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SENSORY
INTEGRATION DISORDER
Sensory integration disorder or dysfunction
(SID) is a neurological disorder that results from the
brain's inability to integrate certain information received
from the body's five basic sensory systems. These sensory
systems are responsible for detecting sights, sounds,
smell, tastes, temperatures, pain, and the position
and movements of the body. The brain then forms a combined
picture of this information in order for the body to
make sense of its surroundings and react to them appropriately.
The ongoing relationship between behavior and brain
functioning is called sensory integration (SI), a theory
that was first pioneered by A. Jean Ayres, Ph.D., OTR
in the 1960s.
Description
Sensory experiences include touch, movement, body awareness,
sight, sound, smell, taste, and the pull of gravity.
Distinguishing between these is the process of sensory
integration (SI). While the process of SI occurs automatically
and without effort for most, for some the process is
inefficient. Extensive effort and attention are required
in these individuals for SI to occur, without a guarantee
of it being accomplished. When this happens, goals are
not easily completed, resulting in sensory integration
disorder (SID).
The normal process of SI begins before
birth and continues throughout life, with the majority
of SI development occurring before the early teenage
years. The ability for SI to become more refined and
effective coincides with the aging process as it determines
how well motor and speech skills, and emotional stability
develop. The beginnings of the SI theory by Ayres instigated
ongoing research that looks at the crucial foundation
it provides for complex learning and behavior throughout
life.
Causes and symptoms
The presence of a sensory integration disorder is typically
detected in young children. While most children develop
SI during the course of ordinary childhood activities,
which helps establish such things as the ability for
motor planning and adapting to incoming sensations,
others' SI ability does not develop as efficiently.
When their process is disordered, a variety of problems
in learning, development, or behavior become obvious.
Those who have sensory integration dysfunction may be
unable to respond to certain sensory information by
planning and organizing what needs to be done in an
appropriate and automatic manner. This may cause a primitive
survival technique called "fright, flight, and
fight," or withdrawal response, which originates
from the "primitive" brain. This response
often appears extreme and inappropriate for the particular
situation.
The neurological disorganization resulting in SID occurs
in three different ways: the brain does not receive
messages due to a disconnection in the neuron cells;
sensory messages are received inconsistently; or sensory
messages are received consistently, but do not connect
properly with other sensory messages. When the brain
poorly processes sensory messages, inefficient motor,
language, or emotional output is the result.
According to Sensory Integration International (SII),
a non-profit corporation concerned with the impact of
sensory integrative problems on people's lives, the
following are some signs of sensory integration disorder
(SID):
-
oversensitivity to touch, movement,
sights, or sounds
-
underreactivity to touch, movement,
sights, or sounds
-
tendency to be easily distracted
-
social and/or emotional problems
-
activity level that is unusually
high or unusually low
-
physical clumsiness or apparent
carelessness
-
impulsive, lacking in self-control
-
difficulty in making transitions
from one situation to another
-
inability to unwind or calm self
-
poor self concept
-
delays in speech, language, or motor
skills
-
delays in academic achievement
While research indicates that sensory
integrative problems are found in up to 70% of children
who are considered learning disabled by schools, the
problems of sensory integration are not confined to
children with learning disabilities. SID transfers through
all age groups, as well as intellectual levels and socioeconomic
groups. Factors that contribute to SID include: premature
birth; autism and other developmental disorders; learning
disabilities; delinquency and substance abuse due to
learning disabilities; stress-related disorders; and
brain injury. Two of the biggest contributing conditions
are autism and attention-deficit hyperactivity disorder
(ADHD).
According to Sensory Integration International,
Inc., when we think of "the
senses", we can easily call to mind taste,
smell, sight, and sound. The senses of touch, movement,
force of gravity, and body position are so natural to
most of us that we assume our way of dealing with incoming
sensation is common to all when in fact, it is not.
Our sense of touch (tactile
sense) enables us to identify a diverse world
of sensations from gently pleasurable to protectively
defensive. " Our sense of movement (vestibular
sense) responds to body movement through space
and change of head position. It is central in maintaining
muscle tone, coordinating the two sides of the body,
and holding the head upright against gravity. Body position
( proprioception) is
that sense which enables us to move different parts
of our bodies smoothly without having to observe every
action. Proprioception enables us to automatically adjust
ourselves to prevent falling out of a chair, or to manipulate
objects by hand such as pencils, buttons, eating utensils,
and combs."
"It is this interplay between the
senses, and their organization for use that is termed
sensory integration. The tactile (touch),
proprioceptive (body position),
and vestibular (movement)
senses are particularly important in providing knowledge
about motor planning which involves having an idea about
what to do, planning an action, and finally executing
the action."
"For most children, sensory integration
develops in the course of ordinary childhood activities.
Motor planning ability is a natural outcome of the process,
as is the ability to respond to incoming sensation in
a adaptive manner. But for some children, sensory integration
does not develop as efficiently as it should. When the
process of sensory integration is disordered, (say through
a lack of stimulation or movement over a long period
of time), a number of problems in learning, development,
or behavior may become evident."
