section r: medical conditions and syndromes · 2020. 3. 12. · rett syndrome, lennox gastaut...

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Section R: Medical Conditions and Syndromes

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Angelman Syndrome Introduction The International Angelman Syndrome Organization was founded in 1998. Angelman is a congenital (present at birth) genetic condition that is caused by various genetic mechanisms. Although the mechanisms vary in their etiology and recurrence risks, all cause the absence of proper expression of the disease gene called UBE3A from the maternally inherited chromosome 15.

UBE3A gene is a gene that has been shown to be disrupted in some children with Angelman Syndrome. The precise function of this gene is not yet known but it is presumed to affect the function of ubiquitin (a regulatory protein) in the brain.

Ubiquitin is a small molecule that is present inside all cells. It can be attached to molecules that are old and ready to be degraded or that need to be removed for whatever reason. This removal system is called the ubiquitin degradation pathway. The Angelman gene, UBE3A, is a component of this ubiquitin pathway but it remains unclear exactly how or if this gene helps degrade proteins in the brain. Children with Angelman Syndrome can expect a normal lifespan.

Characteristics/Symptoms § delayed motor development, such as delay in sitting, crawling, walking, and toilet

training § speech problems § jerky, puppet-‐type movements § stiff-‐legged walking style § hand flapping § hyperactive behaviour § loving, happy and social demeanor § easily moved to laughter § cognitive impairment (severe in most cases) § feeding difficulties § sleep disturbances

Physical Features (are not always obvious at birth but evolve during childhood) § flattened back of head § deep-‐set eyes

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§ wide, ever-‐smiling mouth § prominent jaw and widely spaced teeth § lightly pigmented hair, skin and eyes § small head (sometimes present) § EEG (brainwave) abnormalities (sometimes present)

Diagnosis Diagnosis methods include checking for the clinical features of Angelman Syndrome (A.S.) and performing DNA tests. A.S. could be mistaken for autism because of similar problems, including hyperactive behaviour, speech problems and hand flapping. It is important that the child is carefully diagnosed because sometimes A.S. and autism are both present. The child could also have Rett Syndrome, Lennox Gastaut Syndrome or non-‐specific cerebral palsy.

Programming Options There is no cure for Angelman Syndrome, but the child can benefit from a range of treatments for some symptoms including:

§ speech therapy § behaviour modifications § communication therapy § occupational therapy § physical therapy § special education programming § social skills training § anti-‐epileptic medication § classroom adaptations/modifications § program adaptations/modifications § augmentative equipment

Resources/Reference • www.angelmansyndrome.org

Anxiety Disorders Introduction Anxiety is the uneasiness, worry, or tension students experience when they sense a real or perceived threat to their welfare. Anxiety is the most common problem reported by

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children of all ages. It is ‘normal’ to feel anxious or have fears throughout life. “Normal” anxiety is reasonable, manageable, mobilizing, limited, and age appropriate. An anxiety disorder, however, is a serious mental illness, which causes a student to either avoid situations that might precipitate the anxiety or develop compulsive rituals that lessen the anxiety.

Anxiety becomes a problem for students when it interferes or causes difficulties for them or when it adversely affects their lives. Anxiety is a sign of real personal suffering and should not be viewed as an act of or a way of getting sympathy. It can cause poor school performance, interfere with friendships, and affect an entire family. Childhood anxiety could be the beginning of a lifetime of anxiousness leading to more severe problems, such as substance abuse, depression, or even suicide. Anxiety can be managed, thus, students will benefit from learning about how to develop confidence, take control over fears, and overcome anxiety.

Anxiety out of a ‘normal’ range is excessive, detrimental, uncontrollable, paralyzing, chronic, and not age appropriate. It causes such distress that it interferes with the student’s ability to lead a ‘normal’ quality of life.

Characteristics/Symptoms For students with an anxiety disorder, worries and fears are constant, overwhelming, and can be crippling. Physical symptoms that can exist with all anxiety disorders are:

§ Feelings of panic, fear, and uneasiness § Has difficulty sleeping § Complaints of headaches § Cold or sweaty hands and/or feet § Shortness of breath § Fast breathing § Heart palpitations; fast heartbeat § Fidgety, paces, or an inability to be still and calm § Shakes § Dry mouth § Numbness or tingling in the hands or feet § Complaints of feeling sick or having a stomachache, nausea § Muscle tension § Dizziness

Different types of anxiety disorders exist, each having their own unique symptoms:

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§ Panic Disorder (has sudden attacks of panic out of the blue, avoids activities that might make him/her breathless, thinks that he/she is dying, thinks that something physical is wrong with him/her, scared of having more attacks)

§ Separation Anxiety (worries about getting lost, worries about someone close to him/her getting hurt or sick, gets upset when he/she has to be away from parent, gets upset when parents go out, avoids going to school, refuses to sleep at other people’s homes unless parent is there, complains of feeling sick when he/she must separate, afraid of something terrible happening to parents)

§ Social Phobia or Social Anxiety Disorders (shy, has difficulty meeting people, has difficulty joining in groups, has few friends, avoids interacting with peers, does not like to be the centre of attention, believes others will think badly of him/her, avoids wearing different clothes, does not speak to people, scared of answering questions in class, worries that someone will laugh at him/her, worries that he/she will be embarrassed)

§ Specific Phobias (avoids specific things he/she is afraid of, i.e., the dark, heights, insects, animals, doctors, dentists, storms, water; if confronted with fear becomes panicky)

§ Generalized Anxiety Disorder (extremely conscientious, worries about making mistakes, has difficulty performing in exams, worries about schoolwork or performing well enough, worries about money, bills, family, health, safety, is afraid of new situations, asks a lot of questions, often seeks reassurance, worries a lot after seeing news programs or scary movies)

§ Post-‐Traumatic Stress Disorder (has had a serious traumatic event in the past, has had bad dreams about the event, cannot stop thinking about the event, becomes very upset when he/she thinks about the event, avoids situations that remind him/her about the event, is very jumpy and irritable

§ Obsessive Compulsive Disorder (OCD) (does the same thing over and over again, complains of thoughts that get ‘stuck’ in his/her mind, worries continuously about germs or being dirty, has to do or keep things in a certain order and very precisely, does a certain action in a ritualistic way, gets very upset if he/she cannot perform the ritual)

Diagnosis If you suspect a student has an anxiety disorder, encourage the parents take the student to see their family doctor. The doctor will likely ask the student questions to assess how severe the anxiety is (i.e., see how anxious the student is, how much the student worries). The doctor will assess the student’s symptoms and may even measure the symptoms through a questionnaire. The doctor may refer the student to a mental health professional.

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Causes of anxiety disorders are currently unknown. However, anxiety disorders are not the result of personal weakness, character flaws, or poor upbringing. As researchers continue their studies on mental illness, they are finding that anxiety disorders are caused by a combination of factors (i.e., changes in the brain, chronic stress, brain structure, trauma, environmental stress).

Programming Options The aim of the following programming options is to bring the anxiety down to manageable levels and so it does not rule a student’s life.

§ Lifestyle changes o releasing physical tension (i.e., relaxation techniques, deep breathing, guided

imagery) § Professional counselling § Prescription medication § Develop an anxiety management program (i.e., Stepladders see Helping Your

Anxious Child: A Step-‐by-‐Step Guide for Parents Second Edition by R.M. Rapee, A. Wignall, S.H. Spence, V. Cobham & H. Lyneham)

§ Implement strategies to address anxiety

Helpful Strategies of Dealing with Anxiety (Rapee, Wignall, Spence, Cobham & Lyneham 2008)

1. Reward Brave, Non-‐anxious Behaviour

Look for situations when the student acts brave, reward him/her and it will become more likely he/she will act brave again.

2. Ignore Unwanted Behaviour

Remove attention from when the student acts anxious and attend to the student when he/she has stopped the anxious behaviour.

3. Model Brave, Non-‐anxious Behaviour

Show how adults cope with fears and worries constructively. Do not try to hide fears from students or pretend one never gets scared. Students need to see how others effectively manage fears and worries.

4. Prompt to Use a Coping Strategy

Focus the student’s attention to constructively solving the problem of his/her anxiety on his/her own. One way to help students is through a program called “Stepladders,” which is a way to help students overcome their fears by facing up to the very things they are

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scared of. It gives students opportunities to practice different ways of behaving and learning that he/she is really able to cope with fear.

Unhelpful Strategies of Dealing with Anxiety (Rapee, Wignall, Spence, Cobham & Lyneham 2008)

1. Excessive Reassurance

Constantly telling the student that ‘everything will be all right,’ or, ‘there is nothing to be afraid of,’ is counterproductive. Reassurance to an anxious child has very little effect. In fact, the more reassurance a student receives, the more he/she will demand. Excess reassurance gives the message that there really is something awful to worry about and that the student cannot cope by him/herself, needing someone else to handle the difficult situation.

2. Being Too Involved and Directive

Avoid trying to take over and direct the student by telling the student exactly what to do, how to behave, and what to say.

3. Permitting Avoidance

Do not give in and allow the student to avoid his/her fears. As long as the student is allowed to avoid, he/she will not overcome his/her anxiety. Avoiding things strengthens anxious beliefs. Students must face fear to fight fear.

4. Impatience

Becoming angry of showing frustration will only cause the student to become more frightened and dependent. Implement helpful strategies instead and request help when needed.

Resources / References

For professional development

Alberta Family Wellness. Retrieved from: http://www.albertafamilywellness.org/

Alberta Family Wellness. Retrieved from: http://www.albertafamilywellness.org/resources/video/how-‐brains-‐are-‐built-‐core-‐story-‐brain-‐development

Dawson, P., Guare, R. Smart but Scattered

Green, R. Explosive Child.

Mate, G. Consequences of Stressed Parenting. Retrieved from: http://www.youtube.com/watch?v=UGmADfU5HGU

Mated, G. how Stress Can Cause Disease. Retrieved from: http://www.youtube.com/watch?v=Qf92l7FPyKo

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Nuefeld, G. Raising Children in a Digital World. Retrieved from: https://www.youtube.com/watch?v=Oq8ULEfvF78

Nuefeld, G. Making Sense of Anxiety. Retrieved from: https://www.youtube.com/watch?v=hymwvaZ9oKg

Rapee, R.M., Wignal, A., Spence, S.H., Cobham, V. & Lyneham, H. Helping Your Anxious Child: A Step-‐by-‐Step Guide for Parents 2nd ed.

Wagner, A. P. Worried No More: Help and Hope for Anxious Children.

For Classroom

http://www.anxietybc.com/

http://www.shared-‐care.ca/page.aspx?menu=65&app=250&cat1=619&tp=2&lk=no

Mental Health strategies, games, parent handouts and teacher resources

http://www.setbc.org/pictureset/

http://csefel.vanderbilt.edu/resources/family.html -‐ family resources

http://csefel.vanderbilt.edu/resources/strategies.html -‐ teacher resources

https://www.teachervision.com/emotional-‐development/teacher-‐resources/32913.html

Apraxia of Speech Introduction Childhood Apraxia of Speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words.

Characteristics/Symptoms in a very young child § does not coo or babble as an infant § first words are late § may omit sounds randomly from words § inconsistent use of the same sound or word § only a few different consonant and vowel sounds § problems combining sounds § may have long pauses between sounds

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§ simplifies words by replacing difficult sounds with easier ones, e.g., tat for cat or by deleting difficult sounds, e.g., top for stop

§ may have problems eating

Characteristics/Symptoms in an older child § makes inconsistent sound errors that are not the result of immaturity § receptive language (understanding) is better than expressive language (speaking) § has difficulty imitating speech although imitated speech is more clear than

spontaneous speech § struggles to coordinate the lips, tongue, and jaw when attempting to produce

sounds § has more difficulty saying longer words or phrases clearly than shorter ones § appears to have more difficulty when he or she is anxious § is hard to understand, especially for an unfamiliar listener § sounds choppy, monotonous, or stresses the wrong syllable or word

Other problems that may exist § weakness of the lips, jaw, and/or tongue § delayed language development § other expressive language problems like word order confusions and word recall § difficulties with fine-‐motor movement/coordination § over-‐sensitive or under-‐sensitive in their mouths (e.g., may not like tooth brushing

or crunchy foods, may not be able to identify an object in their mouth through touch)

§ problems when learning to read, spell, and write

Diagnosis A hearing evaluation should be conducted to rule out hearing loss as a possible cause of the child’s speech difficulties. An SLP will assess the child’s oral-‐motor abilities, melody of speech, and speech sound development. The SLP will diagnose CAS and rule out other speech disorders.

Programming Options § speech-‐language services § practice the new strategies learned at home/classroom

Resources/References http:/www.asha.org/public/speech/disorders/ChildhoodApraxia.htm

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Attachment Spectrum of Disorders Introduction Attachment disorder is a broad term intended to describe disorders of mood, behaviour, and social relationships arising from a failure to form normal attachments to primary care giving figures in early childhood, resulting in problematic social expectations and behaviours. Such a failure would result from unusual early experiences of neglect, abuse, abrupt separation from caregivers after about 6 months of age but before about three years of age, frequent change of caregivers or excessive numbers of caregivers, or lack of caregiver responsiveness to child communicative efforts.

Characteristics/Symptoms § not being able to form close relationships with others § low self-‐esteem § a lack of trust of others § failure to respond to others § indiscriminate social behaviour § lack of reciprocity (do not seem genuine in their expression of affection) § aggressive behaviour (helps to keep others at a distance) § control battles (have a need to exert control over his/her environment and will be

unwilling to follow any directions given) § chronic anxiety (do not feel secure about being cared for and does not feel

worthwhile) § delayed conscience development (have not learned right from wrong/truth is not

valued or important and demonstrates little or no remorse when caught misbehaving)

§ indiscriminate affection (demonstrate affection to people who are virtual or complete strangers and the displays of affection may have a seductive quality about them)

§ lack of self-‐awareness (are unaware of his/her own physical and emotional needs and have not learned the basic pattern of cause and effect)

§ over-‐competency (prefer to take care of his/herself and attempt tasks beyond what would normally be expected for his/her age level)

§ poor eye contact (make little direct eye contact when interacting with others or uses the sidelong glance instead)

§ Two-‐And-‐Twenty Syndrome (appear at times too old for his/her age and at other times act too young or immature)

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§ withdrawal (physically cringe or try to avoid physical closeness or puts “a shield around him/her”)

§ impulsivity (what he/she wants at that moment is what guides the child) § poor social relationships (continues in his/her “babyish” ways and acts self-‐

centred) § manipulative

Diagnosis If you suspect a child might have an issue with attachment, direct the parents to consult with their family doctor. Also refer the child to a school psychologist/psychiatrist.

Programming Options Effective intervention involves a combination of approaches which can include counselling, parenting education, safe living environment, positive interactions, family therapy, play therapy, behaviour modification, social skills training, individual psychological counselling, and strategies.

Some effective strategies can include: § establish eye contact (insist that the child maintain normal eye contact during

conversation, e.g., when very angry or manipulating someone, eye contact is excellent and will attempt to control the situation by starting a “staring match”)

§ establish who is “boss” (remind him/her in a calm, firm, controlled voice that the teacher is the boss when the child is trying to manipulate)

§ recognize the child’s subtle attempts to remain in control (acknowledge each completed portion of work as the child finishes it)

§ win all control battles (structure all of the child’s choices so that the teacher remains in control, e.g., if you want the child to take his coat outside on a cold day, ask him/her, “Do you want to wear your coat or carry it?”)

