attention deficit and learning disabliles

7/29/2019 attention deficit and learning disabliles

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ATTENTION DEFICIT

AND LEARNING

DISABILIES


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Videos

Videos: Films on demand

Dx and tx of ADD

http://ezproxy.philau.edu:3857/

PortalViewVideo.aspx?xtid=5334# How difficult can it be?

http://ezproxy.philau.edu:3857/PortalViewVideo.aspx?xtid=41096#


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Attention Deficit Disorder- Definition

Persistent and frequent pattern of developmentally

inappropriate inattention and impulsivity with or without

hyperactivity (Merck).

Heterogeneous behavioral disorder of uncertain cause

Always present in Childhood, usually adolescence, and

may persist into adulthood


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Diagnosing also considers:

symptoms must be more frequent or severe compared to

other children the same age.

In adults, the symptoms must affect the ability to function

in daily life and persist from childhood.

behaviors must create significant difficulty in at least two

areas of life, such as home, social settings, school, or

work.

Symptoms must be present forat least six months.


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Diagnosing

Behavioral observations- checklist

Done by psychiatrists, psychologists, school

psychologists among others


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Incidence

One of the most common neurobehavioral disorders in

childhood

Estimated prevalence in 3 to 5% of school age population

Occurs three times more often in boys than girls


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Etiology

Causes not clear, recent research looking at:

Genetic factors- seems to run in families

Neurologic factors-

Frontal parietal lobe activity is low Frontal orbital under functioning and thus limbic system

to which it is linked

Neurochemical imbalances- medications that influence

neurotransmitters are effective in some


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Subtypes in DSMIV-TR

The DSM-IV identifies three sub-types of ADHD,

depending on the presence or absence of

particular symptoms: Inattentive type,

Hyperactive type, and Combined type. To be diagnosed with ADHD, individuals must

have six of the nine characteristicsin either or

both DSM-IV categories listed below.


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ADHD - Predominantly Inattentive Type

Fails to give close attention to details or makes careless

mistakes.

Has difficulty sustaining attention.

Does not appear to listen. Struggles to follow through on instructions.

Has difficulty with organization.

Avoids or dislikes tasks requiring sustained mental effort.

Loses things. Is easily distracted.

Is forgetful in daily activities.


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ADHD - Predominantly

Hyperactive/Impulsive Type

Fidgets with hands or feet or squirms in chair.

Has difficulty remaining seated.

Runs about or climbs excessively.

Difficulty engaging in activities quietly.Acts as if driven by a motor.

Talks excessively.

Blurts out answers before questions have been

completed. Difficulty waiting or taking turns.

Interrupts or intrudes upon others.


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ADHD - Combined Type

Individual meets both sets ofinattention and hyperactive/impulsive

criteria.


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What we see:

Frequent and severe inattention (poor sustained

attention) and impulsivity, including:

oFailure to attend to details

oPoor attention during play

oDifficulty actively listening to instructions or

conversation,

o Difficult organizing tasksoAvoidance of tasks requiring sustained attention

oEasily distracted


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What we see with hyperactivity

Inability to remain seated when

expected

Frequent fidgetingConstantly on the go

Difficulty playing quietly

Excessive talking


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Impulsivity

Inability to wait ones turn

Frequent and incessant interruptions

Blurting out answers before question isasked


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Thus:

Low frustration tolerance

Sleep disturbances

Demands for attention

poor self esteem

At risk for injury due to risk taking andimpulsive behavior


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Similar conditions

Certain conditions that could mimic ADHD or cause the

ADHD-like behaviors are:

A sudden life changes (such as divorce, a death in the

family, or moving)

Undetected seizures

Thyroid problems

Sleep problems

Anxiety Depression

Lead toxicity


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Prognosis

into adolescence and adulthood

ADD:

Problems with academic failure, low self esteem, diff with

socially appropriate behavior

ADD with impulsivity/hyperactivity:

Higher incidence of personality trait and ab nitsocial

personality

Impulsivity, restlessness, and poor social skills continue

Both:Adjust better to work than school

Depression, interpersonal problems, low intelligience


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Medical management

Medications psychostimulants help with overactivity,

attention span, impulsivity, self control

common names are Ritalin, Concerta, Focolan, Adderall

May take time to determine which one(s) work best forchild (side effects)

Behavioral interventions for persistent behaviors (even

with medications)

Counseling, cognitivebehavioral therapy, behaviormodification, social skills training

Educational support, OT, Speech, behavior specialists

:


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Occupational Therapy Intervention

Referrals in school setting are quite common, for:

Sensory modulation and self regulation

Handwriting,

Organizational skills

Social skills

Environmental modifications

Coordination

Fine motor skills


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The Occupational Therapy Practice FrameworkAreas ofOccupation

Client Factors PerformanceSkills

PerformancePatterns

Context &Envir.

ActivityDemands

ADLs Values, Beliefs

& Spirituality

Sensory

Perceptual

Skills

Habits Cultural Objects Used

& Their

Properties

IADLs Body

Functions

Motor & Praxis

Skills

Routines Personal Space

Demands

Rest & Sleep Body

Structures

Emotional

Regulation

Skills

Roles Physical Social

Demands

Education Cognitive

Skills

Rituals Social Seque. &

Timing

Work Comm. &

Social Skills

Temporal Required

Actions

Play Virtual Required Body

Funct

Leisure

Social Particip.

