Chapter 4 Low Incidence Exceptionalities,

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Chapter 4 Low Incidence Exceptionalities,

• Physical Exceptionalities and Chronic Health
  Conditions

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Low Incidence Exceptionalities

• Severe developmental disabilities Severe
  limitation in both intellectual functioning and
  adaptive behavior
• Focus is on individuals need for support to
  function in the Community

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Severe developmental Disabilities

• 1 1000 in BC
• Leading causes of Developmental Disabilities are
• Fetal Alcohol Syndrome
• Cerebral Palsy
• Spina Bifida
• Down Syndrome
• Fragile X

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Severe Developmental Disabilities

• Wide range of abilities
• Some can acquire academic skills while others
  will require ongoing self care
• Etiology - most of often genetic, however
  teratogens also may be involved ie. Trauma /
  exposure during pregnancy

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Severe Developmental Disabilities

• USA American Association on Mental Retardation
  Dimensions
• Intellectual abilities
• Adaptive behavior
• Participation , interaction and social relations
• Health
• Environmental context
• Age of Onset

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Strengths and Weaknesses

• Assessed over four dimensions
• Psychological, emotional and social
  considerations
• Intellectual, Cognitive and Adaptive skills
• Physical and Health Considerations
• Environmental

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Severe Developmental Disabilities Intellectual,
Cognitive, and Adaptive skills

• Cognitive deficits- difficulties with attention
  and getting information into memory..
• Language likely to be delayed expressive
  language may not develop or be significantly
  impacted
• Adaptive behaviors - Daily living skills -

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Psychological, Emotional and Social Issues

• Frustration, poor impulse control, acting out
  aggressively verbally or physically
• Difficulty in making friends as they do not pick
  up social cues quickly or accurately
• Want to make friends but lack the skills
• Repetitive behaviors that may appear to be
  strange or bizarre to peers

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Physical and Health

• Less Physical dexterity and coordination both
  fine and gross motor skills
• Severe asthmatics / allergies
• Anaphylaxis or anaphylactic shock difficulty
  breathing, swelling of the throat, rash
• Can be life threatening
• 20 of school aged population
• Injection of epinephrine
• Medical attention required immediately

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Environmental

• Wheel chair
• Frequency Modulation Systems built into the
  classroom -teacher wears a microphone
• Braille combined with word processors, three
  dimensional maps
• Speech activated word processors

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AUTISM SPECTRUM DISORDER

• Characteristics
• Impairments in verbal and non verbal
  communication
• Impairments in reciprocal social relationships
• Impairments in imaginative creativity
• Restricted, repetitive and stereotypic patterns
  of behavior and interests
• Language often shows perseveration on one topic
  or echolalia (repeated vocalizations made by
  another person)

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AUTISM SPECTRUM DISORDERS IN BC

• Autistic Disorder
• PDD-NOS/Atypical Autism
• Asperger Disorder/Syndrome
• Rett Syndrome
• Childhood Disintegrative Disorder

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Autism

• Impairments in verbal and non verbal
  communication and reciprocal social interaction,
• Repetitive pattern of behavior
• Intellectual Disability

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Distinctive behaviors

• Restricted range of interests and a preoccupation
  with one specific interest or object
• Inflexible adherence to non-functional routine
• Stereotypic and repetitive motor mannerisms, such
  as hand flapping , finger licking , rocking,
  spinning objects
• Pre-occupation with parts of objects

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Implications for learning and teaching

• Depending on the severity student will likely
  have an aide in the classroom full or part time
• Working with student to have them learn to face U
  when you are teaching
• Focus on what is being said
• May have to repeat instructions
• Utilize visual aids
• Accept limited verbal attempts and non verbal
  communication

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ASD CONTINUED

• Important to encourage social interaction
• Immediate intervention with self abusive or
  acting out behaviors
• Striking/ hitting other students or U , biting ,
  spitting

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Asperger Syndrome

• May be of average or above average intelligence
• Severe and sustained impairment in social
  interactions and development of restricted,
  repetitive patterns of behaviors and interests

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Asperger Syndrome

• Severe and sustained impairment in social
  interactions and development of restricted,
  repetitive patterns of behaviors and interests

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POSSIBLE PSYCHOTROPIC MEDICATION

• Depending on the symptoms and specific nature of
  the particular ASPD there are a variety of
  medications you may see on an IEP or that the
  child is taking while in your classroom

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MEDICATION

• Stimulant Medication for ASPD children with
  attention , concentration problems
• Amphetamines Generally not prescribed for ages
  younger than 3
• Dexedrine and Ritalin the most common
• Cylert banned in Canada due to Liver
  complications , however still utilized in the USA

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Anti-depressant / Anti- anxiety

• Anafranil 10 years and older
• Obsessive Compulsive behaviors extreme
  repetitive behaviors that may be self injurious
• Tofranil Bed Wetting

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Anti -Psychotic

• Severe thought disorder, lack of contact with
  reality
• Haldol and Mellaril children 3 years and older
• MOOD STABILIZERSTegretol Seizure control

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Childhood disintegrative disorder

• is a condition in which young children develop
  normally until age 3 or 4, but then demonstrate a
  severe loss of social, communication and other
  skills.
• Doctors sometimes confuse this rare disorder with
  late-onset autism because both conditions involve
  normal development followed by significant loss
  of language, social, play and motor skills.
  However, autism typically occurs at an earlier
  age. There's also a more dramatic loss of skills
  in children with childhood disintegrative
  disorder and a greater likelihood of mental
  retardation. In addition, childhood
  disintegrative disorder is far less common than
  autism.

