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1 PLACEMENT OF MULTIPLE BIRTH CHILDREN IN SCHOOL A GUIDE FOR PARENTS AND EDUCATORS Publication of MULTIPLES OF AMERICA (also known as National Organization of Twins Clubs, Inc.)

2 PLACEMENT OF MULTIPLE BIRTH CHILDREN IN SCHOOL A GUIDE FOR PARENTS AND EDUCATORS COPYRIGHT © 2020 Reprinted 2002,2004,2010,2015 ALL RIGHTS RESERVED ISBN: 1-880805-08-1 PRINTED IN THE UNITED STATES

3 ACKNOWLEDGEMENTS The Multiples of America also known as the National Organization of Mothers of Twins Clubs, Inc. (NOMOTC) would like to acknowledge the following people who were invaluable in preparing this booklet: ● Donna Kuni, Sara Barr, Elizabeth Law, Pepsi Cordova, Susan Griffith, and Rebecca Moskwinski, who are National Workers for Multiples of America. They served on the revision committee (2020). ● Rebecca Moskwinski, M.D., who servd as coordinator of this revised edition. She is a medical doctor and past president of Multiples of America. She is the editor of Multiples of America’s book, Twins to Quints (2002, Harpeth House). ● Susan Griffith, M.D., who served as a coordinator on this revised edition. She is a medical doctor and a member of ICOMBO. She completed a School Placement Survey for ICOMBO and has shared the results in contribution. ● Contributors to previous editions: Mary Adcock, D’Ann Davis, Martha Eicker Kastens, Jill Heink, Jennifer Herrold, Corliss Hubert, Kim Ozark, Linda Dreyer and Melodie Wisniewski.

4 TABLE OF CONTENTS Acknowledgements…………………………………………… 3 Foreword……………………………………………………… 6 10 Reasons to Separate or Not……………………….……..….8 Basic Information – Multiple Births………………………….10 Early Thoughts on Separating Multiples……………………...14 Parents’ Dilemmas…………………………………………….18 Effects on the Multiples……………………………………….20 Higher Order Multiples.……………..………………………..25 How to Decide………………………..……………………….26 When Separation is Helpful……...…..……………………….29 Retention/Readiness…………………………………………..31 Alternatives to Public School……………………………...….31 Tips for Teachers and Parents……………………………..….33 Tips for Children in Special Programs.……………………….35 Tips Specific to Higher Order Multiples….…………………..36 Conclusion………………...…………………………………..37 Bibliography………………………………….…...…………..38 Appendices……………………………………………...…….41 About Multiples of America……………………………...…..51

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6 FOREWORD Parents of multiple birth children (twins, triplets, and more) frequently ask, “Is it best for my multiples to be separated or placed together in school?” They are looking for answers as to what is best for their children and their unique situations. Yet when consulting local school educators for guidance, parents are often confronted with a firm policy requiring separation, regardless of the circumstances or research. This eliminates parents and their children from the decision-making process. Multiples of America/NOMOTC formally addressed this topic in three organizational surveys reprinted in 2015 and in our book Twins to Quints published by Harpeth House Publishing in 2002. The COVID-19 pandemic has caused critical changes to the classroom setting and virtual environments where our children are learning; therefore parents have new issues to consider when determining appropriate classroom placements for their children. And since the first publishing of this booklet, there have been additional research studies done on placement of multiple birth children. The vast majority of the recent research indicates that each placement decision should be handled on its own merits and that the best policy is a flexible policy with consideration given to the parents’ preferences. More than 25 states have passed or are working on legislation to give parents the right to make placement decisions for their multiples in school.Even with recent research and information available, many districts and educators are still woefully uninformed with regards to placement issues. Additional training and study of multiple birth children is still lacking in college education classes and in virtual settings. Districts infrequently address multiples in staff development programs. Since the incidence of multiple births has remained consistent in recent years, based on statistics from the National Center for Health Statistics, educators are continually confronted with decisions concerning these children. Through this updated booklet, Multiples of America takes another look at multiples in the classroom. As in the past, Multiples of America’s research and studies by other researchers proves that mandatory separation of multiple birth children is ineffective and can be detrimental to the education and emotional growth of these children. With this in mind, Multiples of America strongly recommends decisions regarding the classroom placements of multiple birth children be made on an individual basis focusing on: ● Zygosity of the multiples (identical or fraternal) ● Research studies ● Parental input

7 ● Personality of each child within the multiple birth set ● Intellectual similarities or differences of each child within the multiple birth set ● Previous separation experiences of this set ● Articles and books on the subject The hope is this booklet will serve to inform parents, educators, and school districts about current thoughts and studies regarding the important issue of separation of multiples in school. Decisions should be made based on what is best for each of the children involved. Thank you for your interest in this subject. EDITOR’S NOTE: Although we understand, more than most, the difference between twins and higher order multiples, the term “twins” as used in this handbook will generally refer to both twins and higher order multiples. For simplicity, we have used “twins” and “multiples” interchangeably.

8 10 REASONS TO SEPARATE IN SCHOOL 1. There are insensitive comparisons of multiples as a unit by teachers or other students. 2. One multiple is dominant over the other(s); one multiple may be overprotective of the other(s). 3. Multiples have different educational skill levels. 4. The multiples ask to be separated. 5. There is a delay in the language skills of the multiples so that they communicate only with each other and may use a unique language understandable only to them. 6. One of the multiples resents the lack of privacy from sharing a classroom. 7. Multiples would have the opportunity to flourish independently of one another and develop their unique personalities. 8. The multiples’ extreme togetherness causes disruptive behavior. 9. The close relationship of the multiples impairs development of social relationships with others. 10. There is intense competition among the multiples.

9 10 REASONS NOT TO SEPARATE IN SCHOOL 1. There are emotional issues at home (death, divorce, other). 2. Only one classroom is available. 3. Multiples have similar skill levels in a specialty school. 4. The multiples ask to be placed together. 5. “Two heads are better than one”— i.e., academic support of one another. 6. The multiples need the support of each other in emotionally adjusting to a new environment, especially when younger. 7. The multiples have trouble focusing in class when separated due to worry and concern about the co-multiple(s). 8. The teachers are widely different in teaching methods resulting in unequal education standards and assignments, causing some possible resentment or jealousy of each other. 9. Give teachers the opportunity to observe the multiple relationship. 10. There is a unique bond amongst multiples that provides security.

10 BASIC INFORMATION — MULTIPLE BIRTHS While multiples are still a minority group within the entire school population, educators increasingly need to prepare for children that come to school in twos, threes, fours, and more. Multiple births have risen, almost doubling since 1980. Rapid advancement in the scientific field of fertility as well as an increase in the number of women conceiving later in life have contributed to this increase. The birth rate for twins increased 70 percent from 1980 to 2004. The rate has begun leveling off in the years since 2004. The U.S. Centers for Disease Control and Prevention released the 2018 multiple birth statistics as: 123,536 babies born as twins, 3,400 as triplets, 115 as quadruplets, and 10 as quintuplets and other higher order multiples. Multiple births decreased by 2% from 2017 to 2018. Multiples can be further categorized. Psychologist Nancy L. Segal, Ph.D., currently Professor of Developmental Psychology and Director of the Twin Studies Center, at California State University, Fullerton, addressed these differences in the article, “Not All Twin Types Are Alike”: “Researchers have determined that meaningful interpretations and applications of findings about twins require acknowledgement of specific twin types. Each type (identical, fraternal, same-sex fraternal, and opposite-sex fraternal) presents unique biological and psychological situations that deserve special attention.” (Segal, n.d.)

11 TYPES OF MULTIPLES Identification of Twin Type There are two types of twins: monozygotic (MZ) or identical, one-egg twins; and dizygotic (DZ) or fraternal, two-egg twins. Some researchers also believe there is a third type of twins, sometimes referred to as a half-identical or polar body twin. According to these researchers, this rare type of twin may occur when a precursor to an egg splits and is then fertilized by two separate sperm. These twins would have half their genes alike, those from the mother. Of the entire twin population, approximately one third are identical twins, and two thirds are fraternal twins. Of the fraternal twin population, approximately half are boy/girl sets, while half are same-sex sets. Slightly more than half of all twins are born males. Identical twins result when a single fertilized egg splits at one to 14 days after conception. These twins are genetically alike, having the same chromosomes and usually remarkable physical similarities. These twins are NOT entirely identical, however. Each twin is an individual and has a unique personality and traits of his or her own. Identical twins are always the same sex, have the same blood type, same hair, and eye color, and the same nose and ear shapes. However, they do not have identical fingerprints. Fraternal twins result from two fertilized eggs. On the average, they share half their genes in common. Fraternal twins are not necessarily any more alike than any two single siblings born to the same mother and father. The difference between fraternal twins and non-twin siblings is that twins share the same intrauterine environment and are the same age. They may or may not be of the same gender. Although height and weight differences between identical twins are common at birth, these twins tend to become more similar in size with advancing age. In contrast, fraternal same-sex twins may begin life with size resemblance but show a reduction in similarity with advancing age. If fraternal same-sex twins have a high proportion of their genes in common, they may look quite similar to the point of being confused by other people. Fraternal opposite-sex twins, depending upon the number of shared genes, show varying degrees of resemblance. Types of Higher Order Multiples “Higher Order Multiples” is a term generally used to describe three or more babies born to the same mother during the same pregnancy. Over the years, this type of multiple has been referred

