Detecting Early Childhood Disorders

F O R S C H O O L S W I T H I N C L U S I O N

S R I K A N T H K S

N O V - 2 0 1 5

Early years identification and Intervention – Childhood disorders

© Srikanth KS 2015 . All rights reserved. Copying contents without written permission forbidden 22-11-2015

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Terms and Definitions

� Impairment : Any loss or abnormality of psychological, physiological or anatomical structure or function. In simple Deviation from the normal

� Dis-ability : Any restriction or lack (resulting from an impairment) of ability to perform an activity in the manner or within the range considered normal for a human being. In simple unable to do what an average person of that age can do

� Primary Handicap : a disadvantage for a given individual that limits or prevents the fulfilment of a role that is normal.

� Secondary Handicap: A disadvantage that was created by the person due to lack of movement


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The human brain

T H E R E G I O N O F U S E D M O R E G R O W S M O R E


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Nerve and connections


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Nerve connections


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Bundles of nerves and its relationship

M O R E Y O U W A L K T O T H E W E L L L E S S E R T H E W E E D S © Srikanth KS 2015 . All rights reserved. Copying contents without written permission forbidden 22-11-2015

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Neural Plasticity and Pruning

� Plasticity describes how experiences recognise neural pathway in the brain.

� A new born infant will get a lot of signals directed to the brain. The data from the eyes is sent to the occipital lobe which is the spot for vision and not the temporal lobe which processes language

� An infants brain can have upto 15000

Synapse per neuron.

As age increases, the syaptic connections

Are cut by a routine process called

Synaptic Pruning

B R A I N A L W A Y S K E E P S G R O W I N G


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Neural Plasticity

� Normal brain undergoes pruning on a routine basis, the stronger experience has a stronger path way where as a less used experience is pruned.

� Pruning can also happen as a part of an adaptive mechanism called as Injury induced pruning like stroke or trauma.

� In case of children with ADS, the process of pruning is not complete

T H E P R I N C I P A L A C T I V I T I E S O F B R A I N S A R E M A K I N G C H A N G E S I N T H E M S E L V E S . " - - M A R V I N L . M I N S K Y


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Developmental milestones 0 – 3 months

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0 – 3 months Observation Alarm

Hearing fully developed

Child able to turn in the direction of sound

Does not respond to loud sound or does not turn in the direction of sound

Vision 8-11 inches black and white

Child able to react to bright light

Feeds slowly, sloppy behaviour does not react to bright light

Motor skill Can move hands close to mouth while lying Able to shake hands and legs

Developmental milestones 3 months


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3 months Observation Alarm

Motor skill Can support head. Can lift his/her head and tend to turn around, does mini push-up

Cannot support head well Cannot grasp toys (fine motor)

Speech Starts babbling with VCV double syllable, puts lips together to say “m” Nasal sounds heard. Cries with different tone for different needs Vocally expresses eagerness

Cant focus on moving object Does not smile on seeing familiar face ignores new faces



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Motor skill Can roll over tummy, sit without help support his/her weight using legs Pulls toys closer, can move toys from one hand to another

Cant hold her head steadily, Seems floppy, cant sit down on her own

Speech Babbling conversations with you

Does not express eagerness

Vision Can see full colour. Can track objects moving far away

Focuses on specific toys only like spinning wheels Does not make an eye contact while speaking

Auditory Responds to name call Able to distinguish familiar and unfamiliar voices. Able to track sound

Does not respond to name call



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Motor skill Can crawl quite fast. Can bring toys closer to him Can lift small objects using two fingers Makes gestures like “yes” “no” to express himself. tries to copy elders like drinking from cup, combing hair,

Does not crawl Cant stand with support Cannot hold toys Does not use gestures like yes, no

Speech Babbling continues, able to speak small sentences like amma, appa, papa,

Vision Listens to and sees your lips while speaking



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Social and emotional Is Shy meeting strangers Cries when mother or father leaves Shows fear in situations like lights turned off in a room

Language Points to pictures when its named Says several single words and makes short sentences Follows instructions

Cannot speak small sentences. Does not follow simple instructions Cannot walk by 18 months

Cognitive milestone Begins to sort by shape and colour Demonstrates independence

Cannot push wheeled toys

Development Disabilities an overview

Development Disabilities

Specific disability

Speech and language disorder

Reading disorder/ Spelling disorder

Mathematical disorder

Motor Disorder

Gross motor disorder (CP)

Fine motor disorder

Global intellectual

disbility

Attention deficit hyper

activity disorder

Autism spectrum disorder


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Learning disabilities terms and Definitions (1/2)

� APD : Auditory processing disorder. Inability to distinguish subtle differences in sound example belt/built; three/free

� LPD: Language processing disorder, A part of APD where the child is not able to co-relate an object for a given sound.