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RHETTS

• All of the following                 (1)
  apparently normal prenatal and perinatal
  development                (2) apparently normal
  psychomotor development through the first  5
  months after birth                (3) normal
  head circumference at birth      

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RHETTs

• deceleration of head growth between ages 5 and
  48 months
•  loss of previously acquired purposeful hand
  skills between ages 5  and 30 months with the
  subsequent development of stereotyped hand
  movements  (e.g., hand-wringing or hand washing)
•   loss of social engagement early in the course
  although often social interaction development
  later)

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RHETTs

•                 (4)  appearance of poorly
  coordinated gait or trunk movement               
  (5)  severely impaired expressive and receptive
  language development  with  severe psychomotor
  retardation.

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Hard of hearing and deaf

• Hearing that has significantly affected
  development of speech and or language
• Results in the need to adapt learning strategies

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Visual Impairment

• Blind or partially sighted who need adaptation to
  learn through channels other than visual

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Physical Disabilities and other Chronic Medical
Conditions

• Cerebral Palsy Disorders affecting body
  movement and muscle coordination
• Etiology neurological damage during early
  months of pregnancy

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Spina Bifida

• Neural tube defect that occurs during the first
  month of pregnancy
• Results in improper development of spinal cord
  and vertebrae

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Epilepsy

• Neurological disorder involving sudden electrical
  outbursts in the brain
• Tourette syndrome Neurological disorder
  characterized by tics involuntary vocalizations
  and movement

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Neurological deficits

• Brain injury with either unknown etiology or may
  be caused by variety of factors
• Fetal Alcohol Spectrum Disorder - (FAS/FAE)
  Neurological disorder caused by prenatal exposure
  to Alcohol

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Musculoskeletal Conditions

• Muscular Dystrophy Genetically based muscle
  disorders that result in progressive muscle
  weakness
• Juvenile Arthritis Continuous inflammation of
  joints in young people under 16

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Chronic Health Impairments

• Diabetes Condition in which the body does not
  make enough insulin and has problems absorbing
  and storing sugars
• Allergies Sensitivity or abnormal immune
  response to normal substances peanuts, shell
  fish,

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Asthma

• Chronic lung condition- characterized by
  difficulty breathing
• Exacerbated by strenuous exercise
• Cystic Fibrosis Genetic disorder affecting
  lungs and digestive system
• HIV/AIDS Human Immunodeficiency Virus /
  Acquired Immune Deficiency Syndrome
• A virus causing illness resulting in breakdown of
  immune system

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IEP Academic Program Modifications

• IEP likely includes modified academic program
• Functional academic skills
• Physical development and personal care
• Social skills
• Community skills
• Career development

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Autism Spectrum Disorders

• Common areas of impairment
• Communication skills
• Social interactions/ interpersonal relationship
  issues
• Repetitive and stereotyped behaviors
• 3 10 out of 10,000 births
• More males than females

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Autism Distinctive behaviors

• Perseveration /Echolalia language difficulties
  50 never develop functional expressive
  language skills
• Difficulty coping with change in a routine, lack
  of flexibility
• Stereotypic and repetitive motor mannerisms
  hand flapping, rocking , spinning,
• Impairment in reciprocal social interactions
  i.e. do not make eye contact , difficulty in
  responding to instructions

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ADAPTATIONS

• Visual reinforcers used regularly
• Make contact through directly facing the student
• Structure and predictability important
• Reduce distractions, auditory stimulation

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HARD OF HEARING / DEAF

• Range of hearing impairment
• Dependent upon the decibel level the person can
  hear
• Primary impairment unable to utilize hearing as
  the main channel for learning without assistance
• Language development is also often delayed

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How language is taught? School Placement

• Auditory verbal use of residual hearing to
  learn spoken language use of hearing aids
  /Frequency modulation Regular classroom
• Auditory Oral Use of residual hearing to learn
  spoken language as well as speech and reading
  (visual) and hearing aid
• Regular classroom

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Hard of Hearing / Deaf

• Cued Speech Use of hand shapes in four
  locations near the face to give phonemic cues
  School for deaf children and then regular class
  with interpreter
• ASL Completely visual system of learning
  language
• Congregated school for death children
• Regular class with interpreter

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Vision Disabilities and Blindness