WEBSITES
Basic Information
www.childhoodanxietynetwork.org/htdocs/htm/sid.htm
Additional Links
www.sinetwork.org
Sensory Integration International
www.sensoryint.com
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Dysgraphia
"Dysgraphia" is a learning disability
resulting from the difficulty in expressing thoughts
in writing and graphing. It generally refers to extremely
poor handwriting.
Underlying Causes
Students with dysgraphia often have sequencing
problems. Studies indicate that what usually appears
to be a perceptual problem (reversing letters/numbers,
writing words backwards, writing letters out of order,
and very sloppy handwriting) usually seems to be directly
related to sequential/rational information processing.
These students often have difficulty with the sequence
of letters and words as they write. As a result, the
student either needs to slow down in order to write
accurately, or experiences extreme difficulty with the
"mechanics" of writing (spelling, punctuation,
etc.). They also tend to intermix letters and numbers
in formulas. Usually they have difficulty even when
they do their work more slowly. And by slowing down
or getting "stuck" with the details of writing
they often lose the thoughts that they are trying to
write about.
Students with an attention deficit disorder
(especially with hyperactivity) often experience rather
significant difficulty with writing and formulas in
general and handwriting in particular. This is because
ADHD students also have difficulty organizing and sequencing
detailed information. In addition, ADHD students are
often processing information at a very rapid rate and
simply don't have the fine-motor coordination needed
to "keep up" with their thoughts.
Some students can also experience writing difficulty
because of a general auditory or language processing
weakness. Because of their difficulty learning and understanding
language in general, they obviously have difficulty
with language expression. Recall that written language
is the most difficult form of language expression.
WEBSITES
NINDS Dysgraphia Information Page
www.ninds.nih.gov/disorders/dysgraphia/dysgraphia.htm
Inland Empire Dyslexia Branch
www.dyslexia-ca.org/dysgraphia.htm
www.ldonline.org
Learning Disabilities Association
www.ldanatl.org/aboutld/parents/ld_basics/dysgraphia.asp
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Dyscalculia
The word "dyscalculia" means
difficulty performing math calculations. In other words,
it just means "math difficulty". And specifically,
it means a learning disability which affects math. Sometimes
confusion arises when we start dealing with the term
"dyscalculia" as it relates to "special
education services".
Underlying causes
of math difficulties:
Visual Processing
Weakness - This appears to be the most common
cause of math difficulty. To really be successful in
math you need to be able to visualize numbers and math
situations. When a person has a generalized visual processing
weakness it is sometimes referred to as a nonverbal
learning disability. When this is the cause of a student's
math difficulties, spelling and handwriting are often
also difficult areas (see dysgraphia). Reading and general
writing skills may be relative strengths.
Sequencing Problems
- Students who have difficulty sequencing or organizing
detailed information often have difficulty remembering
specific facts and formulas for completing math calculations.
If this is the underlying cause of a student's math
difficulties, there is often also difficulty in other
detailed learning areas (including reading decoding,
spelling, and anything which requires detailed memorization).
Sequencing problems are also frequently seen in people
with either dyslexia or dysgraphia.
Math "phobia"
- Some students just develop a "fear" or "phobia"
of math either because of negative experiences in their
past, inconsistent educational experiences, or lack
of self-confidence. Sometimes math phobia can cause
as much difficulty as a learning disability.
Strategies for students with
math difficulties:
-
Work extra hard to "visualize"
math problems. Maybe even draw yourself a picture
to help understand the problem.
-
Take extra time to look at any visual
information that may be provided (picture, chart,
graph, etc.).
-
Read the problem out loud and listen
very carefully. This allows you to use your auditory
skills (which may be a strength).
-
Ask to see an example.
-
Ask for or try to think of a real-life
situation that would involve this type of problem.
-
Do math problems on graph paper
to keep the numbers in line.
-
Ask for uncluttered worksheets so
that you are not overwhelmed by too much visual
information.
-
Spend extra time memorizing math
facts. Use rhythm or music to help memorize.
WEBSITES
www.dyscalculia.org
National Center for Learning Disabilities
www.ncld.org/LDInfoZone/InfoZone_FactSheet_Dyscalculia.cfm
Quiz
www.familyeducation.com/quiz/0,1399,23-26245,00.html
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Dyslexia
Dyslexia is a specific difficulty in learning to read
that cannot be attributed to other factors such as low
intelligence, physical disabilities such as poor vision
or hearing, lack of knowledge of English, or lack of
exposure to printed material as a child that results
in the lack of important pre-reading skills such as
the ability to recognize letters and the ability to
attach sounds to letters.
What
causes dyslexia and LD?
Dyslexia is a specific difficulty in learning
to read that cannot be attributed to other factors such
as low intelligence, physical disabilities such as poor
vision or hearing, lack of knowledge of English, or
lack of exposure to printed material as a child that
results in the lack of important pre-reading skills
such as the ability to recognize letters and the ability
to attach sounds to letters.
It is becoming apparent that dyslexia is a brain-based
disorder that is likely to have a genetic component.