� Dyscalculia: Difficulties in mathematics

� Dysgraphia: Handwriting difficulties

� Dyslexia: Reading and language based processing skills


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Terms and definitions (2/2)

� Non verbal learning disabilities : Discrepancy between higher verbal skills and weaker motor or visual-spatial and social skills

� Visual Motor defect: Difficulties to draw or copy


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Non learning disorders. Terms and Definitions

� ADHD (Secondary disorder) Attention deficiency and hyper activity. Unable to pay attention and difficulty in controlling behaviour

� Autism Spectrum disorder

� Dyspraxia: Difficulty in motor control normally co-exist with Dyslexia or Dyscalculia or ADHD

� Executive functioning: Inefficiency of cognitive management like planning, remembering details, paying attention

� Memory : Deficiencies in short term, working or long term memory


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Approach in identifying childhood disabilities

� Disorders can affect a child from 1 to 22 years.

� Many a times a incorrect medical condition can be mistaken for a disorder. Example if a child is very tired, always gazing out of the window, there is a possibility of mistaking it for ADHD where as it could be a simple case of anemia

� Dispassionate observation: A good teacher is one who knows what is in the mind of the last bench students

� Screen the professional

� Create an individualized learning plan for special children.


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Auditory processing disorder and Language processing disorder


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� Difficulty hearing in noisy situations

� Difficulty following long conversations

� Difficulty remembering spoken information (i.e., auditory memory deficits)

� Difficulty taking notes

� Difficulty with reading and/or spelling

� Difficulty processing nonverbal information (e.g., lack of music appreciation)

� Poor spellings bad at dictations

A D H D A N D A P D P R E S E N T S S I M I L A R S Y M P T O M S

APD/LPD Presentation and Intervention


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� Changing the learning environment (Less noisy)

� Use of electronic devices for aiding learning

� Consult a speech therapist and/or audiologist

� For Language processing disability : Use the following technique See � Say

� Do

� Example If the student needs to write the word Bag the teacher says Bag, Bag (two times) student repeats Bag, Bag (two times) and then student writes it once

Short video demonstration

Dyscalculia : Mathematics


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� Can occur any time from childhood until the teen ages

� No feel for numbers, No sense of numbers � Numbers not connected with a Magnitude � 4 + ---- = 9 � Counting for any calculations � Trouble with sequencing � Unable to memorise tables � Tendency not to notice patterns � Left right confusion � Difficulty in reading the clock, Money � Gradually reduce number counting and make

them realise the magnitude

L O O K F O R S I G N S W H O A R E I N C L A S S 5 A N D A B O V E

Dysgraphia – handwriting difficulties


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� Handwriting is illegible

� Missing words and letters incomplete sentences

� Awkward pencil grip , several spelling mistakes

� Says words aloud while writing

� Most of the times does not complete notes

C A N T A K E L O N G T I M E T O C U R E S O M E T I M E S D I S A P P E A R S W I T H A G E

Dyslexia – Reading and writing


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� Affects 3-7% of the population

� Generally very clever child but has difficulty in reading, writing or spellings

� Talented in art, drama sports or music

� Seems to day dream

� Has extended hearing – hears things that are not said example understands and reads “Enabled” as “Disabled”

� Putting letters and figures the wrong way round – such as writing "6" instead "9", or "b" instead of "d"

� Answering questions well orally, but having difficulty writing down the answer

Dyslexia simulation


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� Read the following passage and answer the following questions – Time allotted 2 minutes

� What other roles does the disability advisor at UMIST have ?

Dyslexia original text


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Secondary disorders


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� Attention deficiency-Hyperactivity disorder

� Most common childhood disorder can continue during adulthood. It is mainly composed of three broad types

� Predominantly hyperactive-impulsive: � Fidgeting hands

� Unable to sit in a place for a while

� Dash around and touch or play with everything around.

