Early Identification And Intervention Services (EIIS)

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EIIS Service Delivery System
What is ASD? Service Provider
Parent Resource Package
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Regional Evaluation Report

Section 1 - Autistic Spectrum Disorder
General Information | What is Autistic Spectrum Disorder (ASD)? | Specific Symptoms | How is ASD Diagnosed? | What is the cause? / Is there a cure?

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Section 1 - Autistic Spectrum Disorder (Download Section 1)

General Information
The term Autistic Spectrum Disorders (ASD) is a general term referring to a group of disorders described in the Diagnostic and Statistical Manual, 4th edition (DSM-IV) under the heading Pervasive Developmental Disorders (PDD). The term Autistic Spectrum Disorders is interchangeable with Pervasive Developmental Disorders and refers to the 5 diagnostic categories listed below.

Autistic Disorder
Asperger's Disorder
Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS)
Childhood Disintegrative Disorder
Rett's Disorder

Each of the disorders within the "spectrum" of autism share a range of related characteristics which include impairments in three general areas:

Social Development
Communication
Behaviour

Children along the "autistic spectrum" show impairments in social development, communication and behaviour to varying degrees.⁴ Some children with ASD may not demonstrate any symptoms that are quickly noticeable. Some children with ASD may have normal or even advanced development in certain areas, while others may show more serious impairments.
The tremendous variation in the specific symptoms shown in different children with ASD can make it very difficult to diagnose. Because of this, ASD may be mistaken for deafness, emotional disturbance, language disorder, or just slow development.
The early identification and diagnosis of ASD is very important.⁷ Children who are diagnosed early can receive early intervention that will help them to develop to their potential. Research suggests that interventions should take place as early as possible to provide the most opportunity for progress.

What is Autistic Spectrum Disorder (ASD)?
Autistic Spectrum Disorder is a complex biological disorder of development that lasts throughout a person's life.¹ Autism affects the way people understand what they see, hear and otherwise sense.² People with autism have difficulty with social interaction and communication, so they may not be able to have a conversation with you, or they may not be able to look you in the eye. They sometimes have behaviours that they feel they have to do or behaviours that they do over and over.
One person with autism may have different symptoms, show different behaviours and come from different environments than other people with autism.² Because of these differences we now think of autism as a "spectrum" disorder. The spectrum refers to a group of disorders that share a range of similar features. As more research into autism is done, we gain a better understanding of the "autistic spectrum" that includes autism and other autism-like disorders. Often, when we talk about autism we are actually referring to the autistic spectrum.
The Autistic Spectrum:
Autistic Disorder (classical autism) is the most well known of the disorders on the autistic spectrum. Research estimates that Autistic Disorder occurs in approximately 1 or 2 out of every 1000 births.⁶ When all the disorders on the autistic spectrum are considered, the estimate rises to approximately 4 or 5 out of every 1000 births.
Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder and Rett's Disorder also make up part of the autistic spectrum. These disorders can differ from Autistic Disorder in three ways:¹⁷

In the age of onset (when symptoms first become noticeable)
In the number of autistic symptoms present
In the types of symptoms present

A child along the autistic spectrum can fall anywhere on the continuum from the least to the most affected.4 Every child is different. Each of the disorders that make up the autistic spectrum share a range of related characteristics. These characteristics fall into three general areas of impairment and include:^17,5
1. Impairments in social interaction - how your child relates with you or other people in his or her environment.

For example: A child with ASD may not seek out or enjoy the company of others.

2. Impairments in communication - your child's ability to share information and to let other people know what he or she wants or needs.

For example: A child with ASD may not point to what he/she wants. If they can speak, they may not be able to start a conversation or keep a conversation going.

3. Restricted and repetitive patterns of behaviour, interests, and activities- The way your child acts or responds to the world around him.

For example: A child with ASD may need to follow a very specific routine. If this routine is interrupted or changed the child may become very upset.

The degree to which a child has difficulty in any of these three areas will vary depending on how severe the Autistic Spectrum Disorder is.⁴ At the severe end of the spectrum you may see a child who cannot speak, who does not interact or communicate with others, and has many unusual behaviours. At the milder end of the spectrum you may see a child who is exceptional in his ability to speak, who tries to interact with others and has some behaviours and habits that seem a little unusual.

