Chapter 8 Learning and Behavior Disorders

1. Chapter 8Learning and Behavior Disorders

2. Learning and Behavior Disorders The terms: behavior disorder, ADHD, or learning disability should be used with extreme caution when describing young children.

3. Attention Deficit Hyperactivity DisorderADHD • Attention Deficit Hyperactivity Disorder (ADHD) is a condition that becomes apparent in some children in the preschool and early school years. • It is hard for these children to control their behavior and/or pay attention. • It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. • This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.

4. History of ADHD • ADHD was first described by Dr. Heinrich Hoffman in 1845. • Book of poems, complete with illustrations, about children and their characteristics. • "The Story of Fidgety Philip" was an accurate description of a little boy who had attention deficit hyperactivity disorder.

5. Attention Deficit Hyperactivity Disorder • History of ADHD • It has been studied for the last 50 years. • It was originally thought to be brain damage. • The APA finally decided there were two categories: • ADD • ADHD • There are three patterns of behavior.

6. Attention Deficit Hyperactivity Disorder (continued) • Predominantly hyperactive-impulsive • No inattention • Predominantly inattentive • Often called ADD • No hyperactive-impulsive behavior • Combined • Inattentive and hyperactive-impulsive

7. Attention Deficit Hyperactivity Disorder (continued) • Current attempts at defining ADHD • It must be a clinical diagnosis that involves parent and teacher input. • It must manifest before age seven. • Characteristics must occur in multiple settings. • Characteristics must be maladaptive for the child’s age. • It must effect the child’s academic performance. • It cannot be a temporary response to a situation.

8. Attention Deficit Hyperactivity Disorder (continued) • Causes and prevalence of ADHD • There is no known absolute cause. • Possible causes are genetics; one or more parents is also hyperactive. • Maternal smoking or drug use during pregnancy may be a factor.

9. Causes of ADHD • Alcohol and drug abuse (including nicotine) during pregnancy can cause poor motor and muscular development and sensory impairment; problems with learning, memory, attention, and problem solving; and problems with mental health and social interactions. • Smoking during pregnancy

10. Certain theories regarding other potential causes of ADHD--for example, dietary factors (e.g., food allergies, sensitivities to food additives, sugar consumption), environmental allergies or sensitivities--have garnered much attention in the popular media. • However, they have received little or no research support to date.

11. Symptoms of ADHD • The year 2000 Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) provides criteria for diagnosing ADHD. The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.

12. Symptoms of ADHD DSM-IV Criteria for ADHD Either A or B: A. Six or more of the following symptoms of inattention have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level: • Inattention • Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities. • Often has trouble keeping attention on tasks or play activities. • Often does not seem to listen when spoken to directly. • Often does not follow instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions). • Often has trouble organizing activities. • Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework). • Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools). • Is often easily distracted. • Is often forgetful in daily activities.

13. Hyperactivity Often fidgets with hands or feet or squirms in seat. Often gets up from seat when remaining in seat is expected. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless). Often has trouble playing or enjoying leisure activities quietly. Is often "on the go" or often acts as if "driven by a motor". Often talks excessively. Impulsivity Often blurts out answers before questions have been finished. Often has trouble waiting one's turn. Often interrupts or intrudes on others (e.g., butts into conversations or games). Some symptoms that cause impairment were present before age 7 years. Some impairment from the symptoms is present in two or more settings (e.g. at school/work and at home). There must be clear evidence of significant impairment in social, school, or work functioning. The symptoms do not happen only during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder). B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:

14. Treatment • A child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding from parents, guidance counselors, and the public education system.

15. ADHD Treatment • Although there is no cure for ADHD, treatment can help control symptoms. • Stimulant medications: • amphetamines (examples include Dexedrine or Adderall) • methylphenidate (examples include Ritalin, Concerta, or Metadate CD), are effective in controlling symptoms in children. • Studies show that some children who receive behavioral therapy along with medication improve more than those who receive medication alone.

16. ADHD Treatment • Often, extra support at home and at school and counseling help children find success at school and feel better about themselves. • Doctors recommend that children be closely followed after they begin to take medications for ADHD. • Side effects—including loss of appetite, headaches or stomachaches, tics or twitches, and problems sleeping—usually decrease after a few weeks on the medication, or the dosage can be lowered to offset them.