§ recognize good and poor decisions (relate what a child does back to his/her ability to make decisions whether they were good or bad, e.g., “I see you made a good decision to finish your math” or “I see you chose not to finish your work. You can finish it at recess or after school”)

§ allow the child to accept responsibility (look for creative ways to allow the child to experience the natural consequences of his/her actions)

§ be consistent (confront each misbehaviour and praise each good behaviour) § remain calm (model and verbalize appropriate behaviours) § document interactions and observations of the child (it is necessary to remain

objective if the child accuses parents, teachers, or classmates of abuse)

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§ request help (utilize all sources of assistance)

Resources/References Autism Society of America, 2005, Common Characteristics of Autism, http://www.autism-‐

society.org/site/PageServer?pagename=autismcharacteristics

Autism Society Manitoba, Solving the Puzzle Together (brochure), Winnipeg, MB

BC Ministry of Education, 2000, Special Considerations for Individual Planning Students with Autism, http://www.bced.gov.bc.ca/specialed/ppandg/planning_12.htm

Stokes, Susan, 2005, Structured Teaching: Strategies for Supporting Students with Autism? http://www.cesa7.k12.wi.us/sped/autism/structure/str10.htm

Williams, Donna, 1996, Autism: An Inside-‐Out Approach An Innovative Look at the ‘Mechanics’ of ‘Autism’ and its Developmental ‘Cousins’, Jessica Kingsley Pub., London, England.

Attention Deficit Hyperactivity Disorder (ADHD) Attention Deficit Disorder (ADD) Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is characterized by problems with impulsivity, lack of concentration, and excessive hyperactivity. Students may also have difficulty initiating tasks, completing them, following multi-‐step instructions, and planning.

Attention deficit disorder (ADD) is characterized by poor concentration, short attention span, daydreaming.

Characteristics/Symptoms Developmental delays (advanced and not advanced in different areas of human growth and mastery) may be overly sensitive to sight, sound, touch, excessive movement, unable to focus, impulsivity and short attention span may also have co-‐related conditions of Obsessive Compulsive Disorder (OCD) and Tourette Syndrome (TS) may struggle with issues such as reading and writing due to dyslexia. Movement/balance disorder (often fine-‐motor skills can be challenged due to this conditions and gross motor development can also be affected.)

Diagnosis Many psychologists will identify symptoms of ADHD through formal testing and informal screening tools such as the Connors Screening Tool for ADHD. The actual diagnosis is done by a medical doctor, usually a pediatrician if the students are younger.

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Programming Options Choose appropriate strategies from the categories of high activity level, focusing, and organization.

High Activity Level § provide a safe place for the child to go when he is overwhelmed, e.g., a calm down

tent or a quiet room in the school § allow children to foot or pen tap when trying to focus attend or listen § allow for activities which work the large and small muscles, e.g., push and pull

games, manipulating resistant hand-‐held materials § enlist the child as the classroom helper, e.g., carrying heavy books to the library § traditional drumming and dancing § encourage frequent kinesthetic activities, e.g., shovel snow, do jumping jacks, pull

a weighted sled, use a sit and scoot cushion, push a broom down the hall § facilitate calming environment (sensory room): dark, quiet, and confined with

gentle movement § do not take gross motor opportunities away as a punishment § allow for frequent breaks to release restlessness § at times, allow standing during seat work, especially at the end of a task § use the “how does your engine run” program § some children do need medication

Focus § allow for oral-‐motor activities § allow for hand-‐held manipulatives § reduce visual stimulation § reduce auditory stimulation § present only one task/activity at a time § reduce clutter in the classroom § use content which interests the child § acknowledge that the child may need extra help § allow for the child to do his/her work in a low stimulation area inside and at

times, outside of the room § use portable study corrals § cut down on classroom interruptions

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Organization § give frequent verbal reminders § implement routine reminders with visual/pictorial cues § use concrete visual cues, e.g., egg timers, buzzers, digital clocks § implement a buddy system § use colour coded systems for different subjects § use picture calendars for daily and weekly schedules § use picture mapping § break down activities into small steps § use pictorial symbols for letters and words § repeat things over and over § always check for comprehension § understand the concept of providing an “external brain” § when helping children recall information ensure that the child has consistent

visual prompts § have consistency from day-‐to-‐day § understand that these children can have good day and bad days § use calculators

Resources/References Amen, Daniel G., 1995, Screening Tool for ADHD in Adults

Fowler, Mary, 2002, Attention Deficit Hyperactivity Disorder (PDF File)

Hallowell, Edward M. & Ratey, John J., 1992, The Management of Adult Attention Deficit Disorder

National Institute of Health, 2004, A Look at ADHD (PDF File) National Institute of Mental Health, 2003, Attention Deficit Hyperactivity Disorder (PDF File)

National Center for Disease Control, 2002, Attention Deficit Disorder and Learning Disability: United States, 1997 -‐ 1998 (PDF File)

Packer, Leslie E., 2005, Attention Deficit Hyperactivity Disorder: Differential Diagnoses, Comorbidity, and Prognosis

Packer, Leslie E., 2004, Treatment of ADHD

Packer, Leslie E., 2004, Safety and Accident Risks in ADHD

Packer, Leslie E., 2004, ADDults: ADHD in Adulthood

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U.S. Dept. of Education, 2003, Identifying and Treating Attention Deficit Hyperactivity Disorder: A Resource for Home and School (PDF File)

Webb, James T., 2000, Mis-‐diagnosis and Dual Diagnosis of Gifted Children: Gifted and LD, ADHD, OCD, Oppositional Defiant Disorder (PDF File)

Auditory and Language Processing Disorders Introduction Auditory Processing and Language Processing refers to the ability to attach meaning to auditory information and formulate an expressive response.

They are used interchangeably. People with Auditory Processing Disorders have normal intelligence, normal hearing acuity, and approximately age-‐commensurate performance on receptive and expressive vocabulary development.

Characteristics/Symptoms Auditory

§ majority of cases are male (75%) § normal pure-‐tone hearing results § difficulty following oral directions; inconsistent response to auditory stimuli § short auditory attention span; fatigues easily during auditory tasks § poor short-‐term and long-‐term memory § gives impression of not listening even though looking at the speaker; daydreams § difficulty listening in presence of background noise § difficulty localizing sound § academic deficits (phonics, reading, or spelling) and mild speech-‐language

impairments § disruptive behaviours – distracted, impulsive, frustrated § frequent requests for verbal repetition or often say “huh?” § history of otitis media (middle ear infections)

Language § problems with retrieval of common words § use of neutral, generic, or less-‐specific labels § misuse of words with a similar phonetic structure § generating creative, original language terms; use of descriptions or indirectness,

or roundaboutness

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§ response latency; use of fillers to buy time § frequent “I don’t know” or “I forgot” responses § verbal repetition or rehearsal § inconsistency in learning; requires extensive review of previously learned

material § recognize language errors but can’t fix them § incomplete sentences or thoughts § pragmatic problems; disruptive behaviour § age-‐commensurate IQ and vocabulary with academic deficits; learning disability

label

Diagnosis Results from the speech language pathologist and audiologist together have to prove that the child has normal intelligence and normal hearing. Auditory Processing deficits are subtle, and eventually result in academic problems in reading, spelling, or other learning areas.

Programming Options Teacher

§ amplify the auditory signal § reduce extraneous background noises § allow preferential seating to maximize auditory and visual signals § simplify verbal instructions; include only pertinent content § insure the child’s attention before beginning verbal instruction § restate, paraphrase, and emphasize important information § monitor use of rate, inflection, gestures, etc., to enhance clarity of verbal

presentation § use visual materials and physical demonstration to supplement auditory

instruction § ask questions to check comprehension of material presented § use a peer-‐pairing or buddy system to check notes, assignments, etc.

Student § watch and use visual cues to supplement auditory information § listen for meaning rather than word-‐for-‐word repetition § use the rehearsal technique of repeating information to compensate for poor

memory

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§ desensitize to background noise § learn to concentrate carefully on the speaker § paraphrase and check comprehension frequently § ask clarification questions rather than open-‐ended questions § use peers to check notes and assignments when given § tape record to provide redundancy for lecture presentations § maintain a positive attitude and an active learner role

Resources/References Richard, Gail J.,The Source for Processing Disorders. LinguiSystems, 2001.

Autism Spectrum Disorder (ASD) Introduction Autism Spectrum Disorders (ASD) are lifelong developmental disabilities that impact how individuals understand what they see, hear and sense. These misunderstandings result in difficulties with social relationships, effective communications and appropriate behaviours.

The cause or causes of ASD is not fully known. But studies have revealed a male-‐to-‐female ratio between 4:1 to 5:1.

Characteristics ASD is considered a spectrum disorder since the symptoms can be present in a variety of combinations; can range in severity from mildly to profoundly disabling, and may accompany other disabilities. Some individuals with ASD have normal levels of intelligence, while most individuals have some level of intellectual disability, also ranging from mild to severe. This range is often referred to as high-‐functioning ASD to low-‐functioning ASD.

Because there is also a range of difficulties in expressive and receptive language and communication, a high proportion of individuals with ASD (estimation of 50%) do not develop functional speech. For those individuals who do, speech may have unusual qualities and limited communicative functions.

Individuals with ASD also display difficulties with social interaction and appropriate behaviour. But the extent and type of difficulty varies. Some individuals may be withdrawn, while others may be overly active, approaching people in socially-‐awkward ways. ASD individuals may display selective attention, resistance to change, limited interests or obsessive behaviours. They often respond to sensory stimuli in a non-‐typical manner and may exhibit unusual physical behaviours i.e., hand flapping, spinning or rocking. The individuals may also use objects in unconventional ways and also demonstrate an unusual attachment toward specific objects.

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Diagnosis There is no definitive medical test to identify autism spectrum disorders. The diagnosis can be made by either a pediatrician, child psychiatrist or clinical psychologist with expertise in the area of autism spectrum disorders. The diagnosis of ASD is determined by the presence or absence of certain behaviours, characteristic symptoms and developmental delays.

Autistic Disorder Some of the characteristics/symptoms are:

§ a marked lack of awareness of the existence or feelings of others § atypical seeking of comfort at times of distress § atypical imitation § unusual social play § a limited ability to form friendships with peers § significant limitations in verbal and non-‐verbal communication § limited receptive communication § limited expressive communication § a restricted repertoire of activities § stereotyped and repetitive body movements § a persistent preoccupation with parts of objects or attachments to unusual objects § a markedly restricted range of interests or a narrow preoccupation with one

interest § difficulties with attention and motivation § a need to follow routines in precise detail § marked distress over changes in the environment

Asperger’s Syndrome § shares many of the features of autism spectrum disorders § demonstrates significant difficulties with respect to social interaction § tends to display stereotypical behaviour patterns § is no clinically significant delays in early language development or significant

delays in cognitive development as associated with ASD § does not have the same degree of difficulty in the development of age-‐appropriate

self-‐help skills, adaptive behaviour and curiosity about the environment in childhood as those with ASD

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Rett’s Disorder § occurs only in females § is characterized by the development of significant deficits following a period of at

least five months of normal development § tends to display repetitive hand wringing movements § often has difficulty using her hands in a purposeful manner § tends to be a deceleration of head growth and motor coordination issues § also displays severe communication and social interaction impairments

Childhood Disintegrative Disorder § is characterized by regression, following a period of at least two years of normal

development, in multiple areas: o expressive/receptive language o social skills o adaptive behaviour o play skills o motor skills o and/or bowel/bladder control

§ also have significant communication deficits, social interaction impairments, and restricted, repetitive and stereotyped behaviours and interests

§ is also referred to as Heller’s Syndrome § is much less common than Autistic Disorder

Pervasive Developmental Disorder Not Otherwise Specified (PDD-‐NOS)

§ symptoms are similar to, but not identical to, those displayed by people with ASD § symptoms developed later than the diagnostic criteria stipulate for ASD or the

symptoms that are not outlined in the diagnostic criteria § symptoms can be significant social or communication impairments, stereotyped

behaviours or interests, but who do not meet the criteria for any other Pervasive Developmental Disorder(PDD)

Programming Options General Strategies:

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1. Instruction should emphasize:

§ paying attention

§ imitating

§ comprehending words and instruction

§ using language for social reasons

§ developing functional communication

2. Information and instructional activities should be provided in a format that:

§ is clear and concise

§ is consistent with comprehension level

§ focuses their attention

§ emphasizes the most relevant information

3. Sensory Responses must be continually monitored:

§ Assess sensory responses.

§ Be aware of different experiences of sensory stimulation.

§ Use alerting strategies to help enhance students when hyposensitive.

§ Implement strategies to calm students when hypersensitive.

4. Reduce student’s anxiety levels that often initiate inappropriate behavioural responses:

§ Provide warnings about transitions and changes.

§ Provide daily and weekly schedules.

§ Use social scripts to encourage calming and teach coping skills.

§ Provide facts about anxiety-‐arousing situations.

§ Establish a calming area.

Structuring Environment/Classroom: 1. Structure the classroom (universal design)

§ Placement of furniture

§ Quiet area

2. Attend to sensory issues

§ Lighting

§ Noise levels

§ Textures

3. Organize materials

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§ Accessibility

§ Coding

§ Grouping

4. Use job cards

5. Provide routines

§ Regular

§ Predictable

a) Planning a Routine o What is the routine

o Purpose of the routine

o Task analysis of the routine

o How will the routine be taught

§ visuals

§ written directions

§ backward or forward chaining

§ Write or sketch the routine

b) Forms of communication o Speech/vocalization

o Sign language

o Body language

o Pictures

o Written language

o Behaviour

JOB CARD

Job

1. 2. 3. 4.

ALL DONE

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6. Use desk strips

7. Use schedules

8. Introduce changes gradually using one of the following techniques:

a) Task Analysis o Breaking a large task into smaller sub-‐skills

o Teaching and reinforcing sub-‐skills

o Forward chaining

§ teaching each sub-‐skill in sequence

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o Backward chaining

§ last step in sub-‐skill taught first

b) Shaping Procedures o Shaping behaviours reinforce approximations to the desired behaviour.

o Example: John will be reinforced when he plays for two minutes.

o John will be reinforced when he plays for four minutes. John will be reinforced when he plays for six minutes.

c) Discrete Trial Training o Stimulus

o Prompt

o Response

o Consequence

o Inter-‐trial interval

9. Use written reminders

10. Use First/Then cards

Specific Strategies for: 1. Facilitate Communication:

§ Ensure that a communication system is in place.

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§ Focus on developing interaction.

§ Use clear, concise language.

§ Allow time to process information.

§ Teach listening skills and check comprehension.

§ Use visual supports.

§ Provide social scripts for spoken language.

§ Teach subtleties of tone and intonation.

2. Social Skills

§ Direct teaching

§ Puppets/role playing

§ Cartooning

§ Peer support

§ Social scripts

Example of social script:

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1. Social stories

a) Creating Social Stories o Introduce changes and new routines.

o Explain reasons for others’ behaviour.

o Teach situation-‐specific social skills.

o Assist in teaching new academic skills.

b) Writing social stories: o Descriptive sentences

o Directive sentences

o Perspective sentence

o Formula for writing social stories

§ Two–5 descriptive or perspective statements + 1 directive statement

Examples of social stories: Eating lunch at school:

o Sometimes I eat lunch at school. (Descriptive)

o People feel comfortable when I eat my food nicely. (Perspective)

o Other kids will think I’m friendly when I wait for them to sit down and get their lunch before I start eating. (Perspective)

o I will try to chew my food slowly with my mouth closed. (Directive)

o When I eat slowly with my mouth closed, people will be happy to sit at the same table with me. (Perspective)

Telling a Riddle to Someone

I look at the other person.

I ask, “Do you want to hear a joke?”

If they say, “Yes,” I start.

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If it’s a riddle, I ask the question.

I wait for the other person to find an answer.

When the other person says, “I don’t know,” or doesn’t answer,

I tell them the answer.

When working with ASD students, positive reinforcers are the most effective. There are six types of positive reinforcers:

§ Material reinforcers § Primary/edible reinforcers § Activity reinforcers § Social reinforcers § Sensory reinforcers § Exchangeable reinforcers (token economy)

References Alberta Learning. Special Programs Branch. Teaching Students with Autism Spectrum

Disorders. Edmonton, AB. 2003.

Autism FYI.Com. Does Your Child Suffer From Autism?

Howlin, P. Social & Mental Health: Outcomes for Adults with Autism & Asperger Institute of Psychiatry , King’s College, London, UK. 2008.