On the following pages you will find information that will help you to better understand these three general areas of impairments.
Remember, every child is different.
Some children with ASD may not demonstrate any symptoms that are quickly noticeable,
while others may have more serious impairments.

(1) Impairments in Social Interactions:
Social Interactions: How your child relates with you or other people in his or her environment.
In young children with autism, social behaviour is often delayed and unusual.¹⁴ This may range from aloofness (since the child may not seem to want to interact with others) to odd one-sided relationships.⁴ The degree of social difficulties will vary greatly depending on the child's level of development.^5,17
Look for:

A lack of desire to interact with others: (interpersonal responsiveness)^9,14,17
Children with ASD may not initiate social contact and may seem to lack the desire to interact with others. Often they have difficulty understanding non-verbal social cues such as eye contact, facial expressions, body postures and gestures that regulate social interactions. Because of this, they may be unable to read facial expressions and body language. They may not engage in eye contact and may look through or past people.
Children with ASD may be oblivious to others around them, including their siblings. As a parent you may notice that your child has poor eye contact, that he/she does not like being held or stiffens when held. As your child gets older he /she may not be able to understand the needs of others and may have difficulty recognizing feelings in others. For example, your child may not notice when someone else is hurt or upset.
Difficulty forming attachments: (reciprocal relationships)^9,12,14,17
Children who have autism often do not look to play with other children their age. They may not develop normal attachments to others around them and may have little or no interest in making friends. Infants with autism may not smile or reach out to their caregivers. They may reject parents' affection by refusing to be held or cuddled.
Typically, children with autism are content to play alone, barely noticing what others around them are doing. Seldom do they seek to share their achievements, interests, or enjoyment with others.

(2) Impairments in Communication:
Communication: Your child's ability to share information and to let other people know what he/she wants or needs.
Research suggests that most children with autism are not using language for communication at the time of their initial diagnosis.³ For many children with autism, their use of language is often delayed and unusual.¹⁴ Children with ASD typically experience many language problems; some may not speak at all, others may learn to speak but their use of language may be unusual and not used for the purpose of communicating with others.
Look For:

Failure to communicate: ^{12, 14,17,9,10,11}
Some children with ASD may not attempt to communicate either verbally or through gestures. There may be a delay in, or a total lack of, the development of spoken language. A child with autism may not even attempt to compensate by trying to communicate in other ways; such as, pointing at objects to show interest, shaking their head to indicate yes or no, conveying emotion though facial expression, or using other gestures.
Differences in spoken language: (differences in form, content or production)
When children with autism learn to speak, their speech is often peculiar. They may repeat back what they heard another person say (echolalia). These words or phrases may be frequently repeated regardless of their meaning. Due to echolalic speech, children with autism may refer to themselves as they have heard others speak of them - referring to themselves as "he" or "you" or by their own names; and to others as "I" or "me" (pronoun reversal).
Children with ASD often have an unusual way of talking. The pitch, rate, rhythm or volume of their spoken language may sound exaggerated. For example, they might sound squeaky or speak in a sing-song voice.
Failure to use language for social purposes:
Even after children with ASD learn to speak they often lack verbal spontaneity. Using language to communicate may not come easily or automatically. They may be unable to use their language skills for social purposes, like starting and keeping a conversation. They may not understand simple questions, directions or jokes. They may be very literal in their use of words and unable to use language as a means of communicating with others.

(3) Restricted and repetitive patterns of behaviour, interests, and activities:
Behaviour: The way your child acts or responds to the world around him.
Children with autism often have behaviours that they want to do over and over again (repetitive patterns of behaviour), like saying the same sentence again and again.¹⁴ They may flap their hands to tell you they are happy, or they might hurt themselves to tell you they are not. Behaviours may range from simple, repeated activities to more complex preoccupation with routines or a specific interest. These behaviours vary in their form, intensity, frequency and persistence.
Look For:

Repetitive motor acts: ^{9,10,11,14,17}
Most children who have autism will repeat certain actions over and over. Children may, for example, flap their hands, bang their heads, rock, pace, spin on their feet, or use repetitive finger movements. In some children, these behaviours tend to occur primarily when the child is excited, stressed, or upset.
A preoccupation with routines:
Many children with autism demonstrate a "compulsive adherence" to routines and may become extremely upset over changes in their daily routines and their surroundings. Rearranging the furniture or offering them a drink in a different cup may make them cry or bring on a temper tantrum. A child with autism may insist on always following the same routine. A change in this routine, no matter how small, might easily cause him or her to become frustrated and upset.
Narrow range of interests or activities:
Children with autism have a tendency to be preoccupied with a small number of activities, interests, or objects. The way they play may seem repetitive or restricted. For example, a child with autism might prefer to line up cars in identical patterns rather than play with the cars using their imagination. They may seem fascinated by objects that move; the spinning of wheels on toys, the opening or closing of doors, a piece of string or a rubber band. Some children with ASD master one particular activity by developing a very elaborate academic or artistic skill.