� Difficulty in doing a focussed task like assembling a lego toy

� Talks Non stop

� Be in constant motion, very impatient, difficulty in waiting for their turn

� Poor in academics

ADHD Continued


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� Predominantly inattention : � Be easily distracted, miss details, forget things, and frequently switch

from one activity to another

� Become bored with a task after only a few minutes, unless they are doing something enjoyable

� Daydream, become easily confused, and move slowly

� Struggle to follow instructions.

� Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities

� Poor in academics

� Combined hyperactive-impulsive and inattentive – A mix of both

C A N B E E A S I L Y C O N F U S E D W I T H B I P O L A R D I S O R D E R ! !

ADHD continued


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� Causes : Not clearly identified yet. Mainly due to genetic issues, environmental issues example a mother who smokes during pregnancy can have a child with ADHD and Brain injuries

� Average age of Onset is 7 years can occur later as well

� This Disability is not curable. It can be contained using medication and proper therapy.

Identification techniques


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� No single test can diagnose a child as having ADHD. � Most children get distracted, act impulsively, and struggle to

concentrate at one time or another. Sometimes, these normal factors may be mistaken for ADHD

� Often, teachers notice the symptoms first, when a child has trouble following rules, or frequently "spaces out" in the classroom or on the playground

� Some children with ADHD also have other illnesses or conditions � A learning disability � Oppositional defiant disorder : Very stubborn children who argue

with parents very often � Conduct disorder: Telling lies, stealing, fighting or bullying � Bipolar disorder: Extreme mood swings � Tourette syndrome: Or nervous Tics

T O U G H T O D E T E C T A N D C A N N O T B E F U L L Y C U R E D

Autism Spectrum Disorder


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� Persistent deficits in social communication and social interaction across multiple contexts;

� Restricted, repetitive patterns of behavior, interests, or activities;

� Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.

� The term “spectrum” refers to the wide range of symptoms, skills, and levels of impairment or disability that children with ASD can have.

Autism Spectrum disorder


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� Causes : Scientists don't know the exact causes of autism spectrum disorder (ASD), but research suggests that both genes and environment play important roles

� Most people who develop ASD have no reported family history of autism, suggesting that random, rare, and possibly many gene mutations are likely to affect a person's risk.

Autism Spectrum disorder


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� Repetitive and stereotyped behaviors � Children with ASD often have repetitive motions or unusual behaviors. These behaviors may be

extreme and very noticeable, or they can be mild and discreet. For example, some children may repeatedly flap their arms or walk in specific patterns, while others may subtly move their fingers by their eyes in what looks to be a gesture. These repetitive actions are sometimes called "stereotypy" or "stereotyped behaviors."

� Children with ASD also tend to have overly focused interests. Children with ASD may become fascinated with moving objects or parts of objects, like the wheels on a moving car. They might spend a long time lining up toys in a certain way, rather than playing with them. They may also become very upset if someone accidentally moves one of the toys. Repetitive behavior can also take the form of a persistent, intense preoccupation. For example, they might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Children with ASD often have great interest in numbers, symbols, or science topics.

� While children with ASD often do best with routine in their daily activities and surroundings, inflexibility may often be extreme and cause serious difficulties. They may insist on eating the same exact meals every day or taking the same exact route to school. A slight change in a specific routine can be extremely upsetting. Some children may even have emotional outbursts, especially when feeling angry or frustrated or when placed in a new or stimulating environment.

� No two children express exactly the same types and severity of symptoms. In fact, many typically developing children occasionally display some of the behaviors common to children with ASD. However, if you notice your child has several ASD-related symptoms, have your child screened and evaluated by a health professional experienced with ASD.

Early Symptoms


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� Social impairment, including difficulties with social communication

� Repetitive and stereotyped behaviours. � Social impairment � Most children with ASD have trouble engaging in everyday

social interactions. For example, some children with ASD may:

� Make little eye contact � Tend to look and listen less to people in their environment or

fail to respond to other people � Rarely seek to share their enjoyment of toys or activities by

pointing or showing things to others � Respond unusually when others show anger, distress, or

affection.

Early intervention

� Programs are designed children from 0 to 8 years

� Aimed at children who are “At-Risk” for or having development delays

� May typically involve the whole family

� May include health, educational and therapeutic services.

� The process

� Observe � Screen � Rule out medical issues � Refer for intervention � Follow up


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Assessment report


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� Who is being assessed?

� Why were they sent for assessment?

� Who referred them?

� What were the tools used for assessment?

� What are the findings?

� What are the recommendations?

Health & Medicine

Detecting Early Childhood Disorders