12 to as “Supertwins” or “Grand Multiples,” or more commonly “triplets,” “quadruplets,” etc. Whatever the name, they represent a wide variety in terms of genetic, social and intellectual development. Higher order multiples can be all identical, all fraternal, or a mix of identical and fraternal twins. For example, one set of triplets might be identical girl twins/fraternal boys. Many times, higher order multiples are born prematurely. If this is the case, they need to be monitored closely for delays in development in the same manner as with other premature or low birth weight children. Differences in Social Relationships In examining a number of studies, the most common finding is that identical twins share a closer relationship than fraternal twins. For example, Helen Koch, Ph.D. conducted a study in 1966 at the University of Chicago. She compared the social, intellectual and physical development of five- and six-year-old fraternal and identical twin pairs and matched non-twin siblings. Identical twins showed less rivalry than other twin types. Same-sex fraternal twins displayed the highest. Dr. Segal also conducted a study at the University of Chicago during which identical and fraternal same-sex twins between seven and ten years of age were filmed as they worked jointly on a puzzle completion task. Again, identical twins demonstrated a higher degree of cooperation on this task. All twins were matched in general intelligence so that differences in ability and comprehension of the task did not explain the differences in the degree of cooperation. (Segal, 1984). In a more recent study Asbury, Almeida, Hibel, Harlaar, and Plomin (2008) found that Monozygotic (MZ) twins had different perceptions of the classroom based on perception of positivity, peer interactions, and general stressors. It was unclear in the study if gender played a role in perception. The relationship between opposite-sex twins seems to differ from those of other types of twins. This is most likely due to the basic differences in male-female development. When Dr. Koch analyzed the social relationships between members of young boy/girl twins, she found that females emerged as the more dominant members and chose their peers over twin siblings as playmates. The female twins tended to be more critical of their twin brothers than their twin brothers were of them. Conversely, the males indicated an appreciation of their twin sister’s guidance but felt somewhat threatened by their female twin’s superiority. Difference in Intellectual Development Several studies have shown that, in general, identical twins differ an average of six points in IQ, while fraternal twins differ by approximately ten points. It also was found that fraternal twins are more similar in IQ than ordinary brothers and sisters, who differ by 14 points. Unrelated random

13 individuals will differ by 17 points. (Plomin et. al., 1980). Hayashi, C., Mikami, H., Nishihara, R., Maeda, C., & Hayakawa, K. (2014) found that the mean score of the twins’ close tie in MZ pairs was significantly higher than that in DZ pairs. It has been demonstrated that twins on average score five to ten points below the average singleton in the population on standard tests of intelligence. (Bouchard & Segal, 1985). Since many IQ tests rely on verbal ability, the decline is primarily thought to be due to the tendency toward early delayed speech development in twins. There are several reasons this delay may occur. Twins are frequently born prematurely. Parents also have less time to help develop verbal skills and speech development when raising multiples as they must divide their time among the multiples, thus giving them fewer adult interactions. Twins may be approximately three months slower than single birth children in speech and language development. By the time multiples are nearing eight years old, they have usually “caught up” to single birth children. De Zeeuw E., de Geus E., Boomsma D. (2015) found that genetic variation is an important contributor to the individual differences in educational achievement; heritability in general educational achievement was estimated at 66%. There is also a tendency for multiple birth children, especially boys, to have an increased incidence of Attention Deficit Hyperactivity Disorder (ADHD). The unique family situation of multiples is thought to be the cause because of the need to share parental attention with co-multiple(s) all the time and being constantly interrupted by the co-multiple(s). (Hay & Preedy, 2006). According to the March of Dimes (2009), 10-20% of multiple birth children will have a disability.

14 EARLY THOUGHTS ON SEPARATING MULTIPLES Many schools around the country have mandatory policies with regards to separation of twins in school classrooms. These came about over 30 years ago as educators and psychologists felt that this type of placement would foster individuality in multiples. Hay relates that at one time, in the 1970s, it was common to send one twin home from the hospital first to give parents some experience before sending the second twin home. (Hay & Preedy, 2003). In the book, Twins and Supertwins,Amram Scheinfeld speaks about the origins of separation policies in schools. He said that in 1948 the late Professor Horatio H. Newman was trying to correct the widespread belief that it would be harmful to ever separate twins in school. Newman wrote: “It is a common notion that it is injurious to twins -- especially identical twins -- to separate them: for example, to send each to a different school or college.” Newman pointed out that pairs of twins may differ in their attitudes toward each other, and that the one type might never want to be separated while “reluctant” twins, who resent the fact that they are alike, might want to be separated. Newman went on to state: “Whether any harm would ensue from separating the former type, may be determined only by actually separating them and seeing.” (Scheinfeld, 1967). Often one found that whether a twin pair was kept together or separated in school was decided based on random school policies rather than based on specific child behaviors or parental requests. (Saudino et al., 2005). MZ twins are significantly more likely than DZ twins to compare themselves to their twin according to Huguet et al. (2017). Why do educators believe that multiple birth children must be routinely separated in school? Since educators consider the promotion of positive self-concept among children to be a top priority, they work to insure the healthy social, emotional, creative, physical and intellectual growth of children in school. The conclusion then is that separation policies exist because educators believe separation is healthy for the multiples. In contrast, though, what proof is there that positive self-image does not develop among twins in the same classroom? According to Parten (2011): “There are particular issues that could affect the physical, intellectual, personal, social, and emotional development of multiple-birth children.” Gleeson reported that 92 percent of Australian teachers believed this notion of promoting individual development as the most important reason for separating twins. (Gleeson et al., 1990).

15 Tully reports that in three surveys conducted in the 1990s in Australia, U.K. and America, only one percent of schools had formal written policies on how to handle the education and placement of multiples. Although few schools had formal policies, one third implemented practices that applied to all twins. (Tully et al, 2004). In a study by Grime (2008), all of the twins in the study reported that focusing was an issue for them while they were separated from their co-twin. Each of them reported a need to know where their co-twin was; a need to know that their co-twin was safe. One twin reported that he had to take medicine on a daily basis to help him focus in class. Another twin reported that he perceived his teacher as being angry with him because he had difficulty paying attention in class. When consulting local educators, many parents report facing an ironclad policy concerning the separation of multiple birth children. They find that, although there is usually no written school board policy to dictate separation, there is the tendency to automatically separate twins. School officials have a tendency to separate multiple-birth children simply because they are part of a multiple-birth set of children (Beauchamp & Brooks, 2003). Nancy Segal relates a story about reading a newspaper article in which a principal cited research showing that twins do better when separated. Intrigued, she contacted the principal and asked about the research that he was referring to; she was surprised to learn that he was basing his opinion on events from his own school and NOT from any research findings. (Segal, 1999). She further cited research by Schultz (1972) that shows that children who are placed in an unfamiliar environment do better when they are with a friend. She points out that we do not demand that children who are best friends be separated in school so that they can develop individually. Yet, twins are considered differently. Hay and Preedy (2006) report: “Certainly, there is no evidence separation is necessarily better and more thought needs to be given as to which twins may benefit from being together or apart.” Entry to school is typically the first point at which the question about whether to separate twin children or place them together in the same class arises. The decision centers on the inter-twin relationship and the intended outcome is to optimize social behavioral adjustment and scholastic attainment of each twin child. (Staton et al., 2012) Although administrators and teachers may feel that they know what is best for the education of all students in their care, the truth is that problems associated with the education of multiple birth children are rarely addressed in teacher preparation courses at the university level.

16 This lack of information on the college course level may be somewhat offset by the apparent increase in experience in teaching multiples in recent years. Eifler and Riemann (2019) found the comparison between twins who were assigned to the same classroom and those twins who were assigned to different classrooms yielded somewhat unclear results; findings demonstrate the significance of classroom specific influences that are partly responsible for interindividual differences in academic achievement. According to Parten (2011), a parent’s perspective also should be considered. She goes on to state that no empirical research related to separation or not for multiples was found. Survey results, conducted by Multiples of America (NOMOTC), demonstrated that educators preferred a policy to separate multiples in school; however, a small percentage (15%) of survey participants had college courses that included multiple birth awareness (NOMOTC, 2001). In 2010, a follow-up survey showed similar results regarding separation of multiples in school and the lack of coverage of multiple births in college courses (NOMOTC, 2010). The goal of a survey conducted by the International Council on Multiple Birth Organizations (ICOMBO) in 2019 was to help parents and school personnel be better informed when making decisions about school placement of multiples. A total of 2,842 parents of multiples whose children were three years of age or older and whose children had attended school for at least one year completed this 24-question survey. The respondents were from more than 18 countries, with the United States, Australia, France, Spain, Finland, Canada, and New Zealand being the largest enrollers. The study found that the biggest issues were gaps in knowledge and resources. The four most common resources/references used by parents to try to get the desired school placement were: information from other parents; information from the Internet; information from a Multiple Birth Association booklet; and discussions on a MBO Facebook group. However, over half of the parents weren’t aware that there were publications, research and books to assist them. Only a third of the MBO members said that they got information from their MBO that helped them regarding school placement. Many districts/states/provinces have laws that protect the parents’ right to choose school placement for their multiples, but many are unaware these laws exist.