For example, it is common for a child who has been identified
as having dyslexia to also have one or more relatives
who also have learning difficulties. An individual with
dyslexia typically has difficulty in processing the
constituent sounds (called phonemes) of language, and
research examining the brains of dyslexic individuals
while they are reading has identified differences between
the brain activity of a dyslexic reader and the brain
activity of a normal reader.
The difficulty in processing the constituent sounds
of language often results in language acquisition delays
and in the development of articulation problems. It
is important to recognize that there is virtually no
evidence that dyslexia has anything to do with the visual
system. In other words, the common belief that dyslexics
see letters backwards or read sentences from right to
left rather than from left to right is simply not true.
How do we identify dyslexia and LD?
The diagnostic process typically involves determining
if there is a gap between an individuals general learning
ability, and their performance in an academic skill
such as reading or mathematics. So, for example, an
individual who has normal abilities in areas like speaking
and learning from auditory sources, but difficulties
in learning to read or do mathematics may have a learning
disability.
In addition, an individual with either dyslexia or dyscalculia
typically displays particular patterns of strengths
and weaknesses. The dyslexic reader generally has little
difficulty in identifying letters, but does have difficulties
in reading words, and has particular difficulties in
sounding out letter sequences that do not form words
(e.g., "plok"). The individual with dyscalculia
displays difficulties in learning math facts such as
addition, subtraction and multiplication tables.
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What are the interventions for
learning disabilities such as dyslexia?
Common interventions for students identified
as having dyslexia involve attempting to remediate their
difficulties in processing and using the constituent
sounds in language. For example, one common difficulty
dyslexics have is identifying and using the sounds that
make up words. The ability, to identify sound patterns
is called phonological awareness, and interventions
for dyslexics often include practice in sound identification.
Another intervention approach involves trying to teach
the dyslexic reader to use phonics as a strategy to
assist in the word identification process. There are
many different variations of phonics-based strategies.
Sound based interventions (phonological awareness and
phonics training) are sometimes successful, but can
ultimately be harmful if continued for extended periods
of time without signs of significant progress. The difficulty
is that students develop the habit of sounding out virtually
every word they read. This makes reading painfully slow
and makes it very difficult to read for comprehension
without repeated re-readings.
There is less commonality to interventions for students
with dyslcalculia. Many interventions seem to be based
on the assumption that students do not understand the
conceptual bases of mathematics. However, there is no
evidence that this is true and there is little evidence
that conceptually based interventions are successful
at remediating math learning difficulties.
How successful is the treatment for learning disabilities?
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Learning disabilities vary greatly in
their degree of severity, and this has implications
for the likelihood that they can be successfully treated
via interventions. A severe disorder is less likely
to greatly benefit from an intervention than a mild
disorder.
Another factor contributing to the likelihood of a successful
intervention is the age of the child. Interventions
are most successful if they occur early. Interventions
provided to children prior to grade four are much more
likely to prove beneficial than interventions given
to older children.
What are the interventions for reading difficulties?
The most common intervention provided to a very young
child (kindergarten or first grade) is to teach "phonological
awareness" and letter-sound relationships. Phonological
awareness is the ability to hear and identify the constituent
sounds of spoken words. For example, a child who has
phonological awareness can identify words that rhyme
and words that do not rhyme, and they can tell you what
word would be produced if we took away the "cuh"
sound from the word "cart."
In contrast, a child who is in danger of developing
dyslexia has considerable difficulty performing these
tasks. Research has shown that some children who do
not have phonological awareness can be taught it via
direct instruction, and this in turn can prevent or
alleviate the development of reading problems as the
child matures.
The most common intervention for an older child (first
grade and beyond) involves teaching phonics skills that
assist in word recognition. There are many variations
of phonics-based interventions. However all of the phonics-based
approaches share the assumption that the child has difficulty
recognizing words and that systematic instruction in
identifying the sounds that letters make and in blending
those sounds to produce words will alleviate the reading
difficulties that the child is having.
Phonics-based interventions are effective with some,
but not all children. In some cases children learn to
use phonics to identify words, but they are never able
to develop the rapid sound blending skills that enable
effortless reading. This means that the child will always
have difficulty reading with comprehension and that
reading will continue to be a very effortful activity
requiring numerous re-readings before understanding
will occur.
The Educational Help approach to intervention with dyslexic
readers is to directly teach the rapid recognition of
words without using a phonics-based sound out strategy.
The research supporting the Educational Help approach
has shown that children with reading difficulties can
learn a large sight vocabulary.
In addition, the research has shown that practice in
rapid word recognition generalizes in two important
ways. First, an improvement in the ability to rapidly
recognize words also results in an improvement in reading
comprehension. Second, practice at rapidly recognizing
words generalizes to improvement in recognizing words
that are not being practiced. In other words, the intervention
has been shown to produce overall improvements in reading.
