the reduction of development of neural pathways.  In typically developing children, neurons and synaptic connections form as the brain performs the work of everyday learning, play, and other life functions.  As children have experiences, neurological connections are formed, and new relationships appear.  Researchers have previously theorized that in the absence of certain experiences, excess neurons and connections simply did not develop.  However, researchers have discovered that “non-neuronal brain cells—known as microglia, which comprise up one-tenth of all the cells in the brain and are actually part of the immune system—participate in the pruning process” (Nakazawa, 2016).  The microglia prune neurological connections and consume cells, along with other cellular matter.  Under chronic stress, microglia cells increase their activity and produce chemicals that cause inflammation in the neurological system.  “This below-the-radar state of chronic neuroinflammation can lead to changes that reset the tone of the brain for life” (Nakazawa, 2016).

Long-term exposure to stress in childhood also lead to premature neurological aging by causing increased erosion of telomeres, which protect the ends of DNA strands.  Their purpose is to protect the genes, and as they degrade, they expose DNA to damage.  This increases the risk for disease and may cause cells to age faster (Nakazawa, 2016).

Neurologists have described a decision-making neurocircuitry called the default mode network that regulates and integrates memory and new information to help individuals make decisions about how to respond or what to do in various situations.  It is the part of the brain that determines what is important, what can be ignored, and how to proceed in dealing with tasks and information.  Researchers have documented that in children living with ACES, this network becomes less effective at doing its work.  There is less connectivity in the neurological network, and the brain may not recover these structures, even over the long term and into adulthood (Nakazawa, 2016).

Recently researchers have discovered a previously undocumented network of neurological connections between the brain and the body’s lymphatic system, which is the body’s immune system.  The lymphatic system carries lymph fluid, which circulates throughout the body helping to eliminate toxins and provide a means for immune cells to travel to where they are needed.  This finding supports researchers’ understanding between stress and physiological symptoms.  The chemical impacts of stress on the brain have a direct connection to the rest of the body via the lymphatic system, which can cause the spread of disease-inducing inflammation (Nakazawa, 2016).

Chronic exposure to ACES has been linked to poor neural connectivity between the prefrontal cortex and the hippocampus. In girls, weakened connections have also been found between the prefrontal cortex and the amygdala. “The prefrontal-cortex-amygdala relationship plays an essential role in determining how emotionally reactive we’re likely to be to the things that happen to us in our day-to-day life, and how likely we are to perceive these events as stressful or dangerous” (Nakazawa, 2016).

In summation, recent neurological research indicates that any exposure to ACES can have long-term serious impacts on children that can plague them into adulthood.  Children who experience multiple incidents of ACES over time may experience even more profound impacts.

  • đź“ąEmbedded Videos: Throughout the course there are videos from various YouTube channels. Many of these videos must be viewed in its entirety before moving on to the next topic. Usually this means waiting until the Related Videos pops up at the end, after the credits. If you encounter a problem with a video please use the Contact Us button below and include the name of the course, topic and video you are having trouble with.

Effects of this exposure can:

  • Weaken a child’s ability to respond appropriately, learn, remember, and problem-solve
  • Reduce ability to tolerate stress, which can result in an increase in fighting, opposition and defiance, or disengagement
  • Reduce social and emotional skills necessary to create and maintain important social relationships with peers and adults
  • Increase the body’s production of stress hormones and reduce its ability to regulate its stress responses, which can lead to long-term health problems
  • Create a constant state of fight-or-flight arousal that increases heart rate, blood pressure, respiration, and muscle tension

Children experiencing negative impacts of ACES exposure are at increased risk for adolescent pregnancy, substance abuse and smoking, depression and other psychological disorders, heart and liver disease, risky sexual behavior and sexually transmitted diseases, dangerous behavior, and suicide. Increased exposure to ACES is strongly correlated with the likelihood of serious disease, at-risk behaviors, and premature death in adults (Felitti, V. J., Anda, R. F., Nordenberg, D., et al., 1998).  Exposure to ACES results in genetic and chemical changes that have severe implications on long-term health and well-being for children and can increase the risk for debilitating disease (Nakazawa, 2016).  The connections between ACES and changes in brain development and functioning have significant implications for our understanding of children experiencing trauma and their behavior.

Continue watching: Childhood Trauma – America’s Hidden Health Crisis

Lesson 3: External Transition: Impacts on Families


Although the impact of external transition on children is well documented in the literature reviewed, little or no hard data is available on how these transitions directly impact families because it is not tracked.  Anecdotally, families may be impacted by both voluntary and involuntary transition.  The impacts can have implications for work, finance, family dynamics, and social functioning.  Clearly, unexpected center-initiated external transitions may contribute to increased family stress and burden.  Often families do not receive assistance in identifying an alternative placement, leaving the burden of finding another program entirely to the family.  There may be challenges accessing another program, particularly an affordable, high-quality program.  Even in cases where assistance is offered, often there is a lapse in service which leaves families, especially working families, in difficult situations (United States Department of Health and Human Services, 2016).

