Chapter 13: Students with Neurological Disabilities and Chronic Health Needs

1. Chapter 13: Students with Neurological Disabilities and Chronic Health Needs • Misconceptions about ASD students (pp. 165-166) • Different Types of Autism (p. 166) • Characteristics of ASD (p. 167) • Red flags for parents (p. 168) • Treatment (p.170) • Issues in the Field (pp. 173-174) • Classroom strategies (pp. 174-176)

2. Misconceptions about ASD (pp. 165-166) • ASD is a kind of mental illness. No known psychiatric illness • ASDs are untreatable. Early intensive intervention • Preoccupied, career parents are most at risk for causing ASD – no evidence • ASDs are result of social disconnected urban culture – no connection • ASDs can be caused by vaccination – 1998 journal retracted in 2004

3. Different Types of Autism (p. 166) • There are 5 different types of Autism listed under the title, Pervasive Development Disorder. Included are: • Autistic Disorder • Asperger’s Disorder • Pervasive Development Disorder • Rett’s Disorder (girls only) • Childhood Disintegrative Disorder

4. Who Has It? • More common in boys than girls, 3:1 or 4:1 • Over 7,000 kids in Ontario public schools have autism. • Around 5 per 10,000 births are born with “classic” autism. • Asperger’s syndrome is over 90 per 10,000 births. • Asperger’s is not easily recognizable and may be confused or misdiagnosed with other neurological disorders such as Attention Deficit Disorder, No medical tests available for diagnosis (ex. Blood Test)

5. Characteristics of Autism (p. 167) • Social Interaction- aloofness and distancing oneself from others (like to be alone), lack eye-contact nor body language, little shared play or making friend. • Communication- speech delay, diminished or absent, may use gestures, and attach words to unusual meanings • Behaviour- “bizarre”, obsessed with a theme or object, repeated actions, delays in responding, imitative learning is limited • Responses to Sensory Stimuli-responses to sights, sound can be dramatic/upset or none. • Transition/Responses to Change- difficulty coping with changes in environment/routines, e.g. recess, EA

7. Characteristics : • Inappropriate laughing or giggling • No real fear of danger • Apparent insensitivity to pain • Rejects physical contact • Sustained unusual or repetitive play • Avoids eye contact • Displays lack of interest in people or play • Has difficulty expressing needs and may use gestures instead • Displays inappropriate attachments to objects • Resistant to change • Echoes words or phrases • Inappropriate response or no response to sound • Obsessive spinning of objects or self • Has difficulty interacting appropriately with others *these characteristics may be displayed in various combinations and in varying degrees of severity depending on the child

8. Red flags for parents (p. 168) • Does not babble at 1 • Hears but does not respond to name • Avoids eye contact and cuddling • Begins language then stops • Does not point to things or seek attention

9. Treatment (p.170) • No cure or accepted treatment for ASDs • Treatment approaches fall into 4 principle categories: • Biochemical (vitamin supplements, medications, food allergies) • Neurosensory (overstimulation and patterning, sensory integration techniques, facilitated communication, and auditory training) • Psycho-dynamic (holding and body contact therapy, psychotherapy) • Behavioural (intensive behaviour intervention, behavioural modification)

10. Issues in the Field (pp. 173-174) • Parent advocates for programs • Cost of programs – who should pay? • Media – Rain Man • Integration “If you let your students pick their own groups we’ll always be picked last. Defeats purpose of having groups, doesn’t it” Asperger student, age 19

11. Classroom strategies (pp. 174-176) • Placement already in place - Most students will have a program implemented by and EA or teacher • Intuition - Due to variability among students, often a trial and error process • Teaching essential skills - must be simple in order to process, need more time to process • Understand the ordinary -Teachers must be aware of adverse behaviours (sometimes obvious) and alternatives must be taught, NOT punished • Provide a safe haven – provide a quiet place if needed (with adult), tell other students • Prepare for changes in routine – provide assistance

12. Classroom strategies (pp. 174-176) • Structure group work deliberately – clear instructions for every member • Provide a seating plan – classroom location and who • Provide access to the Internet – ideal tool, individual • Be a positive role model – coach the class • Capitalize on special interests – ASD student teach others about ASD • Create a caring community

13. Suggestions For Teachers • Be consistent and be sure students know the consequences of their own actions. • Display ground rules in a visual spot. • Only give the child attention/praise for positive behaviour. • Avoid unnecessary routines and provide transition time with warnings. • Continually search for objects, activities, etc. that the child enjoys as these can help motivate and reward the student. • Integrate the student into normal sociable time during class, so they can learn from their peers. • Have highly structured and consistent education plans tailored to the individual student. • Add visual stimuli and textures to the classroom. • Avoid unexpected loud noises. • Avoid humor/irony (ex. It’s raining cats and dogs) • Repeat instructions multiple times. • Remove distractions.

14. Chapter 12: Students with Autism Spectrum Disorders (ASD) • Misconceptions about students with Neurological Disabilities and Chronic Health Needs (pp. 179-180) • The Needs (pp. 180-185) • Issues in the Field (pp. 185-187) • Classroom implications (p. 187) • Classroom strategies (pp. 188)

15. Misconceptions about Neurological Disabilities and Chronic Health Needs (pp. 179-180) • Conditions like epilepsy and Tourettes indicate mental illness. No more or less disposed to mental illness than anyone else. • People with spin bifida are incontinent. Bowel and bladder problems in severe cases but not with milder cases. • Arthritis is found only in elderly adults, no, with all ages • Medical science is reducing the incidence of physical disabilities and chronic conditions. Number increases as technology is increasing the survival rates.

