Children with special needs

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Children with special needs

• 21st Feb 2011

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Down syndrome

• Types
• Indications
• Additional health problems
• Developing speech and language
• Social and emotional development
• Medical difficulties
• Factors for you to consider
• Additional developments

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Introduction

• First described in 1866
• Genetic condition extra chromosome
• Learning disability and may have some physical
  difficulties e.g. heart problems
• In the UK it occurs in about 1 in 700 births
• It occurs in all social, economic, cultural,
  religious and racial backgrounds
• It is not a disease and children do not suffer
  from Down syndrome

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Types

• 3 different types but the effects on the child
  are very similar
• Standard trisomy 95 of cases an accident of
  nature 47 chromosomes and not 46
• Translocation 2 of cases 46 chromosomes but
  one of the parents passes on an abnormal
  chromosome 21
• Mosaic Down syndrome 2-5 of cases some of
  childs cells have 46 chromosomes and some have
  47 chromosomes effects of condition less severe

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Indications at birth

• Floppy poor muscle tone
• Small mouth highly arched palate and protruding
  tongue
• Flattened nasal bridge
• Low hairline
• Eyes slant upwards and outwards epicanthic folds
• Ears are small and low set
• Broad hands with short fingers one crease across
  palm
• Feet are short and broad with a deep cleft
  between the first and second toe extending as a
  long crease on the side of the foot

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Possible additional health difficulties

• Hearing vulnerability to glue ear
• Vision possibly a squint
• Physical development may be smaller
• Tendency to gain weight
• Underdeveloped immune system in early years
• Heart problems - 40 half of these will require
  surgery

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Diagnosis

• The risk of having a child with Down syndrome
  increases with maternal age
• Increases if you already have one child with Down
  syndrome
• Genetic counselling often advised
• Tests during pregnancy

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Developing speech and language

• Small nasal passages and sinuses small mouth
  cavity thick tongue that tends to protrude
  leads to breathing and articulation difficulties
• Make sure child can watch your face and mouth
• Be patient
• Sign system can be very helpful
• Liaise with the speech and language therapist

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Social and emotional development

• Children with Down syndrome are all different!
• Always praise and acknowledge good behaviour do
  not constantly criticise
• Be realistic in your expectations the pattern
  of development will be the same as a typical
  child but will be slower
• Always explain simply and clearly what you expect
• Be consistent in your approach
• Remember that you are an important role model

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Factors to consider for the early years worker

• Essential that you motivate and encourage child
  to regard learning as fun and pleasurable
• Watch out for any over protection by other
  children
• Watch out for any bullying or teasing

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Factors continued

• Only ask for one thing at once
• Break down every task into the smallest unit
• Check the child understands what you want-
  demonstrations accompanied by simple instructions
  work best
• Do not assume that the child understands basic
  terms such as over and under, top and
  bottom
• Always allow the child enough time
• If teaching the child something new, make sure
  there are no or minimal distractions
• Gym clubs, ballet classes and swimming can all
  help gross motor control and development and
  community inclusiveness
• Use a lot of encouragement and positive feedback

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General implications

• Tendency for society to stereotype children with
  Down syndrome
• It is important that you care for every child as
  an individual, balancing all needs and valuing
  and understanding differences make sure you do
  not reinforce stereotypes
• Increasingly leading full and independent lives
  and making positive contributions to society

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Additional developments

• New techniques of detecting Down syndrome
• Cosmetic surgery
• Support groups down syndrome Ireland

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Case study

• Role of the Father in caring for a child with
  disability

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Prader Willi Syndrome
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Introduction

• Genetic disorder
• Seven genes on Chromosone 15 are missing or
  partially missing
• Incidence is between 1 in 12,000 and 1 in 15,000
  live births
• Affects both sexes and all races

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Causes and diagnosis

• Normally contributed to father
• Diagnosed by genetic testing
• Rare to reoccur in same family
• But all families should receive genetic
  counselling

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Clinical features and signs

• In utero
• Reduced foetal movement
• Frequent abnormal foetal position
• At birth
• Often breech/caesarian birth
• Lethargy
• Hypotonia
• Feeding difficulties
• Difficulties establishing respiration
• Small gonads

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Clinical features and signs

• Infancy
• Failure to thrive (continued feeding
  difficulties)
• Delayed milestones/intellectual delay
• Excessive sleeping
• Strabismus
• Scoliosis (often not detected at birth)

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Clinical features and signs

• Childhood
• Speech delay
• Poor physical co-ordination
• Over eating from age 2-4 years (different from
  earlier difficulties)
• Excessive weight gain
• Adolescence
• Delayed puberty
• Short stature
• Obesity

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Clinical features and signs

• Adulthood
• Infertility
• Small gonads
• Sparse pubic hair
• Obesity
• Hypotonia
• Learning difficulties
• Proneness to diabetes
• Delayed motor development

• Prominent nasal bridge
• Small hands and feet
• Soft skin that is easily bruised
• Excess fat especially in central part of body
• High narrow forehead
• Picking at skin
• Almond shaped eyes

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Intelligence

• May have learning difficulties
• Show an unusual cognitive profile
• Strong in visual organisation and perception
  (including reading and vocabulary)
• Spoken language generally poorer
• Skill in completing jigsaws
• Poor with auditory skills
• Poor at maths and writing

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Treatment

• No cure
• Growth hormone replacement therapy
• Early intervention team based approach
• Highly structured learning environment
• Controlling of food intake

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Dyslexia
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Introduction