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18 PARENTS’ DILEMMAS How do parents of multiples feel about the issue of separation? In the 2009 Multiples of America/NOMOTC survey of 467 parents, two thirds reported that they had asked for their multiples to be placed together at some point in their schooling. This survey was completed by mothers of multiples, with the majority of those having children in grades preschool through elementary school. Results determined that almost all of the multiples had been separated at some time in their schooling, with the trend showing that 86 percent were together in pre-kindergarten, but by first grade only about 40 percent were still in the same class. By 8th grade, 80 percent were in separate classes. The majority of the time, the reason given to those who were consistently denied placement together was for development of individuality. Sadly, over seven percent were told that there was research showing that they should be separated. Only about 10 percent were unable to achieve the placement they requested despite numerous contacts with administration, while 65 percent only required one phone call or letter to the school. Over half of the mothers reported that their multiples were currently placed in the same classroom (mostly pre-kindergarten and kindergarten) and about one-half of those said they made the decision not to separate the multiples themselves (Multiples of America/NOMOTC 2009). More recently, Klein (2017) published a different perspective: “Respect for the twin bond is critical. Undermining the twin relationship by suggesting that it is just a normal sibling attachment will confuse twins who know how close they feel to their twin even if they are still unable to verbalize their attachment. Twins know through lived experiences how friendships are different and less intense than the bond they share with their brother or sister. When you undermine the twin relationship you will confuse young twins, leaving them unprepared for interacting socially at school or in after-school activities. (56)” Tully et al. (2004) reported that three surveys conducted in the 1990s in Australia, U.K., and America showed that 30-50 percent of parents polled did not feel that they were consulted regarding placement of their multiples in the classroom. In the U.K. study, only one in four schools reported consulting the parents prior to placement. An American survey by Segal and Russell (1992) related that 50 percent of parents who knew there was a mandatory policy of separation at their school did not agree with the policy. Most schools did not have an official written policy regarding multiples, according to Preedy (2001), but still felt they could impose policies that affected all twins. In the Multiples of America survey, it was the principal or school administrator who set the policy the majority of the time and to whom parents made their request.

19 In a paper by Jamison Grime (2008), a mother who was interviewed expressed: “The principal said that we want them to go ahead and develop their individual personalities, be on their own, and again they could find zero research that said they won’t develop personalities if they are or aren’t together. I mean, they were able to give me no reason other than this is what we tell every year to every parent of twins.” Grime also related: “The mothers all express feelings of guilt and anger because they couldn’t control the separation. One of the mothers reported that she cried daily and was overcome by the guilt of having to lie to her twins that they would be alright when she knew that they wouldn’t be. Another reported that she was angry during the initial separation. She researched home-schooling options and was willing to do whatever needed to be done to put an end to her twin’s classroom separation. Another mother recalled feeling desperate that nothing she said or did would comfort her twins.” Grime further reported that the mothers he interviewed all questioned the principals about the policy of mandatory separation. Several related that the principal became defensive when questioned about the policy. None who asked were provided with a written policy and most were told that the policy had always been in place and that it was the way it had always been done. One principal, when presented with current research attempted to find research to refute it but could find none. Some felt that, although they could not support their policy with research, their experience educating twins was more compelling than current research. The ICOMBO survey (2019) also showed that there are a lack of policies on school placement: A majority of the parents said that their school didn’t have a fixed or set policy on placement of multiples, yet it was often difficult to achieve the school placement they wanted. It also concluded that parents’ wishes are not always accommodated: Almost one-fourth of the families in this survey who requested school placement for their multiples were denied their desired school placement at least one of the years that their multiples attended school. Parents often feel that keeping multiples in the same classroom would help the multiples to feel secure (Segal & Russell, 1992). Kay Cassill writes: “Since twins face a double separation as they enter school -- separation from home and separation from each other -- the traumatic experience may so affect them that they present the teacher with disciplinary problems, whereas, they have never before been anything but model children.” The ICOMBO study (2019) also found that there is a common desire to place multiples together. Just over half of parents asked for their multiples to be placed together in the classroom at some

20 point in their school years. The three most common reasons were: Multiples wouldn’t be happy apart; easier to communicate with one teacher; and easier to keep track of school assignments. Tully (2004) feels that schools need to adopt a more family focused approach that takes into account the views of the parents. White et al. (2018) shared a similar finding in that twins (both MZ and DZ) who were separated in school did not differ in level of achievement, ability or motivation from twins who were not separated. Some parents recognized a need to separate their multiples at school. Just over 40% of parents asked for their multiples to be separated in the classroom at some point in their school years. The three most common reasons were: To help their individuality; one multiple was too dominant; and multiples are too competitive. (ICOMBO, 2019) EFFECTS ON THE MULTIPLES One of the considerations in the development of multiples and especially higher order multiples is that many are born prematurely. This can lead to some developmental delays that must be considered when discussing educational effects of multiple birth. But just the fact of being born “early” can be significant even if there are no birth injuries to consider. The date of birth, and not the developmental age, often determines the stated age of a preterm child. Doctors often refer to the “corrected age” of a preterm baby based on the date that the child should have been born. If parents and educators are not using this corrected age, the child could be started in school early, that is to say at a younger developmental age than peers. This can account for some of the IQ and behavioral differences between multiples and their peers.

21 It would seem that monozygotic twins would be the most affected by forced separation due to their genetic similarity. However, Jamison Grime in his doctoral dissertation (2008) found that even dizygotic twins who were unwillingly separated in the early grades encountered emotional stress that impacted their ability to concentrate in school. Not only were the twins themselves stressed, but such classroom separations also impacted the home and parent interactions. There is no difference in educational achievement between twins who share a classroom and twins who do not share a classroom during their primary school time. The choice of separation should be made by teachers, parents and their twin children, based on individual characteristics of a twin pair (Polderman et al., 2010). However, positive social interactions between twin siblings that are stable over time, creating such consistent exposure to a positive sibling relationship may thus create a stable context for positive social learning, regardless of zygosity. (Bekkhus et al., 2016) Dr. John Mascazine, in his book Understanding Multiple-Birth Children and How They Learn(2004), documents the learning style difference among twin siblings and how they problem solve. Even the most identical of twins are more likely to have learning styles that are more different than alike. He offers advice for parents and teachers on how to help same-age siblings adjust and thrive in the school setting. He also found that many separated sets of twins reflected back upon their early school years, when they were separated, and commented that such forced separation had negative effects upon their learning and school adjustment. He did not find the same pattern of negative effects on siblings who were kept together in the early school years (Mascazine, 2004). Tully et al., perhaps have the most definitive study of the effects of separation in school. They conducted a longitudinal study of twins who were assessed at the start of their schooling at age five and then again when they were aged seven. There were three groups: those who were placed in the same class at both ages; pairs who were separated into different classes at both ages; and those in the same class at age five but separated at age seven. Results showed that, when compared to those twins not separated, those separated early (at age five) showed more teacher-rated internalizing problems. Those separated later showed more internalizing problems as well as lower reading scores. Monozygotic twins showed more problems as a result of separation than dizygotic twins. Those separated early were rated as having more ADHD symptoms and learning less in school than those not separated (but only for dizygotic twins), while those monozygotic twins not separated were rated as having more pre-social behavior than those separated late (Tully et al., 2004). Preedy and Hay (2006) also report similar results in the Twins Early Development Study (TEDS) in the U.K. Results from a Dutch study showed that twins separated into different classrooms are

22 more likely to have internalizing problem behaviors and are no more likely to be academically successful than twins kept in the same class. Therefore, the data suggests separation does not eliminate behavior problems, nor does it positively or negatively affect academic achievement (Van Leeuwen et al., 2005). In analyzing the effects of twins being separated into different classes for at least one year, Webbink, Hays and Viccher (2007), found an effect on cognitive ability by grade two. All three analysis approaches (analytic test models) demonstrated that non-separated twins performed higher on language and arithmetic measures at grade 2. The effect was larger for same sex pairs of twins. For later grade levels, no effect of classroom separation was shown on cognitive ability. (Note: this study did not control for MZ or DZ pairs.) They state, “Hence, the presence of a co-twin seems to matter at the early stages of primary education for same-sex pairs. At the later stage of primary education, we hardly find any differences.” Therefore, it seems this study confirms the effect that keeping same sex pairs together as they begin school could contribute to increased language and arithmetic skills over separating them before grade two. Gordon’s survey questioned 131 elementary principals, 54 kindergarten teachers, 201 parents of twins, and 112 twins. A majority of principals (71%) believed that twins should be separated in kindergarten, while only 49% of teachers, 38% of parents, and 19% of preschool and kindergarten twins agreed. The recommendation is that principals should avoid making unilateral twin placement decisions. Three percent of all twins who are placed in separate classes are very traumatized by kindergarten separation, and an additional 17 percent are somewhat traumatized, according to parents. In the meantime, 69 percent of principals believe that separation is probably a little traumatic, and six percent believe that separating twins is very traumatic. The study’s primary conclusion is that, unless there is a compelling reason to separate twins, it is often best to keep thm together, at least in kindergarten (2015). A twin herself, Kay Cassill wrote the following in her book, Twins: Nature’s Amazing Mystery: “At the same time that they are ... under pressure from family to remain alike and stay together, twins are often confronted with well-meaning school teachers, guidance counselors, and psychologists who insist that they make an abrupt ... break with each other in school. This is what happened to my sister and me. ... In our case, it wasn’t just the idea of enforced separation that annoyed me; it was the belief on the part of strangers that they knew what was best for my twin and myself. Such good intentions coupled with poor judgement may set the twin bond in