How is Autism diagnosed?
The criteria for diagnosing Autistic Spectrum Disorders (ASD) are listed in the American Psychiatric Association's Diagnostic and Statistical Manual, 4th edition (DSM-IV) under the heading Pervasive Developmental Disorders (PDD). The terms Autistic Spectrum Disorders (ASD) and Pervasive Developmental Disorders (PDD) are interchangeable. Parents and clinicians generally prefer the term ASD because it implies a range of disorders along a continuous spectrum.
In Nova Scotia, only licensed physicians and licensed clinical psychologists are authorized to make a formal diagnosis of autism. Sometimes it can be difficult to determine if a child has an Autistic Spectrum Disorder (ASD). The reason for this is that some of the symptoms of autism can also be seen in children who do not have autism. Instead, they may have other conditions such as cognitive delays, deafness, language disorders, attention deficit and hyperactivity disorders or various types of emotional problems. Part of the diagnostic process is to identify if a child has autism or one of these other conditions. Sometimes, these other disorders can co-exist with autism.
The Diagnostic Assessment:
In western Nova Scotia, once a child is identified as possibly having ASD he or she is seen by the EIIS Autism Team for a formal assessment. The child and family are asked to meet with this team for their child's assessment. The team is made up of two psychologists and may include other professionals like an occupational therapist, a speech language pathologist, an early interventionist and/or a community support worker.
During the diagnostic assessment, the psychologist will do some fun activities and have a snack with the child. These activities are from a test called the Autism Diagnostic Observation Schedule (ADOS) and will help the psychologists to determine if the child meets the criteria for an Autistic Spectrum Disorder. The psychologists may also take into consideration information that has been gathered through parent questionnaires, videotaping, and other assessments. To be diagnosed with ASD a child must show symptoms in each of the three areas of impairment: Social Development, Communication and Behaviour.
Once the diagnosis of an Autistic Spectrum Disorder is confirmed, the child and his or her family will be asked to meet with the EIIS Autism Team several times. Other people who are involved with the child or family may also be asked to join the team. As a parent, you may also want to include other family members or caregivers in these meetings. These meetings will help parents and professionals to determine what interventions (treatments) will best meet the child and family's needs.

What is the cause?
The exact causes of autism are unknown. Autism is thought to be a biological condition that can be triggered by a number of factors, most of which are not yet completely understood. Currently, autism is believed to have a genetic basis that affects the neurological development of the brain. In some families, there seems to be a pattern of Autistic Spectrum Disorders, which suggest that it may be genetic. However, some theories connect autism with specific environmental factors or other triggers.^1,16
What we do know is that autism is NOT caused by the parents or the way the child is raised (as once thought). The cause is physical and it affects the development of some parts of the brain.¹ How or why this happens is unknown. Some of the causes currently being explored are chromosomal abnormalities, viruses and pollutants. The genetics of autism are now being intensively researched.
Is there a cure?
To date, there is no cure for autism, and children do not outgrow the symptoms. However, there are a number of treatments that can help children with autism and their families lead more normal lives.
Individualized treatments, designed to meet the specific needs of the child and family, which begin as early as possible, give children with autism their best chance for progress.⁹ In Western Nova Scotia, the EIIS Autism Teams work with families to develop treatment plans specific to their children's needs. This plan is called an Individual Family Service Plan (IFSP).