Manitoba, Education, Citizenship and Youth. Supporting Inclusive Schools: A Handbook for Developing and Implementing Programming for Students with Autism Spectrum Disorder

Mirenda, P. Positive Behaviour Support & Individuals with Asperger Syndrome. University of British Columbia. 2008

Mirenda, P. A Picture is Worth a Thousand Words. University of British Columbia. 2008.

The Centre for Speech, Language and Occupational Therapy, Inc. What is Autism? 2007.

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Cerebral Palsy (CP) Introduction Cerebral Palsy is a disabling condition. “Cerebral” refers to the brain and “Palsy” refers to a lack of muscle control. CP is neither hereditary nor contagious. CP results from damage to the brain, usually caused by a lack of oxygen. The damage interferes with messages sent from the brain to the body or from the body to the brain and may cause involuntary movement and/or speech, hearing or sight disorders. CP is not progressive, nor is it medically curable. CP is not something an individual will “grow out of.” But a positive attitude and acceptance of the condition by other will enhance the quality of life for the child with CP.

CP can vary from mild speech impairment or no obvious signs to no speech at all and a severe lack of muscle coordination. Many children with CP have normal learning skills and intellectual development and are able to care for themselves and to walk unaided. Other children with CP require very specialized treatment including multi-‐disciplinary care from doctors, occupational therapists, physical therapists, speech pathologists and resource teachers.

Characteristics / Symptoms There are three main types of CP:

1. Spastic—stiff and difficult movement, since muscles are contracted all the time and limbs feel stiff. (50% to 75% of cases)

2. Athetoid—involuntary and uncontrolled movement, as messages from the brain to the muscles are not coordinated. These movements occur all the time and may interfere with speech. (10% to 20% of cases)

3. Ataxic—disturbed sense of balance and depth perception, resulting in awkward and unsteady movements of the hands and feet. (5% to 10% of cases)

There may be a mixture of these types in any one individual diagnosed with CP. (10% of cases) In addition, the lower limbs or one side of the body may be affected more then the other.

Quadriplegia—when a child shows CP in all four of their limbs—both arms and both legs, it is called quadriplegia. Quad means four. Usually children with quadriplegia have trouble moving all the parts of their bodies, their face and trunk as well as their arms and legs, and may need a wheelchair to get around. Because of the problems controlling the muscles in their face and upper body, they also have trouble talking and eating.

Hemiplegia—means that the CP affected one side of the child’s body. Hemi means half, so the right arm and leg or the left arm and leg are affected. The other side of the child’s body

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works just fine. Many kids with hemiplegia are able to walk and run, although they may look a little awkward or have a limp.

Diplegia—some children have CP just in their legs or the CP is much more severe in their legs than in their arms. This is called diplegia. Di means two, so in diplegia only the two lower limbs are affected. The difficulty for children with diplegia is using their legs, so walking and running may be hard for them. Because their upper bodies are usually not affected they have good ability to hold themselves upright and good use of their arms and hands. CP can occur in just the arms but not the legs but this is very, very rare.

Developmental Delays § Deficits in school performance § Deficits in higher level expressive language

Behaviour Uniqueness § Spells of staring § Inconsistent and uneven attention span

Absence of Speech § Difficulty in speaking, swallowing and/or chewing § Speech impairments which makes understanding difficult

Movement / Balance Disorder § Spasmodic, uncontrolled or jerky movements of the limbs, head or face § Rigid, postured limbs § Contracted muscles (may not be able to get the foot flat, with heels down, when

standing or walking)

Seizures About half of all children with CP have seizures might stop moving, stare, fall down, or shake

Sensory Disorder

Possible hearing loss that may result in delayed language development.

Impairment of vision and perception. (Students with this difficulty may not be aware that what they are seeing is any different from what other see.)

Planning

Often needs help organizing daily tasks and materials

Has difficulty in carrying out multi-‐step tasks

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Spatial Memory

Has difficulty navigating from point a to point b

Social Skills and Adaptive Behaviour

Has difficulty with communicating and interacting with peers

Diagnosis

It is the medical doctor that will diagnose CP.

Programming Options Classroom adaptations/modifications:

§ Modify the classroom environment to accommodate the student’s movement. § Become familiar with the student’s primary and preferred methods of

communication. § Schedule bathroom breaks for the student who needs assistance just before class

breaks. § Orient the student to the school, e.g., ramps, bathrooms, elevators. § Learn the language of the student—body gesture, eye movements, and/or sound

that many students with CP use to communicate. § Tape lectures for students with poor motor skills.

Program adaptations/modifications § Utilize assistive technology to achieve full participation in the classroom § Make curriculum adaptations, i.e., fewer questions, longer time to complete tasks § Allow students to tape record answers to tests or type answers, as needed § Writers should be provided for test-‐taking if the student is unable to write (or give

oral tests out of the earshot of other students) § Have Individual Transition Plans (ITPs) from school-‐to-‐adult life include

structured learning experiences, job sampling, career exploration and links to adult services

§ Have Individualized Education Plans (IEP) include activities for daily living including travel options and prevention education

§ Obtain support from other resources, e.g., Cerebral Palsy Association

Augmentative Equipment § Wheelchairs § Walkers § Adapted silverware

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§ Adapted pencils § Book holders § Page Turners § Word Boards § Adapted Desks § Communication Aids § Helmets § Communication board with symbols, words, and letters on it § Computerized communication device with a keyboard, digital display, and/or

voice simulator § Unicorn stick (strapped to the head) or other pointing device

Resources Borowita, K.C. 1994.Children’s Medical Center, University of Virginia

Government of New Brunswick, Department of Education, 2003. www.gnb.ca/education

Greene, 2002, Cerebral Palsy. Retrieved from: www.nichy.org/pubs/factshe/fs2txt.htm

Neurology, Cerebral Palsy. Retrieved from: www.neurologychannel.com/cerebralpalsy

Conduct Disorder (and Oppositional Defiant Disorder) Introduction Conduct disorder is a description of behaviours that tend to cluster together. The essential underlying feature of these behaviours is a repetitive and persistent pattern of behaviours in which the basic rights of others are violated, or majorage-‐appropriate societal norms or rules are violated. One time or short duration behaviours do not fit this category; neither do persistent violations of minor rules or norms.

Conduct disorder is a serious behavioural and emotional disorder that can occur in children and teens. A child with this disorder may display a pattern of disruptive and violent behaviour and have problems following rules.

It is not uncommon for children and teens to have behaviour-‐related problems at some time during their development. However, the behaviour is considered to be a conduct disorder when it is long-‐lasting and when it violates the rights of others, goes against accepted norms of behaviour and disrupts the child’s or family’s everyday life.

The disorder can vary in severity from mild, to moderate, to severe.

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According to U.S.A. statistics, it is estimated that 2%-‐16% of children have conduct disorder. It is more common in boys than in girls and most often occurs in late childhood or the early teen years.

Although it may not be possible to prevent conduct disorder, recognizing and acting on symptoms when they appear can minimize distress to the child and family, and prevent many of the problems associated with the condition. In addition, providing a nurturing, supportive, and consistent home environment with a balance of love and discipline may help reduce symptoms and prevent episodes of disturbing behaviour.

Oppositional defiant disorder (ODD) is the milder version of a conduct disorder is typically diagnosed earlier. Children with ODD show a pattern of disobedient, hostile, defiant behaviour toward authority figures such as parents, teachers, daycare workers etc. Symptoms include refusing to follow rules, deliberately annoying others, arguing often, blaming others for mistakes, difficulty making or keeping friends, discipline problems at school, acting spitefully or seeking revenge, and being touchy or easily annoyed. Some research suggests that approximately half of children with untreated ODD will continue to have the behaviour years later and about half of those kids (about 1/4 of the original group) will progress to conduct disorder.

Characteristics/Symptoms

Symptoms of conduct disorder fall into four general categories: 1. Aggressive behaviour. These are behaviours that threaten or cause physical harm

and may include fighting, bullying, being cruel to others or animals, using weapons, and forcing another into sexual activity.

2. Destructive behaviour. This involves intentional destruction of property such as arson (e.g., deliberate fire-‐setting) and vandalism (e.g., harming another person’s property).

3. Deceitful behaviour. This may include repeated lying, shoplifting, or breaking into homes or cars in order to steal.

4. Violation of rules. This involves going against accepted rules of society or engaging in behaviour that is not appropriate for the person’s age. These behaviours may include running away, skipping school, playing pranks, or being sexually active at a very young age.

Other Symptoms § Irritable § Low self-‐esteem § Tend to throw frequent temper tantrums § Abuse drugs and/or alcohol. Children with conduct disorder

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§ Unable to appreciate how their behaviour can hurt others § Have little guilt or remorse about hurting others

Diagnosis It is important to point out that conduct disorder is not a diagnosis but a descriptor of a cluster of behaviours. It is not uncommon for people to use the term as if it is a diagnosis with implications that are not relevant. A diagnosis should communicate at least four types of information:

§ 1) presentation, or how it looks now § 2) etiology, or cause § 3) prognosis, or how it will unfold over time, and § 4) treatment guidelines.

Children who are suspected of having conduct disorders need to be referred to their family doctor. Mental illnesses in children are diagnosed based on signs and symptoms that suggest a particular problem. If symptoms of conduct disorder are present, the doctor may begin an evaluation by performing complete medical and psychiatric histories. A physical exam and laboratory tests (for example, neuroimaging studies, blood tests) may be appropriate if there is concern that a physical illness might be causing the symptoms. The doctor will also look for signs of other disorders that often occur along with conduct disorder, such as ADHD and depression.

If the doctor cannot find a physical cause for the symptoms, he or she will likely refer the child to a child and adolescent psychiatrist or psychologist, mental health professionals who are specially trained to diagnose and treat mental illnesses in children and teens. Psychiatrists and psychologists use specially designed interview and assessment tools to evaluate a child for a mental disorder. The doctor bases his or her diagnosis on reports of the child’s symptoms and his or her observation of the child’s attitudes and behaviour. The doctor will often rely on reports from the child’s parents, teachers, and other adults because children may withhold information or otherwise have trouble explaining their problems or understanding their symptoms.

If the child is displaying symptoms of conduct disorder, it is very important that parents seek help from a qualified doctor. A child or teen with conduct disorder is at risk for developing other mental disorders as an adult if left untreated. These include antisocial and other personality disorders, mood or anxiety disorders, and substance use disorders.

Programming Options It is common with conduct disorders that there are multiple problems and co-‐ morbidities. It is also well demonstrated that addressing one of the problems successfully is unlikely to

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impact the other problem areas. Each difficult area must be specifically identified and addressed if there is to be any expectation that that area will improve.

Treatment for conduct disorder is based on many factors, including the child’s age, the severity of symptoms, as well as the child’s ability to participate in and tolerate specific therapies.

Early intervention may help to reduce the risk for incarcerations, mood disorders, and the development of other comorbidities such as substance abuse.

Treatment Usually Consists of a Combination of the Following: 1. Psychotherapy: (a type of counselling) is aimed at helping the child learn to

express and control anger in more appropriate ways. A type of therapy called cognitive behavioural therapy aims to reshape the child’s thinking (cognition) to improve problem solving skills, anger management, moral reasoning skills, and impulse control. Family therapy may be used to help improve family interactions and communication among family members. A specialized therapy technique called parent management training (PMT) teaches parents ways to positively alter their child’s behaviour in the home.

2. Medication: Although there is no medication formally approved to treat conduct disorder, various drugs may be used to treat some of its distressing symptoms, as well as any other mental illnesses that may be present, such as ADHD or major depression.

Helpful Strategies of Dealing with Conduct Disorders (in Preschool Children): § Head Start Programs § Dealing with temperament and goodness of fit § Parental effectiveness

Helpful Strategies of Dealing with Conduct Disorders (in School Age Children): § Parenting skills training § Training the child in peer relationship skill § Academic skill development § Social skills training § Problem solving skill training § Multi-‐systemic Therapy (MST) for violent conduct disorders (especially in

adolescents)

Unhelpful Strategies of Dealing with Conduct Disorders (any age) § Boot camps

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§ Shock incarceration § Isolated medication trials § Psychiatric hospitalization § Cognitive behavioural interventions that are limited in number of sessions § Individual psychodynamic psychotherapy

Recommended Guidelines for Treatment Teams 1. Conduct a thorough assessment using multiple informants to identify all

significant problems (e.g., delinquent behaviours, substance abuse, learning disability, reading difficulties).

2. Identify strengths and resiliency factors of the youth, family, and community on which to build successful strategies.

3. Identify each problem domain and plan specific interventions for all of them.

4. Be prepared to maintain interventions for a long period of time.

5. The Treatment Team should be sufficiently broad-‐ based to cover the range of needed skills, services, funding, and supports. This should include members from the domain of public safety (e.g., juvenile justice, police).

6. The Coordinated Service Plan

§ Will need to include supervision and monitoring as part of the public safety component. Who provides and pays for it in the home, school, and community may vary by child and situation.

§ Should include cognitive behavioural therapy, but not individual psycho -‐dynamic psychotherapy; and

§ Should be designed to change and demonstrate progress over an extended period of time.

7. Families are important members of the successful Treatment Team; it is critical to assign them a realistic role for this type of situation. If the child is young, refining parenting skills through training can be beneficial. If the child is an adolescent, the family will need to share the responsibilities for supervision and monitoring with other team members, especially members from the public safety domain.

*Remember that the vast majority of youth with these types of problems do not carry them into adult life, and these issues exist along a spectrum, with most youth in the mild to moderate range and amenable to treatment.

Resources / References http://www.webmd.com/mental-‐health/mental-‐health-‐conduct-‐disorder

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http://mentalhealth.vermont.gov/sites/dmh/files/publications/DMH-‐CAFU_Conduct_Disorder_Treatment.pdf

Conduct Disorders: The Latest Assessment and Treatment Strategies by J.M. Eddy

Conduct Disorder by B.G. Hollander

Oppositional Defiant Disorder and Conduct Disorder by W. Matthys & J.E. Lochman

Depression Introduction Childhood and adolescent depression has increased dramatically in the past 40 to 50 years. During childhood the number of boys and girls affected are almost equal. But in adolescence, as in adulthood, twice as many girls as boys are diagnosed with depression. Well over half of all depressed adolescents have a recurrence of depression within seven years. Children who suffer with major depression have an increased incidence of Bipolar Disorder and recurrent Major Depression.

As with adult depression, the symptoms are similar. The criteria for childhood and adult Major Depression are also the same. Because many children do not have the vocabulary to adequately express their feelings, they often express their feelings through behaviour. Also, younger children with depression are more likely to show phobias, separation anxiety disorder, somatic complaints and behaviour problems.

With psychotic depression, children are more likely to report hallucinations while older adolescents, like adults with psychotic depression, are more likely to have delusions. (Delusions require more advanced cognitive functioning than simple hallucinations)

Characteristics Preschool or young elementary age

The child might look serious or vaguely sick. He might be less bouncy or spontaneous. While other children would become tearful or irritable when frustrated, this child may show these states spontaneously. He may say negative things about himself and may be self-‐destructive.

Older elementary school through adolescence

The adolescent may present with academic decline, disruptive behaviour, and problems with friends. Sometimes one can also see aggressive behaviour, irritability and suicidal talk. The parent may say that the adolescent hates himself and everything else.

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Diagnosis It usually takes more time to diagnose Major Depression in a child than it does to diagnose an adult. The diagnostic process should include interviews of parents and the child. Even if the child is only living with one parent, both parents should be interviewed. Parents are more likely to report outward signs of depression. There should also be a recent physical for the child. Although this is usually done by the primary care physician, the psychiatrist may do the screening of neurological and relevant parts of a physical exam.

The psychiatrist will ask about the developmental history and about the existence of other psychiatric conditions.

Program Options There is no cookbook technique. Treatment must be tailored to the needs and schedule of the child and his family. Generally, with mild to moderate depression, one first tries psychotherapy and then adds an antidepressant if the therapy has not produced enough improvement. If it is a severe depression, or there is serious acting out, one may start medication at the beginning of the treatment.

