Children with special needs

1. Children with special needs 21st Feb 2011

2. Down syndrome • Types • Indications • Additional health problems • Developing speech and language • Social and emotional development • Medical difficulties • Factors for you to consider • Additional developments

3. Introduction • First described in 1866 • Genetic condition – extra chromosome • Learning disability and may have some physical difficulties e.g. heart problems • In the UK it occurs in about 1 in 700 births • It occurs in all social, economic, cultural, religious and racial backgrounds • It is not a disease and children do not suffer from Down syndrome

4. Types • 3 different types but the effects on the child are very similar • Standard trisomy – 95% of cases; an accident of nature; 47 chromosomes and not 46; • Translocation – 2% of cases; 46 chromosomes but one of the parents passes on an abnormal chromosome 21 • Mosaic Down syndrome – 2-5% of cases; some of child’s cells have 46 chromosomes and some have 47 chromosomes; effects of condition less severe

5. Indications at birth • Floppy; poor muscle tone • Small mouth; highly arched palate and protruding tongue • Flattened nasal bridge • Low hairline • Eyes slant upwards and outwards; epicanthic folds • Ears are small and low set • Broad hands with short fingers; one crease across palm • Feet are short and broad with a deep cleft between the first and second toe extending as a long crease on the side of the foot

6. Possible additional health difficulties • Hearing – vulnerability to ‘glue ear’ • Vision – possibly a squint • Physical development – may be smaller • Tendency to gain weight • Underdeveloped immune system in early years • Heart problems - 40%; half of these will require surgery

7. Diagnosis • The risk of having a child with Down syndrome increases with maternal age • Increases if you already have one child with Down syndrome • Genetic counselling often advised • Tests during pregnancy

8. Developing speech and language • Small nasal passages and sinuses; small mouth cavity; thick tongue that tends to protrude – leads to breathing and articulation difficulties • Make sure child can watch your face and mouth • Be patient • Sign system can be very helpful • Liaise with the speech and language therapist

9. Social and emotional development • Children with Down syndrome are all different! • Always praise and acknowledge good behaviour – do not constantly criticise • Be realistic in your expectations – the pattern of development will be the same as a ‘typical’ child but will be slower • Always explain simply and clearly what you expect • Be consistent in your approach • Remember that you are an important role model

10. Factors to consider for the early years worker • Essential that you motivate and encourage child to regard learning as fun and pleasurable • Watch out for any over protection by other children • Watch out for any bullying or teasing

11. Factors continued • Only ask for one thing at once • Break down every task into the smallest unit • Check the child understands what you want- demonstrations accompanied by simple instructions work best • Do not assume that the child understands basic terms such as ‘over’ and ‘under’, ‘top’ and ‘bottom’ • Always allow the child enough time • If teaching the child something new, make sure there are no or minimal distractions • Gym clubs, ballet classes and swimming can all help gross motor control and development and community inclusiveness • Use a lot of encouragement and positive feedback

12. General implications • Tendency for society to stereotype children with Down syndrome • It is important that you care for every child as an individual, balancing all needs and valuing and understanding differences – make sure you do not reinforce stereotypes • Increasingly leading full and independent lives and making positive contributions to society

13. Additional developments • New techniques of detecting Down syndrome • Cosmetic surgery • Support groups – down syndrome Ireland

14. Case study • Role of the Father in caring for a child with disability

15. Prader Willi Syndrome

16. Introduction • Genetic disorder • Seven genes on Chromosone 15 are missing or partially missing • Incidence is between 1 in 12,000 and 1 in 15,000 live births • Affects both sexes and all races

17. Causes and diagnosis • Normally contributed to father • Diagnosed by genetic testing • Rare to reoccur in same family • But all families should receive genetic counselling

18. Clinical features and signs • In utero • Reduced foetal movement • Frequent abnormal foetal position • At birth • Often breech/caesarian birth • Lethargy • Hypotonia • Feeding difficulties • Difficulties establishing respiration • Small gonads

19. Clinical features and signs • Infancy • Failure to thrive (continued feeding difficulties) • Delayed milestones/intellectual delay • Excessive sleeping • Strabismus • Scoliosis (often not detected at birth)

20. Clinical features and signs • Childhood • Speech delay • Poor physical co-ordination • Over eating from age 2-4 years (different from earlier difficulties) • Excessive weight gain • Adolescence • Delayed puberty • Short stature • Obesity

21. Adulthood Infertility Small gonads Sparse pubic hair Obesity Hypotonia Learning difficulties Proneness to diabetes Delayed motor development Prominent nasal bridge Small hands and feet Soft skin that is easily bruised Excess fat especially in central part of body High narrow forehead Picking at skin Almond shaped eyes Clinical features and signs

22. Intelligence • May have learning difficulties • Show an unusual cognitive profile • Strong in visual organisation and perception (including reading and vocabulary) • Spoken language generally poorer • Skill in completing jigsaws • Poor with auditory skills • Poor at maths and writing

23. Treatment • No cure • Growth hormone replacement therapy • Early intervention – team based approach • Highly structured learning environment • Controlling of food intake