Christina Schulze-Allen - EIIS Regional Coordinator
Western Regional CAYAC, P.O. Box 520, Middleton
Nova Scotia, B0S 1P0
Email: csa.cyiwg@ns.sympatico.ca Phone: (902) 825-5377
Fax: (902) 825-5379

Supported by
Kings Regional Rehabilitation Centre
Technical Resource Centre


What is EIIS? EIIS Video EIIS Service Delivery System What is ASD?		Service Provider Parent Resource Package Training Opportunities Regional Evaluation Report
Section 1 - Autistic Spectrum Disorder General Information \| What is Autistic Spectrum Disorder (ASD)? \| Specific Symptoms \| How is ASD Diagnosed? \| What is the cause? / Is there a cure? Return to Table of Contents Parent Resource Package Section 1 - Autistic Spectrum Disorder (Download Section 1) General Information The term *Autistic Spectrum Disorders* (ASD) is a general term referring to a group of disorders described in the Diagnostic and Statistical Manual, 4th edition (DSM-IV) under the heading *Pervasive Developmental Disorders* (PDD). The term Autistic Spectrum Disorders is interchangeable with Pervasive Developmental Disorders and refers to the 5 diagnostic categories listed below. Autistic Disorder Asperger's Disorder Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS) Childhood Disintegrative Disorder Rett's Disorder Each of the disorders within the "spectrum" of autism share a range of related characteristics which include impairments in three general areas: Social Development Communication Behaviour Children along the "autistic spectrum" show impairments in social development, communication and behaviour to varying degrees.⁴ Some children with ASD may not demonstrate any symptoms that are quickly noticeable. Some children with ASD may have normal or even advanced development in certain areas, while others may show more serious impairments. The tremendous variation in the specific symptoms shown in different children with ASD can make it very difficult to diagnose. Because of this, ASD may be mistaken for deafness, emotional disturbance, language disorder, or just slow development. The early identification and diagnosis of ASD is very important.⁷ Children who are diagnosed early can receive early intervention that will help them to develop to their potential. Research suggests that interventions should take place as early as possible to provide the most opportunity for progress. What is Autistic Spectrum Disorder (ASD)? Autistic Spectrum Disorder is a complex biological disorder of development that lasts throughout a person's life.¹ Autism affects the way people understand what they see, hear and otherwise sense.² People with autism have difficulty with social interaction and communication, so they may not be able to have a conversation with you, or they may not be able to look you in the eye. They sometimes have behaviours that they feel they have to do or behaviours that they do over and over. One person with autism may have different symptoms, show different behaviours and come from different environments than other people with autism.² Because of these differences we now think of autism as a "spectrum" disorder. The spectrum refers to a group of disorders that share a range of similar features. As more research into autism is done, we gain a better understanding of the "autistic spectrum" that includes autism and other autism-like disorders. Often, when we talk about autism we are actually referring to the autistic spectrum. The Autistic Spectrum: Autistic Disorder (classical autism) is the most well known of the disorders on the autistic spectrum. Research estimates that Autistic Disorder occurs in approximately 1 or 2 out of every 1000 births.⁶ When all the disorders on the autistic spectrum are considered, the estimate rises to approximately 4 or 5 out of every 1000 births. Asperger's Disorder, Pervasive Developmental Disorder - Not Otherwise Specified (PDD-NOS), Childhood Disintegrative Disorder and Rett's Disorder also make up part of the autistic spectrum. These disorders can differ from Autistic Disorder in three ways:¹⁷ In the age of onset (when symptoms first become noticeable) In the number of autistic symptoms present In the types of symptoms present A child along the autistic spectrum can fall anywhere on the continuum from the least to the most affected.4 Every child is different. Each of the disorders that make up the autistic spectrum share a range of related characteristics. These characteristics fall into three general areas of impairment and include:^17,5 1. Impairments in social interaction - how your child relates with you or other people in his or her environment. For example: A child with ASD may not seek out or enjoy the company of others. 2. Impairments in communication - your child's ability to share information and to let other people know what he or she wants or needs. For example: A child with ASD may not point to what he/she wants. If they can speak, they may not be able to start a conversation or keep a conversation going. 3. Restricted and repetitive patterns of behaviour, interests, and activities- The way your child acts or responds to the world around him. For example: A child with ASD may need to follow a very specific routine. If this routine is interrupted or changed the child may become very upset. The degree to which a child has difficulty in any of these three areas will vary depending on how severe the Autistic Spectrum Disorder is.