Required Body

Structures


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LEARNING DISABILITIES


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Definition

A group of problems that affect a childs ability to master

school tasks, process information, and communicate

effectively.

Most children have average or above average intelligence

Do not have deafness or blindness

As defined by IDEA:

Group of disorders that interfere with child's ability to

learn in typical classroom Discrepancy between childs cognitive ability and their

academic achievement


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Incidence

Affects 4 to 5% of the school

population

More boys than girls affected by ratioof 4 to 1.

Girls may be less frequently

diagnosed


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Etiology

No single cause defined

Neurologic defects presumed or evident

Genetic influences

Maternal causes: illness, drug use,

Complications during pregnancy or delivery:

spotting, toxemia, prolonged labor, precipitous labor

Neonatal problems: prematurity, low birth weight, jaundice, perinatal

asphyxia, respiratory distress


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Signs and Symptoms (associated problems)

Child may exhibit any number of these behaviors:

Disorders of motor function may include:

Clumsiness, poor gross and fine motor skills, dyspraxia (motor

planning), problems with balance and sensorimotor problems

Educational disorders in one or more subject area.

Related problems with copying from board, handwriting, organizing

time and materials, understanding written and oral directions, letter

reversals, cutting, coloring, drawing.

Disorders of attention and concentration (ADD ADHD) Disorders of thinking and memory:

abstract reasoning, and concept formation, poor short and long

term memory


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Signs and Symptoms (cont)

Problems with Speech and Communication: Sequencing words, sentences, sounds, articulation

problems, shifting topics, conversation

Sensory Integration and perceptual disorders,

including laterality, directionality as well as otherVisual Perceptual problems

Psychosocial problems:

Social delays, tantrums, antisocial behaviors,poor self esteem (have the intellect to know they

are not performing as peers, may be teased)


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Specific Learning Disability may include:

Dyslexia affects how a person processes language.Reading and writing are difficult, as are grammar andreading comprehension. May also have trouble expressing

themselves verbally and putting together thoughts during

conversation.

Dysgraphia affects a person's writing abilities. May have avariety of problems, including: handwriting, spelling, putting

thoughts on paper

Dyscalculia affects a person's ability to do math. Many

forms and different symptoms seen. In young children,dyscalculia may affect learning to count and recognize

numbers. In the older child, trouble solving basic math

problems or memorizing things like multiplication tables may

occur.


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Signs and Symptoms (cont)

Auditory difficulties that have a huge impact on schoolperformance:

problems with auditory perception and auditory memory,

not hearing acuity.

Auditory memory,

Phonemic synthesis sound out words and blends

Speech in noise screen out background noise

Auditory sequencing of sounds, words, or numbers

best tested by audiologists for CAPD (Central Auditory Processing Disorder)


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Diagnosing Learning Disability

Neurologic or neurodevelopmental eval

Testing by a clinical psychologist, a school

psychologist, a developmental

psychologist.

Evaluations may also be done by an

occupational therapist, or a speech and

language therapist
http://www.webmd.com/mental-health/guide-to-psychiatry-and-counselinghttp://www.webmd.com/mental-health/guide-to-psychiatry-and-counseling


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Management of Learning Disabilities

Special education Under the Individuals WithDisabilities Education Act (IDEA), qualified

children with learning disorders are entitled to

receive special education services for free in

public schools.

A team of special educators create an

individualized education program (IEP) that

outlines what special services he needs to learnat school. Educators and related services

personnel implement IEP.
http://www.webmd.com/brain/autism/individualized-education-programs-ieps-for-autismhttp://www.webmd.com/brain/autism/individualized-education-programs-ieps-for-autism


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Management (cont)

Resources are also available outside of the public school

system, including:

Private schools that specialize in treating children with

learning disabilities

After-school programs designed for children with learning

disabilities

At-home tutoring and therapy services


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Prognosis

Early intervention is critical

Outcomes can be good depending on how extensive the

learning problem and appropriate support for learning and

psychosocial issues

Life and career options can be made to capitalize on

ones strengths

College is not out of the questions

LD is much more recognized and accepted, and

resources are available even on college level


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Areas of Occupation Client Factors: Values, beliefs and spirituality,

Body function, Body structure

Performance Skills-Sensory perceptual skills,

Motor and praxis skills, Emotional regulation

Cognition, Communication and Social skills

ADLs

IADLs

Rest and Sleep

Education

Work

Play

Leisure and Social skills

Impact of the Condition on Occupation


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OT Intervention

Sensory motor

Sensory integration

Handwriting

Organizational skills

Visual perceptual remediation

Social skills

Community and vocational skills

Visual Perceptual problems


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References

Case-Smith, J. and OBrien, J. Occupational Therapy for

Children, Sixth edition(2010). Maryland Heights: Mosby

Elsevier.

Beers, M and Berkow, R., (eds). The Merck Manual of

Diagnosis and Therapy, 17th edition(1999). WhitehouseStation: Merck Research Laboratories

http://children.webmd.com/detecting-learning-disabilities

http://children.webmd.com/detecting-learning-disabilities

http://www.chadd.org
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attention deficit and learning disabliles

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