23 concrete; some duos acquire an ‘it’s us against the world’ attitude and in the process ensnare themselves (Cassill, 1982).” Nancy J. Sipes, Ph.D., and Janna Sipes, J.D., of San Diego, CA, identical twins and co-authors of Dancing Naked in Front of the Fridge and Other Lessons from Twins(1999), wrote about their forced separation in the first grade: “As was predicted by the school officials, we did adjust to being apart in school, on some level. Yet, for us, a pattern of dependency had been set that would follow us into adulthood.” The Sipes sisters also acknowledged that separation is inevitable for twins, whether it happens in the first grade or not. But when it happens too early in twins’ lives, it has a profound effect not to be underestimated. They state they believe that twins need to be left together as long as possible (depending on the maturity and personalities of the twins) in order for them to be given the opportunity to feel safe before being separated. Psychologist David Hay, retired from twin research at Curtin University in Perth Australia, when discussing his LaTrobe study of 560 sets of school-age twins, commented: “It is interesting that when we ask twins about their feelings on this topic (school placement), the only twins who complain about what has happened to them are some of those who have been separated (Hay, 1994).” Jamison Grime interviewed several twin sets who were separated in school. Many related that they had problems focusing in school when their co-twin was not with them, which had negative effects on their success in school. Often, they reported anger, sadness and loneliness during their separation and had negative feelings about school in general. Their negative feelings also impacted their ability to make friends (Grime, 2008). In a study done by Elliott, answers from both members of 73 twin sets between the ages of 12 and 73 regarding separation, 41 percent agreed with the decision made for them; 51 percent favored separation, but not in early childhood; 31 percent favored total separation from the start of elementary school; and 25 percent chose gradual separation after grade three to six. The twins indicated that they wanted involvement in matters that affect them personally. They also felt that those not given the opportunity to experience being together or being separated are robbed of an opportunity that only twins can experience. Those who had more flexible arrangements did not harbor feelings of resentment (Elliott).

24 Megan T. Alexander (2012) conducted research interviews with multiples on the issue of separation in school. She found that amongst those being interviewed, they did not want to be in the same class with their multiple(s). Alexander goes on to say: “… one can conclude that this is not a question with one, right answer. There are pros and cons, both to keeping multiple siblings together in school and to assigning them to different teachers and classrooms.” Veldkamp et al. (2017) reiterates the point that: “Twin pairs who attend the same classroom do not bully more or less than separated pairs, but they seem to be less victimized. This effect is restricted to girl-girl twin pairs, independent of zygosity, as it does not hold for boy-boy twin pairs or twin pairs of opposite sex. ... The finding that girl-girl twins in the same classroom are bullied less often seems to indicate that classroom sharing has a protective effect for victimization.” It would appear that all twins do not want to be placed in separate classrooms, just as all twins do not want to be placed in the same classroom. Twins feel that the best policy is no policy at all. The ICOMBO study (2019) also showed the desire of parents to have their multiples together or apart changes with age: From the study results, it is clear that at younger ages, especially three to six years old, the parents were more likely to request that the multiples be placed together in the classroom. However, when the multiples were seven years and older, the parents were more likely to ask that they be separated at school, and this percentage became larger as the children advanced in school. In conclusion, the survey showed that the clear message for educators and school policy makers is that they should be making placement decisions for multiple birth children based on the individual needs of each child. No two sets of multiples are exactly the same, so fixed school policies do not take each child into consideration. Schools should respect the close bond that the multiples have while also encouraging individual abilities and strengths.

25 HIGHER ORDER MULTIPLES The difficulty of classroom placement for twins is compounded for parents of higher order multiples. Limited school facilities in many school districts may result in only one or two classrooms per grade. School officials and parents may have no choice but to keep triplets or quadruplets together in the same class, or to divide them between the classes in pairs, threes or fours. Since higher order multiples tend to be born prematurely more often than singletons or twins, they are thus more likely to have learning disabilities and this can add to the complications in making placement decisions. Jill Heink, mother of triplet girls relates: “Having my triplet daughters together through elementary and middle school worked out very well for their academic and social success, and it was also the most convenient arrangement for our family. Actually, I think most of their teachers found it fascinating to see how my trio was so similar in some ways but so different in others. I think they enjoyed having the three together! When my daughters started high school, they chose to study different languages and chose some different electives so they were in a number of different classes as well as some common classes. That also worked out well, and they were very successful in high school. Two chose to attend the same college and the third attended college about an hour away, so they got together often during their college years. I think they found their own balance of exploring their individual interests while enjoying their triplet sister relationship.” (Heink, personal communication, 2010). A study completed in 1997 by Denina Brown for a dissertation through the University of Denver further explored the classroom placement of higher order multiples. As the mother of triplets, Brown interviewed both parents and teachers on this question and other educational issues. She concluded that schools need to revisit the placement of children annually. Further, teachers are urged to examine the academic and emotional needs of the children, evaluate classroom observations, and consider recommendations from previous teachers, as well as from the parents and students themselves. Brown also suggested that schools need to obtain more knowledge in general about the multiple birth population.

26 HOW TO DECIDE Parents are often unsure about how their multiples will respond to separation at school. Some prefer to leave the final decision up to the teacher or principal. Unfortunately, teachers and school administrators often know less about twins than parents themselves. Almost three-quarters of the educator respondents in Multiples of America’s more recent survey felt that adults at their school had trouble telling the twins apart. And further, 29 percent felt it was acceptable to call the multiples “the twins” (or “the triplets”). (Multiples of America/NOMOTC 1999) Parents and teachers should not be reluctant to reverse a separation decision if the situation warrants it. Nancy Kenny, a teacher and parent of identical boys who were in 8th grade at the time, commented: “After separating them in first grade, I wanted the decision changed. One twin had difficulty adjusting, and I realized I made a mistake. I met with opposition from the administration. At first, I believed that they would flourish independently. I’m regretful; I should have kept them together. (Kenny, 2004).” Corliss and Joe Hubert, parents of fraternal twin sons and both mathematics teachers, saw their multiples suffer academically because of a forced separation policy. Gifted in mathematics, both boys were ahead of their classmates at the 4th-grade level. The Huberts suggested that the boys be allowed to work together. School administration finally agreed with this request, and the boys were assigned to the same classroom for the next two years after being separated in pre-kindergarten. This fostered their development in mathematics, as they were then able to work together on math problems. (Hubert, 1999) Barbara Schave Klein, in her 2003 book, Not All Twins are Alike, Psychological Profiles of Twinship,makes the case for understanding each set of twins as a unique set with its own concerns, strengths and challenges. And although some patterns exist in the twin relationship, not all relationship types lead to problems in school placement or competition. She feels that early parental practices can prompt or limit later issues with individual identity and interdependence. Schave Klein classifies twin relationships into four categories: the unit identity, which is overdependence between twins; interdependent identity, in which the twins become co-dependent upon each other due to indifferent parenting or abuse; split identity,that represents conflicts with parents, often leading to “good” or “bad” twin labeling and difficulty trusting others; and individual identity, representing the most healthy and well-adjusted type, achieving a balance between individuality and respect for the twin bond.

27 Schave Klein found that competition was common in early twin life and in the school environment but most times it was the healthy type of competing and not the “cut-throat” variety. It often also served as a way of distinguishing each twin’s ability and individual identity. The competition she noted was either healthy or harmful based on which of the four types of twin relationships had been established earlier. Twins in her study experienced unique struggles as they sought to achieve individuality, but it was related more to how they were treated by their parents and family that determined how well the twins adjusted, and also was based on the four types of twin relationships. She felt that dressing twins alike can contribute to adjustment, separation and identity problems. Klein states: “The unique circumstances that each twin pair confronted enhanced, rather than diminished, each person’s capacity to become a highly functional individual.” On the school separation issue, Klein advocates separation for children who need to be separated to help them develop as individuals, but as in the analysis of her research, it all depends on the nature and type of the twin relationship as to whether school separation is actually necessary in the early grades. (Klein, 2003) Hay and Preedy (2006) related that the twin bond is stronger and more emotional than most other types of sibling bonds and that parents, relatives and friends who make comparison comments fuel this bond intensity. Such comments also may contribute to misunderstandings of the twin relationship, and to unfair stereotypes. External comparisons of one twin against another, specifically by others (not the twins themselves), can contribute to loss of self-esteem. The siblings may become preoccupied with judging all their talents or abilities according to those of their sibling twin. A sibling’s concept of self and their individual development is closely linked to how intensely they are perceived as a unit by themselves and others. An overemphasis on the twin bond and the twinship can lead to overdependence that inhibits each from functioning as individuals. DiLalia and Mullineaux studied only monozygotic twin sets at age four and age seven, and compared the behavior of those in separate versus combined classrooms. Although they expected that separation of multiples would help with externalizing problems, their study showed that those MZ twins separated in school showed more peer problems than those who stayed together. They speculated that MZ twins serve as attachment figures for each other, and those that were together had a “safe base” to fall back on, from which they felt free to then develop other attachments. They also found that those twins who were separated had more behavior problems both in school and at home than those kept together. They concluded that families should be allowed the choice to place twins in the same classroom. (DiLalia et al., 2007) Most psychologists agree that personality and one’s sense of individuality develop early in one’s life, prior to age five. Therefore, it would appear prudent for teachers to consult closely with the

28 parents of multiples to determine their perspectives on the social behaviors and individuality of siblings as part of the school enrollment process. As with competitiveness, many same-age siblings have already negotiated some of these issues to their mutual satisfaction. What some children may not be prepared for is the number of peers and adults who do not understand them and therefore expect them to compete or to behave in similar ways. (Mascazine, 2004) Nancy Segal, in an unpublished study (2020), suggests: “Decisions should be arrived at cooperatively, with reference to the views of the parents, twins and administrators. It is also important to note that decisions are never final but can be monitored and modified over time.” When discussing parental choice, Lana Larsen Dean related in an article published in 1999: “Because the traditional family relationship and parental choices relating to that relationship are fully protected under the Constitution, the school by employing such an arbitrary ‘one size fits all’ policy, totally usurps the parents’ right to make a crucial decision about what is best for their family. Fortunately, some schools are realizing that only through parent participation in evaluating twins on a case by case basis.” Larche, in the Marquette Law Review in 2008, however, reviewed laws that parents might use to force schools to agree with their wishes and felt that it is unlikely that parents would prevail with regard to classroom placement. He gives an argument that the recent growing movement among state legislators to enact laws giving parents a greater voice in how and why their children will be placed into separate classrooms may be the best way for parents to be successful. The fact that parents have had to resort to passing legislation to bring their concerns to the forefront only underscores the importance of this issue for parents and multiples.