• www.prcvi.org adaptive technologies, books on
  tape
• Students who require adapted teaching with
  correction visually disabled
• IEP should identify , level of impairment and
  what is required
• Do they need a vision teacher paraeducator/resourc
  e teacher

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Visual impairment

• For those who do not process information
  visually- give instructions/directions verbally
  as well as visually
• Partial vision large font on your computer,
  zeroxing over sized, contrast colors
• Classroom organized to ensure that paths not
  blocked to door way, black board
• Three dimensional maps, voice activated word
  programs

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Physical Disabilities and Chronic Medical
Conditions

• CNS Impairment
• Cerebral Palsy - Severity Varies
• Muscle tightness or spasm
• Involuntary Movement
• Gross motor walking or running
• Fine Motor writing, speaking
• Abnormal perception and sensation
• Developmental delays, learning disabilities,
  hearing or vision impairment

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Spina Bifida

• Vertebrae or spinal cord fail to develop properly
  paralysis of lower limbs
• Hydrocephalus accumulation of fluid in the
  brain ,shunt likely
• EPILEPSY Neurological disorder
• Partial and generalized seizure activity

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Epilepsy

• Partial seizures inappropriate movements,
  strange sensations- smells, sounds, Confusion
• Generalized Simple absence and Tonic Clonic
• Simple Absence Petit Mal short day
  dream/stare Andromeda Strain Triggered by
  blinking light

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Tonic-clonic (Grand Mal)

• Fall to the floor, muscles stiffen, jerk
  rhythmically
• Assist the student to become comfortable,
  disoriented
• Place blanket , pillow under the head
• Turn on their side, allow saliva to flow out of
  the mouth
• Length of seizure important
• School policies vary

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Fetal Alcohol Spectrum Disorder

• FAS/FAE Neurological disorder caused by
  prenatal exposure to alcohol
• 1/1000 births in Canada, however in a number of
  Aboriginal Communities estimates range as high as
  19/1000
• Wide range of symptoms and disabilities
• Sometimes physical changes short eye openings,
  flattened mid face, a long space between nose and
  lip

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FAS

• Often present well verbally but significant
  problems with memory, ability to apply learning
  in different settings, poor impulse control
• Difficulty understanding cause and effect
• Easily distractible
• Lack of social judgement

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CHRONIC HEALTH ISSUES

• Diabetes, allergies, asthma, cystic fibrosis,
  HIV/AIDS
• DIABETES body does not make enough insulin,
  problems with absorbing and storing sugar.
• Insulin injections, planned eating, regular
  physical activity
• Low and High blood sugar

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CHILDHOOD CANCER

• In Canada, childhood cancer remains responsible
  for more deaths from one year through adolescence
  than any other disease more deaths than asthma,
  diabetes, cystic fibrosis and AIDS combined
• There are about 10,000 children living with
  cancer in Canada today.
• Each year, about 1500 cases are diagnosed
• Because of significant advances in therapy, 78
  of these children will survive 5 years or more,
  an increase of almost 46 since the early 1960s

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Childhood cancer

• Childhood cancers differ from adult cancers.
  Adults are most affected by breast, lung,
  prostate, bowel and bladder cancers. Children are
  most affected by acute leukemia, tumours of the
  brain and nervous system, the lymphatic system,
  kidneys, bones and muscles.
• Leukemia is the most commonly diagnosed cancer in
  children, comprising some 30 of the total new
  cases diagnosed each year. Acute lymphoblastic
  leukemia (ALL) is the most common form and
  comprises about 75 of these cases. Peak
  incidence is at two to three years of age, with
  boys 20 more likely to contract the disease.
  Survival rate is now 95, with a 30 relapse
  rate.

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Childhood cancer

• Childhood cancers have close to a 75 cure rate,
  with leukemia leading the success charge with
  close to 90 overall cure rate.

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Diabetes

• Low blood sugar Hypogylcemia - confusion ,
  difficulty speaking, feels cold, blurred vision..
  Intake of sugar required , followed by
  carbohydrates and protein
• High Blood Sugar Hyper gylcemia over eating,
  to little insulin , chronic stress

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BRAIN INJURY

• Acquired Brain Injury Car accidents, falls
• STRATEGIES FOR TEACHING
• Physical
• Schedule more breaks, shorten day
• More difficult material present earlier in the
  day
• Ensure technology is available

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Language adaptation

• Shorter simpler sentences pictures and gestures
• Repitition , present at slower pace
• Communicate with pictures , charts

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Cognitive Adaptations

• Reduce distractions
• Provide focusing cues and visual cues, step by
  step instruction
• Attention the length of the assignments
• Limit the number of steps
• Use a tape recorder instead of expecting note
  taking

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Cognitive

• Praise and reinforcement
• Reminders and feedback important
• Structure and consistency very important

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Social Adaptations

• Encourage the student to ask for assistance
• Check the work , give feedback regularly
• Arrange for counseling / support
• Model patience and understanding