The relationship between group A streptococcal infections and Tourette syndrome

America, Inc, http://www.lpaonline. org). Assessments included the criterion explicit tool, the Functional Independence Measure for Children (Wee FIM) and its domains of mobility, self-care and social cognitive functioning in daily activities. What were the findings? First, children with short limbs have challenges in transferring and climbing stairs that may not be directly discovered by clinicians who assess upright mobility on level surfaces. Second, though children master basic hand function skills at near distances with small objects and in using feeding utensils, they struggle and need assistance in grooming, dressing, and toileting. This is a direct consequence of the difficulty that short limbs have in reaching the top of the head for hair grooming, the toes for lower extremity dressing, and the sacrum for toileting hygiene. Third, although children are age appropriate in basic cognitive skills, they continue to need parental supervision for many tasks at kindergarten entry and at age 7. Some of this is a failure of thinking through accommodation strategies for task completion and some is the need for explicit parental instruction on promoting age-appropriate self-care and community mobility independence. Fourth, subtle delays in communicative challenges in children of short stature and parental fears may lead to less adept social skills between the ages of 5 and 7 years, a critical period for beginning the tasks of developing friendships and participating in community activities. Fifth, explicitly measuring criterion specific tasks in functioning and children’s participation in developmentally appropriate roles helps us to understand the impact of body structure on living with a difference and proactively monitoring for secondary complications that often require both medical and environmental interventions. What are the next steps? First, an explicit understanding of required modifications is needed to facilitate self-care and toileting skills. Second, the promotion of architectural modifications for negotiating the physical and recreational environment requires ongoing awareness and advocacy. Health professionals should not only encourage appropriate recreational experiences, but also emphasize the importance of physical activity in order to optimize fitness and lessen the risk for obesity. A useful resource is the Dwarf Athletic Association of America (http://www.daaa.org). Third, families require explicit ongoing counseling and support to promote age-appropriate learning and social experiences. Critical to this approach is to treat the individual child as a person with agenot statureappropriate expectations who will become adults. Fourth, support groups cannot only help parental caregivers but can allow social networking so that children can become aware that they are not the only ones with a genetic difference. In addition, both children and parents can observe models of successful older peers attaining higher education, working, and raising children of their own. With the increased awareness of opportunities in the personalized medicine of the new genetics and the enablement perspective of the International Classification of Functioning (ICF) model, we can explicitly promote interventions and strategies so that genetic differences in body structure do not lead to missed opportunities to promote independent functioning and participation among children and adults.