29 WHEN SEPARATION IS HELPFUL Placement together certainly works for many twins, but it doesn’t work for all of them. Hay and Preedy discuss types of twins, from those who are closely coupled,in which the twins behave as a unit and spend the majority of their time with each other and communicating with each other, to the exclusion of others; to those who are extreme individuals,in which the twins may deny their multiple relationship, rebel against their twin and polarize to opposite extremes. Those in the middle ground are called mature dependentsand are comfortable in the twin relationship but also as individuals. Those who are closely coupled or extreme individuals may benefit from being separated into different classes. (Hay & Preedy, 2006) Parents may need to consider separation when one twin is ahead of the other in maturity and academic measures, but consistently “underperforms” so that the twins’ performance in school is always the same. Conversely, some twins are so fiercely competitive that separation would be beneficial so that their relationship doesn’t suffer. Parents also must consider privacy concerns, where one twin constantly “tattles” on the other, leading to resentment of each other. Segal points out that some twins take pleasure in manipulating others by using their “twin language” and may resist giving that up. Several case studies of language-delayed identical twins showed that separation into different classes along with speech therapy can aid their verbal development. (Segal, 1999) The Twins Foundation, an international clearinghouse of information for and about twins and twin research, provides an example in terms of twins. According to an article published in the organization’s newsletter: “A majority of twins do not suffer from being in classes together, especially in the early elementary years; when conflicts come, if they are going to come, is during the onset of adolescence.... Adolescence is often a time of traumatic changes ... but for twins, adolescence may produce added conflicts and confusions that their single born peers do not face to the same degree. The inner turmoil twins are naturally feeling becomes a challenge to the twinship from within rather than from without. Jealousies and conflicts of interests seem to arise from nowhere. The sense of ‘my space’ and ‘your space’ suddenly becomes a major issue.” Teen twins begin individually searching for ‘self’ and wondering why and how that ‘self’ must reflect on the other. A teacher who responded to the Multiples of America/NOMOTC survey emphasizes the differing relationships of adolescent twins in school by writing:

30 “I teach 6th grade science. This year, I had two sets of identical twins and one set of fraternal twins. The girls, who are identical, get along great and are in the same classes all day long. I see many differences in the girls. Homework, class work, and test scores are never the same. The identical boys could not stand to be in the same room with each other, got a schedule change, and never did anything together at school. One of the boys even got his hair cut very short so that he would not look like his brother.” After her experience, this teacher felt that each child should be treated as an individual, and came to the conclusion that the teacher, parents and the students should decide their placement in school. Nancy Segal further comments on adolescent and older twins with regards to their similarity in IQ and intelligence: “If older twins (particularly identical twins) are in the same classroom, they should always sit apart, especially during exams, to avoid false accusations of cheating should they produce similar answers.” (Segal, 2010Tully calls for more research to be done on what factors predict the development of internalizing problems in separated twins as, she points out, some twins in their study clearly did well when separated. She states: “It is possible that other factors, such as aspects of the twin relationship, may determine the effects of separation and should be explored.” (Tully et al., 2004)

31 RETENTION AND/OR SCHOOL READINESS OF ONE MULTIPLE In some pairs, one twin may show signs of being ready to begin school while the other does not. This is particularly common in opposite sex twins when the girl is generally ready before her brother. The problem becomes more complex in higher order multiples where a variety of gender combinations can exist. A kindergarten teacher responding to Multiples of America’s survey of educators wrote: “After teaching kindergarten for five years, my opinion is that children should start kindergarten at their correct age regardless of ability. A kindergarten teacher is trained in early childhood techniques. Each child is taught according to his/her capabilities.” All children mature at differing rates, and one that is considered to be developmentally behind during kindergarten may catch up by 1st or 2nd grade. The mother of triplet girls in pre-kindergarten was presented with a dilemma concerning development when the teacher suggested that one of the girls was ready to be skipped to kindergarten ahead of her sisters. The mother related that she was happy and proud of the fact that one of her children was gifted, yet worried that the others might feel they were being punished or that the promoted child might feel punished by being separated from her sisters. There are times when one twin may be doing poorly in school and retention is recommended. Retention of one twin should be a last resort, since it is rarely the answer to the problem. In the case of twins, both can suffer resentment. The passing twin often feels guilt for being smart; the retained twin often feels he/she will never measure up. About half the educators felt that one twin should not be retained if the other is failing. Ninety-two percent recommended special tutoring before retention is considered. In fact, almost all respondents to the educators’ survey felt that if only on twin was ready for kindergarten, both should wait another yearDecisions to send one twin or higher order multiple to school before his or her co-multiples or to retain one of a set of multiples should be made very carefully, and only should be done after all other solutions fail. It is best to identify the problem and provide the appropriate services or remediation. All authorities recommend intervention programs and consulting a psychologist before coming to such a decision. ALTERNATIVES TO PUBLIC SCHOOL Dissatisfaction with public school policies may cause parents to seek alternative schooling methods. Private school has always been available to those with the means and inclination; however, it may not be a panacea since private schools may impose their own restrictions regarding classroom placement. In recent years, the charter school movement has seen rapid growth. Charter schools are public schools that maintain a special contract with a local or state agency and receive public funds for a specified period. The charter school can set its own goals

32 for student achievement and provide new models of education free from the policies of the local schools. With the renewed popularity of “school choice,” the percentage of all public school students who attended public charter schools increased from 1 to 6 percent between fall 2000 and fall 2017. The percentage of all public schools in the United States (defined in this indicator as the 50 states and the District of Columbia) that were charter schools increased from 2 to 7 percent, and the total number of charter schools increased from approximately 2,000 to 7,200. [National Center for Education Statistics (NCES), May 2020] Homeschooling affords parents the ultimate control over their children’s education. The ability to travel and maintain close family relationships were also cited as major advantages to homeschooling. As one homeschooler of twins put it: “I don’t want to send my children off to have someone else take care of them and teach them things they think are important. I can best manipulate their environment to give them the ultimate options.” Homeschoolers often find support through other homeschoolers and can obtain information through the internet where distance learning opportunities abound. One disadvantage to homeschooling might be the time commitment required of the parents. While homeschooling remains an option with “school choice,” fewer families are choosing this option. However, the number of students who receive homeschool instruction is still substantial: over 1.7 million students were homeschooled in the United States in 2016. This number was higher than in 2003 (1.1 million students) and in 1999 (850,000 students) (NCES, 2019) For some, online learning is a better option since it gives students time to focus, take breaks, and work at his or her own pace. For others, the loss of personal connections in the classroom made the experience less successful. Online learning can be taxing on a family since aspects of that type of learning is out of the parents’ control, however some families have used virtual learning with great success. Education will have many changes as a result of the COVID-19 pandemic, from remote learning, vouchers for private education and homeschooling. While remote learning was challenging in March 2020, it has become an effective format for learning for many students. As remote learning evolves, it will be primarily teacher led but structured to allow students to go at their own pace. It is less expensive and can be effective for learning. Rationale continues to grow for vouchers and school choice. Public education options have grown to include charters, dual enrollment, and magnet schools. Options will move toward private school choices. The move will be driven by costs and increased opportunities. Home-

33 schooling is another option that continues to increase. It’s an option that allows families more control over curriculum and schedule. (http://laschoolreport.com/analysis-7-ways-american-education-co uld-change-forever-after-covid/) TIPS FOR TEACHERS AND PARENTS OF MULTIPLES Regardless of whether twins are separated in school, the role of educators is to assess the strengths and weaknesses of each child based on his or her own merits and to develop lesson plans to meet the needs of all children. We recommend the following tips for teachers to help avoid the pitfalls of treating twins as a unit, rather than individually. ● When twins are in the same classroom, seat them separately. This makes it easier to identify who is who (in the case of identicals) and serves as a deterrent to twins who are contemplating doing one another’s work. ● Try to find physical differences between identical twins in the same classroom. Ask parents for tips for quick identification. Some means of identification might be handedness; birthmarks, moles, and freckles; differently slanted handwriting; slight voice differences; different facial widths, etc. Physical identification of twins is the first step toward personality identification. ● Expect differences in behavior, personality, and test scores. Conversely, sometimes differences cannot be found, especially in the case of identical twins. ● Always refer to each multiple by name within the classroom. This not only aids you in learning to identify each, but also serves as a good example to other students in helping them realize the multiples are individuals. ● Avoid insensitive comparisons. An example would be saying to one twin, “You are smarter than your sister.” This type of comparison is detrimental to the self-esteem of both. ● If one member of a set of multiples (especially identical twins) is markedly behind the other, investigate the cause. It has been shown that the IQ of twins is normally remarkably similar. ● Likewise, it’s important for teachers and adults notto withhold an award from one sibling simply based on the possible effects it may have on their sibling twin. ● Schedule separate parent/teacher conferences for each multiple, allowing the same time that would be given to singletons. Gather information from parents regarding birth