16. Misconceptions about Neurological Disabilities and Chronic Health Needs (pp. 179-180) 1) Students with special health conditions are automatic candidates for special education. (false) Students with chronic needs may miss a great deal of schooling and may benefit from remedial work. • Students with Tourette syndrome swear and “talk dirty”, called coprolalia. Only 1/3 manifests the trait. • Physical condition of cerebral palsy students cannot be improved. Intervention and therapy can make a positive change • Neurologically disabilities implies diminishing intellectual capacity. This connection is not absolute.

17. Cerebral palsy (p. 180) • injury to the brain either before, during and after birth • motor disorder, difficulty maintaining posture (floppy muscle tone, involuntary movements) • slow, poorly coordinated voluntary movement, stiff, tense muscles, some degree of involuntary movement • not progressive but not curable • intellectual and development delays such as speech and language problems, visual auditory difficulties, and seizures • requires special equipment and E.A. may present a range of problems in the classroom

18. Spina bifida (p. 181) • any sudden injury that causes temporary permanent brain damage after birth • occurs in spinal column when one or more vertebrae do not close during pre-natal development • often accompanied by hydrocephalus, enlargement of the head caused by pressure from cerebral spinal fluid • doesn’t really affect progress in school, however, problems include difficulty paying attention, processing judgment, problem solving, sudden outburst of anger • higher than average chance of L.D.

19. Acquired brain injury (ABI)(pp. 181-2) • a sudden injury that causes temporary or permanent injury to the brain after birth, e.g.car accidents, near drawning, violence, sports related injuries • serious effect on cognitive, behavioural/emotional and physical well being • Physical difficulty in fine and gross motor skills, speech, hearing and vision, difficulty with attention, processing, judgment, problem solving, memory, • behavioural and emotion problems, • usually need specialized help in a school setting • a team approach involving parents, school and medical personal, is suggested

20. Seizure disorders (Epilepsy) (pp. 182-3) • symptom of a brain disorder that leads to seizures • losses of consciousness, often convulse, may fall or stop breathing • may lose bladder control, bight tongue • teacher’s post seizure responses should be positive • teacher’s reassurance and emotional support is crucial

21. Tourette syndrome(p. 183-4) (p • is a low-incident need, there is no test for “tourettes” • neurological disorder that usually manifests itself in childhood (motor/vocal tics), small percentages use obscenities or curses • Behaviour-hyperactivity, obsession, indiscriminate rage • symptoms can disappear for long periods or all together • Due to advocacy it has become well known/researched • Other indicators: Difficulty starting or finishing work • Problems comprehending verbal instructions • Confusion over space time direction

22. Fetal Alcohol Syndrome (FAS)(p. 157) • Even small amounts of alcohol can result in FAS, damaging the fetus • FAS is lifelong and can be physical, behavioural and intellectual, from minor to major • FAS individuals have a higher epilepsy rate • FAS is more common in homeless population • Cases of FAS cases are on the rise • Since the 1970’s • FAS is 100% preventable. Don’t Drink While Pregnant!

23. Multiple Disabilities (pp. 184-5) • Has one or more special needs, e.g. 1/3 of students with hearing loss have other special needs • not always intellectually slow, some have oral language • tendency to place students with multiple disabilities is self-contained classes, sometimes integrated into regular classes with an EA • they need extra communication and support

24. Chronic Health Needs (p. 185) • e.g. cystic fibrosis, scoliosis, MD, diabetics, cancer, etc • Chronic health care not automatic special education. • may mean that both special program and services • Important for teachers to have an understanding of both daily and emergency procedures (i.e. Epi-pens) • school is a crucial element in the normalization • if a health needs can be met in a regular school • special attention is required (e.g. missed time due to frequent medical appointments)

25. Issues in the Field (pp. 185-187) • Teachers are concerned with how to react in emergency situations. • Families often experience emotional havoc (see movie). • They require extra time, money, energy and love, thus become draining on the teacher and parents and family. • Responsibility usually happens by default in a case of severely disabled students, especially on the teacher. • EA sometimes becomes the sole teacher and even sole companion.

26. Classroom Implications (p. 187) • Awareness and caution – but don’t be fearful & ignorant. • Attention to behaviour (class culture) as well as instruction and curriculum for the regular class • Involves medication with sedating side effects. • Students often miss instructional time due to illness/ therapy. Teacher must stay on top of this with extra help. • Personal needs are intensified in cases of chronic health needs • Affect progress through natural stages of development (e.g. Cerebral palsy) • North American culture obsessed with body image - these students cannot hide their disabilities

27. Classroom strategies (pp. 188) • Teachers must model (to class) on how to “be helpful without taking over” and react with empathy not pity. • The teacher must treat students the same as everyone else while making allowances for everyday needs • Use technology to assist students learning • Itinerant teachers are available for students at home, in the hospital or in other institutions • On occasion teachers help to discovery disabilities that go unnoticed (i.e. seizures, Tourettes) • Communication and cooperation are essential between teachers, parents and EAs