24. Dyslexia

25. Introduction • Affects between 1-4% of children – mainly boys • It occurs despite normal teaching and ability • In schools may be called ‘specific learning difficulty’ • It mainly affects one or more areas of reading, spelling and written language • In the past children may have been perceived as being lazy or stupid • Should not be used as a handy cover-all label for children with minor problems of reading and writing

26. What happens • Condition is not fully understood • No genetic pattern of inheritance yet often found running in families • Premature babies and those who have a difficult period immediately after birth are most at risk • Can cause stress and anxiety for a child leading to low self esteem and a hatred of school

27. Features • Speech difficulties • Jumbled words and phrases • Difficulties naming colours • Confusion with directional words e.g. up, down, right, left • Movement control • Delayed fine motor skills • General clumsiness • Catching, throwing, riding a bike etc. • Memory and sequencing • Rhymes, days of the week, months, alphabet etc. • Other areas • Boredom, shy, withdrawn, unco-operative, but may enjoy chatting to others • Creative

28. Who makes the diagnosis? • Parents • School • Educational psychologist • GP • Speech and language therapist • Hearing and sight tests should be carried out to exclude any other possible difficulties

29. Care • Good practice for a child with dyslexia is also good practice for any child, but child will need more one to one attention • Will need time and patience and to be able to talk about problems as they happen • Use appropriate language and repetition • Boost self confidence by praising achievements • Listen carefully to the child

30. Suggested activities • Rhyming songs • Clapping out rhythms • Encourage games to develop sequencing • Picture lotto • Sorting games • Encourage co-ordination with large ball games and balancing games • Top, bottom, right and left • Painting • Dressing games

31. Ongoing management • Carefully organised and structured • Multi-sensory • Systematic with lots of reinforcement • Provide a framework of acceptable codes of behaviour • Individualised learning programme • May get very tired due to the need to concentrate more than most children

32. General implications and additional developments • Needs lots of encouragement to practise skills • Will take longer to reach goals • Intelligence is the same so may shine in other areas • Many child care workers feel that they needed more knowledge and confidence in working with these children

33. Alternative therapies • Main approach is the use of teaching strategies e.g. multi-sensory • Movement based therapies • Eye related therapies • Auditory therapies • Nutritional supplements/diet

34. Epilepsy

35. Introduction • Most common serious neurological condition • In epilepsy there is an interruption in the chemical activity in the nerve cells in the brain and a ‘fit’ or seizure can result • Seizures can occur that are not epilepsy i.e. febrile convulsions • About 6 in 1000 children have epilepsy and 80% attend mainstream school • Slightly more girls than boys have epilepsy

36. What happens? Electrical changes in the brain caused by something in the brain itself - • Antenatal infections • Family history • Jaundice • Some drugs taken in pregnancy

37. What happens? Electrical changes caused by factors external to the brain – • Temporary lack of oxygen • Photosensitivity • Severe infections – brain infections • Certain severe diseases

38. Types of seizures Over 40 different types – classified as generalized or partial seizures. They need to be managed in different ways. Generalized seizures • Tonic/clonic – ‘grand mal’ • Absences Partial seizures • Simple partial seizures • Complex partial seizures

39. Diagnosis • Pattern of repeated fits • Electroencephalogram (EEG) is used to confirm. Electrodes are placed on various points of the head and the brain activity is monitored – painless and harmless

40. Care • See first aid leaflet • Be careful of your reaction for the sake of the child and other children • The child may not remember the seizure only sensing what has happened from others around them

41. Ongoing management • Medication – but the success of this depends on several factors: • Type of epilepsy • Accuracy of the diagnosis • Accuracy of the treatment • The child’s response to the medication • Additional problems

42. Ongoing management • Seizures can be controlled in 80% of cases • Occasionally seizures lessen as the child grows older • A child needs to be involved in the management of their own treatment and see medication as a positive part of remaining healthy and not part of an ‘illness’ • Beware of negative images born out of fear and ignorance

43. Management in school/pre-school The disabling effects of epilepsy can be lessened if there is good communication between professionals, parents, the child and their friends. A teacher or pre-school worker must have full information on: • Type of epilepsy • Frequency of seizures • Speed of recovery following a seizure • The most appropriate management for the child • How the child feels about their epilepsy • Information about triggering factors • Details about medication including any possible side effects

44. General implications • Over protection will affect a child’s self esteem • Answer the child any other children’s questions honestly • Activities such as swimming and climbing? • Identification bracelet • Medication – careful storage; dosage checked; possible side effects known

45. General implications • Additional help must be sought in the following situations; • Child has injured themselves during a seizure • Child has trouble breathing after a seizure • One seizure immediately follows another, or the seizure lasts longer than 5 minutes • The seizure lasts longer than usual

46. General implications • Do not have low expectations • Epilepsy should not be used as an excuse for attention seeking or any other unacceptable behaviour • Possible causes of underachievement • Frequent major seizures • Frequent ‘absence’ seizures • Severe epilepsy – disorganised brain activity • Incorrect or excessive drug use – sleepiness • Rapid growth can affect amount of drug needed

47. Additional developments Epilepsy and surgery • Useful if scarring has occurred e.g. from meningitis or head injury • Only undertaken after extensive investigation • Specific stimulation, via a nerve in the neck, is offered to some older children • Most children manage their epilepsy well through medication

48. Case study