Identification of Children with Special Education Needs

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Identification of Children with Special Education Needs

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1. Identification of Children with Special Education Needs Mark D. Simms, MD, MPH Professor and Chief, Developmental Pediatrics Medical College of Wisconsin

2. How Children With Special Education Needs Present in the Classroom Speech and/or language delay “Slow learner” – difficulty acquiring basic academic (reading/writing/math) skills Hyperactive/inattentive/disruptive behaviors Oppositional – refusal to do school work or home work, won’t follow rules, fighting with peers Aggressive – fighting with peers Does not complete assignments, forgetful (doesn’t hand in completed work), doesn’t bring work between home and school Excessively “shy” or withdrawn behaviors

3. Developmental Concerns in School-Age Children Approximately 11% of all children in USA receive special education services High incidence-Low severity: speech/language disorders; mild mental retardation; ADHD, learning disabilities Low incidence-High severity: Sensory impairment (blind-deaf), moderate-severe mental retardation; autism, cerebral palsy, serious emotional disturbance

4. Four Common Developmental Disorders in School-Age Children Language Disorder Mental Retardation Learning Disability Attention Deficit/Hyperactivity Disorder

5. Language Disorders Prevalence: about 7-9% of kindergarten children have difficulty with one or more aspects of language use and/or comprehension Language delay/disorder is a significant factor in reading/writing disorders

6. Communication Disorders Speech disorders: Sound production (articulation) Rate (cluttering) Fluency (stuttering) Language disorders: Expressive: use of words/ability to put thoughts into words Receptive: understanding of language

7. Language Disorders Lower level: Grammar (syntax) Word meaning (semantics) Higher level: Conversation Drawing inferences Pragmatic use of language Social interaction Turn-taking

8. Language Disorders Language disorders can occur in isolation Non-verbal intelligence is normal “Specific Language Impairment” (SLI) Language disorder may be part of a broader developmental disorder Mental retardation Autism/Pervasive Developmental Disorder

9. Language Disorders Educational Consequences: Poor academic progress Reading/writing disorders Social deficits Emotional difficulty

10. How Language Disorders Present in the Classroom Child is very quiet or unresponsive Grammatical errors when talking; speaks in phrases rather than complete sentences Lacks coherence (inadequate references, incomplete ideas) May use “space holders” – uhhh (word retrieval/language formulation difficulty) May use paraphasias – similar sounding or related words – or vague references (“that thing”)

11. How Language Disorders Present in the Classroom Behavior may be inattentive or “off-task” Fails to grasp concepts Inappropriate questions/statements/behaviors

12. Mental Retardation Prevalence: about 2-3% of children are mentally delayed in development Definition: (AAMD, 1992): “Significantly sub-average general intellectual functioning accompanied by significant limitations in adaptive functioning in at least 2 of the following skill areas: communication, self-care, social skills, self-direction, academic skills, work, leisure, health and/or safety”

13. Mental Retardation Intelligence tests were developed in the late-19th century to identify children who would require assistance in school They are not predictive of personality, behavior, or “success” in life – other than identifying individuals with slow cognitive development

14. Mild Mental Retardation 85% of children with MR are only mildly delayed (IQ 75-55) Most have normal appearance and develop at the “lower limit of normal” during early childhood years Developmentally, they resemble “younger” children Language development may be slow in early childhood, but “superficially normal” at school age Articulation and grammar are normal Content of communication is less complex than age peers and comprehension is delayed

15. Mild Mental Retardation Many of these children “lose” their diagnosis as adults: fewer academic demands, able to engage in vocational activities that rely on their “strengths,” blend in with their community Presentation in the Classroom Short attention span Slow to learn academic skills Seem “immature” compared with peers

16. Mild Mental Retardation Educational Consequences: Unrecognized, may develop secondary behavioral problems and/or poor self-esteem Parents and teacher may blame them for being “lazy” or attribute lack of success to other causes (e.g., ADHD) Social stigmas – peers call them “stupid” Excessive focus on “deficits” may result in failure to identify “strengths” – delay appropriate vocational preparation and overlook development of independence/life skills

17. Learning Disability In English – graphic forms are mapped to sounds (phonemes) In Chinese – graphic forms are mapped to syllables In both languages, dyslexia is manifested by a phonological deficit (graphic form to sound conversion) – the neural mechanism is different

18. Dyslexia A reading disorder characterized by difficulty with accurate and/or fluent word recognition and by poor spelling and decoding ability Phonological processing ? word reading ? reading comprehension May or may not have a language deficit: Comprehension may be good if information is presented orally

19. Dyslexia – English Speakers

20. Dyslexia – English Speakers

21. Dyslexia – Chinese Speakers In Chinese, acquisition of reading involves learning by rote memorization and repeated copying of newly learned characters. The area affected (the left middle frontal gyrus) is involved with the allocation and coordination of cognitive resources in working memory. This region is also very close to the primary motor cortex that is involved with handwriting.

22. Brain regions with significant activation during rhyme judgment. (a and b) Cortical activation associated with rhyme judgment contrasted with font-size decision in normal and dyslexic Chinese readers. (c) Brain regions showing group differences during rhyme judgment.Brain regions with significant activation during rhyme judgment. (a and b) Cortical activation associated with rhyme judgment contrasted with font-size decision in normal and dyslexic Chinese readers. (c) Brain regions showing group differences during rhyme judgment.

23. Comparison of English and Chinese Speakers with Dyslexia

24. Reading Disorder “Poor Comprehenders” – individuals with good phonological processing and fluent reading skills but poor comprehension of what they read May be missed in early grades and become more apparent as work load shifts from “learning to read” to “reading to learn” Common outcome for children with early language disorders

25. Attention Deficit/Hyperactivity Disorder About 3-6% of school-age children have difficulty focusing, planning, sustaining interest and shifting attention from one stimulus to another in a stable and efficient manner Children with ADHD have difficulty with “Executive Functions” – organizing things, working independently, completing tasks, bringing assignments from school-to-home and from home-to-school

26. Diagnosis of ADHD Symptoms must be pervasive Occur in more than one setting (home, school, work, play) Onset of symptoms before age 7 years and persist for at least 6 months Symptoms are not secondary to other disorders: mental retardation, language disorder, anxiety disorder, hearing deficit, epilepsy, etc.

27. Types of ADHD Three subtypes are recognized: Hyperactive/Impulsive Inattentive Combined: Hyperactive/Impulsive and Inattentive Comorbid Conditions: At least 50% of children with ADHD also have another problem Learning disorder Behavioral disorder (oppositional defiant or conduct disorder) Tourette’s syndrome (with tics) Bipolar disorder (with mania and depression)

28. Other Disorders that Results in ADHD Symptoms Emotional disorders: anxiety and depression Language disorders: poor comprehension Social/environmental stress: marital discord/abuse and neglect Sleep disorders Hearing deficits Side effect of common medications: phenobarbital, bronchodilators, corticosteroids, antihistamines

29. Referral for Developmental Evaluation All children with behavioral/emotional or learning difficulty should have a thorough evaluation: Intellectual ability: verbal and non-verbal skills Communication ability: expressive and receptive language skills Academic achievement: reading/writing/math Behavioral assessment: information provided by parents and teachers; observations in more than one setting Comprehensive medical evaluation, including family history of individuals with developmental/learning/behavioral/emotional problems

30. Developmental Evaluation Physical and neurological examination Ancillary medical diagnostic tests: MRI of brain EEG (“brain wave test” for epilepsy) Chromosome tests Consideration of medication treatment Counsel parents Most Important Action: Physicians should collaborate with teachers to identify the most effective ways to help the child be successful in school

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