⁴ At the severe end of the spectrum you may see a child who cannot speak, who does not interact or communicate with others, and has many unusual behaviours. At the milder end of the spectrum you may see a child who is exceptional in his ability to speak, who tries to interact with others and has some behaviours and habits that seem a little unusual. On the following pages you will find information that will help you to better understand these three general areas of impairments. Remember, every child is different. Some children with ASD may not demonstrate any symptoms that are quickly noticeable, while others may have more serious impairments. (1) Impairments in Social Interactions: Social Interactions: How your child relates with you or other people in his or her environment. In young children with autism, social behaviour is often delayed and unusual.¹⁴ This may range from aloofness (since the child may not seem to want to interact with others) to odd one-sided relationships.⁴ The degree of social difficulties will vary greatly depending on the child's level of development.^5,17 Look for: A lack of desire to interact with others: (interpersonal responsiveness)^9,14,17 Children with ASD may not initiate social contact and may seem to lack the desire to interact with others. Often they have difficulty understanding non-verbal social cues such as eye contact, facial expressions, body postures and gestures that regulate social interactions. Because of this, they may be unable to read facial expressions and body language. They may not engage in eye contact and may look through or past people. Children with ASD may be oblivious to others around them, including their siblings. As a parent you may notice that your child has poor eye contact, that he/she does not like being held or stiffens when held. As your child gets older he /she may not be able to understand the needs of others and may have difficulty recognizing feelings in others. For example, your child may not notice when someone else is hurt or upset. Difficulty forming attachments: (reciprocal relationships)^9,12,14,17 Children who have autism often do not look to play with other children their age. They may not develop normal attachments to others around them and may have little or no interest in making friends. Infants with autism may not smile or reach out to their caregivers. They may reject parents' affection by refusing to be held or cuddled. Typically, children with autism are content to play alone, barely noticing what others around them are doing. Seldom do they seek to share their achievements, interests, or enjoyment with others. (2) Impairments in Communication: Communication: Your child's ability to share information and to let other people know what he/she wants or needs. Research suggests that most children with autism are not using language for communication at the time of their initial diagnosis.³ For many children with autism, their use of language is often delayed and unusual.¹⁴ Children with ASD typically experience many language problems; some may not speak at all, others may learn to speak but their use of language may be unusual and not used for the purpose of communicating with others. Look For: Failure to communicate: ^{12, 14,17,9,10,11} Some children with ASD may not attempt to communicate either verbally or through gestures. There may be a delay in, or a total lack of, the development of spoken language. A child with autism may not even attempt to compensate by trying to communicate in other ways; such as, pointing at objects to show interest, shaking their head to indicate yes or no, conveying emotion though facial expression, or using other gestures. Differences in spoken language: (differences in form, content or production) When children with autism learn to speak, their speech is often peculiar. They may repeat back what they heard another person say (echolalia). These words or phrases may be frequently repeated regardless of their meaning. Due to echolalic speech, children with autism may refer to themselves as they have heard others speak of them - referring to themselves as "he" or "you" or by their own names; and to others as "I" or "me" (pronoun reversal). Children with ASD often have an unusual way of talking. The pitch, rate, rhythm or volume of their spoken language may sound exaggerated. For example, they might sound squeaky or speak in a sing-song voice. Failure to use language for social purposes: Even after children with ASD learn to speak they often lack verbal spontaneity. Using language to communicate may not come easily or automatically. They may be unable to use their language skills for social purposes, like starting and keeping a conversation. They may not understand simple questions, directions or jokes. They may be very literal in their use of words and unable to use language as a means of communicating with others. (3) Restricted and repetitive patterns of behaviour, interests, and activities: Behaviour: The way your child acts or responds to the world around him. Children with autism often have behaviours that they want to do over and over again (repetitive patterns of behaviour), like saying the same sentence again and again.