17. Attention Deficit Hyperactivity Disorder (continued) • Causes and prevalence of ADHD • There is no known absolute cause. • Possible causes are genetics; one or more parents is also hyperactive. • Maternal smoking or drug use during pregnancy may be a factor.

18. Attention Deficit Hyperactivity Disorder (continued) • Intervention strategies • Medication and behavior management combined seems to be the best approach. • Medication • Ritalin is the most common. • It helps a child control impulsivity and pay attention in class. • It can cause sleep disorders, weight loss, and increased blood pressure. • Parents and teacher rely on the medicine to fix the behaviors.

19. Attention Deficit Hyperactivity Disorder (continued) • Special diets such as the Feingold Diet, which linked artificial food coloring and food additives with hyperactivity, have proven ineffective. • Parents feed the child additive- and dye-free foods to lessen hyperactive behaviors. • Nutrition is key, but eliminating foods does not solve the problem.

20. Attention Deficit Hyperactivity Disorder (continued) • Behavior management • Reward positive behaviors. • Evaluate the environment for behavior-causing areas and correct. • Plan developmentally appropriate activities for all children.

21. Attention Deficit Hyperactivity Disorder (continued) • Disorders that sometimes accompany ADHD • Learning disabilities • Oppositional Defiant Disorder • Conduct Disorder • Bipolar Disorder

22. Learning Disabilities • What is a learning disability? • A disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in the imperfect ability to listen, think, speak, write, spell, or do mathematical calculations

23. Learning Disabilities • Learning Disabilities (LD) are neurologically-based processing problems. • These processing problems can interfere with learning basic skills such as reading, writing, or math. • They can also interfere with higher level skills such as organization, time planning, and abstract reasoning.

24. Learning Disabilities • The types of LD are identified by the specific processing problem. • They might relate to getting information into the • brain (Input), • making sense of this information (Organization), • storing and later retrieving this information (Memory), • or getting this information back out (Output).

25. Learning Disabilities (continued) • It states clearly that a learning disability is not the result of: • visual, hearing, or motor handicaps. • mental retardation. • emotional disturbance. • environmental, cultural, or economic disadvantage. • second language learning.

26. Learning Disabilities (continued) • Non disadvantaged ruling • This excludes children who live in environmental or economic disadvantage from being labeled learning disabled. • Academic ruling • The definition states that there should be difficulty in reading, writing, spelling, and mathematical calculations. At what age?

27. Learning Disabilities (continued) • Areas that children may show signs of future learning disabilities: • Perinatal stress • Genetic or environmental conditions • Developmental milestones • Attention and behavior

28. Learning Disabilities (continued) • Predicting learning disabilities • Observation of child • Matching observation to performance measures • Caution: Children can develop skills in a range; looking for deviations from the range is a sign of possible learning disability.

29. Learning Disabilities (continued) • Prerequisite skills • These are skills needed to enter school. • Often children with learning disabilities lack these necessary skills to be successful in school.

30. Learning Disabilities (continued) • Examples • Sensorimotor difficulties (gross motor) • Imperfect body control • Poor balance • Uncertain bilateral and cross-lateral movements • Inability to cross body midline • Faulty spatial orientation • Sensorimotor difficulties (fine motor) • Problems in buttoning, lacing, snapping, cutting, pasting, and stringing beads • Perseveration

31. Sensory-motor Difficulties • Motor Disability: A student with motor problems might have difficulty with • fine motor planning (coloring, cutting, writing, buttoning, zipping, tying) and/or with • gross motor planning (running, jumping). • Some may have difficulty with visual-motor (eye-hand) activities required when doing certain visual spatial tasks or when catching or hitting a ball. • In addition, this child might have difficulty with vestibular function, manifested by weak upper trunk muscles and possibly by difficulty learning to ride a bike. • Finally, some may show tactile sensitivity, not liking to be held or cuddled or not liking cloths that are felt to be too rough. • This total clinical picture of motor problems is called Sensory Integration Dysfunction.