Resources Watkins,C. Depression in Children and Adolescents, November 23, 2005. Retrieved from:

http://www.baltimorepsych.com/cadepress.htm#Depression%20in%20Children%20and%20Adolescents

Down Syndrome Introduction Down syndrome (DS), also known as Trisomy 21, is a condition in which extra genetic material causes delays in the way a child develops, both mentally and physically. Down Syndrome is a chromosomal disorder caused by an error in cell division that results in the presence of an additional third chromosome (an extra part or full 21st chromosome), whereas individuals have 47 chromosomes instead of the usual 46 chromosomes. Down Syndrome is named after John Langdon Down, the first British doctor who first described the condition in 1887. It affects about one in every 800-‐1,000 live births. Down Syndrome is the most frequent genetic cause of mild to moderate intellectual and developmental disabilities and associated medical problems.

Characteristics / Symptoms Individuals with DS share some typical physical features:

§ Flat facial profile (flat nose and head) § Upward slant to the eyes

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§ Small or abnormal outer ears § Protruding tongue § Low muscle tone (may contribute to sucking and feeding problems, as well as

constipation and other digestive issues) § Shortened hands and neck § Poor immune function § At risk for a number of other health problems (i.e., congenital heart disease,

leukemia, thyroid disorders, mental illness)

Along with physical features, the extra genetic material causes developmental delays: § Mild to moderate intellectual impairment (the average IQ of a young adult with DS

is 50, which is equivalent to the mental age of an 8 or 9 year old child, but this varies widely)

§ Slower growth rate and tend to remain smaller than their peers § Will reach developmental milestones at a later point in time than their peers § Delay in self-‐care skills (i.e., feeding, dressing, toilet training) § Delay in speech and language

The physical features and medical problems associated with DS can vary greatly from child to child. While some students with DS need a lot of medical attention, others lead healthy lives.

Diagnosis Down Syndrome can be detected before a child is born. Down syndrome can be identified during pregnancy by prenatal screening followed by diagnostic testing, or after birth by direct observation and genetic testing.

Programming Options Students with DS can and do learn. They are capable of developing skills throughout their lives. They simply reach goals at a different pace, which is why it is important not to compare a student with DS against typically developing siblings or even other students with the condition. Students with DS have a wide range of abilities, and there is no way to tell at birth what they will be capable of as they grow up. The health problems that can go along with DS can be addressed.

Students with DS should be full members of age-‐appropriate classes to the extent they can be. Effective inclusion means that the teacher must be fully supportive of the model. The strategies teachers use to reach and teach the student with DS will often be beneficial to many learners in the classroom. An inclusive environment is less likely to stigmatize and provide a much more natural environment for the student. There are more opportunities

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for positive peer relationships to develop. Much of the research states that full integration of students with DS within the regular classroom works best.

Individualized education planning (IEP) will most likely be necessary for the duration of the student’s school career. Careful planning with the parents can lead to a rich and rewarding school experience for the student with DS. Some topics that might be addressed in the IEP can include:

Intellectual Concerns § Students with DS usually face many intellectual challenges. Strategies that work

for mild to moderately intellectually challenged students will also for with students with DS. Always strive to move the student progressively along the learning continuum and never assume the student is not capable. Solid intervention and high quality instruction have been proven to lead to improved academic achievement for students with DS.

§ Some suggestions for teaching students with DS include: o Implement a multi-‐modal approach. o Use as many concrete materials and real-‐world authentic situations as

possible. o Talk using language appropriate for student understanding. o Speak slowly when necessary. o Break tasks into smaller steps and provide instruction for each step.

Speech and Language Issues § Students with DS can experience hearing difficulties and articulation problems.

Sometimes a speech/language assessment and direct instruction are necessary. In some cases, augmentative or facilitated communication will be a required alternative for communication, depending on the severity of the student’s communication problem. Use patience and model appropriate interactions at all times.

Behaviour Planning § Behaviour planning and discipline used for other students should not differ for the

student with DS. Down Syndrome should never be viewed as an excuse for poor behaviour, as students with DS need to be taught (as with all children) how to behave in appropriate ways. Positive reinforcement is a much better method than punishment. Reinforcers and rewards need to be meaningful.

Self-‐Esteem § The physical characteristics and intellectual challenges of a student with DS will

often result in a lowered self-‐esteem, which means educators will need to take

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every opportunity to boost self-‐confidence and foster self-‐worth through a variety of strategies.

Resources / References http://Studentshealth.org/parent/medical/genetic/down_syndrome.html

http://specialed.about.com/od/disabilities/a/downs.htm

Chamberlain, C.E. & Strode, R.M. (1999). The source for down syndrome. East Moline, IL: Linguisystems.

Gearheart, B.R., Weishahn, M.W. & Gearheart, C.J. (1996). The exceptional student in the regular classroom. Upper Saddle River, NJ: Prentice Hall, Inc.

National Association for Down Syndrome www.nads.org/

National Association of School Psychologists: “Helping Children at Home and School II: Handout for Families and Educators”

National Down Syndrome Congress www.ndsccenter.org

Oelwein, P.L. (2008). Teaching reading to children with down syndrome: A guide for parents and teachers. Bethesda, MD: Woodbine House.

Dysgraphia Introduction Dysgraphia means difficulty with handwriting. Dysgraphia can interfere with a student’s ability to express ideas. Expressive writing requires a student to synchronize many mental functions at once: organization, memory, attention, motor skill, and various aspects of language ability. Automatic accurate handwriting is the foundation for efficient writing. In the complexity of remembering where to put the pencil and how to form each letter, a student with dysgraphia forgets what he or she meant to express. Dysgraphia can cause low classroom productivity, incomplete homework assignments, and difficulty in focusing attention.

There are several different kinds of dysgraphia. 1. Dyslexic: spontaneously written text is illegible, especially when the text is

complex. Oral spelling is poor, but drawing and copying of written text are relatively normal. Finger-‐tapping speed (a measure of fine-‐motor speed) is normal.

2. Motor: both spontaneously written and copied text may be illegible, oral spelling is normal, and drawing is usually problematic. Finger-‐tapping speed is abnormal.

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3. Spatial: illegible writing, whether spontaneously produced or copied. Oral spelling is normal. Finger-‐tapping speed is normal, but drawing is very problematic.

In all cases of dysgraphia, writing requires inordinate amounts of energy, stamina, and time. A few people with dysgraphia lack only the fine-‐motor coordination to produce legible handwriting, but some may have a physical tremor that interferes with writing. In most cases, however, several brain systems interact to produce dysgraphia. Some experts believe that dysgraphia involves a dysfunction in the interaction between the two main brain systems that allows a person to translate mental into written language (phoneme-‐to-‐grapheme translation, i.e., sound to symbol, and lexicon-‐to-‐grapheme translation, i.e., mental to written word). Other studies have shown that split attention, memory load, and familiarity of graphic material affect writing ability. Typically, a person with illegible handwriting has a combination of fine-‐motor difficulty, inability to re-‐visualize letters, and inability to remember the motor patterns of letter forms.

Characteristics/Symptoms § Handwriting that is often illegible and shows irregular and inconsistent letter

formations § Writing may be legible, but it was completed very slowly and/or is very tiny § Printing is a random mixture of upper and lowercase letters

Diagnosis Dysgraphia cannot be diagnosed solely by looking at a handwriting sample. A qualified clinician must directly test the individual. Such a test includes writing self-‐generated sentences and paragraphs and copying age-‐appropriate text. The examiner assesses not only the finished product, but also the process, including posture, position, pencil grip, fatigue, cramping, or tremor of the writing hand, eyed-‐ness and handedness, and other factors. The examiner may assess fine-‐motor speed with finger tapping and wrist turning.

Programming Options 1. Prevention (kindergarten and Grade One)

§ Early training in correct letter formation

2. Remediation

§ Muscle training and over-‐learning good techniques in specifically designed fine-‐motor exercises to increase strength and dexterity – letter formation in isolation

§ Kinesthetic writing (writing with eyes closed or averted)

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§ Letters of alphabet and numbers often need to be practiced daily for months to mastery

§ Teach cursive writing instead of printing, because it has many more advantages

3. Adaptations

§ Use a word processor

§ Experiment using a variety of writing tools

§ Pencil grips may be helpful

§ Allow student to answer questions orally

§ Have student tape record their answers instead of writing them

§ Reduce amount of written assignments so less writing is required

§ Allow extended time to complete written assignments and tests

§ Reduce or eliminate copying tasks (provide notes instead)

§ Provide outlines with spaces left for students to fill in blanks

§ Write on an incline

Resources/References Deuel, Ruthmary K., M.D. Developmental Dysgraphia and Motor Skills Disorders. Journal of

Child Neurology,Vol. 10, Supp.1. January 1995, pp. S6-‐S8.

The International Dyslexia Association Tel: 410-‐296-‐0232 • Fax: 410-‐321-‐5069 • Website: http://www.interdys.org

Dyslexia Introduction Dyslexia is a specific learning disability that is neurological in origin. Close to equal numbers in both boys and girls are born with dyslexia. Dyslexia is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction (Lyon, Shaywitz, & Shaywitz, 2003).

Dyslexia is not caused by poverty, developmental delay, speech or hearing impairments, or learning a second language, although these conditions can contribute to developing a reading disability (Snow, Burns, & Griffin, 1998). People with dyslexia might have trouble naming a letter, but letters do not look backwards. People with dyslexia are usually not only very smart but also really creative. They also have extensive oral vocabularies.

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Dyslexia does not only affect people who speak English. Dyslexia appears in all cultures and languages in the world with written language, including those that do not use an alphabetic script such as Korean and Hebrew. In English, the primary difficulty is accurate decoding of unknown words. In consistent orthographies such as German or Italian, dyslexia appears more often as a problem with fluent reading—readers may be accurate, but very slow (Ziegler & Goswami, 2005).

People with dyslexia can get any job they want! Even though dyslexia makes some things harder, there are people with dyslexia in all kinds of jobs, e.g., actor, Whoopie Goldberg; writer, John Irving; financial guru, Charles Schwab; basketball star, Magic Johnson, actor, Orlando Bloom.

Characteristics / Symptoms (Bright Solutions for Dyslexia)

In Preschool § Delayed speech § Mix up the sounds and syllables in long words § Chronic ear infections § Severe reactions to childhood illnesses § Constant confusion of left versus right § Late establishing a dominant hand § Difficulty learning to tie shoes § Trouble memorizing their address, phone number, or the alphabet § Cannot create words that rhyme § A close relative with dyslexia

In Elementary School § Dysgraphia (slow, non-‐automatic handwriting that is difficult to read) § Letter or number reversals continuing past the end of first grade § Extreme difficulty learning cursive § Slow, choppy, inaccurate reading:

o Guesses based on shape or context o Skips or misreads prepositions (at, to, of) o Ignores suffixes o Can’t sound out unknown words

§ Terrible spelling

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§ Often cannot remember sight words (they, were, does) or homonyms (their, they’re, and there)

§ Difficulty telling time with a clock with hands § Trouble with math

o Memorizing multiplication tables o Memorizing a sequence of steps o Directionality

§ When speaking, difficulty finding the correct word o Lots of “whatyamacallits” and “thingies” o Common sayings come out slightly twisted

§ Extremely messy bedroom, backpack, and desk § Dreads going to school

o Complains of stomach aches or headaches o May have nightmares about school

In High School (all of the above symptoms plus) § Limited vocabulary § Extremely poor written expression § Large discrepancy between verbal skills and written compositions § Unable to master a foreign language § Difficulty reading printed music § Poor grades in many classes § May drop out of high school

In Adults (education history similar to above, plus) § Slow reader § May have to read a page 2 or 3 times to understand it § Terrible speller § Difficulty putting thoughts onto paper

o Reads writing memos or letters § Still has difficulty with right versus left § Often gets lost, even in a familiar city § Sometimes confuses b and d, especially when tired or sick

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Identification Dyslexia is not a disability that is diagnosed because it is not a medical condition, but an educational condition. Students as young as age 5½ years of age can be identified as having dyslexia by an individual qualified as having dyslexia expertise (i.e., dyslexia screener, dyslexia consultant). Someone specializing in dyslexia can identify whether a student displays a typical profile of dyslexia based on the student’s history, background, behaviours, assessments, and work samples. There is not a single ‘magic test’ that assesses for dyslexia, nor can dyslexia be properly identified through school psychologists, speech/language pathologists or reading clinicians, unless those professionals specialize in dyslexia. Not all reading clinicians specialize in dyslexia either, so check a professional’s credentials as to whether he/she specializes in dyslexia before pursuing dyslexia assessment or consultation.

In the classroom setting when students demonstrate the following difficulties, the ‘red flags’ of concern for dyslexia should be raised.

Decoding Students with dyslexia tend to attempt to identify unknown words but produce many errors because they lack decoding strategies. They are not efficient in using letter–sound relationships in combination with context to identify unknown words. These problems in word recognition are due to an underlying deficit in the sound component of language that makes it very difficult for readers to connect letters and sounds in order to decode. People with dyslexia often have trouble comprehending what they read because they have great difficulty decoding words.

The following are some typical reading difficulties: § Can read a word on one page, but will not recognize it on the next page § Will read words in context better than reading words in isolation § Have been taught phonics but will struggle to applying phonic knowledge to sound

out an unknown word § Reading comprehension may be low due to spending so much energy trying to

figure out the words, however, listening comprehension is usually significantly higher than reading comprehension

§ Become visibly tired after reading for only a short time

The following are some typical reading errors: § Substitutions

o Words that have similar letters but out of sequence (e.g., who-‐how, lots-‐lost, saw-‐was

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o Words with similar shape (e.g., form-‐from, trial-‐trail, sunrise-‐surprise, house-‐horse, while-‐white, wanting-‐walking)

o Semantic -‐ words that mean the same but do not look similar (e.g., trip-‐journey, fast-‐speed, cry-‐weep)

o Misreads, omits, or adds small function words (e.g., as, an, a, from, the, to, were, are, of)

o Suffixes (e.g., talks for talking) o Insert letters (e.g., could-‐cold) o Omit letters (e.g., star-‐stair) o Omits suffixes (e.g., need-‐needed, late-‐lately) o Directionality confusion (e.g., b-‐d, p-‐q, n-‐u, m-‐w, g-‐j)

Fluency Students with dyslexia have difficulties when asked to read text at their grade level. They will not be able to read as many of the words in a text by sight as average readers. There will be many words on which they stumble, guess at, or attempt to “sound out.” When reading aloud, they tend to read in a slow, choppy manner (not in smooth phrases) and will often ignore punctuation.

Spelling Students with dyslexia often spell worse than they read. They have extreme difficulty hearing sounds in words and keeping the sounds in sequence. Vowel sounds are very difficult because they are abstract and are inconsistent.

The following are some common spelling difficulties: § With enormous effort, they may be able to “memorize” Monday’s spelling list long

enough to pass Friday’s spelling test, but they will not spell those very same words two hours later when writing those words in sentences

§ Misspell when copying from the board or from a book § Written work shows signs of spelling uncertainty (e.g., numerous erasures, cross

outs) § Misspell high frequency sight words (e.g., they, what, where, does, because)

despite extensive practice § Vowels – will leave them out or will write the incorrect vowel

Other Difficulties § Memorizing random facts and arbitrary information (e.g., alphabet, multiplication

tables)

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§ Sequencing tasks (e.g., learning to tie shoe laces, locker combinations) § Learning to tell time on an analogue clock § Directionality (e.g., distinguishing left from right, North and South) § Directionality vocabulary (e.g., over-‐under, before-‐after) § Confusing similar looking letter pairs, e.g., b-‐d, b-‐p, p-‐q, or g-‐j § Saying sounds out of order in multi-‐syllable words (e.g., aminal for animal,

bisghetti for spaghetti, hekalopter for helicopter, hangaberg for hamburger, mazageen for magazine)

§ Organizational tasks § Following 2-‐ or 3-‐step oral instructions § Word retrieval – will have difficulty summoning an oral response on demand

For more information, see “Warning Signs of Dyslexia” by Bright Solutions for Dyslexia

Programming Options Identification Having a student properly identified as having dyslexia is an ideal situation. However, proper identification involves complete disclosure, cooperation, and support from the parents. Birth history is a major part of the identification process so parents have to be willing to provide the necessary information to the dyslexia screener. Screening for dyslexia must involve the parent so, if the parent is unwilling to provide the screener with the necessary information, the screener cannot continue with the dyslexia screening process.