34 trauma, birth defects or frequent illnesses. Comparison of the multiples should be only with their peers in the classroom and not just the co-multiples, and emphasize the individual’s progress in the class. ● Check to make sure each multiple is doing his/her own work while continuing to encourage cooperative learning, realizing that multiples often aid each other in learning. ● Accusations of cheating should not be put forward before taking into account the fact that abilities, interests and talents of identical twins are genetically based and identical twins would be expected to perform similarly. ● Do not rule out the possibility of a learning disability in one of a multiple group. It is as possible for one of an identical pair to have a learning disability as it is for one of a fraternal pair. ● Dr. John Mascazine, author of the book Understanding Multiple Birth Children and How They Learn: A handbook for parents, teachers, and administrators,offers additional tips: ● No placement decision needs to be a permanent decision. If a placement is not working out for the benefit of all children involved, revisit that decision and consider options. We do this as educators for any number of other children with individualized issues; why can’t we do it for same-age siblings? ● Help peer students observe and treat same-age siblings as individuals. Encourage them to discover each sibling’s talents and form friendships. ● Allow same-age siblings to let you know what they are thinking, what they are feeling, and allow time for them to work apart and work together. ● If they are placed into separate classrooms, introduce each child to the other’s teacher(s) and make sure that at some point they can look in on their sibling(s) just to be assured they are nearby, and that they are available if needed. There’s an emotional security that accompanies the knowledge that you know where your siblings are in case you need them. This is especially important in the early years when schools can be confusingly large buildings for small young learners. ● When it comes to lining up, space other children between the same-age siblings. This is especially important at school picture time. Many photographers have made the mistake of thinking they took doubles (for identical twins) of the same child often resulting in only one child receiving school pictures.

35 ● Encourage each child to participate in after-school clubs, activities, sports, etc., according to their individual interests and talents. Such activities offer wonderful opportunities for children to pursue individual interests. ● Ask for criterion-referenced feedback from teachers and school personnel. Instead of relying on scores or grades, ask about how your child performs against the expected standard for a specific skill or criterion. This is often more helpful than comparing how your children are performing against each other or compared to their classmates. It also gives you specific feedback that can guide tutoring or remediation work on specific skills when necessary. TIPS FOR CHILDREN IN SPECIAL PROGRAMS Drs. Joseph S. Renszulli and Ann M. McGreevy, who conducted the study, “Twins Included and Not Included in Special Programs for the Gifted,” offered recommendations regarding multiples in special programs. ● Do not place both twins in a special program simply because they are twins. ...Nevertheless, cases of identical twins should be treated with great care and sensitivity. ...Under most circumstances, both identical twins should be capable of benefiting from a special program (when one has been selected) and depending upon the nature of the relationship between the twins, they may enjoy and profit from being in the program together. ● We recommend that the program should encourage the twin who is not included in the program to be a guest participant in the special program, especially on those occasions when activities such as a guest speaker, field trips, or other special events are being planned. Such occasional participation may allow Twin A (the twin who is in the program) to share his/her enthusiasm for the program with Twin B (the co-twin) and may serve the purpose of increasing motivation and performance in Twin B. ● Whenever possible, twins should be provided with opportunities for collaborative efforts on school projects and home projects. ● We recommend that school records indicate somewhere that a student is a member of a multiple birth. Presently, most school records do not note this information. The more we know about a child, the better we, as educators, are able to help that child learn. Although we believe that individuality should be respected and encouraged, the special effect of the “twinship bond” may present situations where twins can best express their individuality when they are most like their brother or sister. This recommendation is especially important in the case of identical twins.

36 • Our major recommendation relates to the finding about differences in style between Twin A and B. In most cases, Twin A was selected for the special program because he or she displayed the types of motivation and performance that are most consistent with the traditional academic view of the achieving student. But the non-selected student oftentimes expressed the kinds of creativity and preferences for open-ended and unstructured learning that are frequently valued by special programs for gifted and talented. These creative and divergent thinking skills are oftentimes “lost” when the major criterion for selection into special programs is based on strict assessment of academic performance. In many cases, parents reported that “the wrong twin” was selected for the program. ... Special consideration should be given to these types of abilities and learning styles, especially in the case of twin assessment. TIPS SPECIFIC TO HIGHER ORDER MULTIPLES The following tips offered by educators and parents of higher order multiples are designed to help teachers of higher order multiples: ● Treat each child as an individual, but be aware that each set of multiples has its own “group” dynamic. Some multiples really resent being called “the triplets,” for instance, while other children might not mind. Take your cues from the multiples themselves on whether to correct a classmate who calls them “the triplets” as it might not necessarily be a big deal. ● Monitor the multiples individually and carefully for learning problems and differences in learning styles. Separate gradually, if needed, even considering placement in separate schools if one school lacks the classroom space to separate and it is determined that they would benefit from separation. ● If a problem is noted, adjustments in classroom placement should be made as soon as possible. Do not wait for the start of a new school year. ● Give parents specific feedback. Rather than stating or writing a note that “all your children are doing well” or “all your kids could benefit from being more responsible about completing work on time,” list several points and examples about each child. ● As a result of growing up together, more closely than other siblings, be aware that multiples may do their homework in a very similar way, but not necessarily copying from each other. Discuss any concerns you have about this with the parents and be ready with specific points for each child.

37 Jeanna, Anna, and Nora Heink, triplet daughters of Jill Heink, had one additional tip to offer teachers: “If you like to arrange seats or give out papers in alphabetical order, try to mix things up a little bit so we’re not always one after another.” CONCLUSION Twins and higher order multiples have become more common in the past 20 years due to advances in health and reproductive technology, leading to many more showing up in classrooms throughout the world. Parents and researchers have challenged old thinking by school systems, which was not based on any research findings, that multiples always should be separated in schools. Parents have often run up against stubborn education systems that would not consider being flexible in their policies. Multiples of America has published this booklet in the hopes of bringing together current research and knowledge regarding placement of multiple birth children in schools, so that parents will have a tool to aid them in doing what is right for their multiples. This reasoning is also presented in Multiples of America’s Position Paper, “Guidelines for the Education of Multiple Birth Children” in the Appendix. These tools, aimed at educators and school support staff, outline the special academic, social and emotional needs that can affect multiple birth children in an educational setting. School staff and administrators often lack specific knowledge regarding the development of twins/multiples. Reading that should be required for every teacher and administrator should be Dr. John Mascazine’s book Understanding Multiple-Birth Children and How They Learn: A Handbook for parents, teachers, and administrators,and Dr. Preedy’s useful checklist inventory to help teachers and parents consider the important elements that lead to prudent and productive classroom placements, available in the book: Twin and Triplet Psychology: A Professional Guide to Working with Multiples edited by Audrey Sandback. The clear message for educators and school policy makers is that the best policy on placement of multiple birth children is no policy at all. Therefore, we recommend a flexible approach, making placement decisions based on the individual needs of the children involved, especially since “one-size” does not meet the needs of every set of twins or multiples. Schools should provide an atmosphere that respects the close nature of the multiples’ bond while at the same time encouraging individual abilities.

38 BIBLIOGRAPHY Alexander, M.T. Educating Multiples in the Classroom: Together or Separate? Early Childhood Educ J40,133–136 (2012). https://doi.org/10.1007/s10643-011-0501-x Bouchard, T.J. & Segal, N.L. (1985). IQ and Environment (pp 391-462). In Woman, B.B. (Ed.) Handbook of Intelligence. NY: John Wiley & Sons. Cassill, K. (1982). Twins: Nature’s Amazing Mystery.New York: Atheneum. Dean, L.L. (1999). Mandatory Twin Separation in Schools: How Parents Can Best Rely on Another Set of ‘Twins’-Meyer and Pierce-to Keep Their Children Together. Stetson Law Review,Vol 29, No. 2, Stetson University College of Law, U.S. Elliott, C. Twin Education Research. Mississauga, Ontario. Gleeson, C., Hay, D.A., Johnston, C.J., & Theobald, T.M. (1990). “Twins in School” An Australian-wide program. Acta Geneticae Medicae et Gemellologiae. 39: 231-244. Grime, Jamison J. (2008). The educational effect of forced separation on twins (Doctoral Dissertation). University of Toledo, U.S. Hay, D. (1984). Twins in School.La Trobe University Twin Study. La Trobe University, Australia. Hay, D.A. (1999). Adolescent twins and Secondary Schooling. In A.C. Sandbank (Ed.), Twin and triplet psychology (pp 119-142). London: Routledge. Hay, D., Preedy, P. (2006). Meeting the educational needs of multiple birth children. Early Human Development,82, 397-403. International Council of Multiple Birth Organizations; School Placement Survey, 2019. Klein, N.S. (2003). Not all twins are alike: Psychological profiles of Twinship, Westport, CT: Praeger. Koch, H.L. (1966). Wins and Twins Relations.Chicago: University of Chicago Press. (Reprinted 1977).