Interventions can improve the reading ability of a dyslexic
reader, but they cannot "cure" dyslexia. A
dyslexic reader can develop the ability to easily read
and understand familiar material. However, the symptoms
of dyslexia often reappear when the reader begins to
read in a new area (such as a science) or attempts to
learn a new language. This means that the reader should
also learn and use general strategies that will help
them any time they need to master new material. The
Educational Help approach includes assistance in learning
these strategies. More
on Dyslexia
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Autistic
Spectrum Disorders
AUTISM
Autism is a developmental disability that
affects, often severely, a person's ability to communicate
and socially interact with others. It is four times
more prevalent in males than females. Currently, autism
is believed to affect 1 in every 166 people. The rate
of people being diagnosed with autism has increased
substantially over the past two decades. Although this
may be in part due to improved diagnostic techniques
and to changes in the criteria for autism spectrum disorders
(see below), the majority of experts agree these changes
are not enough to explain the epidemic rates at which
autism is being diagnosed.
Autism Spectrum Disorders is an umbrella
term that includes classic autism (also known as Kanner's
autism or Kanner's syndrome), Asperger's syndrome, and
pervasive developmental disorder (PDD). Autism is considered
a spectrum disorder because the number and intensity
of the symptoms people with autism display may vary
widely. However, all people with autism demonstrate
impairments in the following three areas: communication,
social relationships and restricted patterns of behavior.
The spectrum ranges from those who are
severely affected, less able, and dependent on others
to those who are of above-average intelligence and independent,
yet lacking in social skills.
Autism Symptoms
Autism Symptoms vary widely in severity,
include impairment in social interaction, fixation on
inanimate objects, inability to communicate normally,
and resistance to changes in daily routine. Characteristic
traits include lack of eye contact, repetition of words
or phrases, unmotivated tantrums, inability to express
needs verbally, and insensitivity to pain. Behaviors
may change over time. Autistic children often have other
disorders of brain function; about two thirds are mentally
retarded; over one quarter develop seizures. more
on autism
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ASPERGER'S
SYNDROME
Asperger's Syndrome, also known as Asperger's
Disorder or Autistic Psychopathy, is a Pervasive Developmental
Disorder (PDD) characterized by severe and sustained
impairment in social interaction, development of restricted
and repetitive patterns of behavior, interests, and
activities. These characteristics result in clinically
significant impairment in social, occupational, or other
important areas of functioning.
In contrast to Autistic disorder (Autism),
there are no clinically significant delays in language
or cognition or self help skills or in adaptive behavior,
other than social interaction.
Prevalence is limited but it appears to be more common
in males. Onset is later than what is seen in Autism,
or at least recognized later. A large number of children
are diagnosed between the ages of 5 and 9. Motor delays,
clumsiness, social interaction problems, and idiosyncratic
behaviors are reported. Adults with Asperger's have
trouble with empathy and modulation of social interaction
- the disorder follows a continuous course and is usually
lifelong.
Aspergers is not easily recognizable -
in fact, many children are misdiagnosed with other neurological
disorders such as Tourette's Syndrome or Autism. More
frequently, children are misdiagnosed with Attention
Deficit (and Hyperactivity) Disorders (ADD & ADHD),
Oppositional Defiant Disorder (ODD), or Obsessive-Compulsive
Disorder (OCD). more
on asperger's syndrome
WEBSITES
Autism
Society
www.autism-society.org/site/PageServer
Autism
Society of America, Orange County Chapter...
website is http://www.asaoc.org
Cure
Autism Now
www.cureautismnow.org
Autism
Resources
www.autism-resources.com
Autism
Today - E-Zine
www.autismtoday.com
Autism
Information Center
www.cdc.gov/ncbddd/dd/ddautism.htm
OASIS
- Asperger syndrome
www.udel.edu/bkirby/asperger
ASPEN
http://maapservices.org/
Asperger
Info
www.aspergerinfo.com
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ADHD
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.
The principal characteristics of ADHD
are inattention, hyperactivity, and impulsivity. These
symptoms appear early in a child's life. Because many
normal children may have these symptoms, but at a low
level, or the symptoms may be caused by another disorder,
it is important that the child receive a thorough examination
and appropriate diagnosis by a well-qualified professional.
Symptoms of ADHD will appear over the course of many
months, often with the symptoms of impulsiveness and
hyperactivity preceding those of inattention, which
may not emerge for a year or more. Different symptoms
may appear in different settings, depending on the demands
the situation may pose for the child's self-control.
A child who "can't sit still" or is otherwise
disruptive will be noticeable in school, but the inattentive
daydreamer may be overlooked. The impulsive child who
acts before thinking may be considered just a "discipline
problem," while the child who is passive or sluggish
may be viewed as merely unmotivated. Yet both may have
different types of ADHD.
All children are sometimes restless, sometimes
act without thinking, sometimes daydream the time away.
When the child's hyperactivity, distractibility, poor
concentration, or impulsivity begin to affect performance
in school, social relationships with other children,
or behavior at home, ADHD may be suspected. But because
the symptoms vary so much across settings, ADHD is not
easy to diagnose. This is especially true when inattentiveness
is the primary symptom.
According to the most recent version of
the Diagnostic and Statistical Manual of Mental Disorders2
(DSM-IV-TR), there are three
patterns of behavior that indicate ADHD. People
with ADHD may show several signs of being consistently
inattentive. They may have a pattern of being hyperactive
and impulsive far more than others of their age. Or
they may show all three types of behavior.