A dyslexia screening will also be beneficial because the screening report will indicate to what severity the student has dyslexia, as dyslexia presents itself on a spectrum of mild to moderate to severe to profound. The level of severity is important because this will gauge how long it will take for the student to bring his/her skills to grade level.

Tutoring and Intervention

Reality dictates that, under some circumstances, parents will not be willing to disclose information about their child’s history, for whatever reasons they may have. Educators need not despair, as students do not need to be assessed by a dyslexia specialist to obtain appropriate intervention.

Students with dyslexia need different programming, not more of the same traditional classroom teaching of reading and spelling. The only method recommended by the International Dyslexia Association proven to teach students with dyslexia to read and write is an Orton-‐Gillingham (O-‐G) method. O-‐G methods provide explicit, intense, systematic instruction in the sound structure of language (phonemic awareness) and teach how sounds relate to letters (alphabetic principle, phonics).

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Program Resources Some Orton-‐Gillingham programs include:

Barton Reading & Spelling System Designed for one-‐on-‐one tutoring of children, teenagers and adults by parents, volunteer tutors, reading or resource specialists or their aides, and professional tutors. The Barton System is the easiest one to learn because all of the tutor training comes on DVD, along with fully scripted lesson plans. Published by Bright Solutions for Dyslexia in California. (408) 559-‐3652

www.BartonReading.com

Orton-‐Gillingham The pure, unchanged, original method. Taught by Eileen Faggiano, Orton-‐Gillingham Associates, in Massachussetts.

(781) 934-‐5548

Slingerland Designed for classroom settings of young children in the first, second, and third grades. The Slingerland Institute is in Washington

(425) 453-‐1190 www.Slingerland.org

MTA (Multi-‐sensory Teaching Approach) Edmar Educational Services in Texas

(972) 552-‐1090 www.MTSEdmar.com

Alphabetic Phonics (updated version is called “Take Flight”) Texas Scottish Rite Hospital for Children in Texas

(214) 559-‐7800 www.tsrhc.org

Wilson Reading System Wilson Language Training Corporation in Massachussetts

(800) 899-‐8454 www.WilsonLanguage.com

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Language! Sopris West, which was acquired by Cambium Learning Group

(800) 547-‐6747 www.SoprisLearning.com

Project Read by Enfield and Greene, published by The Language Circle in Minnesota

(612) 884-‐4880 www.ProjectRead.com

Recipe for Reading Published by Educators Publishing Service

(516) 242-‐8943 eps.schoolspecialty.com/products/details.cfm?seriesonly=491M

Preventing Academic Failure (PAF) Published by Educators Publishing Service

(845) 279-‐8810 www.PAFProgram.com

Schools need not order all the O-‐G programs listed above, but they should have one O-‐G system in place to provide intervention for students with identified or suspected dyslexia.

Some students have auditory discrimination and/or auditory memory problems that make beginning an Orton-‐Gillingham based system an inappropriate intervention. These populations of students need a program designed to explicitly teach these necessary skills, which are prerequisites to beginning an O-‐G program. The prerequisite program is called Lindamood-‐Bell Phoneme Sequencing (LiPS). It used to be called “Auditory Discrimination in Depth.” The program is similar to speech therapy. LiPS is the only proven research-‐based program to help with auditory discrimination difficulties. Once students gain success with this program, they will benefit from an Orton-‐Gillingham based program.

You can find out more information on LiPS from http://www.lindamoodbell.com/programs/lips.html

One method to determine whether a student is able to begin an Orton-‐Gillingham based program is the “Barton Student Screening” available FREE at:

www.bartonreading.com. Click on the “Students” link then choose “Student Screening.” You must be able to pass the “Tutor Screening” first so complete this task first. Once you pass the Tutor Screen, print a copy of the “Scoring Sheet” then watch Susan Barton’s video on how she screens students. Practice screening colleagues or other individuals a few times

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before you screen a student for real so you are accurate and know how to screen and score the screen (see “Student Screening Answer Sheet”).

Provide Adaptations

Adaptations are adjustments to how teachers teach, the materials they use, and the way they assess students with dyslexia. Adaptations are provisions so that students with dyslexia can access the provincial curriculum. Because students with dyslexia have difficulties in language processing, word retrieval, directionality, and organization, adaptations are necessary so they can survive daily in the classroom.

For in-‐depth information on providing adaptations, see “Adaptations for Students with Dyslexia” by Richelle Lovegrove, Reading Clinician, MFNERC (May & November 2013).

The template for Sample Adaptation Checklist for Students with Dyslexia, Oral Reading Error Checklist and Spelling Error Checklist can be found in FNSEPH’s Section O.

Resource / References Ball-‐Dannenberg, S. I Have Dyslexia. What Does That Mean?

Eide, B. & Eide, F. The Dyslexic Advantage: Unlocking the Hidden Potential of the Dyslexic

Foss, B. The Dyslexia Empowerment Plan: A Blueprint for Renewing Your Child’s Confidence and Love of Learning

Gorman, C. , Caudros, P., Scully, S. & Song, S. (2003). “The New Science of Dyslexia.” Time Magazine, 162 (4), p. 1-‐10.

Mather, N. & Wendling, B.J. Essentials of Dyslexia Assessment and Intervention

Moats, L.C. & Dakin, K.E. Basic Facts About Dyslexia & Other Reading Problems

Richards, R,G. (1999). The source for dyslexia and dysgraphia. East Moline, IL: Linguisystems.

Rief, S.F. & Stern, J.M. (2010). The dyslexia checklist: A practical reference for parents and teachers. San Francisco, CA: Jossey-‐Bass.

Shaywitz, S. (2003). Overcoming dyslexia: A new and complete science-‐based program for reading problems at any level. Toronto, ON: Random House of Canada Ltd.

Vail, P. About Dyslexia: Unraveling the Myth.

www.interdys.org

www.dyslexia.yale.edu

www.dys-‐add.com

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Executive Dysfunction (EDF) Introduction Executive dysfunction can lead to a variety of problems with academics and behaviour. Everyday tasks like sharing, taking turns, picking up on subtle social cues and staying attentive in class can be very difficult for kids who struggle with executive skills. And when children and teens falter in these basic social interactions, it can hurt them socially—isolating them from peers and making it difficult for them to make and keep friends. Difficulties in the social realm can cause students pain and embarrassment.

Executive Dysfunction (EDF) is a term used to refer to regulatory disorders referring to abnormality in executive functioning which happens in the orbital frontal cortex of the brain. Issues related to ADHD, OCD, Tourettes, explosiveness, chronic non-‐compliance, autism and sensory dysfunction are biologically rooted in the brain.

Children with EDF may be oppositional and not able to follow rules like other students. They may be constantly challenging authority and may be overly active, may have difficulty focusing and may need one-‐on-‐one instruction and assisting with organization and completing educational projects. They may also require adaptation in the manner in which you test for learned material.

Characteristics § Difficulty initiating, shifting, inhibiting and sustaining. personal actions § Mood instability, concrete rigid black and white thinking § Difficulty with working memory § May have frequent outbursts, are often frustrated § Need coaching or constant cueing for multi-‐step activities § Difficulty in behaving in socially acceptable ways, e.g., saying “the wrong thing at

the wrong time,” running into things and people, talking rapidly and excessively, continuing to roughhouse after peers have stopped)

§ Difficulty with solving interpersonal problems § Difficulty with considering the consequences of his/her behaviours § Difficulty with understanding non-‐verbal communication, et. everything from

facial expression and tone of voice to interpretation of what others say § Difficulty with adapting to new social situations § Difficulty with handling frustration and tolerating failure

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Diagnosis The term Executive Dysfunction is identified through psychological testing and medical testing such as an EEG. A combination of psychological, medical and education professionals can be useful in making this diagnosis.

Programming Options Employ a variety of classroom adaptations / accommodations / modifications similar to the adaptations / accommodations / modifications for those students who have a diagnosis of ADHD, OCD and or Tourettes Syndrome.

A sample list of cues follows below:

Visual Cues to Enhance Organization § Writing the daily schedule on the board § Teachers can check off each item on the board throughout the day and edit the

schedule to point out/highlight changes in the usual routine § Use a visual list or organizer at home § Use day planners or agendas (either hard copy or electronic) for individual days

or weeks

Cognitive Cues § Colour code school books so that all “science” books, workbooks, and notebooks

are one colour, while all “social studies” books and materials are another colour § Utilize mnemonics wherever possible, e.g., “CLIPS” reminds them to check for:

Capitalization, Leave space between words, Ideas complete, Punctuation, Spelling

Managing Materials and Belongings § Maintain an extra stash of supplies that the student can access when he/she

cannot find his/her own § Schedule a weekly time when the student will clean out his/her desk, backpack

and locker

Resources Parker, Leslie, http://www.tourettesyndrome.net/ef_tips_time.htm

How Executive Dysfunction Can Cause Trouble Making Friends

Packer, L. EDF: Environmental Cues, Supports, & Strategies

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Fetal Alcohol Spectrum Disorder (FASD) Introduction Alcohol affects the fetus. Alcohol consumed by the mother passes freely through the placenta to her child. Since the fetus is in an insulated state the fetus’s blood alcohol level can actually be higher than the mother’s alcohol level. The fetus’ ability to decrease and eliminate the alcohol level is at a much slower rate than that of the mother’s.

Alcohol affects the baby’s brain whether the mother is only taking an occasional drink, is drinking daily or is binge drinking. Drinking any amount of alcohol during a pregnancy can cause damage that is like buck shot—scattered holes. These scattered holes occur in whatever area is developing at the time of alcohol consumption causing the death of brain cells, or migration of brain cells to the wrong place or tangles in the neurons with inaccurate connections. Regular drinking in any amounts causes continuous damage.

There is no cure for FASD’s. It is found in all economic and racial groups. FASD is not genetic or inherited. There is no definitive information regarding a safe quantity of alcohol. FASD is one of the leading causes of preventable birth defects and developmental delays. It is a lifelong disability and often has overlapping disabilities such as Attention Deficit Disorder (ADHD), Attachment Disorder, Autism, Oppositional Defiant Disorder and Conduct Disorder.

There are also secondary disabilities associated with FASD: § 95% will have mental health problems § 68% will have disrupted school experiences § 68% will experience trouble with the law § 55% will be confined to prison, treatment centres or institutions § 52% will exhibit inappropriate sexual behaviour § More than 50% of males and 70% of females will have alcohol/drug problems § 82% will not be able to live independently § 70% will have problems with employment

Characteristics § Facial anomalies § Short palpebral tissues § Flat upper lip § Flatten philtrum § Growth retardation § Low birth weight for gestational age

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§ Decelerating weight over time not due to nutrition § Disproportional low weight to height § CNS neurodevelopment abnormalities

o Decreased cranial size at birth o Structural brain abnormalities o Neurological hard or soft signs (fine motor)

§ Developmental delays o Deficits in school performance o Deficits in higher level receptive and expressive language o Poor capacity for abstraction or metacognition o Specific deficits in mathematical skills or problems in memory

§ Behaviour Uniqueness o Poor impulse control o Attention judgment o Problems in social perception

§ Creative intelligence (artistic, musical) § Perseverance(determined, willing, energetic, committed hard workers) § Highly moral (deep sense of fairness, rigid belief systems)•Strong sense of self § Friendly and trusting § Loyal, loving, affectionate, gentle § Tactile, cuddly § Concerned, sensitive

Diagnosis Because of the complexity and the range of expression of dysfunction related to prenatal alcohol exposure, a multi-‐disciplinary team is essential for an accurate and comprehensive diagnosis and treatment recommendations. The core team is made up of a physician specifically trained in FASD diagnosis, psychologist, occupational therapist, speech language pathologist and may also have some or all of the following members also: geneticist, nurse, neuropsychologist, family therapist, psychiatrist, mental health worker, addiction counsellors, etc. The team must follow the Public Health Agency of Canada guidelines to give an official diagnosis of FASD.

Program Options Classroom adaptations/modifications:

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§ Keep classroom movement to a minimum since FAS students become easily overwhelmed with the physical movement of more than 15 other people in a room.

Reading Strategies: § Debug the book, e.g., give a brief summary and point out unfamiliar words § Audio tape the book § Have the student follow along with their finger as the book is being read § Select topics of high interest of the student § Use window overlays to focus student’s attention § Use page summaries to assist with long-‐term memory retention § Have the student draw pictures about the paragraphs read § Paraphrase instructions using simple language § Break down instructions into smaller steps § Have the students repeat the instructions back to you § Highlight main points and reprint these main points § Use three dimensional shapes for letters § Teach directional skills § Allow students to sit or lay on the floor while reading § Provide students with a place or area of low/minimum stimulation, e.g., study

corrals § Have student use earphones to listen to directions/stories § Give books younger than chronological age when needed § Give extra one-‐on-‐one help § Use picture association when introducing letters § Show patterns in words and teach new words with similar word patterning § Use repetition when introducing new concepts and giving instructions § Allow the student more time to complete tasks and to master basic concepts § Use activities that raise words off of the paper, e.g., trace the letter with glue and

add sprinkles on top of the glue § Use multi-‐sensory textures, e.g., use materials with different textures § Repeat the line, up to the problem word while making the initial sound § Use social stories to teach specific concepts listed on the student’s IEP’s

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§ Use “hooks” to aid student with comprehension and memory, e.g., refer to quotation marks as talking signs

§ Use sentence strips with associated pictures and cut the sentence strips into chunks, e.g., I/ have a pet/ dog called Rex/

§ Draw pictures and have the student place the word on top of the correct picture § Use sound boxes to aid in spelling words (e.g., played playing) § Use analogies to aid in spelling words, e.g., start with a word the child knows then

take them to the unknown (look/book) § Allow invented spelling, e.g., the student inserts the word the way he/she thinks it

is spelled § Allow for sub-‐vocalizing or reading quietly so they can hear the words during

silent reading periods § Encourage metacognitive strategies such as paraphrasing, retelling, summarizing,

brief note taking and self-‐questioning while reading § Allow students to take part in listening to stories and listening to other students

reading Encourage oral story telling § Encourage reading volunteers to spend extra individual time with FAD students § Group words by rhyming sound families, e.g., rock/stock/clock or

right/might/flight § Use colour coded systems for easier recall § Use sticky pads to write down words/main points to remember while reading § Use story mapping/clustering/story webbing § Make reading assignments as concrete as possible § Underline or circle important points of text § Put events into chronological timeline § Provide the initial part of sentence and ask the students to fill in the remainder § Using vibrating pens to provide increased sensory and tactile feedback § Precede a focused reading activity with a gross motor activity § Allow a student to experiment with different positions while reading, e.g., lying on

the carpet or rocking in a rocking chair

Math Strategies: § Separate the four types of operational questions into separate sections, i.e., all

addition questions in one section, all subtractions questions in another section § Use pictures to represent fractions, e.g., relate a fraction to the visual

representation of a part of a whole pie

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§ Break down the steps of each math process § Put the math process steps into rap songs or mnemonics § Have the students repeat the instructions back to you § Arrange for repetition and practice of basic math process at a basic level § Use concrete manipulative whenever possible, e.g., cubes, counters, calculators,

cheerios § Use coins when teaching money management skills § Use game format whenever possible § Use computer programs such as Math Blaster § Allow for more time to learn each math process § Do not assume student can generalize information across each math process § Use math tricks, e.g., nine times tables § Use written charts of math times tables § Allow students to use calculators to recheck work § Incorporate activities which promote experimental movement and using the math

process in a practical application, e.g., cutting a log into parts or cutting a desert into different parts

§ Allow adaptations in test writing, e.g., give them more time, allow them to go to a quiet space or to use support tools

§ Reduce the number of problems given on assignments § Focus on the success not the failure, e.g., look at what the student is able to do § When testing for math operations, test for comprehension of the process § Provide multiplication tables for each student

Augmentative Equipment: § Computers § Computer programs, e.g., Board Maker § Calculators § Alpha Smart (mini word processor) § Audio cassette recorder/player § Video record/player § Earphones

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Resources American Psychiatric Association, DSM-‐IV Diagnostic and Statistical Manual of Mental

Disorders. 1994, Donnelly and Sons, Washington D.C.

