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Student with Special Needs. Class #5 - Chapter 8 ADHD & Chapter 12 – Other Health Impairments Karen Gatto & Roni Kramer Winter 2009. Other Health Impairment.

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Student with Special Needs

Class #5 - Chapter 8 ADHD & Chapter 12 – Other Health Impairments

Karen Gatto & Roni Kramer

Winter 2009


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Other Health Impairment

Having limited strength, vitality or alertnessincluding a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment, that is due to chronic or acute health problems, including but not limited to a heart condition, tuberculosis, rheumatic fever, nephritis, asthma, sickle cell anemia, hemophilia, epilepsy, lead poisoning, leukemia, diabetes, attention deficit disorder, attention deficit /hyperactivity disorder or tourette syndrome, which adversely affects a student's educational performance.


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Attention Deficit/Hyperactivity Disorder

Attention Deficit/Hyperactivity Disorder (AD/HD)

  • Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurobehavioral disorder that affects an estimated 4 - 12% of the school age population. The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV), published by the American Psychiatric Association, describes three subtypes of AD/HD:

  • Inattentive: can't seem to get focused or stay focused on a task or activity

  • Hyperactive: impulsive: very active and often acts without thinking

  • Combined: inattentive, impulsive, and too active


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Some sources have reported that AD/HD affects to varying degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

NYSED P-16


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Definition and Characteristics of ADD and ADHD degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more(see page 182)

  • A persistent pattern of inattention

    and /or hyperactivity-impulsivity.

  • Severe, frequent, persistent, and interfer with one’s ability to perform on a daily basis .

  • APA criteria: Must be manifested before the age 7

  • Symptoms must persist for at least 6 months

  • 3 times as many boys as girls are affected

  • AD/HD is on the rise

  • Some “recover” as they get older


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Inattentive type degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Appears ages 8-12

  • “daydreamers”

  • Overlooked at times

  • “ADD”

  • Internally rather than externally focused

  • Can’t get started


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Inattentive type cont’d degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Fails to pay close attention to details

  • Difficulty sustaining attention

  • Does not follow through on instructions

  • Fails to finish things

  • Forgetful

  • Difficulty organizing tasks

  • Avoids things that require sustained mental effort

  • Loses things


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What to do degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Make sure you allow enough time to shift from one activity to the next

  • Teach organizational strategies

  • Flexible time limits

  • Simplify multi step activities


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AD/HD -Hyperactive-Impulsive Type degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

AD/HD – must have 6 or more characteristics that are present for at least 6 months

  • Cannot sit still

  • Talks excessively

  • Acts as if “driven by a motor”

  • Difficulty playing in leisure activities quietly

  • Leaves seat in classroom when others are seated

  • Runs or climbs excessively


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AD/HD – Hyperactive-Impilsive Type (cont.) degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Blurts out answers

  • Difficulty waiting for turn

  • Interrupts or intrudes on others


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AD/HD - COMBINED TYPE (CB) degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Inattention and hyperactivity (used to be AD/HD)

  • 85% of students with AD/HD fall into this category

  • Easily distracted

  • Can’t finish work


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Behavioral Inhibition degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Controlled by the four executive functions of the brain

  • Students with AD/HD have difficulty here resulting in high risk for conduct disorders, delinquency, low self esteem, dropping out, interpersonal difficulties, etc. know what to do but can’t do it.


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Impairments in 4 types of Executive Functioning degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

Nonverbal Working Memory:

  • Allows one to retrieve auditory, visual, and sensory memories from the past

Internalization of speech

  • We talk to ourselves in planning our responses. We think about social rules.


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4 Exec. Functions cont’d. degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

Self regulation of affect, motivation and arousal:

  • The presence of external rewards that that fuels persistence and drive. Students with AD/HD are less objective and more emotional

Reconstitution:

  • Analyzing and synthesizing behavior. The ability to break behavior or task into steps


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Biological Explanations degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Genetics

  • Brain differences – not just an attention disorder

  • Not an issue of filtering out stimuli but inability to inhibit impulses to that input. Smaller overall brain volume. They know what to do – they cannot control what they do


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The presence of AD/HD degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • 10-40% have a learning disability

  • 30% have a reading disability

  • Assessment includes:

    • Psych evaluation

    • Medical evaluation

    • Achievement tests

    • Behavior rating scales

    • Teacher observation

  • Only an MD can recommend medication


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Connor’s Abbreviated Rating Scale degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much morea total of more than 15 is suggestive of AD/HD


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Myths and Causes degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • Not sugar and many other environmental causes

  • Not poor parenting

  • Heredity, structural differences in the brain, prenatal and perinatal factors


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PLANNING A LESSON – Augmenting Curriculum degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

The need for external motivation – 7 key words:

  • Relevance

  • Novelty

  • Variety

    4. Challenge

    5. Feedback

    6. Choices

    7. Activity


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Augmenting Curriculum degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

  • FOSTER SELF EFFICACY

  • PERSONAL ACCOMODATIONS

    See page 194 – putting strategies to work


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Tourette’s Syndrome degrees upwards of 30-40% of the general population. This can interfere with an individual's ability to focus for extended periods of time, or to break from focus in order to move forward. For some individuals with AD/HD, it is often difficult to filter key information from the distraction of sensory overload. Others may be described as having a 'racing-mind', which suggests information is processed so fast that key information for understanding is missed. AD/HD may adversely impact social interactions, personal relationships, time management, organization, anxiety levels, patience, and much more

Tourette’s Syndrome is a neurobiological disorder characterized by motor and vocal tics with an onset in childhood.

  • Motor tics – Involuntary movements may be sudden twitches of the head, shoulders or even the entire body, eyeblinks, grimacing or repetitive tapping, drumming or touching behaviors.

  • Vocal tics – involuntary uttering of noises, words or phrases. Could include: sniffing, throat clearing or repeated coughing, varity of sounds or yells, echolalia and coprolalia (saying socially inappropriate words – only 15% of people have this)


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Obsessive Compulsive Disorder go

  • Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as handwashing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called "rituals," however, provides only temporary relief, and not performing them markedly increases anxiety

    NIMH



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Definition of Orthopedic Impairment go

  • Orthopedic impairment: A severe orthopedic impairment that adversely affects a student's educational performance. The term includes impairments caused by congenital anomaly (e.g., clubfoot, absence of some limb, etc.), impairments caused by disease (e.g., poliomyelitis, bone tuberculosis, etc.), and impairments from other causes (e.g., cerebral palsy, amputation, and fractures or burns which cause contractures

  • Physical disability and orthopedic impairment can be used interchangeably


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Cerebral = brain/Palsy = muscle control that affects movement

  • 4 types of CP – spastic (involves 70-80%, muscles tighten), athetoid (abrupt involuntary movements), ataxic (unsteadiness), and mixed

  • 40-50% have seizures

  • 50-70% have mental retardation

  • 30% hearing, speech/language impairments

  • Other issues are common


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CAUSES go

  • Perinatal

  • Prenatal

  • postnatal


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Spina Bifida go

  • Malformation of spinal cord – does not close completely and cover the cord

  • Typically this occurs in the lower region of the spine and results in paralysis of lower extremities and loss of skin sensation

  • Not progressive

  • Low socioeconomic

  • About 75% have typical IQ


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CAUSES go

  • Unknown but appear to occur very early in pregnancy

  • Daily vitamin supplements containing folic acid can reduce the risk


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Epilepsy go

  • Seizures – temporary neurological abnormalities that result from unregulated electrical discharges in the brain

  • 2 types of seizures: tonic-clonic (used to be grand mal) and absence seizures (petit mal)

  • After a 1st seizure 40-50% have another

  • ¾ of children go into remission

  • Medication is often successful in controlling seizures

  • See page 291 for types of seizures


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  • Average IQs for most

  • More likely to experience LD

  • Students with absence seizures are often misidentified as students with ADHD

  • Higher rate of depression


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Sensory Processing Disorder go

Sensory Processing Disorder (SPD) is a complex disorder of the brain that affects developing children and adults. People with SPD misinterpret everyday sensory information, such as touch, sound, and movement. They may feel bombarded by information, they may seek out intense sensory experiences, or they may have other symptoms.


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"Sensory processing" refers to our ability to take in information through our senses (touch, movement, smell, taste, vision, and hearing), organize and interpret that information, and make a meaningful response. For most people, this process is automatic. When we hear someone talking to us or a bird chirping, our brains interpret that as speech or an animal sound, and we respond to that information appropriately.


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  • Children who have a Sensory Processing Disorder (SPD), however, don’t experience this process in the same way. SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional, motor, and other responses.

  • Sensory avoidance

    • Touch, smell, taste, noise

  • Sensory Seeking

    • Inappropriate touching

    • Loud noise levels

  • Motor Skills Deficits

    • Motor Planning

    • Dyspraxia


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Evaluation and Instruction however, don’t experience this process in the same way. SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional, motor, and other responses

  • Often PTs and OTs provide functional tests (page 295)

  • School function assessment is criterion based

  • Health care plan is essential (See page 298)

  • Related services and assistive technology

  • Adapted physical education

  • Self awareness and counseling


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IDEA or 504 Accommodation Plan however, don’t experience this process in the same way. SPD affects the way their brains interpret the information they take in and also how they act on that information with emotional, attentional, motor, and other responses

  • Does the health problem adversely affect educational performance?

  • Does the student require educational services to address delays in educational performance?

  • Does the student require accommodations to allow for performance?


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