Loss of care can create significant challenges for working parents as they attempt to procure new child care placements because of the lack of suitable programs conveniently located near workplaces with availability during times care is needed (Oldham, 2018).  They may be forced to take any siblings to another center as well because of an inability to logistically manage to drop their children off at different centers and the impact that would have on their schedules.  Parents seeking care may be unable to work while they seek new services, and may be at risk for reduced income, disciplinary actions on the job, or loss of a job.  Family finances can be impacted if comparable care at the same cost is not available.  Lack of adequate transportation can become an issue as well.  Women living in child care deserts are especially vulnerable in the event of an unplanned external transition.  Lack of available child care may result in women leaving the workforce on a temporary or permanent basis.  Women leaving the workforce after having children may be a factor in the gender wage gap (Redden, 2018).

Loss of child care may also impact family dynamics.  Parents may experience a range of emotional responses as their child experiences disruption in his or her programs.  Child behavior issues may emerge, and regression can occur. This can elicit feelings of frustration, sadness, anger, helplessness, and powerlessness in the parent and the child, which can impact relationships with other family members and peers.  External transition also has the potential to impact all family members’ social interactions and their participation in the community (“School suspension, exclusion or expulsion,” 2017).

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What personal data we collect and why we collect it

Comments Submitted by Users

When visitors leave comments on the site we collect the data shown in the comments form, and also the visitor’s IP address and browser user agent string to help spam detection.

An anonymized string created from your email address (also called a hash) may be provided to the Gravatar service to see if you are using it. The Gravatar service privacy policy is available here: After approval of your comment, your profile picture is visible to the public in the context of your comment.

Media Submitted by Users

Some lessons include assignments which require you to upload materials for grading. In creating these materials you should not include any personal information within the document that you would not want shared (e.g., personal pictures uploading images with embedded location data (EXIF GPS) included). User submitted materials will be deleted upon grading or course completion.

Contact forms

Contact forms are used to allow visitors to submit comments and support requests. Wherever possible we attempt to explain why we need contact information and we obtain opt-in consent prior to form submission.


If you leave a comment on our site you may opt-in to saving your name, email address and website in cookies. These are for your convenience so that you do not have to fill in your details again when you leave another comment. These cookies will last for one year.

If you have an account and you log in to this site, we will set a temporary cookie to determine if your browser accepts cookies. This cookie contains no personal data and is discarded when you close your browser.

When you log in, we will also set up several cookies to save your login information and your screen display choices. Login cookies last for two days, and screen options cookies last for a year. If you select “Remember Me”, your login will persist for two weeks. If you log out of your account, the login cookies will be removed.

If you edit or publish an article, an additional cookie will be saved in your browser. This cookie includes no personal data and simply indicates the post ID of the article you just edited. It expires after 1 day.

Embedded content from other websites

Lessons on this site may include embedded content (e.g. videos, images, articles, etc.). Embedded content from other websites behaves in the exact same way as if the visitor has visited the other website.

These websites may collect data about you, use cookies, embed additional third-party tracking, and monitor your interaction with that embedded content, including tracing your interaction with the embedded content if you have an account and are logged in to that website.

Link to Youtube and Vimeo policies.



HDI uses Google analytics to analyze our website activities in order to better serve our visitors’ needs. We do not capture IP addresses or other personally identifiable data  with the exception of visitors’ state, city or town. This geographical data is only used in aggregate to help us better understand any correlations between the popularity of our content and its usage among geographical areas.

Who we share your data with

HDI partners with state and federal agencies to provide required professional development courses. In this capacity we are required to maintain a record of user course completions and share these records with the partner agency.

How long we retain your data

If you leave a comment, the comment and its metadata are retained indefinitely. This is so we can recognize and approve any follow-up comments automatically instead of holding them in a moderation queue.

For users that register on our website (if any), we also store the personal information they provide in their user profile. All users can see, edit, or delete their personal information at any time (except they cannot change their username). Website administrators can also see and edit that information.

What rights you have over your data

If you have an account on this site, or have left comments, you can request to receive an exported file of the personal data we hold about you, including any data you have provided to us. You can also request that we erase any personal data we hold about you. This does not include any data we are obliged to keep for administrative, legal, or security purposes.

Where we send your data

Visitor comments may be checked through an automated spam detection service.

Your contact information

We allow visitors to submit comments and support requests. Wherever possible we attempt to explain why we need contact information and we obtain opt-in consent prior to collecting any contact information.