Ashley S. & Sterling,C. . Diagnostic Guide for FAS and Related Conditions, University of Washington, Seattle, 1999

Gillingham, G. Autism A New Understanding. 2000. Tacit Publishing Inc., Edmonton

Temple, G. Thinking In Pictures, 1995, Random House

Pinnell, G. S. & Fountas, I. Word Matters, Guided Reading, 1998, Heineman, Portsmouth

Packer, L. E.., Greene, P.S. & Ross W. Notes from Neuro-‐Behavioural Workshop, Winnipeg, 2002

Reif S. The ADD/ADHD Checklist, 1998, Prentice Hall

Shackel, D. et al, 1999, Living and Working with FAS, Interagency FAS Program, Health Canada,Winnipeg, MB

Sheda, C. Developmental Motor Activities for Therapy. 1990. Therapy Skills Builders, Tucson Arizona

Sinclair ,G. Reading and Writing Strategies, Manitoba First Nations Education Resource Centre, 2000.

Giftedness Introduction Children and youth who give evidence of high performance capability in areas such as intellectual, creativity, or in specific academic fields and who require services or activities not ordinarily provided by the school in order to fully develop such capabilities are termed gifted. There are numerous lists of characteristics or features and attributes of gifted children. However, few gifted children will display all of the characteristics/features/attributes on any of these lists.

Understanding the characteristics of gifted children will help both parents and teachers to sharpen their observations of these children in two distinct ways:

a) while characteristics do not necessarily define who is a gifted child, they do constitute observable behaviours that can be thought of as clues to more specific behaviours, and

b) these characteristics are signals which indicate that a particular child might warrant closer observation and could require specialized educational attention, pending a more comprehensive assessment.

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Characteristics § Show keen powers of observation § Have an eye for important details § Read a great deal on their own (prefer books/magazines written for youngsters

older than themselves) § Take great pleasure in intellectual activity § Have well developed powers of abstraction, conceptualization, & synthesizing

abilities § Have rapid insight into cause-‐effect relationships § Tend to like structure, organization, and consistency in their environments § May resent the violation of structure and rules § Display a questioning attitude (seek information for the sake of having it as much

as for its instrumental value) § Are often skeptical, critical, and evaluative § Are quick to spot inconsistencies § Have a large storehouse of information regarding a variety of topics which they

can recall quickly § Show a ready grasp of underlying principles and can often make valid

generalizations about events, people or objects § Readily perceive similarities, differences and anomalies § Attack complicated materials by separating it into its components and analyzing it

systematically § Have a well developed common sense § Are willing to examine the unusual and are highly inquisitive § Are well organized, goal directed and efficient with respect to task and problems. § Exhibit an intrinsic motivation to learn, find out or explore and are often very

persistent. § “I’d rather do it myself” is a common attitude § Enjoy learning new things and new ways of doing things § Have a longer attention and concentration span than their peers § Are more independent and less subject to peer pressure than their age mates § Can be conforming or non-‐conforming as the situation demands § Have a highly developed moral and ethical sense

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§ Are able to integrate opposing impulses, such as constructive and destructive behaviour

§ Exhibit daydreaming behaviour § May seek to conceal their abilities so as not to “stick out.” § Have a well developed sense of self and a realistic idea about their capabilities and

potential

Identification Types of Giftedenss

1. Successful—as many as 90% of identified gifted students in school programs are Type I’s. These students have mastered the system. (They have listened closely to their parents and teachers and have discovered what “sells” at home and at school and they display those appropriate behaviours.) They learn able to score high on achievement tests and tests of intelligence. They are usually identified for placement in programs for the gifted and rarely exhibit behaviour problems. They are eager for approval from teachers, parents and other adults.

2. Challenging—typically possess a high degree of creativity and may appear to be obstinate, tactless, or sarcastic. (They do not conform to the system and may or may not feel included.) These students often question authority and may challenge the teacher in front of the class. They receive little recognition and few rewards or honours. Their interactions at school and at home often involve conflict. They feel frustrated because the school system has not affirmed their talents and abilities. They often possess negative self-‐concepts and may be “at risk” as eventual dropouts if appropriate interventions are not made by junior high.

3. Underground—generally, these are females whose belonging needs rise dramatically in middle school. (If a gifted boy goes underground, it tends to happen later, in high school, and typically in response to the pressure to participate in athletics.) These students frequently feel insecure and anxious. In the past they were highly motivated and intensely interested in academic or creative pursuits but have undergone an apparently sudden radical transformation, losing all interest in previous passions. Their changing needs are often in conflict with the expectations of teachers and parents. Adults react to them in ways that only increase their resistance and denial.

4. Dropouts—are angry with adults and with themselves because the system has not met their needs for many years. These students feel rejected and neglected. They are bitter and resentful. They may express their anger by acting depressed and withdrawn or by acting out and responding defensively. They frequently have

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interests that lie outside the realm of the regular school curriculum. School seems irrelevant and perhaps hostile to them. They are usually high school students, but occasionally may be an elementary student who attends school sporadically or only on certain days. These were identified as gifted very late, perhaps not until high school. Their self-‐esteem is very low. Traditional programming is no longer appropriate for them.

5. Doubled Labelled—are physically or emotionally handicapped in some way, or have some type of learning disability. These students do not exhibit behaviours that schools look for in the gifted (i.e., have sloppy handwriting or disruptive behaviours). They show symptoms of stress (they may feel discouraged, frustrated, rejected, helpless, or isolated).

They may deny that they are having difficulty by claiming that activities or assignments are “boring” or “stupid.” They may use their humour to demean others in order to bolster their own lagging self-‐esteem. They urgently want to avoid failures and are unhappy about not living up to their own expectations. They are often impatient and critical and react stubbornly to criticism. Traditionally, these students are either ignored because they are perceived as average or referred for remedial assistance. School systems tend to focus on their weaknesses and fail to nurture their strengths or talents.

6. Autonomous—like the Type 1s, these students have learned to work effectively in the school system. Unlike the Type 1s these students strive to do as little as possible. Type 6s have learned to use the system to create new opportunities for themselves (they do not work for the system; they make the system work for them). They have strong, positive self-‐concepts. They are successful, and they receive positive attention and support for their accomplishments as well as for who they are. They are well respected by adults and peers and frequently serve in some leadership capacity within their school or community.

They are independent and self-‐directed. They are able to take risk and possess a strong sense of personal power. They are able to express their feelings, goals, and needs freely and appropriately.

Programming Options Classroom

Adjust the content § Include facts, concepts, and generalizations along with basic skills § Use anomalies and paradoxes to peak interest § Use more variables to a task to increase complexity of a topic and interrelations to

other fields

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Adjust the Process § Lessons move into more challenging realms § Open-‐ended questions § Less yes/no questions § Avoidance of playing “Guess what the teacher is thinking” § Adopt new practices / techniques

Adjust the Product § From groups with assigned different products to individuals with self-‐ chosen

products § Develop a list of alternate products according to the eight intelligences for student

from which to chose § Use the alternate products list as a menu, organized or record keeper

Placement § By subject

o Coursework at a higher level § By alternative programs

o Self-‐contained full day programs providing an intensive curriculum to students identified as gifted

§ By cluster core classes o Ability groups in advanced levels of the core subjects

§ By extended day programs o Enrichment programs offered before or after school

§ By regular classes o Use differentiated instruction strategies

Augmentative Equipment § Computers & tablets § Computer programs § Calculators § Audio cassette recorder/player § Video record/player § Earphones

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References ERIC Clearinghouse on Disabilities and Gifted Education, Common Myths About Gifted

Students, 2001, http://ericec.org

Harvey, D. A Model for Gifted Programming in Regular Classrooms, 1999.

KidSource on line, Giftedness and the Gifted: What’s It All About?, 2001, www.kidsource.com

Manitoba Association for Gifted Education, Coaching Student Growth, #1 October 2002

McQuarrie Enrichment Centre, WRDSB Enrichment Matrix of Programming, 2003, http://mcquarrie.wrdsb.on.ca

National Association for Gifted Children, Who Are the Gifted?, 2001, www.nagc.org

NW Regional Educational Laboratory, Evolving Definitions of Giftedness, 2003, ERIC www.nwrel.org

Gigantism Introduction Gigantism is a rare condition that causes abnormal growth in children. It occurs when a child’s body produces too much growth hormone. Early diagnosis is important. Prompt treatment can stop or slow the changes that may cause a child to grow larger than normal. However, the condition can be hard for parents to detect, since symptoms of gigantism might first be seen as normal childhood growth spurts.

Characteristics Physical Features

If the child has gigantism, you may notice that he or she is much larger than other children of the same age. Also, some parts of the body may be larger in proportion to other parts. Common symptoms include very large hands and feet, a thickening of toes and fingers, a prominent jaw and forehead, and coarse facial features. Children with gigantism may also have flat noses and large heads, lips, or tongues. The symptoms a child experiences may depend on the size of the pituitary gland tumor. As the tumor grows, it may press on nerves in the brain. Many people experience headaches, vision problems, or nausea from tumors. Other symptoms of gigantism may include:

§ Excessive sweating § Weakness § Delayed puberty in both boys and girls § Irregular menstrual periods in girls

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§ Deafness § Double vision or difficulty with side (peripheral) vision § Frontal bossing and a prominent jaw § Gaps between the teeth § Release of breast milk § Sleep problems § Tall stature § Cardiovascular disease

Diagnosis (medical) If the gigantism is suspected, either a blood test or an oral glucose tolerance test will be conducted. The blood test measures levels of growth hormones and an insulin-‐like growth factor (called IGF-‐1), which is a hormone produced by the liver. If the blood tests indicate a pituitary gland tumor, the child will need a magnetic resonance imaging (MRI) scan of the gland. Doctors use the scan to see the size and position of the tumor.

The oral glucose tolerance test measures growth hormone levels before and after consuming a glucose beverage. In a normal body, growth hormone levels will drop after eating or drinking glucose. If the child’s levels remain the same, it means his or her body is producing too much growth hormone.

Treatments for gigantism aim to stop or slow the child’s production of growth hormones.

Surgery

Removing the tumor is the preferred treatment for gigantism, if that is the underlying cause. The surgeon will reach the tumor by making an incision in the child’s nose. Microscopes or small cameras may be used to help the surgeon see the tumor in the gland. In most cases, your child should be able to return home from the hospital the day after the surgery.

Medication

If surgery is not an option, the child’s doctor may recommend medication. This treatment is meant to either shrink the tumor or stop the production of excess growth hormone. The doctor may use the drugs octreotide or lanreotide to prevent the growth hormone’s release. According to the Mayo Clinic, these drugs mimic another hormone that stops growth hormone production (Mayo Clinic, 2010). Most often, these drugs are given as an injection about once a month. To shrink a tumor before surgery, bromocriptine and cabergoline can be used. These are typically given in pill form. They may be used with octreotide injections, which will also lower the levels of growth hormones and IGF-‐1. In situations where these drugs are not helpful, daily shots of pegvisomant might be used as

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well. Pegvisomant blocks the effects of the growth hormones, but it does not lower the levels of growth hormones in the body or shrink the tumor.

Gamma Knife Radiosurgery

A gamma knife radiosurgery is an option if the child’s doctor believes that a traditional surgery is not possible. The “gamma knife” is a collection of highly focused radiation beams. These beams do not harm the surrounding tissue, but they are able to deliver a powerful dose of radiation at the point where they combine and hit the tumor. Gamma knife treatment takes years to be fully effective and return the levels of growth hormone to normal. It is performed on an outpatient basis under general anesthetic. However, since the radiation used has been linked to obesity, learning disabilities, and emotional issues in children, it is usually used only when other treatment options fail.

Programming Options Incorporation of adaptations and accommodations as necessary to meet student’s needs.

Resources/References http://www.healthline.com/health/gigantism

http://emedicine.medscape.com/article/925446-‐overview

Grief and Mourning Introduction Grief is internal to the individual and mourning is taking the internal grief to the outside, e.g., sharing and talking. Mourning is ongoing, gets less and less but never really truly completely ends. There is no “right” way of mourning to express a person’s grief.

Six Needs When Mourning: 1. Acknowledge the death/loss

2. Embrace the pain

3. Remembering the presence of life / the meaning of life

4. New self identity

5. Search for meaning

6. Ongoing support

Mourning is a process done over time in doses: § Children grieve in smaller doses, i.e., cry hard for 2 minutes and then play § Children may not be able to verbalize the scary feelings they have about death

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§ Each child’s reaction is based on cognition, emotion, spiritual and physical response to the loss of a loved one

§ Children grieve through their behaviour

Internal factors that influence the grieving process: § Loss and death history § Attachment history § Age and development level § Nature of your relationship with the deceased § Support network

External factors that influence the grieving process: § Place of death § Successive deaths or losses § Nature of the death

Characteristics The Cycle of Grief

§ Denial and Isolation-‐-‐This is often the initial reaction: “No, it can’t be happening to me.” This is often a healthy way to get some distance and perspective on the reality of the situation until the time the person is ready to deal with it. People in this stage often feel alone and think that there is no one they can talk to about it.

§ Anger-‐-‐ Once the person begins to accept the loss, the person usually feels anger, rage, envy and resentment. “Why me? Why not someone else?” This stage is apt to alienate other people, but it is very important for the person experiencing it. The person is rightfully angry about being cheated of many things that have been planned for, worked for, and believed in, and is jealous of others who are not facing such a difficult situation.

§ Bargaining-‐-‐ Bargains are often based on guilt, desperation, hopelessness and remorse. The person may try to make bargains with her/himself, feeling that if she/he changes everything she/he feels guilty for, maybe things will work out again.

§ Depression-‐-‐ Sometimes depression may be based on guilt and shame which are unrealistically exaggerated. In this kind of depression, it may be helpful to remind oneself of the real facts and the positive things. It is important to allow this grief to be fully experienced (thinking, talking and crying).

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§ Acceptance-‐-‐ Eventually the person experiencing loss has worked through all these feelings and is resigned to the situation. The past no longer has the power to evoke uncontrollable or heavy feelings. We accept the loss and move into living.

Identification

Grief is a profound emotional process with very real biological symptoms that can endure for months. Clinical specialists, e.g., psychologists need to be consulted when an individual displays signs of complicated and prolonged grief.

Programming Options § Create safe places for students to experience and process their grief § Offer physical support § Provide structure and routine § Allow student to express emotion on an ongoing basis § Give permission to concentrate on their mourning § Offer constructive venting alternatives § Try to understand acting out behaviour § Provide support and opportunities though sharing circles § Encourage student to ask questions § Do not punish student’s expression of anger, sadness, withdrawal or depression § Be open minded concerning the length of time the student requires to deal with

his/her grief § Expressing emotion

o Drawing painting o Writing letters o Journaling o Crying o Asking questions

References / Resources Kubler-‐Ross. Death & Dying

Wolfelt, A. http://www.centerforloss.com/pg/default.asp

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Hearing Loss Introduction Hearing is one of the five senses. It is a complex process of picking up sound and attaching meaning to it. The human ear is fully developed at birth and responds to sounds that are very faint as well as sounds that are very loud. Even in utero, infants respond to sound. The ability to hear is critical to the attachment of meaning to the world around us

Characteristics Five Sections of the Hearing Mechanism

1. Outer ear

2. Middle ear

3. Inner ear

4. Acoustic nerve

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5. Brain’s auditory processing centres

The outer ear consists of the pinna, or auricle and the ear canal (external auditory meatus). The pinna -‐ the “ear” that we see on each side of our heads -‐ is made of cartilage and soft tissue so that it maintains a particular shape but is also pliable.