This means that there are three subtypes
of ADHD recognized by professionals. These are the:
-
predominantly hyperactive-impulsive
type (that does not show significant inattention)
-
the predominantly inattentive type
(that does not show significant hyperactive-impulsive
behavior) sometimes called ADD-an outdated term
for this entire disorder
-
and the combined type (that displays
both inattentive and hyperactive-impulsive symptoms)
Hyperactivity-Impulsivity
Hyperactive children always seem to be
"on the go" or constantly in motion. They
dash around touching or playing with whatever is in
sight, or talk incessantly. Sitting still at dinner
or during a school lesson or story can be a difficult
task. They squirm and fidget in their seats or roam
around the room. Or they may wiggle their feet, touch
everything, or noisily tap their pencil. Hyperactive
teenagers or adults may feel internally restless. They
often report needing to stay busy and may try to do
several things at once.
Impulsive children seem unable to curb
their immediate reactions or think before they act.
They will often blurt out inappropriate comments, display
their emotions without restraint, and act without regard
for the later consequences of their conduct. Their impulsivity
may make it hard for them to wait for things they want
or to take their turn in games. They may grab a toy
from another child or hit when they're upset. Even as
teenagers or adults, they may impulsively choose to
do things that have an immediate but small payoff rather
than engage in activities that may take more effort
yet provide much greater but delayed rewards.
Some signs of hyperactivity-impulsivity
are:
-
Feeling restless, often fidgeting
with hands or feet, or squirming while seated
-
Running, climbing, or leaving a
seat in situations where sitting or quiet behavior
is expected
-
Blurting out answers before hearing
the whole question
-
Having difficulty waiting in line
or taking turns.
Inattention:
Children who are inattentive have a hard
time keeping their minds on any one thing and may get
bored with a task after only a few minutes. If they
are doing something they really enjoy, they have no
trouble paying attention. But focusing deliberate, conscious
attention to organizing and completing a task or learning
something new is difficult.
Homework is particularly hard for these
children. They will forget to write down an assignment,
or leave it at school. They will forget to bring a book
home, or bring the wrong one. The homework, if finally
finished, is full of errors and erasures. Homework is
often accompanied by frustration for both parent and
child.
The DSM-IV-TR gives these
signs of inattention:
-
Often becoming easily distracted
by irrelevant sights and sounds
-
Often failing to pay attention
to details and making careless mistakes
-
Rarely following instructions carefully
and completely losing or forgetting things like
toys, or pencils, books, and tools needed for a
task
-
Often skipping from one uncompleted
activity to another. more
on adhd
WEBSITES
www.adhdnews.com
www.adhd.com/index.jsp
www.help4adhd.org
www.adhdsupport.com/default.asp
www.chadd.org
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RARE
DISORDERS
There are too many rare disorders to list
or describe them in a comprehensive way in this format.
Instead, we have complied a list of website referrals
for you.
WEBSITES
www.rarediseases.org
National Organization for Rare Disorders is dedicated
to helping people with
rare, orphan diseases
www.cafamily.org.uk/rda-uk.html
www.irsc.org:8080/irsc/irscmain.nsf/cat?readform&cat=Rare+Disorders&type=Web+Pages
The Internet Resources for Special Children (IRSC) -
Global disABILITY resource
is dedicated to communicating information relating to
the needs of children with special needs
http://rarediseases.info.nih.gov
National Institutes of Health website
http://rarediseases.about.com/od/blooddisorders
Rare Blood Disorders
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Visual
Processing Disorder
What is it?
A visual processing, or perceptual, disorder
refers to a hindered ability to make sense of information
taken in through the eyes. This is different from problems
involving sight or sharpness of vision. Difficulties
with visual processing affect how visual information
is interpreted, or processed by the brain.
Common areas of difficulty
and some educational implications:
Spatial relation
This refers to the position of objects
in space. It also refers to the ability to accurately
perceive objects in space with reference to other objects.
Reading and math are two subjects where
accurate perception and understanding of spatial relationships
are very important. Both of these subjects rely heavily
on the use of symbols (letters, numbers, punctuation,
math signs). Examples of how difficulty may interfere
with learning are in being able to perceive words and
numbers as separate units, directionality problems in
reading and math, confusion of similarly shaped letters,
such as b/d/p/q. The importance of being able to perceive
objects in relation to other objects is often seen in
math problems. To be successful, the person must be
able to associate that certain digits go together to
make a single number (i.e., 14), that others are single
digit numbers, that the operational signs (+, x,=) are
distinct from the numbers, but demonstrate a relationship
between them. The only cues to such math problems are
the spacing and order between the symbols. These activities
presuppose an ability and understanding of spatial relationships.
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Visual discrimination
This is the ability to differentiate objects
based on their individual characteristics. Visual discrimination
is vital in the recognition of common objects and symbols.
Attributes which children use to identify different
objects include: color, form, shape, pattern, size,
and position. Visual discrimination also refers to the
ability to recognize an object as distinct from its
surrounding environment.
