Student with Special Needs

1. Student with Special Needs Class #5 - Chapter 8 ADHD & Chapter 12 – Other Health Impairments Karen Gatto & Roni Kramer Winter 2009

2. Other Health Impairment Having limited strength, vitality or alertnessincluding a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems, including but not limited to a heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, diabetes, attention deficit disorder, attention deficit /hyperactivity disorder or tourette syndrome, which adversely affects a student's educational performance.

3. Attention Deficit/Hyperactivity Disorder Attention Deficit/Hyperactivity Disorder (AD/HD) • Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurobehavioral disorder that affects an estimated 4 - 12% of the school age population. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), published by the American Psychiatric Association, describes three subtypes of AD/HD: • Inattentive: can't seem to get focused or stay focused on a task or activity • Hyperactive: impulsive: very active and often acts without thinking • Combined: inattentive, impulsive, and too active

4. Some sources have reported that AD/HD affects to varying degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more NYSED P-16

5. Definition and Characteristics of ADD and ADHD (see page 182) • A persistent pattern of inattention and /or hyperactivity-impulsivity. • Severe, frequent, persistent, and interfer with one’s ability to perform on a daily basis . • APA criteria: Must be manifested before the age 7 • Symptoms must persist for at least 6 months • 3 times as many boys as girls are affected • AD/HD is on the rise • Some “recover” as they get older

6. Inattentive type • Appears ages 8-12 • “daydreamers” • Overlooked at times • “ADD” • Internally rather than externally focused • Can’t get started

7. Inattentive type cont’d • Fails to pay close attention to details • Difficulty sustaining attention • Does not follow through on instructions • Fails to finish things • Forgetful • Difficulty organizing tasks • Avoids things that require sustained mental effort • Loses things

8. What to do • Make sure you allow enough time to shift from one activity to the next • Teach organizational strategies • Flexible time limits • Simplify multi step activities

9. AD/HD -Hyperactive-Impulsive Type AD/HD – must have 6 or more characteristics that are present for at least 6 months • Cannot sit still • Talks excessively • Acts as if “driven by a motor” • Difficulty playing in leisure activities quietly • Leaves seat in classroom when others are seated • Runs or climbs excessively

10. AD/HD – Hyperactive-Impilsive Type (cont.) • Blurts out answers • Difficulty waiting for turn • Interrupts or intrudes on others

11. AD/HD - COMBINED TYPE (CB) • Inattention and hyperactivity (used to be AD/HD) • 85% of students with AD/HD fall into this category • Easily distracted • Can’t finish work

12. Behavioral Inhibition • Controlled by the four executive functions of the brain • Students with AD/HD have difficulty here resulting in high risk for conduct disorders, delinquency, low self esteem, dropping out, interpersonal difficulties, etc. know what to do but can’t do it.

13. Impairments in 4 types of Executive Functioning Nonverbal Working Memory: • Allows one to retrieve auditory, visual, and sensory memories from the past Internalization of speech • We talk to ourselves in planning our responses. We think about social rules.

14. 4 Exec. Functions cont’d. Self regulation of affect, motivation and arousal: • The presence of external rewards that that fuels persistence and drive. Students with AD/HD are less objective and more emotional Reconstitution: • Analyzing and synthesizing behavior. The ability to break behavior or task into steps

15. Biological Explanations • Genetics • Brain differences – not just an attention disorder • Not an issue of filtering out stimuli but inability to inhibit impulses to that input. Smaller overall brain volume. They know what to do – they cannot control what they do

16. The presence of AD/HD • 10-40% have a learning disability • 30% have a reading disability • Assessment includes: • Psych evaluation • Medical evaluation • Achievement tests • Behavior rating scales • Teacher observation • Only an MD can recommend medication

17. Connor’s Abbreviated Rating Scalea total of more than 15 is suggestive of AD/HD

18. Myths and Causes • Not sugar and many other environmental causes • Not poor parenting • Heredity, structural differences in the brain, prenatal and perinatal factors

19. PLANNING A LESSON – Augmenting Curriculum The need for external motivation – 7 key words: • Relevance • Novelty • Variety 4. Challenge 5. Feedback 6. Choices 7. Activity

20. Augmenting Curriculum • FOSTER SELF EFFICACY • PERSONAL ACCOMODATIONS See page 194 – putting strategies to work

21. Tourette’s Syndrome Tourette’s Syndrome is a neurobiological disorder characterized by motor and vocal tics with an onset in childhood. • Motor tics – Involuntary movements may be sudden twitches of the head, shoulders or even the entire body, eyeblinks, grimacing or repetitive tapping, drumming or touching behaviors. • Vocal tics – involuntary uttering of noises, words or phrases. Could include: sniffing, throat clearing or repeated coughing, varity of sounds or yells, echolalia and coprolalia (saying socially inappropriate words – only 15% of people have this)

22. Variability in frequency and intensity. Tics often come and go • Symptoms change over time. • While involuntary, some children are able to suppress symptoms for seconds or longer.

23. Obsessive Compulsive Disorder • Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety NIMH

24. Anecdotal stories activity

25. Definition of Orthopedic Impairment • Orthopedic impairment: A severe orthopedic impairment that adversely affects a student's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some limb, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputation, and fractures or burns which cause contractures • Physical disability and orthopedic impairment can be used interchangeably

26. Cerebral Palsy Cerebral = brain/Palsy = muscle control that affects movement • 4 types of CP – spastic (involves 70-80%, muscles tighten), athetoid (abrupt involuntary movements), ataxic (unsteadiness), and mixed • 40-50% have seizures • 50-70% have mental retardation • 30% hearing, speech/language impairments • Other issues are common

27. CAUSES • Perinatal • Prenatal • postnatal

28. Spina Bifida • Malformation of spinal cord – does not close completely and cover the cord • Typically this occurs in the lower region of the spine and results in paralysis of lower extremities and loss of skin sensation • Not progressive • Low socioeconomic • About 75% have typical IQ

29. CAUSES • Unknown but appear to occur very early in pregnancy • Daily vitamin supplements containing folic acid can reduce the risk

30. Epilepsy • Seizures – temporary neurological abnormalities that result from unregulated electrical discharges in the brain • 2 types of seizures: tonic-clonic (used to be grand mal) and absence seizures (petit mal) • After a 1st seizure 40-50% have another • ¾ of children go into remission • Medication is often successful in controlling seizures • See page 291 for types of seizures

31. Epilepsy cont’d • Average IQs for most • More likely to experience LD • Students with absence seizures are often misidentified as students with ADHD • Higher rate of depression

32. Sensory Processing Disorder Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects developing children and adults. People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may seek out intense sensory experiences, or they may have other symptoms.

33. "Sensory processing" refers to our ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response. For most people, this process is automatic. When we hear someone talking to us or a bird chirping, our brains interpret that as speech or an animal sound, and we respond to that information appropriately.

34. Children who have a Sensory Processing Disorder (SPD), however, don’t experience this process in the same way. SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional, motor, and other responses. • Sensory avoidance • Touch, smell, taste, noise • Sensory Seeking • Inappropriate touching • Loud noise levels • Motor Skills Deficits • Motor Planning • Dyspraxia

35. Evaluation and Instruction • Often PTs and OTs provide functional tests (page 295) • School function assessment is criterion based • Health care plan is essential (See page 298) • Related services and assistive technology • Adapted physical education • Self awareness and counseling

36. IDEA or 504 Accommodation Plan • Does the health problem adversely affect educational performance? • Does the student require educational services to address delays in educational performance? • Does the student require accommodations to allow for performance?