[Code of Federal Regulations]
[Title 45, Volume 4]
[Revised as of October 1, 2007]
From the U.S. Government Printing Office via GPO Access
[CITE: 45CFR1308.7]

[Page 165]
 
                        TITLE 45--PUBLIC WELFARE
 
CHAPTER XIII--OFFICE OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH 
                           AND HUMAN SERVICES
 
PART 1308_HEAD START PROGRAM PERFORMANCE STANDARDS ON SERVICES FOR CHILDREN 
 
             Subpart D_Health Services Performance Standards
 
Sec.  1308.7  Eligibility criteria: Health impairment.

    (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.

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