39 Larche, S.H. (2008). From the Twin Cities to “Twin” States: Legislating the Classroom Placement of Twins and Other Higher Order Multiples. Marquette Law Review.Marquette University, U.S. Martin, J.A., Hamilton B.E., Sutton P.D., Ventura S.J., et al. (2009). Births: Final Data for 2006, National Vital Statistics Report, vol 57, No. 7, NCHS, Jan 7, 2009. Mascazine, J.R. (2004). Understanding multiple-birth children and how they learn: A handbook for parents, teachers, and administrators.Bloomington, IN: Authorhouse. Multiples of America/NOMOTC. (1989). Survey for Educators: Education of Multiple Birth Children.Research Report #11. Franklin, TN: Author. Multiples of America/NOMOTC. (1999). Survey for Educators: Education of Multiple Birth Children.Research Report #60. Franklin, TN: Author. Multiples of America/NOMOTC. (2004). School Placement of Multiple Birth Children.Research Report #22. Franklin, TN: Author. Multiples of America/NOMOTC. (2002). In Moskwinski, R.E. (Ed.) Twins to Quints: The Complete Manual for Parents of Multiple Birth Children.Nashville, TN: Harpeth House. Plomin, R., & DeFries, J.C. (1980). Genetics and Intelligence: Recent data. Intelligence,4, 15-24. Preedy, P. (1999). Meeting the educational needs of pre-school and primary aged twins and higher multiples. In Sandbank, A.C. (Ed.); Twin and Triplet psychology: A professional guide to working with multiples. New York: Routledge. Preedy, P. (2001). Are Multiple Birth Children Different from Singletons? Meeting the educational needs of multiple birth children upon school entry. (Unpublished Dissertation). School of Education, The University of Birmingham, U.K.: Author. Saudino, K.J., Ronald, A., Plomin, R. (2005). The etiology of behavior problems in 7-year old twins: Substantial genetic influence and negligible shared environmental influence for parent ratings and ratings by same and different teachers. Journal of Abnormal Psychology, 33, 113-30. Scheinfeld, A. (1967). Twins and Supertwins.Philadelphia and New York: J.B. Lippincott Co. Segal, N.L (n.d.) Not all Twin Types are Alike, Twins Magazine, Vol.1, No.4.

40 Segal, N.L (1984). Cooperation, competition, and altruism within twin sets: A reappraisal. Ethology & Sociobiology,5:3, 163-177. Segal, N.L (1994). Developing in Tandem: Intelligence and Special Mental Skills. In Entwined Lives: Twins and What They Tell Us About Human Behavior,49-69. New York: Plume. Sipes, N.J. & Sipes, J.S. (1999). Parting Ways. Twins Magazine, January/February. Tully, L.A., Moffitt, T.E., Caspi A., Taylor A., Keirnam H., & Andreou P. (2004). What Effect Does Classroom Separation Have in Twins’ Behavior, Progress at School, and Reading Abilities? Twin Research, 7.2 (2004): 115-24. Twins Foundation. Twins in School. The Twins Letter,Vol.6, No. 1&2, Providence, RI. Van Leeuwen, M., Van Den Berg, S.M., & Boomsma, D.I. (2005). Effects of twin separation in primary school. Twin Research and Human Genetics, 8: 384-391. Webbink, D., Hay, D., & Visscher P.M. (2007). Does sharing the same class in school improve cognitive abilities of twins? Twin Research and Human Genetics, 10.4, 573-580.

41 APPENDIX I. GLOSSARY OF TERMS Multiple Birth Children: a group of two (twins) or more (higher order) children who typically are conceived at the same time of the same parents, are born at the same time, and share a certain biological and genetic make-up. Identical: monozygotic, or one egg twins or higher order multiples who share all of their genes in common; they are always the same sex, have identical features, eye, and hair color. Fraternal: dizygotic, or two egg twins or higher order multiples resulting from the separate fertilization of two (or more) ova; fraternal siblings have their own unique genes and may be same sex or different sex. Higher Order Multiples: a multiple birth set consisting of three or more children (triplets, quadruplets, quintuplets, etc.). Co-twin or Co-multiple: one child of a multiple birth set. Singleton: a child who is not part of a multiple birth set.

42 APPENDIX II. POSITION PAPER MULTIPLES OF AMERICA REGARDING SCHOOL PLACEMENT OF MULTIPLE BIRTH CHILDREN Introduction: In the United States, the incidence of multiple births to the number of births was 32.6 per 1,000. For triplet and higher-order multiple births, the ratio was 93 per 100,000 births. 10 quadruplet or higher multiple births were reported in 2018. 123,536 multiple births were recorded in the United States in 2018. Twin birth rates declined among mothers aged 30 and over, with the largest declines among older mothers aged 40 and over from 2014-2018. Statement of Purpose: As a national, non-profit support organization for parents of twins and higher order multiples, Multiples of America also known as National Organization of Mothers of Twins Clubs, Inc. (NOMOTC) is dedicated to supporting families of multiple birth children through education, research, and networking. In partnering with local support groups, health care providers, researchers and educators, Multiples of America/NOMOTC endeavors to aid parents of multiples and to raise public awareness of the unique qualities of multiple birth families. This paper offers a set of general guidelines meant to engage educators and school support staff to become better acquainted with the special academic, social and psychological considerations affecting the education of multiple birth children. Guidelines: The general guidelines that follow are intended to be used at all levels of education and provide a broad framework within which educators may begin to dialogue on this topic. Basic Principles: Due to the ever-increasing number of multiple births in the United States, and due to the special academic, social, and psychological considerations involving multiple birth children, educators and educational training institutions should consider the following: 1. Schools should provide an atmosphere which respects the close nature of the multiples’ bond while at the same time encouraging individual abilities.A basic knowledge of the psychology of multiple birth children, especially as it differs between

43 identical and fraternal, is essential. An awareness of the depth of bonding between identical siblings and some same-sex fraternal will promote greater sensitivity to the needs of those children. An understanding that each multiple birth child is unique (even when the child is part of an identical set) will prompt the school’s staff to recognize and encourage each child’s abilities. Educators should learn to recognize each child in a set of multiples individually without resorting to extraordinary means, such as requiring identical twins to wear name tags, different color clothing, or different hair styles. The children should be called correctly by their own name and not simply referred to as “the twins.” The classroom teachers should be able to recognize each child’s particular academic strengths and weaknesses. No overt comparisons should be made between siblings in a multiple set. Instead, academic growth should be evaluated around a common set of benchmarks or standards. 2. Schools should maintain a flexible placement policy throughout the preschool and elementary years. Successful placement involves a collaborative decision which allows for ease of separation from the parent and the other multiple as well as for successful academic and social growth. Placement decisions should not center on a “one size fits all” policy. Decisions should not be made for the purpose of promoting the children’s individuality or the teachers’ convenience and ease in terms of name/face recognition. Consultation with parents will provide clearer insights into how to best serve the children’s needs. As children enter into the late elementary years, their input can also provide information critical to decision making. Decisions should be reviewed annually to see if they are accomplishing the desired goals. In cases where a placement obviously creates a negative learning environment, mid-year changes should also be considered. 3. When multiple birth children are enrolled in different classrooms at the same grade a. level, there is a need for a consistent approach to instruction and classroom management.Teachers at the same grade level are encouraged to coordinate their efforts when a set of multiples is split between their classrooms. Preschool and primary aged multiples can experience disappointment, confusion, or other negative emotions about school experiences as a result of teacher directed activities in one classroom which may be lacking in another. In these cases, jealousy and anger may be directed toward the sibling who is perceived to have the “better classroom.” However, multiples who are separated in same grade classrooms can also become a catalyst for an added emphasis on team-teaching and use of a guaranteed curriculum or curriculum mapping. While this problem may lessen by the middle school years, teachers and administrators still need to recognize the very real problems which placement in separate classrooms can create for multiple birth children.

44 4. Educators should move with extreme caution when considering retention, acceleration, or designation in any one of the areas of exceptionality of one or more children in a set of multiples.Psychological and social considerations involving the nature of the multiples’ bond must receive equal weight with academic considerations. The effects of school retention, accelerations, or designation in any area of exceptionality are much greater on a multiple birth child since they may alter the sibling relationship in a profound manner. These effects can range from mild loss of self-esteem and confusion over the status of the siblings in the multiple birth grouping to a deeper sense of loss of identity with the co-multiple(s) and feelings of anger and rejection. On the other hand, there is a definite need to separate the multiple birth issue from the issue of what is best for the individual child. As a result, the question of exceptionality of a multiple birth child is highly complicated and needs to be approached with full consideration of all the possible benefits and harm which may result from the decision. Teachers need to be sensitive to the feelings and actions of all co-multiples and alert to possible problems for all of the children. If retention or acceleration is unavoidable, counseling services should be made available to all of the affected multiples. 5. Teachers at the primary, middle, and high levels should value parental input regarding the nature of the multiples’ relationship.Parents can be a valuable source of information and insight for teachers of multiples, since parents can usually provide information into the dynamics at work within the multiples’ relationship at any given point in their development. 6. Classroom observations, particularly if the multiples are in separate classrooms, will not provide educators with the comprehensive knowledge needed to make decisions, which may impact the children’s social or psychological well-being. Teachers need to become aware of the level of dependency between the co-multiples and respond in a manner that makes each child comfortable. Adolescent multiples may be having difficulty with their relationship as each strives to establish an independent identity. Identical and fraternal relationships will differ, as will relationships between same-sex and different-sex fraternal. a. School districts should provide staff at all grade levels with professional development opportunities focused on the specialized concerns surrounding the education of multiple birth children. Information and research regarding the education of multiple birth children is readily available through published and online sources. Schools should assist certified and classified staff in increasing knowledge in this area. Educators should seek out the latest research findings about the psychology and education of multiple birth children and incorporate

45 these findings into their instructional methodologies. Certified and classified staff should familiarize themselves with the research, information, and services available through multiple-specific support organizations. Parents of older multiples can be another source of support for this expanding knowledge specific to multiple birth children. 7. At the university level, schools of education should include research findings into the psychology of twins and higher order multiples in their curricula at both the undergraduate and graduate levels.Attention should be paid to preparing teachers and administrators who are informed and sensitive to the needs of an increasing population of multiple birth children. Conclusion: The needs of an increasing population of multiple birth children should be considered at all levels of educational instruction. School policies, decisions, and instruction which are based on a sound understanding of the psychology and social development of multiples will enable these children to move through the school years more happily and successfully. Any assumptions that twins and higher order multiples have the same needs as singleton children can be damaging and counterproductive to the purpose of the educational institution. Appropriate research and literature exist which can provide a basis for a sensitive, knowledge-based approach to the education of multiple birth children. Parents and experts in the field should be considered valued resources for assisting school administrators and faculties with decisions affecting multiples.

