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This could be managed in the form of a token economy, given Eddie s age The behavioral plan should be coordinated with the parents to ensure consistency between home and school, including target behaviors, reinforcers, and punishments Given Eddie s pattern of strengths and weaknesses, it is recommended that academic instruction in reading/writing emphasize phonetic and multisensory approaches In order to enhance Eddie s learning/retention, new material should be presented in an organized format that is meaningful to him The material to be learned should be pretaught, broken down into smaller components/steps, and presented in a highly structured format with frequent repetition to facilitate new learning Instruction should be supplemented with visual aids, demonstrations, and experiential/procedural learning whenever possible Eddie should be provided with periodic review of previously learned material in order to enhance long-term retention.

The cost associated with genetic counseling may well dwarf the direct expenditure on testing The most obvious testing cost is the direct cost of the genotyping, that is, the price of testing a population for the presence of speci c alleles Given the likely economies of scale that will be realized from population-based (or at least large segments of the population) testing, genetic tests should not be very expensive According to one estimate, the costs of genetic tests are likely to range from about $10 for single mutations to $250 for multiple genetic screens (Flockhart, 2001) A signi cant increase in health care expenditure will ow from the increased demand for genetic testing Screening and diagnostic testing will precede the use of pharmacogenomics-based drugs and will create an additional economic burden on the health care system.

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Finally, the underlying assumptions should be believable, and ideally have been well studied For example, an often-used assumption is that factoring is a hard problem that is, that if p and q are large enough (eg, 1024-bit) primes, then recovering p and q from n = pq takes more.

When diagnostic and screening tests become available, it is reasonable to expect at least some individuals to demand the tests even if treatments are not yet available Once pharmacogenomics-based drugs become available, an additional increase in testing cost will be from derived demand That is, the demand for testing will grow in concert with the demand for pharmacogenomics-based drugs The economic impact of the costs of services associated with testing could be substantial Additional physician or clinic visits will be needed in conjunction with individual testing Also, genetic counseling will be required for many individuals once the genotype has been determined The magnitude of the economic effects will be driven by how many tests a person will receive.

For example, will there be individual testing for speci c genetic variations, or will there be an omnibus test at birth, the results of which will be used over the lifetime of the individual In the latter case, populationbased testing could be a type of capital investment for which the bene ts and savings will be long-term Availability of diagnostic and screening tests also raises questions about who should be tested, when they should be tested, and who should pay for the testing The possibilities range from testing the entire population and all newborns (or embryos) with all known screens, to selective testing for speci c patient groups or diseases, to testing only when symptoms are present Each of these possibilities presents a different economic burden Moreover, genetic testing will increase the population at risk for treatment to everyone in society.

In light of his inattention and impulsivity, teachers, therapists, and parents should keep in mind several general rules when interacting with Eddie Eye contact should be ensured A prompt to look at the speaker before directions are presented will be helpful Instructions and directions should be kept short, simple, and concrete Requests should be limited to single commands Instructions should be presented several times as necessary Accommodations will be necessary to enhance Eddie s ability to succeed in the classroom, including preferential seating away from bulletin boards, doorways, windows, or other students, if necessary, where excessive stimuli might prove distracting Instruction should be provided in small-group settings, and efforts should be made to redirect his attention Given his ADHD, a reduction in the amount, but not the dif culty level, of assignments may assist Eddie in completing classroom tasks and homework in a timely manner.

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