• Affects between 1-4 of children mainly boys
• It occurs despite normal teaching and ability
• In schools may be called specific learning
  difficulty
• It mainly affects one or more areas of reading,
  spelling and written language
• In the past children may have been perceived as
  being lazy or stupid
• Should not be used as a handy cover-all label for
  children with minor problems of reading and
  writing

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What happens

• Condition is not fully understood
• No genetic pattern of inheritance yet often found
  running in families
• Premature babies and those who have a difficult
  period immediately after birth are most at risk
• Can cause stress and anxiety for a child leading
  to low self esteem and a hatred of school

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Features

• Speech difficulties
• Jumbled words and phrases
• Difficulties naming colours
• Confusion with directional words e.g. up, down,
  right, left
• Movement control
• Delayed fine motor skills
• General clumsiness
• Catching, throwing, riding a bike etc.
• Memory and sequencing
• Rhymes, days of the week, months, alphabet etc.
• Other areas
• Boredom, shy, withdrawn, unco-operative, but may
  enjoy chatting to others
• Creative

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Who makes the diagnosis?

• Parents
• School
• Educational psychologist
• GP
• Speech and language therapist
• Hearing and sight tests should be carried out to
  exclude any other possible difficulties

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Care

• Good practice for a child with dyslexia is also
  good practice for any child, but child will need
  more one to one attention
• Will need time and patience and to be able to
  talk about problems as they happen
• Use appropriate language and repetition
• Boost self confidence by praising achievements
• Listen carefully to the child

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Suggested activities

• Rhyming songs
• Clapping out rhythms
• Encourage games to develop sequencing
• Picture lotto
• Sorting games
• Encourage co-ordination with large ball games and
  balancing games
• Top, bottom, right and left
• Painting
• Dressing games

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Ongoing management

• Carefully organised and structured
• Multi-sensory
• Systematic with lots of reinforcement
• Provide a framework of acceptable codes of
  behaviour
• Individualised learning programme
• May get very tired due to the need to concentrate
  more than most children

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General implications and additional developments

• Needs lots of encouragement to practise skills
• Will take longer to reach goals
• Intelligence is the same so may shine in other
  areas
• Many child care workers feel that they needed
  more knowledge and confidence in working with
  these children

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Alternative therapies

• Main approach is the use of teaching strategies
  e.g. multi-sensory
• Movement based therapies
• Eye related therapies
• Auditory therapies
• Nutritional supplements/diet

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Epilepsy
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Introduction

• Most common serious neurological condition
• In epilepsy there is an interruption in the
  chemical activity in the nerve cells in the brain
  and a fit or seizure can result
• Seizures can occur that are not epilepsy i.e.
  febrile convulsions
• About 6 in 1000 children have epilepsy and 80
  attend mainstream school
• Slightly more girls than boys have epilepsy

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What happens?

• Electrical changes in the brain caused by
  something in the brain itself -
• Antenatal infections
• Family history
• Jaundice
• Some drugs taken in pregnancy

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What happens?

• Electrical changes caused by factors external to
  the brain
• Temporary lack of oxygen
• Photosensitivity
• Severe infections brain infections
• Certain severe diseases

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Types of seizures

• Over 40 different types classified as
  generalized or partial seizures. They need to be
  managed in different ways.
• Generalized seizures
• Tonic/clonic grand mal
• Absences
• Partial seizures
• Simple partial seizures
• Complex partial seizures

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Diagnosis

• Pattern of repeated fits
• Electroencephalogram (EEG) is used to confirm.
  Electrodes are placed on various points of the
  head and the brain activity is monitored
  painless and harmless

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Care

• See first aid leaflet
• Be careful of your reaction for the sake of the
  child and other children
• The child may not remember the seizure only
  sensing what has happened from others around them

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Ongoing management

• Medication but the success of this depends on
  several factors
• Type of epilepsy
• Accuracy of the diagnosis
• Accuracy of the treatment
• The childs response to the medication
• Additional problems

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Ongoing management

• Seizures can be controlled in 80 of cases
• Occasionally seizures lessen as the child grows
  older
• A child needs to be involved in the management of
  their own treatment and see medication as a
  positive part of remaining healthy and not part
  of an illness
• Beware of negative images born out of fear and
  ignorance

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Management in school/pre-school

• The disabling effects of epilepsy can be lessened
  if there is good communication between
  professionals, parents, the child and their
  friends. A teacher or pre-school worker must have
  full information on
• Type of epilepsy
• Frequency of seizures
• Speed of recovery following a seizure
• The most appropriate management for the child
• How the child feels about their epilepsy
• Information about triggering factors
• Details about medication including any possible
  side effects

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General implications

• Over protection will affect a childs self esteem
• Answer the child any other childrens questions
  honestly
• Activities such as swimming and climbing?
• Identification bracelet
• Medication careful storage dosage checked
  possible side effects known

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General implications

• Additional help must be sought in the following
  situations
• Child has injured themselves during a seizure
• Child has trouble breathing after a seizure
• One seizure immediately follows another, or the
  seizure lasts longer than 5 minutes
• The seizure lasts longer than usual

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General implications

• Do not have low expectations
• Epilepsy should not be used as an excuse for
  attention seeking or any other unacceptable
  behaviour
• Possible causes of underachievement
• Frequent major seizures
• Frequent absence seizures
• Severe epilepsy disorganised brain activity
• Incorrect or excessive drug use sleepiness
• Rapid growth can affect amount of drug needed

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Additional developments

• Epilepsy and surgery
• Useful if scarring has occurred e.g. from
  meningitis or head injury
• Only undertaken after extensive investigation
• Specific stimulation, via a nerve in the neck, is
  offered to some older children
• Most children manage their epilepsy well through
  medication

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Case study