32. Learning Disabilities (continued) • Cognitive disorders • Trouble organizing • Abstract thought is difficult • Poor memory • Problems with generalizing information

33. Learning Disabilities (continued) • Visual and auditory perception problems • Information is primarily brought into the brain through the eyes (visual perception) and ears (auditory perception). An individual might have difficulty in one or both areas. • Visual discrimination • Visual orientation • Visual memory • Visual tracking • Visual-motor integration • Auditory perception problems

34. Visual Perception • One might have difficulty distinguishing subtle differences in shapes (called graphemes). • They might rotate or reverse letters or numbers (d, b, p, q, 6, 9); thus misreading the symbol. • Some might have a figure-ground problem, confusing what figure(s) to focus on from the page covered with many words and lines. • They might skip words, skip lines, or read the same line twice. • Others might have difficulty blending information from both eyes to have depth perception. • They might misjudge depth or distance, bumping into things or having difficulty with tasks where this information is needed to tell the hands or body what to do. • If there is difficulty with visual perception, there could be problems with tasks that require eye-hand coordination (visual motor skills) such as catching a ball, doing a puzzle, or picking up a glass.

35. Auditory Perception Also called Receptive Language • The individual might have difficulty distinguishing subtle differences in sound (called phonemes) • Might have difficulty distinguishing individual phonemes as quickly as normal. • Either problem can result in difficulty processing and understanding what is said. • Individuals might have difficulty with what is called auditory figure-ground. • They have difficulty identifying what sound(s) to listen to when there is more than one sound.

36. Learning Disabilities (continued) • Language deviations • Receptive language • Expressive language • Social skills deficits • Bullying • Withdrawn • Aggressive • Overdependent

37. Learning Disabilities (continued) • Response to intervention • This allows a teacher to intervene with a child without there being a required discrepancy between ability and achievement. • Tiered approach • Screening and group interventions • Target and short-term interventions • Intensive instruction

38. Learning Disabilities (continued) • Program considerations • All children will show signs of learning disabilities at one time or another. • Children need environments that are positive and developmentally appropriate. • Schedules need to be consistent. • Tasks need to be broken down into smaller chunks of information.

39. Behavior Disorders • Behavior is extreme, chronic, and unacceptable. • Experts who work with these children prefer the term behaviorally disordered because it places the focus on the observable aspect of the children’s problems: the behavior that is causing problems in school and at home.

40. Behavior Disorders (continued) • The term emotional or behavioral disorder means a disability characterized by behavioral or emotional responses in school so different from appropriate age, cultural, or ethnic norms that they adversely affect educational performance.

41. Behavior Disorders (continued) • Emotional and behavioral disorders can co-exist with other disabilities.

42. Behavior Disorders (continued) • This category may include children or youths with schizophrenic disorders, affective disorders, anxiety disorder, or other sustained disorders of conduct or adjustment when they adversely affect educational performance in accordance with section (I) (Forness & Knitzer, 1992, p. 13).

43. Behavior Disorders (continued) • Severe depression • This is categorized by low self-esteem, poor school performance, lack of friends, inability to cope with daily routines. • Some children with depression have parents who suffer from depression.

44. Behavior Disorders (continued) • Anxiety • People who experience excessive fear, worry, or uneasiness. • Some fears may even become phobias. • Fears are normal, but when taken to the extreme, they can cause multiple maladaptive behaviors.

45. Behavior Disorders (continued) • Anxiety • People who experience excessive fear, worry, or uneasiness. • Some fears may even become phobias. • Fears are normal, but when taken to the extreme, they can cause multiple maladaptive behaviors.

46. Anxiety Disorders • Panic Disorder—Repeated episodes of intense fear that strike often and without warning. • Physical symptoms include • chest pain, • heart palpitations, • shortness of breath, • dizziness, • abdominal distress, • feelings of unreality, and • fear of dying.

47. Obsessive-Compulsive Disorder—Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control. • Post-Traumatic Stress Disorder—Persistent symptoms that occur after experiencing or witnessing a traumatic event such as rape or other criminal assault, war, child abuse, natural or human-caused disasters, or crashes. • Nightmares, flashbacks, numbing of emotions, depression, and feeling angry, irritable or distracted and being easily startled are common. • Family members of victims can also develop this disorder.

48. Phobias Two major types: • social phobia • People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities. • specific phobia • People with specific phobia experience extreme, disabling, and irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.

49. Generalized Anxiety Disorder • Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months. • Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.

50. Autism Spectrum Disorders • Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDDs), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. • These disorders are usually first diagnosed in early childhood and range from a severe form, called autistic disorder, through pervasive development disorder not otherwise specified (PDD-NOS), to a much milder form, Asperger syndrome. • They also include two rare disorders, Rett syndrome and childhood disintegrative disorder.