In terms of reading and mathematics, visual
discrimination difficulties can interfere with the ability
to accurately identify symbols, gain information from
pictures, charts, or graphs, or be able to use visually
presented material in a productive way. One example
is being able to distinguish between an /nl and an Imp,
where the only distinguishing feature is the number
of humps in the letter. The ability to recognize distinct
shapes from their background, such as objects in a picture,
or letters on a chalkboard is largely a function of
visual discrimination.
Visual closure
Visual closure is often considered to
be a function of visual discrimination. This is the
ability to identify or recognize a symbol or object
when the entire object is not visible.
Difficulties in visual closure can be
seen in such school activities as when the young child
is asked to identify, or complete a drawing of, a human
face. This difficulty can be so extreme that even a
single missing facial feature (a nose, eye, mouth) could
render the face unrecognizable by the child.
Object recognition (Visual
Agnosia)
Many children are unable to visually recognize
objects, which are familiar to them, or even objects,
which they can recognize through their other senses,
such as, touch or smell. One school of thought about
this difficulty is that it is based upon an inability
to integrate or synthesize visual stimuli into a recognizable
whole. Another school of thought attributes this difficulty
to a visual memory problem, whereby the person cannot
retrieve the mental representation of the object being
viewed or make the connection between the mental representation
and the object itself.
Educationally, this can interfere with
the child's ability to consistently recognize letters,
numbers, symbols, words, or pictures. This can obviously
frustrate the learning process, as what is learned on
one day may not be there, or not be available to the
child, the next. In cases of partial agnosia, what is
learned on day one, "forgotten" on day two,
may be remembered again without difficulty, on day three.
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Whole/part relationships
Some children have a difficulty perceiving
or integrating the relationship between an object and
symbol in its entirety and the component parts, which
make it up. Some children may only perceive the pieces,
while others are only able to see the whole. The common
analogy is not being able to see the forest for the
trees and conversely, being able to recognize a forest
but not the individual trees, which make it up.
In school, children are required to continuously
transition from the whole to the parts and back again.
A "whole perceiver", for example, might be
very adept at recognizing complicated words, but would
have difficulty naming the letters within it. On the
other hand, "part perceivers" might be able
to name the letters, or some of the letters within a
word, but have great difficulty integrating them to
make up a whole, intact word. In creating artwork or
looking at pictures, the "part perceivers"
often pay great attention to details, but lack the ability
to see the relationship between the details. "Whole
perceivers", on the other hand, might only be able
to describe a piece of artwork in very general terms,
or lack the ability to assimilate the pieces to make
any sense of it at all. As with all abilities and disabilities,
there is a wide range in the functioning of different
children.
Interaction with other
areas of development
A common area of difficulty is visual
motor integration. This is the ability to use visual
cues (sight) to guide the child's movements. This refers
to both gross motor and fine motor tasks. Often children
with difficulty in this area have a tough time orienting
themselves in space, especially in relation to other
people and objects. These are the children who are often
called "clumsy" because they bump into things,
place things on the edges of tables or counters where
they fall off, "miss" their seats when they
sit down, etc. This can interfere with virtually all
areas of the child's life: social, academic, athletic,
pragmatic. Difficulty with fine motor integration affects
a child's writing, organization on paper, and ability
to transition between a worksheet or keyboard and other
necessary information, which is in a book, on a number
line, graph, chart, or computer screen.
Interventions
First, a few words about interventions
in general. Interventions need to be aimed at the specific
needs of the child. No two children share the same set
of strengths or areas of weaknesses. An effective intervention
is one that utilizes a child's strengths in order to
build on the specific areas in need of development.
As such, interventions need to be viewed as a dynamic
and ever-changing process.
The following examples provide some ideas
regarding a specific disability. It is only a beginning,
which is meant to encourage further thinking and development
of specific interventions and intervention strategies.
The following represent a number of common
interventions and accommodations used with children
in their regular classroom:
For readings
Enlarged print for books, papers, worksheets
or other materials which the child is expected to use
can often make tasks much more manageable. Some books
and other materials are commercially available; other
materials will need to be enlarged using a photocopier
or computer, when possible.
There are a number of ways to help a child
keep focused and not become overwhelmed when using painted
information. For many children, a "window"
made from cutting a rectangle in an index card helps
keep the relevant numbers, words, sentences, etc. in
clear focus while blocking out much of the peripheral
material which can become distracting. As the child's
tracking improves, the prompt can be reduced. For example,
after a period of time, one might replace the "window"
with a ruler or other straightedge, thus increasing
the task demands while still providing additional structure.
This can then be reduced to, perhaps, having the child
point to the word s/he is reading with only a finger.
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For writing
Adding more structure to the paper a child
is using can often help him/her use the paper more effectively.
This can be done in a number of ways. For example, lines
can be made darker and more distinct. Paper with raised
lines to provide kinesthetic feedback is available.
Worksheets can be simplified in their structure and
the amount of material, which is contained per worksheet,
can be controlled. Using paper, which is divided, into
large and distinct sections can often help with math
problems.
Teaching Style
Being aware and monitoring progress of
the child's skills and abilities will help dictate what
accommodations in classroom structure and/or materials
are appropriate and feasible. In addition, the teacher
can help by ensuring the child is never relying solely
on an area of weakness, unless that is the specific
purpose of the activity. For example, if the teacher
is referring to writing on a chalkboard or chart paper,
s/he can read aloud what is being read or written, providing
an additional means for obtaining the information.