The pinna serves as a collector of sound vibrations around us and funnels the vibrations into the ear canal. It assists us in determining the direction and source of sound.

The ear canal is about an inch long and ¼ inch in diameter. It extends from the pinna to the eardrum (tympanic membrane). The outer foundation of the ear canal is cartilage covered with skin that contains hairs and glands that secrete wax (cerumen). The hairs and wax help to prevent foreign bodies, such as insects or dust, from entering the ear canal. Near the eardrum (tympanic membrane), the wall of the ear canal becomes bony and covered tightly by skin.

The middle ear begins with the eardrum at the end of the ear canal. The middle ear contains three tiny bones called the ossicles. These three bones called the hammer, anvil and stirrup form a connection from the eardrum to the inner ear. As sound waves hit the eardrum, it moves back and forth causing the ossicles to move. Thus the sound wave is changed to a mechanical vibration.

The middle ear is located in the mastoid section of the temporal bone (a skull bone on each side of the head) and is filled with air. A tube called the eustachian tube runs from the front wall of the middle ear down to the back of the nose and throat (the nasopharynx). This tube provides ventilation and access to outside air and equalizes air pressure on both sides of the eardrum -‐-‐ the middle ear side and the outer ear side. We are aware of the eustachian tube at work when we feel air pressure changing in our ears as we yawn, chew, or swallow.

Because of the facial and skull structure of children, the eustachian tube is in a rather flat position between the middle ear and the nasopharynx rather than in the downward slanting position from the middle ear to the nasopharynx in adults. The flat positioning of the tube in children creates risk for infection travelling from the nasopharynx into the middle ear.

The inner ear contains the sensory organs for hearing and balance. The cochlea is the hearing part of the inner ear. The semicircular canals, the utricle and the saccule are the balance part of the inner ear.

The cochlea is a bony structure shaped like a snail and filled with fluid (endolymph and perilymph). The Organ of Corti is the sensory receptor inside the cochlea which holds the hair cells, the nerve receptors for hearing. Individual hair cells respond to specific sound frequencies (pitches) so that, depending on the pitch (frequency) of the sound, only certain hair cells are stimulated.

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Signals from these hair cells are translated into nerve impulses. The nerve impulses are transmitted to the brain by the cochlear portion of the acoustic nerve.

The acoustic nerve carries impulses (messages) from the cochlea, and on to other brain pathways that end in the auditory cortex of the brain. At the cochlear nucleus, nerve fibers from each ear divide into two pathways.

The central auditory system deals with the processing (understanding) of auditory information as it is carried up to the brain. Central auditory processes are the auditory processes responsible for the following behaviours:

§ Sound localization and lateralization § Auditory discrimination (hearing the differences between different sounds) § Recognizing patterns of sounds § Time aspects of hearing (temporal aspects of audition): temporal resolution,

temporal masking, temporal integration, temporal ordering § Reduction in auditory performance in the presence of competing acoustic signals § Reduction in auditory performance in the presence of degraded (less than

complete) acoustic signals

Balance is the second essential function of the ear.

Balance, or one’s sense of equilibrium, is controlled through the vestibular system that is also contained in the inner ear. Balance and equilibrium help us stay erect when standing, know where we are in relation to gravity, and help us walk, run, and move without falling. The functioning of the vestibular system depends on information from many systems, hearing as well as vision and muscle feedback.

Genetic Hearing Loss

Those children with a parent or parents with a genetic loss of hearing should be tested for hearing loss when beginning school if not earlier. The genetic presence of hearing loss in a family is a caution not a guarantee of hearing loss in children.

Types of Hearing Loss § Conductive

This is caused by problems in the outer or middle ear which prevent the sound from being ‘conducted’ to the inner ear and hearing nerves. The hearing may fluctuate and may affect one or both ears to varying degrees. Conductive problems generally affect the quantity (loudness only) of the sound that is heard. It is usually medically or surgically treatable. A common cause of conductive loss in children is middle ear infection.

§ Sensorineural

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This type of hearing loss is due to a problem in the cochlea (the sensory part of the ear) or the hearing nerve (the neural part). It can be acquired or be present at birth. There is usually a loss of clarity as well as loudness, e.g., the quality and the quantity of the sound is affected.

NOTE: It is possible to have both a conductive and a sensorineural hearing loss. This type of loss is called a mixed hearing loss.

Immediately following is the familiar audiogram. It shows the range of the phonologicial sounds along with sample noise emitations of various objects that the human ear hears. The audiogram also displays the degrees of hearing loss.

Diagnosis A hearing loss is diagnosed based on the person’s history, behaviour, and the results of medical and audiological examinations. An audiologist can determine the type and degree of hearing loss and whether or not the hearing loss can be reduced by the use of hearing aids.

Programming Options Accommodations in the Classroom

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Seating § Seat the hearing impaired student close to the teacher for the best sound

reception and visual information. However, don’t restrict them to only one location. Allow the student to move to a better listening position if they wish.

§ Check the student has a clear view of the whole class for participation in group activities if possible.

§ If one ear is better than the other, ensure the better ear is directed to class and teacher.

§ Seat the student away from noisy areas. It may be necessary to change the seating arrangements for particular activities.

Visual Supplements § Ensure good lighting on your face. The glare of strong lighting (such as a window)

behind the speaker makes lip reading difficult. § Speak clearly but naturally; exaggeration or shouting can make it more difficult for

the child to understand speech. § Try to remain in one area while talking. It’s difficult to lip read someone moving

about a lot. § Don’t talk while your back is turned to the child (e.g., when writing on the

blackboard). § Try to use as many visual aids as possible. § When reading aloud, try not to let the book cover your face.

General Accommodations § Be sure the student is paying attention (not just looking) to the lesson § Check with the student to ensure that the information and/or instructions were

understood § Have another student act as a buddy for the hearing impaired student § Reduce or eliminate background noise whenever possible § Schedule short regular breaks § Use a sound-‐field amplification system § Use of a hearing aid by student

References / Resources World Around You Magazine for young people and Odvssev magazine for Deaf education

http:/clerccenter.gallaudet.edu

http://clerccenter.gallaudet.edu

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http://www.phonicear.calindex.html Equipment for Deaf and Hard of Hearing

http://www.asha.orq -‐ Speech and Hearing Association http://www.cad.ca -‐ Canadian Association of the Deaf

httpa/www.ccsdeaf.com

http:/hvww.wfdnews.org -‐ World Federation of the Deaf http:/hvww.deafcanada.com

http://www.agbell.orq Alexander Graham Bell Association for Deaf and Hard of Hearing

Irlen Syndrome Introduction Irlen Syndrome is a type of visual perception problem discovered by a psychologist named, Helen Irlen, in the 1980’s. It used to be referred to as ‘Scotopic Sensitivity Syndrome’ but its name is now referred to Irlen Syndrome. It is not an optical problem but a problem with the brain’s ability to process visual information. Students will not outgrow the syndrome, neither will it get worse over time. Irlen Syndrome is not a result of IQ or maturation either. Irlen Syndrome can affect many different areas, including academic and work performance, behaviour, attention, ability to sit still, or concentration. Irlen Syndrome prevents an estimated 10-‐12% of the population from being able to learn, read, or study efficiently. Irlen Syndrome has a genetic component and affects both males and females equally.

Characteristics / Symptoms

Irlen Syndrome can manifest itself differently for each individual. People with Irlen Syndrome may have some of the following characteristics, but not all symptoms have to be present:

Visual/Perceptual Distortions § Print distortions (i.e., blurry, moving, rising/floating, shaky), especially with black

print on white backgrounds. To view samples of these distortions, see FNSEPH’s Section O

§ Background distortions (i.e., glowing, glaring, flickering, flashing, changing colour), especially with black print on white backgrounds

§ Depth perception problems (i.e., sports, driving, stairs, escalators) § Span of recognition (i.e., inability to perceive letters, words, musical notes, or

numbers in groups) § Light Sensitivity § Bothered by glare, bright lights, fluorescent lights, headlights § Prefers to read in dim light

Physical Discomfort

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§ Eye strain § Headaches or migraines § Fatigue / drowsiness § Nausea § Dizziness

Mental Functioning § Poor attention and/or concentration § Anxiety § Irritability § Sensory overload § Takes breaks § Fidgety or restless

Reading Problems § Poor comprehension § Misreads words § Problems tracking from line to line § Skips words or lines § Reads slowly or hesitantly § Loses place § Avoids reading

Writing Problems § Trouble copying § Unequal spacing § Unequal letter size § Writing up or downhill § Inconsistent spelling

Identification Certified Irlen Screeners or Irlen Diagnosticians are the only individuals who can accurately identify Irlen Syndrome in an individual as young as 5 years old. Optometrists or ophthalmologists are not required to identify Irlen Syndrome as part of their professional training. Irlen Syndrome cannot be identified by standardized, educational, medical, or optical tests. Irlen Screeners ask specific questions and place a student under specific visual

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stressor tasks unique to the screening process designed by Helen Irlen to identify an individual’s unique set of symptoms.

Irlen Syndrome is genetic so it runs in families.

Programming Options Irlen Syndrome is not remediable and is often a lifetime barrier to learning and performance.

§ Irlen Coloured Overlays

Irlen Screeners are specially trained to help the student select the correct Irlen Overlay or combination of Irlen Overlays unique to the student. Irlen Overlays can reduce the distortions and physical discomfort the child experiences with reading black print on white background texts.

§ Irlen Spectrally Modified Filters

An Irlen Diagnostician is a professional who prescribes the correct combination of Irlen Spectrally Modified Filters to be worn as glasses or contact lenses. The Irlen Diagnostician is specially trained to help the student identify the problematic wavelengths of light is his/her visual spectrum, which are then neutralized by Irlen Filters.

Irlen Filters are designed to eliminate distortions in other areas that cannot be addressed through overlays, which can include writing, copying, depth perception, night driving, sports performance, headaches, stomachaches, and strain for fluorescent lights and sunlight.

Resources / References Croyle, L. (1998). Rate of reading, visual processing, colour and contrast.

Australian Journal of Learning Disabilities, 3(3), 13-‐20.

Edwards, V.T., Hogben, J.H., Clark, C.D., & Pratt, C. (1996). Effects of a red background on magnocellular functioning in average and specifically disabled readers. Vision Research, 36(7), 1037-‐1045

Fletcher, J., & Martinez, G. (1994). An eye movement analysis of the effects of scotopic sensitivity correction on parsing and comprehension. Journal of Learning Disabilities, 27, 67-‐70.

Good, P.A., Taylor, R.H., & Mortimer, M.J. (1991). The use of tinted glasses in childhood migraine. Headache, September, 533-‐536.

Irvine, J.H., & Irvine, E.W. (1997). Scotopic sensitivity syndrome in a single individual (a case study). Naval Air Warfare Centre, Weapons Division, China Lake, California, April.

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Irlen, H. (1983, August). Successful treatment of Learning Disabilities. Paper presented at the 91st Annual Convention of the American Psychological Association, Anaheim, California.

Irlen, H. (1991). Reading by the colors. New York: Avery.

Irlen, H., & Robinson, G.L. (1996). The effect of Irlen coloured filters on adult perception of workplace performance: A preliminary survey. Australian Journal of Remedial Education, 1, 7-‐17.

Jeanes, R., Busby, A., Martin, J., Lewis, E., Stevenson, N., Pointon, D., & Wilkins, A. (1997). Prolonged use of coloured overlays for classroom reading. British Journal of Psychology, 88, 531-‐548.

Robinson, G.L. (1994). Coloured lenses and reading: A review of research into reading achievement, reading strategies and causal mechanisms. Australasian Journal of Special Education, 18(1), 3-‐14.

Robinson, G.L., & Conway, R.N.F. (2000). Irlen lenses and adults: A small scale study of reading speed, accuracy, comprehension and self-‐image. Australian Journal of Learning Disabilities, 5(1), 4-‐13.

Robinson, G.L., & Foreman, P.J. (1999a). The effect of Irlen coloured filters on eye movement. Behavioural Optometry, 7(4), 5-‐18.

Robinson, G.L., & Foreman, P.J. (1999b). Scotopic Sensitivity/Irlen Syndrome and the use of coloured filters: A long-‐term placebo controlled and masked study of reading achievement and perception of ability. Perceptual and Motor Skills, 89, 83-‐113.

Tyrrell, R., Holland, K., Dennis, D., & Wilkins, A. (1995). Coloured overlays, visual discomfort, visual search and classroom reading. Research in Reading, 18, 10-‐23.

Waterhouse, S. (1995). Sensory overload. Special Children, 80, 19-‐21.

Whichard, J.A., Feller, R.W., & Kastner, R. (2000). The incidence of scotopic sensitivity syndrome in Colorado inmates. Journal of Correctional Education, 51(3), 294-‐299.

Whiting, P.R., & Robinson, G.L. (2001). Social relations and Irlen Syndrome. Fifth Australian Conference for Perceptual and Learning Development, Christchurch, New Zealand, 29 September – 1 Octber, 2001.

Whiting, P. (1985). How difficult can reading be? New insight into reading problems. Journal of the English Teachers’ Association, 49, 49-‐55.

Whiting, P., Robinson, G.L., & Parrot, C.F. (1994). Irlen coloured filters for reading: A six year follow-‐up. Australian Journal of Remedial Education, 26(3), 13-‐19.

Wilkins, A.J. & Lewis, E. (1999). Coloured overlays, text and texture. Perception, 28, 641-‐650.

Wilkins, A.J., Lewis, E., Smith, F., & Rowland, F. (2001). Coloured overlays and their benefits for reading. Journal of Research in Reading, 24(1), 41-‐64.

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www.irlen.com – Irlen Institute International Headquarters

www.irlen.ca -‐-‐ Irlen Institute Canada

www.zuccone-‐irlen.com

www.yellenandassociates.com

www.DrCarolKessler.com

Obsessive Compulsive Disorder (OCD) Introduction Obsessions are unwanted, intrusive irrational thoughts that produce anxiety and occur over and over again in the person’s mind. Compulsions are ritualized behaviours the person does to deal with the obsessions. Children with OCD often have repeated behaviours of counting or checking. These children have overactive/ increased neuro-‐chemical activity in the frontal cortex of the brain. (Packer Pruitt and Green, notes from lecture, Winnipeg, 2002)

Characteristics Behaviour Uniqueness:

§ Counting, checking § Overly anxious behaviour § Meltdowns § Tantrums § Preservation § Inability to follow direction § May seem to “be in another world”

Obsessions:

Common OCD obsessions include fears of acquiring disease, getting hurt, or causing harm to someone. Obsessions are typically automatic, frequent, distressing, and difficult to control or put an end to. People with OCD who obsess about hurting themselves or others are actually less likely to do so than the average person.

Compulsions:

Compulsions are actions that the OCD sufferer willingly performs most often repeatedly, in an attempt to cause the obsession to go away . Most of the time the actions become so regular that it is not a noticeable problem. Common compulsions include excessive washing, cleaning , checking, hoarding, repetitive actions such as touching, counting, arranging and ordering, and other ritualistic behaviours that the person feels will lessen

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the chances of provoking an obsession. Complusions can be observable—washing, for instance—but they can also be mental rituals such as repeating words or phrases, or counting.

Diagnosis The diagnosis of OCD should be made by a psychiatrist trained in working with children with anxiety disorders. A psychologist can screen for OCD. OCD may occur concurrently with ADHD and Tourettes Syndrome.