46 APPENDIX III. TWIN’S LEGISLATION REGARDING PLACEMENT OF MULTIPLES IN SCHOOL Introduction Parents and educators who are concerned that mandatory policies regarding placement of multiples in school are contrary to the best interest of multiple birth children have started a grassroots effort to have legislation passed that gives placement decisions back to the parents. As of 2019, 14 states have laws regarding multiple birth school placement and 11 states have legislation under review. The legislation basically states that parents should have the final say in whether their multiples should be placed in separate or the same classroom at the beginning of a school year. The law does allow the schools to give professional advice to the parents and make recommendations. The law also has a provision that keeps the control of the educational process with the school. The school evaluates the placement during the year and can determine if the placement decision disrupts the classroom. If it is disruptive to the class, the principal can request that the school board make a decision. Each state that has passed school placement legislation has tweaked the original wording of the Minnesota statute to suit its own legislature and district. Some states have broader interpretations, while others are more restrictive. Most have included language that ultimately lets the school retain some control. Individuals who are interested may wish to check their own state’s legislature to determine if any type of “twin placement” legislation has been attempted or passed. They may want to initiate the process in their own state. Although most clubs and Multiples of America are 501(c)(3) non-profit organizations and are not permitted to lobby legislation, individuals may do so as concerned citizens wishing to bring about change in their own state or district. This effort would be done at their own expense and time. Following is an outline provided by Multiples of America members who were successful in having school placement legislation passed in their own state. It is a guide that might be useful to an individual who would like to begin organizing such a process.

47 Organization and Networking Begin networking with fellow parents, utilizing area coordinators: Set a date and time and choose either a central location or conference call to discuss the issue at hand. Have one central location for posting information, such as a website During early discussions seek to set objectives. Also establish area coordinator(s) to help disseminate information. Networking through legislators: Contact local State Representatives and State Senators. Meet local representatives while the legislative session is not active for the best opportunity for a meeting. Introduce yourself through email or phone call. Support Documentation Gather as much information as possible to support your issue. Obtain letters and/or speaking engagements from medical and other professionals. Reach out to national experts in the field for their support, such as professionals who are conducting studies. Contact others in organizations you know who may offer support, such as PTA’s and other support organizations. These local leaders’ names may be meaningful to local legislators. Research what the opposition’s hot topics are. Be prepared to counter them. Bill Introduction & Support from Legislators The issue has to have support from a legislator in the form of “sponsorship” to have it introduced as a bill: Contact your local State Representative and local State Senator asking for their support and sponsorship. The primary goal of the meeting is to get sponsorship for the issue for the legislator to introduce the bill.

48 If the issue does have a sponsor, then meet to explain your support of the bill and ask the legislature to support and vote for it: Set up an appointment with yourself or with your group. Be prepared for the meeting, knowing who will speak, what will be said, what questions to ask, and who will be the facilitator. Make sure all attendants are on the same page. It is good for as many parents to meet with their local State Representatives and Senators as possible. These should be happening throughout your state with State Representatives and State Senators, each of which has local constituents at the meetings. During meeting: Begin with brief introductions: Who are you? Examples, “I’m a mom of twins. There are XX number of multiple births in Georgia every year.” Your connection with legislators? Examples, “I worked on your campaign.” “I had a sign in my yard.” Be concise and to the point. Present your issue; answer any questions the elected official has but, ask for support; ask what else you can do to help move the bill (or issue) forward, and leave. Watch for nonverbal clues from the elected official that the meeting has ended for him/her. Ask Representatives and Senators to introduce and sponsor the bill if your state needs sponsors from both sides of the legislature. Check your current state laws. Successful strategies for the meeting: Be prepared for some elected officials to be against the bill. Be prepared (from research stage) to counter opposition arguments. No small talk; get to the point right away as soon as you hit the chair. Use names of industry organizations and local nonprofits that support your efforts. Use the terms: twins, triplets, etc. when speaking. Most people who do not have multiples do not know what “multiples” means. If the legislator asks a question, you do not know the answer to, admit this and tell them you will research it and get back to them. Always be honest.

49 Give legislators time to express their views. Be a good listener as they talk. You must “close the sell” (get a commitment).The first step is to ask for it. Without a commitment, you have wasted your time. Give them supporting documents and publications with highlighted sections for easy reference as you leave. Do not lose your temper and do not take political issues personally. You may need the legislator’s vote later on down the road. After they agree, continue to be persistent to get the vote through. Ask how you can help by speaking with others on the committee who are wavering, and asking if the legislator will attend with you. Sincerely thank them for their time. After the meeting, follow up with a thank you letter. Thank them for their time, repeat the details of the meeting, and agreement that was made, relay any outcomes, and provide any information you promised. When the bill is introduced, find out the exact wording and the bill number. Committee Hearing and Floor Vote Stages Once your issue is introduced as a bill, it will be heard by both branches of the legislature. Generally, the bill will have to go through a committee hearing before moving to the floor of the legislature for a vote. Then it moves to the other side of the legislature for a committee hearing and floor vote. Ask your email network to email everyone on the committee hearing the bill. It is acceptable and recommended to email (and even phone) each member of the committee stating your support of the bill. Plan to attend each and every one of these hearings with as many of your fellow concerned parents as possible. If the bill concerns childhood issues, bring children who are old enough to sit still as an example of who the bill is affecting. Do know you may have less than 24 hours advance notice if your issue will be heard on any given day. Make sure your network of parents is aware that hearings will be forthcoming, their presence is requested, and notice of said committee hearing meetings may (and probably will) be very short. Have each parent be prepared to speak at every hearing on your issue’s behalf, noting not all may have an opportunity to do so.

50 Assign/appoint your top 1 or 2 people to speak to the committee on your behalf, preferably a professional. It is a bonus if they also have multiples. When you speak before the committee, be concise and to the point. You may only be given 3 minutes to prevent your entire case. When notice of a hearing has been made public, get your networks emailing your representatives and Senators asking for their support. You know you are doing a good job of it when your sponsoring Senator/Representative asks you to slow down on the emails coming in. While you are in the building for the hearing, take the time to speak to your local legislators in person. If they are not in their office, have a hand-signed note ready to leave them. This way they know you are their constituents, support this bill, want their vote, and were willing to meet face to face with them. When the bill comes out of the hearing process will have to be repeated and you will have to again ask for votes from local representatives. Media Outlets (Newspapers, Internet, Social Media) Be prepared to respond to any “buzz” that your issue may create through newsprint, online blogs and chats. Be proactive with local print media. Write letters to the editor supporting the bill. During session it is likely that your local legislators only have time to read the letters to the editor in local papers. Use Google Blog Search or other search engines to search for the most recent blog posts about the issue (e.g. blogsearch.google.com). They will be returned sorted by most recent posts, not most popular. Legislators watch these media outlets to get a feel for what the public mindset is and will place their vote according to what they read and hear. Try to watch/read as many media outlets as possible and respond accordingly. Sometimes an innocuous posting on a political blog may load too many comments, possibly propelling the issue to the front page of the paper. Other news outlets could then pick this up. Submission provided by: Jennifer Herrold and Jenny Beth Martin Disclaimer: 501 (c) (3) organizations are not permitted to lobby legislation. Any concerned citizen may utilize their right to bring forth change within their local, state, and national government if so inclined at their time and expense.

51 ABOUT MULTIPLES OF AMERICA Multiples of America, also known as the National Organization of Mothers of Twins Clubs, Inc. (NOMOTC), in 2020 celebrated its 60th anniversary.60thanniversary of offering support for parents of mult MulMultiples of America was established to cooperate with medical and educational professionals engaged in multiple birth research, increase the understanding of child development and rearing, especially as it relates to multiple births, and to increase awareness of the individuality of each child. Multiples of America is a non-profit corporation funded by dues, donations and grants. Headquartered in Franklin, TN, the organization serves approximately 12,000 members with approximately 150 clubs in 44 states. Please visit us on the web at: www.multiplesofamerica.org. MISSION Multiples of America is a 501(c)(3) non-profit organization dedicated to supporting multiple birth children through education, research, and networking. In partnering with local support groups, health care providers, researchers, and educators, and with the highest standards of integrity, respect, and professionalism, we endeavor to aid parents of multiples and to raise public awareness of the unique qualities of multiple birth families.

52 CONNECTING + SUPPORTING MULTIPLE BIRTH FAMILIES (also known as The National Organization of Mothers of Twins Clubs Inc.) Connect to us at: MULTIPLES OF AMERICA 2000 Mallory Lane, Suite 130-600 Franklin, Tennessee 37067-8231 Dawn Keller, Executive Director Email: info@multiplesofamerica.org www.multiplesofamerica.org Twitter: @MultiplesUSA https://www.facebook.com/NOMOTC/