If you are concerned that your child may
have some of the above disorders-and need to seek a
professional diagnosis- I strongly advise you to ask
professionals if they are trained to diagnose processing
difficulties. Not all audiologists or developmental
optometrists are trained to test for this.
In addition, there are visual distortions
(like oscillopsia-which gives the sense that letters
are jumping when reading) that can be caused by vestibular
conditions. Clear vision is dependant upon a normally
functioning vestibular system. One of the functions
of the vestibular is to control eye positions and 20%
of our visual neurons respond to vestibular stimulation.
Therefore, you may be sent to a vestibular specialist
for what seems to be a vision problem. Do not be afraid
to ask your doctors questions if you do not understand
what they are looking for.
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Auditory
Processing Disorders
Children who have difficulty
using information they hear in academic and social situations
may have central auditory processing disorder (CAPD),
more recently termed auditory processing disorder (APD).
These children typically can hear information but have
difficulty attending to, storing, locating, retrieving,
and/or clarifying that information to make it useful
for academic and social purposes (Katz & Wilde,
1994). This can have a negative impact on both language
acquisition and academic performance.
What is central auditory
processing?
When the ears detect sound, the auditory
stimulus travels through the structures of the ears,
or the peripheral auditory system, to the central auditory
nervous system that extends from the brain stem to the
temporal lobes of the cerebral cortex. The auditory
stimulus travels along the neural pathways where it
is "processed," allowing the listener to determine
the direction from which the sound comes, identify the
type of sound, separate the sound from background noise,
and interpret the sound. The listener builds upon what
is heard by storing, retrieving, or clarifying the auditory
information to make it functionally useful. What is
a disorder of auditory processing? APD is an impaired
ability to attend to, discriminate, remember, recognize,
or comprehend information presented auditorily in individuals
who typically exhibit normal intelligence and normal
hearing (Keith, 1995). This definition has been expanded
to include the effects that peripheral hearing loss
may contribute to auditory processing deficits (Jerger
& Musiek, 2000). Auditory processing difficulties
become more pronounced in challenging listening situations,
such as noisy backgrounds or poor acoustic environments,
great distances from the speaker, speakers with fast
speaking rates, or speakers with foreign accents (Sloan,
1998).
What are the behaviors
of children with APD?
Children who have auditory processing
disorders may behave as if they have a hearing loss.
While not all children present all behaviors, Keith
(1995) offers the following examples of behaviors that
may be displayed by children who have APD:
-
Inconsistent response to speech
-
Frequent requests for repetition
(What? Huh?)
-
Difficulty listening or paying attention
in noisy environments
-
Often misunderstanding what is said
-
Difficulty following long directions
-
Poor memory for information presented
verbally
-
Difficulty discerning direction
from which sound is coming
-
History of middle ear infection.
-
What are academic characteristics
of children who have APD?
In addition to the preceding behaviors,
children may also present a variety of academic characteristics
that may lead teachers and parents to suspect APD. Baran
(1998) offers the following characteristics. Again,
all children will not present all characteristics.
-
Poor expressive and receptive language
abilities
-
Poor reading, writing, and spelling
-
Poor phonics and speech sound discrimination
-
Difficulty taking notes
-
Difficulty learning foreign languages
-
Weak short-term memory
-
Behavioral, psychological, and/or
social problems resulting from poor language and
academic skills.
-
How is APD diagnosed?
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Given the complexity of auditory processing
disorders, it is important to involve a multidisciplinary
team including psychologists, physicians, teachers,
parents, and of course, audiologists and speech-language
pathologists. Audiologists diagnose the presence of
APD (hearing and processing problems), and speech-language
pathologists evaluate a child's perception of speech
and receptive-expressive language use. Other team members
conduct additional assessments to determine a child's
educational strengths and weaknesses. Checklists that
ask teachers and parents to observe the child's auditory
behaviors may be used to determine a need for the APD
evaluation. The parent's description of the child's
auditory behavior at home is an especially important
contribution to the diagnosis of APD.
What does the audiologist
do?
The audiologist assesses the peripheral
and central auditory systems using a battery of tests,
which may include both electrophysiological and behavioral
tests. Peripheral hearing tests determine if the child
has a hearing loss, and, if so, the degree to which
the loss is a factor in the child's learning problems.
Assessment of the central auditory system evaluates
the child's ability to respond under different conditions
of auditory signal distortion and competition. It is
based on the assumption that a child with an intact
auditory system can tolerate mild distortions of speech
and still understand it, while a child with APD will
encounter difficulty when the auditory system is stressed
by signal distortion and competing messages (Keith,
1995). The test results allow the audiologist to identify
strengths and weaknesses in the child's auditory system
that can be used to develop educational and remedial
intervention strategies.
How should test results
be interpreted?
As with any kind of evaluation, test results
should be interpreted with caution. The effects of neurological
maturation may influence test results for children under
the age of 12 years. A true diagnosis of APD cannot
be determined until that time (Bellis, 1996). However,
there are much younger children whose auditory behaviors,
language, and academic characteristics indicate that
APD is a strong possibility, and even without a formal
diagnosis, these children would benefit from intervention.