Symptoms may include some, all, or perhaps none of the following: § Repeated hand-‐washing § Specific counting systems, e.g., counting in groups of four, arranging objects in

groups of three, grouping objects in odd/even numbered groups, etc. § Perfectly aligning objects at complete, absolute right angles, etc. § Having to “cancel out” bad thoughts with good thoughts § Sexual obsessions or unwanted sexual thought, e.g., fear of being homosexual § Fear of contamination, e.g., tears, mucus, etc. § A need for both sides of the body to feel even, e.g., while walking down a sidewalk,

stepping on a crack with the ball of the left foot, then feel the need to step on another crack with the ball of the right foot or if one hand gets wet, the sufferer may feel very uncomfortable if the other hand is not

There are many other possible symptoms and one need not display those mentions previously to suffer from OCD. Furthermore, possessing those symptoms is not an absolute sign of OCD.

Treatment needs to be conducted by a specialist in systematic desensitization. The may be done by a therapist, a psychologist or a psychiatric nurse with specific expertise in this area.

Programming Options Classroom adaptations / modifications:

§ Create safe emotional space § Help the students and family to understand the disorder § Share and plan with treatment specialists § provide opportunities for counselling and expression of feelings

Resources http://en.wikipedia.org/wiki/Obsessive-‐complusive_disorder

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St. Boniface General Hospital, The Anxiety Disorders Program, Winnipeg

Selective Mutism Introduction Selective mutism (formerly known as elective mutism) usually happens during childhood. A child with selective mutism does not speak in certain situations, like at school, but speaks at other times, like at home or with friends. Selective mutism often starts before a child is 5 years old. It is usually first noticed when the child starts school.

Many times a child with selective mutism has or is experiencing: § An anxiety disorder § Inner self/self-‐esteem issues § A speech, language, or hearing problem

According to the DSM-‐5, selective mutism is an apparently rare disorder that affects fewer than 1% of individuals seen in mental health settings.

Symptoms § Consistent failure to speak in specific social situations (in which there is an

expectation for speaking, such as at school) despite speaking in other situations. § Not speaking interferes with school or work, or with social communication. § Lasts at least 1 month (not limited to the first month of school). § Failure to speak is not due to a lack of knowledge of, or comfort, with the spoken

language required in the social situation. § Not due to a communication disorder (e.g., stuttering). It does not occur

exclusively during the course of autism spectrum disorder, schizophrenia, or other psychotic disorder.

§ May also show: o Anxiety disorder (e.g., social phobia) o Excessive shyness o Fear of social embarrassment o Social isolation and withdrawal

Diagnosis A child with selective mutism should be seen by a speech language pathologist (SLP), in addition to a pediatrician and a psychologist or psychiatrist. These professionals will work as a team with teachers, family, and the individual.

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It is important that a complete background history is gathered, as well as an educational history review, hearing screening, oral-‐motor examination, parent/caregiver interview, and a speech and language evaluation.

The educational history review seeks information on: § Academic reports § Parent/teacher comments § Previous testing (e.g., psychological) § Standardized testing

The hearing screening seeks information on: § Hearing ability § Possibility of middle ear infection

The oral-‐motor examination seeks information on: § Coordination of muscles in lips, jaw, and tongue § Strength of muscles in the lips, jaw, and tongue

The parent/caregiver interview seeks information on: § Any suspected problems (e.g., schizophrenia, pervasive developmental disorder) § Environmental factors (e.g., amount of language stimulation) § Child’s amount and location of verbal expression (e.g., how he acts on playground

with other children and adults) § Child’s symptom history (e.g., onset and behaviour) § Family history (e.g., psychiatric, personality, and/or physical problems) § Speech and language development (e.g., how well does the child express himself

and understand others)

The speech and language evaluation seeks information on: § Expressive language ability (e.g., parents may have to help lead a structured story

telling or bring home videotape with child talking if the child does not speak with the SLP)

§ Language comprehension (e.g., standardized tests and informal observations) § Verbal and non-‐verbal communication (e.g., look at pretend play, drawing

Treatments are available for individuals with selective mutism

The type of intervention offered by an SLP will differ depending on the needs of the child and his or her family. The child’s treatment may use a combination of strategies, again depending on individual needs. The SLP may create a behavioural treatment program,

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focus on specific speech and language problems, and/or work in the child’s classroom with teachers.

A behavioural treatment program may include the following: § Stimulus fading: involve the child in a relaxed situation with someone they talk to

freely, and then very gradually introduce a new person into the room § Shaping: use a structured approach to reinforce all efforts by the child to

communicate, (e.g., gestures, mouthing or whispering) until audible speech is achieved

§ Self-‐modelling technique: have child watch videotapes of himself or herself performing the desired behaviour (e.g., communicating effectively at home) to facilitate self-‐confidence and carry over this behaviour into the classroom or setting where mutism occurs

If specific speech and language problems exist, the SLP will: § Target problems that are making the mute behaviour worse; § Use role-‐play activities to help the child to gain confidence speaking to different

listeners in a variety of settings; and § Help those children who do not speak because they feel their voice “sounds

funny.”

Programming Options § Encouraging communication and lessening anxiety about speaking; § Forming small, cooperative groups that are less intimidating to the child; § Helping the child communicate with peers in a group by first using non-‐verbal

methods (e.g., signals or cards) and gradually adding goals that lead to speech; and § Working with the child, family, and teachers to generalize learned communication

behaviours into other speaking situations.

References Diagnostic and Statistical Manual (DSM-‐5). 2013. Selective Mutism. Diagnostic and

Statistical Manual of Mental Disorders: Fifth Edition, p.195–197.

Smith-‐Magenius Syndrome Introduction Smith – Magenius Syndrome is a developmental disorder that affects many parts of the body. The major features of this condition include mild to moderate intellectual disability,

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distinctive facial features, sleep disturbances, and behavioural problems. It affects an estimated 1 in 25,000 individuals.

The syndrome is named for Drs. Ann Smith (at NIH) and Ruth Ellen Magenis (in Oregon) who first described it.

Characteristics § Developmental delays § Sensory integration *OT/PT § Delayed toilet skills § Inattention § Impulsivity § Aggression § Language, learning and social development § Attention deficit disorders sometimes with hyperactivity § Frequent temper tantrum § Impulsivity § Distractibility § Disobedience § Aggressive § Self -‐ injury § Toilet training difficulties § Self-‐injurious behaviours(SIB) including self-‐hitting, self-‐biting, and skin picking,

inserting foreign objects into body orificies § There are stereotypic behaviours including spasmodic upper-‐body squeeze (“self

hug”), hand licking and page flipping (“lick and flip”) behaviour, mouthing objects, insertion of hand in mouth, teeth grinding, body rocking, and spinning or twirling objects

§ Dyspraxia-‐ Developmental Coordination Disorder (DCD) impairment, immaturity or disorganization of movement. Term DCD is replacing the “Clumsy Child Syndrome” and “Motor and learning difficulties” o Immature speech or articulation o Immature fine and gross motor skills. (C) will have difficulty learning new

motor tasks. He/She may appear clumsy and awkward o Difficulty with reading, writing, and spelling and some math

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o Behavioural/emotional problems – difficulty joining with peers, low self-‐esteem

§ Distinctive physical features (particularly facial features that progress with age) § Short flat head, prominent forehead, broad square face, upslanting eyelids, deep-‐

set eyes, underdeveloped midface, broad nasal bridge, short nose, tented upper lip, and a chin that is small in infancy and becomes relatively prominent chin with age.

Diagnosis The diagnosis of Smith-‐Magenius Syndrome (SMS) is based on clinical findings and confirmed by either detection of an interstitial deletion of chromosome 17p11.2 or by molecular genetic testing of RAII. SMS is usually confirmed by blood test called chromosome (cytogenetic) analysis and utilize a technique call FISH (fluorescent in situ hybridization). The characteristic micro-‐deletion was sometimes overlooked in a standard FISH test, leading to a number of people with the symptoms of SMS with negative results.

Children with SMS are often given psychiatric diagnosis such as autism, attention deficit/hyperactivity disorder (ADHD), obsessive – compulsive disorder (OCD), attention deficit disorder (ADD) and /or mood disorders,

Programming Options § Early childhood intervention programs § Special education § Vocational training/supports later in life § Speech Language Therapy § Physio-‐therapy § Occupational therapy § Behavioural therapy § Sensory integration therapy § Psychotropic medication to increase attention and/or decrease hyperactivity, and

therapeutic management of sleep disorders § Respite care and psychosocial support for family members are recommended

Resources/References http://www.medterms.com/script/main/art.asp?articlekey=21931

http://en.wikipedia.org/wiki/Smith-‐Magenis_syndrome

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Stuttering Introduction Stuttering affects the fluency of speech. It begins during childhood and, in some cases, lasts throughout life. The disorder is characterized by disruptions in the production of speech sounds, also called “disfluencies.” Most people produce brief disfluencies from time to time. For instance, some words are repeated and others are preceded by “um” or “uh.” Disfluencies are not necessarily a problem; however, they can impede communication when a person produces too many of them.

In most cases, stuttering has an impact on at least some daily activities. The specific activities that a person finds challenging to perform vary across individuals. For some people, communication difficulties only happen during specific activities, i.e., talking on the telephone or talking before large groups. For most others, however, communication difficulties occur across a number of activities at home, school, or work. Some people may limit their participation in certain activities. Such “participation restrictions” often occur because the person is concerned about how others might react to disfluent speech. Other people may try to hide their disfluent speech from others by rearranging the words in their sentence, pretending to forget what they wanted to say, or declining to speak. Other people may find that they are excluded from participating in certain activities because of stuttering. Clearly, the impact of stuttering on daily life can be affected by how the person and others react to the disorder.

Characteristics Stuttered speech often includes:

§ Repetitions of words (Where, Where, Where are you going?) or parts of words (W-‐ W-‐ W-‐ Where are you going?)

§ Prolongations of speech sounds (SSSSave me a seat) § Appear very tense or “out of breath” when talking § Speech may become completely stopped or blocked (blocked is when the mouth is

positioned to say a sound, sometimes for several seconds, with little or no sound forthcoming)

§ Interjections such as “um” or “like” can occur more frequently

Diagnosis Diagnosing stuttering requires the skills of a certified speech language pathologist (SLP). During an evaluation, an SLP will note the number and types of speech disfluencies a person produces in various situations. The SLP will also assess the ways in which the person reacts to and copes with disfluencies. The SLP may also gather information about factors such as family history of stuttering, whether stuttering has continued for 6 months

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or longer, presence of other speech or language disorders, strong fears or concerns about stuttering on the part of the child or the family. A variety of other assessments (e.g., speech rate, language skills) may be completed as well. Information about the person is then analyzed to determine whether a fluency disorder exists.

No single factor can be used to predict whether a child will continue to stutter. The combination of these factors can help SLPs determine whether treatment is indicated.

Programming Options Most treatment programs for people who stutter are “behavioural.” They are designed to teach the person specific skills or behaviours that lead to improved oral communication. For instance, many SLPs teach people who stutter to control and/or monitor the rate at which they speak. In addition, people may learn to start saying words in a slightly slower and less physically tense manner. They may also learn to control or monitor their breathing. When learning to control speech rate, people often begin by practicing smooth, fluent speech at rates that are much slower than typical speech, using short phrases and sentences. Over time, people learn to produce smooth speech at faster rates, in longer sentences, and in more challenging situations until speech sounds both fluent and natural. “Follow-‐up” or “maintenance” sessions are often necessary after completion of formal intervention to prevent relapse

Resources/References http://www.asha.org/public/speech/disorders/stuttering.htm

Visually Impaired Introduction The eye is an amazing organ and has many component parts, all of which must work in coordination to ensure true and accurate vision. The following is an illustration of the eye with the main external components identified.

These are the components you see when you look at someone’s eyes.

Illustration by Mark Erickson

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The main internal components of the eye are:

Illustration by Mark Erickson

The Visual Process In the normal eye the light rays enter through the cornea and are bent. This process is known as refraction. The light rays pass through the aqueous humor to the iris. The iris controls the amount of light going to the inside of the eye by getting larger (dilating) or getting smaller (contracting). The rays are then refracted a second time to fine tune the focus. This second refraction process is called accommodation. The rays of light then focus on the retina. From the retina the images are changed to electric impulses that travel through the optic nerve to the brain for interpretation, and we “see.”

Children, who are blind or have reduced or limited vision, have unique needs.

Children that have difficulty learning because of visual input difficulties require accommodations to be made to assist this student.

The definition of a legally blind child is a legal one and is “a person shall be considered legally blind whose central acuity does not exceed 20/200 in the better eye with correcting lenses or whose visual acuity if better than 20/200 has a limit to the central field of vision of no greater than 20 degrees.”

To further explain the word “acuity” means clarity of vision. Normal vision is measured at 20 feet, and the measure of loss of vision is compared to this standard. If you see a number of 20/80 it means that a visually impaired person sees at 20 feet what a person normal vision sees at 70 feet.

Characteristics The most common problems of refraction are:

1. Myopia or nearsightedness-‐in which the person has difficulty focusing on distant objects but can focus on near objects.

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2. Hyperopia or farsightedness-‐in which a person has difficulty focusing on near objects but can focus on far objects.

3. Astigmatism alone or in conjunction with other problems is related to irregular curve of the cornea. This results in distorted vision.

There are many reasons why children are having difficulty in a classroom. Visual impairment especially an undiagnosed impairment is the one which may be demonstrated by many symptoms or behaviours including but not limited to:

§ Tendency to rub eyes § Squinting, linking, twitching of eyes § Extreme sensitivity to light § Unusual eye movements § Tendency to close one eye when looking at materials § Complaint of pain or discomfort in eyes § Poor eye-‐hand coordination

Diagnosis The child must be diagnosed by a clinician and the limits of vision will be established during this time. The severity of the vision loss will establish the level of support the child may need during school activities. Those students with the most severe loss may need to be taught to use Braille, mobility and orientation training, and functional living skills.

Legally blind children may have some vision and part of teaching the visually impaired is to utilize what vision is available. This may be through the use of low vision aides and technology.

If a child has been assessed by an eye specialist, the report will place a number as a term of description to indicate the degree of loss of vision. These numbers help to understand the varying degree of loss. It is helpful to understand what these numbers mean.

Visual Acuity is measured with a Snellen chart. This is a chart that you will have seen in a doctor’s office or in the eye specialist office. The chart consists of a number of lines of letters and figures that begin large and graduate to small. The results are given as a fraction such as 20/70. This means that the person being tested can see at 20 feet what a normal person can see at 70 feet.

There are other losses that can occur including loss of peripheral vision, loss of core vision, reduced or altered field of vision. These are conditions that create the condition known as low vision. Low vision is defined as the situation of an individual retaining some usable vision but is unable to carry out desired tasks because of impaired visual function.

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Programming Options Visually impaired students are now included in community schools and it is important to understand the role of vision in the learning process. About 80% of information we receive is received through visual channels. For those students who cannot see we must be prepared to present information and experiences in other formats or in supported activities in the classroom.

If a child comes to the classroom with a diagnosis of visual impairment other techniques can be employed to provide information and experiences. It will be necessary to provide information through other sensory inputs such as large print or Braille, and/or auditory inputs. Tactile opportunities will help the child learn experientially. Special seating and lighting may be advantageous for children with low vision. Depending on the degree of visual loss the student may require mobility and orientation (M and O) training. Ideally this skill will be directed by the M and O trainer, or in some other situations the occupational therapist will provide the training program, but the day-‐to-‐day program may be carried out by classroom staff. The place of technology for children with visual impairments cannot be underestimated. The era of talking computers and voice activate equipment can greatly enhance the potential of the child.

If a child has other disabilities as well as vision loss, other professionals such an occupational therapist, speech and language pathologist, and or a behaviour specialist may become involved. The composition of the team will depend on the specific impairments of the child.

Consideration when planning for children with visual deficit-‐the IEP: § Visual loss is more than the ability to see -‐it is related to all areas of function § Visual skill training must cross all subject and activity boundaries § Social skill development must be an integral part of all activities § Goals must translate to all life situations § Independence or the highest possible level of independence must be the ultimate

goal of all programs § Environmental accommodation must be made for students § Evaluation may be accomplished using alternative formats

Resources/References Mandal, A. What is visual impairment? http://www.news-‐medical.net

Teen Health kidshealth.org

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Section S: MFNERC Support Personnel Phone Directory

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