¹⁴ They may flap their hands to tell you they are happy, or they might hurt themselves to tell you they are not. Behaviours may range from simple, repeated activities to more complex preoccupation with routines or a specific interest. These behaviours vary in their form, intensity, frequency and persistence. Look For: Repetitive motor acts: ^{9,10,11,14,17} Most children who have autism will repeat certain actions over and over. Children may, for example, flap their hands, bang their heads, rock, pace, spin on their feet, or use repetitive finger movements. In some children, these behaviours tend to occur primarily when the child is excited, stressed, or upset. A preoccupation with routines: Many children with autism demonstrate a "compulsive adherence" to routines and may become extremely upset over changes in their daily routines and their surroundings. Rearranging the furniture or offering them a drink in a different cup may make them cry or bring on a temper tantrum. A child with autism may insist on always following the same routine. A change in this routine, no matter how small, might easily cause him or her to become frustrated and upset. Narrow range of interests or activities: Children with autism have a tendency to be preoccupied with a small number of activities, interests, or objects. The way they play may seem repetitive or restricted. For example, a child with autism might prefer to line up cars in identical patterns rather than play with the cars using their imagination. They may seem fascinated by objects that move; the spinning of wheels on toys, the opening or closing of doors, a piece of string or a rubber band. Some children with ASD master one particular activity by developing a very elaborate academic or artistic skill. How is Autism diagnosed? The criteria for diagnosing Autistic Spectrum Disorders (ASD) are listed in the American Psychiatric Association's Diagnostic and Statistical Manual, 4th edition (DSM-IV) under the heading Pervasive Developmental Disorders (PDD). The terms Autistic Spectrum Disorders (ASD) and Pervasive Developmental Disorders (PDD) are interchangeable. Parents and clinicians generally prefer the term ASD because it implies a range of disorders along a continuous spectrum. In Nova Scotia, only licensed physicians and licensed clinical psychologists are authorized to make a formal diagnosis of autism. Sometimes it can be difficult to determine if a child has an Autistic Spectrum Disorder (ASD). The reason for this is that some of the symptoms of autism can also be seen in children who do not have autism. Instead, they may have other conditions such as cognitive delays, deafness, language disorders, attention deficit and hyperactivity disorders or various types of emotional problems. Part of the diagnostic process is to identify if a child has autism or one of these other conditions. Sometimes, these other disorders can co-exist with autism. The Diagnostic Assessment: In western Nova Scotia, once a child is identified as possibly having ASD he or she is seen by the EIIS Autism Team for a formal assessment. The child and family are asked to meet with this team for their child's assessment. The team is made up of two psychologists and may include other professionals like an occupational therapist, a speech language pathologist, an early interventionist and/or a community support worker. During the diagnostic assessment, the psychologist will do some fun activities and have a snack with the child. These activities are from a test called the Autism Diagnostic Observation Schedule (ADOS) and will help the psychologists to determine if the child meets the criteria for an Autistic Spectrum Disorder. The psychologists may also take into consideration information that has been gathered through parent questionnaires, videotaping, and other assessments. To be diagnosed with ASD a child must show symptoms in each of the three areas of impairment: Social Development, Communication and Behaviour. Once the diagnosis of an Autistic Spectrum Disorder is confirmed, the child and his or her family will be asked to meet with the EIIS Autism Team several times. Other people who are involved with the child or family may also be asked to join the team. As a parent, you may also want to include other family members or caregivers in these meetings. These meetings will help parents and professionals to determine what interventions (treatments) will best meet the child and family's needs. What is the cause? The exact causes of autism are unknown. Autism is thought to be a biological condition that can be triggered by a number of factors, most of which are not yet completely understood. Currently, autism is believed to have a genetic basis that affects the neurological development of the brain. In some families, there seems to be a pattern of Autistic Spectrum Disorders, which suggest that it may be genetic. However, some theories connect autism with specific environmental factors or other triggers.^1,16 What we do know is that autism is NOT caused by the parents or the way the child is raised (as once thought). The cause is physical and it affects the development of some parts of the brain.¹ How or why this happens is unknown. Some of the causes currently being explored are chromosomal abnormalities, viruses and pollutants. The genetics of autism are now being intensively researched. Is there a cure? To date, there is no cure for autism, and children do not outgrow the symptoms. However, there are a number of treatments that can help children with autism and their families lead more normal lives. Individualized treatments, designed to meet the specific needs of the child and family, which begin as early as possible, give children with autism their best chance for progress.⁹ In Western Nova Scotia, the EIIS Autism Teams work with families to develop treatment plans specific to their children's needs. This plan is called an Individual Family Service Plan (IFSP).

Christina Schulze-Allen - EIIS Regional Coordinator Western Regional CAYAC, P.O. Box 520, Middleton Nova Scotia, B0S 1P0 Email: csa.cyiwg@ns.sympatico.ca	Phone: (902) 825-5377 Fax: (902) 825-5379
Supported by Kings Regional Rehabilitation Centre Technical Resource Centre