Remediation should address their strengths and areas
of need based on available speech-language and psychoeducational
testing.
Is there a relationship
between APD and ADHD?
The behaviors of children with APD and
ADHD may be very similar, especially with regard to
distractibility. Given what is presently known, APD
and ADHD do not appear to be a single developmental
disorder. Each can occur independently, or they can
coexist. This is a prime example of where the team approach
to evaluation is critical, as the team can rule out
the presence of ADHD or determine its contribution to
the potential educational impact on the child.
What can be done to help
children with APD in the classroom?
Traditional educational and therapeutic
approaches can be employed to remediate areas of need
in language, reading, and writing. Many techniques that
have shown to be effective with children with APD would
be beneficial to all children, with and without APD,
if the strategies employed are specific to the child's
areas of need (Bellis, 1996; Chermak & Musiek, 1997;
Sloan, 1998). Some of these are described below:
Modify the environment by reducing
background noise and enhancing the speech signal to
improve access to auditory information:
-
Eliminate or reduce sources of
noise in the classroom (air vent, street traffic,
playground, hallway, furniture noises, etc.).
-
Use assistive listening devices
(ALDs) such as a sound field amplification system
or an FM auditory trainer.
-
Allow preferential or roving seating
to ensure that the child is seated as close to the
speaker possible.
-
Allow the child to use a tape recorder
and/or a peer notetaker.
-
insure that the speaker gets the
child's attention before speaking, and considers
using a slower speaking rate, repeating directions,
allowing time for the child to respond to questions,
pausing to allow the child to catch up, and presenting
information in a visual format through overheads,
illustrations, and print.
Teach the child
to use compensatory strategies, "meta" strategies,
or executive functions to teach how to listen actively.
The child should:
- Learn to identify and resolve difficult listening
situations.
- Develop skills to understand the demands of listening:
attending, memory, identifying important parts of
the message, self-monitoring, clarifying, and problem
solving.
- Develop memory techniques: verbal rehearsal (reauditorization),
mnemonics (chunking, cueing, chaining).
- Encourage use of external organizational aids:
checklist, notebook, calendar, etc.
Develop vocabulary, syntax, and pragmatic skills to
facilitate language comprehension.
Provide auditory
training to remediate specific auditory deficits:
- Children who have poor reading, writing, and spelling
skills may benefit from phonological awareness activities.
- Auditory closure activities may assist children
in filling in or predicting the information they are
listening to in the classroom and conversations.
- Instruction in interpreting intonation, speaking
rate, or vocal intensity, and in the relationship
between syllable and word may assist children in determining
important parts of the message.
- When the child has demonstrated success on the
above tasks in a quiet environment, give the child
practice engaging in the same tasks in an environment
that includes background noise.
- Explore the use of commercially available computer
programs designed to develop the child's attention
to the phonological aspects of speech. These should
be recommended by a professional who can determine
their applicability to the child's needs.
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Resources
American Speech-Language-Hearing Association. Task Force
on Central Auditory Processing Disorders. (1995). Central
auditory processing: Current status of research and
implications for clinical practice. Rockville, MD: Author.
Baran, J. A. (1998). Management of adolescents
and adults with central auditory processing disorders.
In Masters, M.G., Stecker, N.A., & Katz, J. (Eds.).
Central auditory processing disorders: Mostly management.
Needham Heights, MA: Allyn and Bacon, 195-214.
Bellis, T.J. (1996). Assessment and management
of central auditory processing disorders in the educational
setting: From science to practice. San Diego, CA: Singular
Publishing Group, Inc.
Chermak, G.D. & Musiek, F. E. (1997).
Central auditory processing disorders: New perspectives.
San Diego, CA: Singular Publishing Group, Inc.
Jerger, J. & Musiek, F.E. (2000).
Report on the consensus conference on the diagnosis
of auditory processing disorders in school-aged children.
Journal of the American Academy of Audiology, 11, 467-474.
Katz, J. & Wilde, L. (1994). Auditory
processing disorders. In Katz, J. (Ed). Handbook of
clinical audiology. (4th edition.). Baltimore, MD: Williams
and Wilkins, (4th ed.). 490-502.
Keith, R.W. (1995). Tests of central auditory
processing. In Roeser, R.J. & Downs, M.P. (Eds.).
Auditory disorders in school children. New York, NY:
Thieme Medical Publishers, Inc., 101-116.
Sloan, C. (1998). Management of auditory
processing difficulties: A perspective from speech-language
pathology. Seminars in Hearing, 19, 367-398.
Sandra R. Ciocci is a professor in Communication
Disorders at Bridgewater College, Bridgewater, MA.
Reading
Disorders
Math
Disorders
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of Written Language
What
is a Sensory Integration Disorder?
What
is Dysgraphia?
What
is Dyscalculia?
What
is Dyslexia
What
is Autism?
What
is ADHD - Attention-Deficit/Hyperactivity Disorder
What
is Asperger's Disorder
Information
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