chapter 8 learning and behavior disorders

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Chapter 8Learning and Behavior Disorders


Learning and Behavior Disorders

The terms:

behavior disorder,

ADHD, or

learning disability

should be used with

extreme caution when

describing young

children.


Attention Deficit Hyperactivity DisorderADHD

• Attention Deficit Hyperactivity Disorder (ADHD) is a condition that becomes apparent in some children in the preschool and early school years.

• It is hard for these children to control their behavior and/or pay attention.

• It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. – This means that in a classroom of 25 to 30 children,

it is likely that at least one will have ADHD.


History of ADHD

• ADHD was first described by Dr. Heinrich Hoffman in 1845.

• Book of poems, complete with illustrations, about children and their characteristics.

• "The Story of Fidgety Philip" was an accurate description of a little boy who had attention deficit hyperactivity disorder.


Attention Deficit Hyperactivity Disorder

• History of ADHD– It has been studied for the last 50 years.– It was originally thought to be brain damage.– The APA finally decided there were two

categories:• ADD• ADHD

– There are three patterns of behavior.


Attention Deficit Hyperactivity Disorder (continued)

• Predominantly hyperactive-impulsive– No inattention

• Predominantly inattentive – Often called ADD– No hyperactive-impulsive behavior

• Combined – Inattentive and hyperactive-impulsive



• Current attempts at defining ADHD– It must be a clinical diagnosis that involves parent and

teacher input.– It must manifest before age seven.– Characteristics must occur in multiple settings.– Characteristics must be maladaptive for the child’s

age.– It must effect the child’s academic performance.– It cannot be a temporary response to a situation.



• Causes and prevalence of ADHD– There is no known absolute cause.– Possible causes are genetics; one or more

parents is also hyperactive.– Maternal smoking or drug use during

pregnancy may be a factor.


Causes of ADHD

• Alcohol and drug abuse (including nicotine) during pregnancy can cause poor motor and muscular development and sensory impairment; problems with learning, memory, attention, and problem solving; and problems with mental health and social interactions.

• Smoking during pregnancy


• Certain theories regarding other potential causes of ADHD--for example, dietary factors (e.g., food allergies, sensitivities to food additives, sugar consumption), environmental allergies or sensitivities--have garnered much attention in the popular media.

• However, they have received little or no research support to date.


Symptoms of ADHD

• The year 2000 Diagnostic & Statistical Manual for Mental Disorders (DSM-IV-TR) provides criteria for diagnosing ADHD. The criteria are presented here in modified form in order to make them more accessible to the general public. They are listed here for information purposes and should be used only by trained health care providers to diagnose or treat ADHD.


Symptoms of ADHDDSM-IV Criteria for ADHD Either A or B:A. Six or more of the following symptoms of inattention have been present for at least 6

months to a point that is disruptive and inappropriate for developmental level:

• Inattention• Often does not give close attention to details or makes careless

mistakes in schoolwork, work, or other activities. • Often has trouble keeping attention on tasks or play activities. • Often does not seem to listen when spoken to directly. • Often does not follow instructions and fails to finish schoolwork,

chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).

• Often has trouble organizing activities. • Often avoids, dislikes, or doesn't want to do things that take a lot of

mental effort for a long period of time (such as schoolwork or homework).

• Often loses things needed for tasks and activities (e.g. toys, school assignments, pencils, books, or tools).

• Is often easily distracted. • Is often forgetful in daily activities.


Hyperactivity• Often fidgets with hands or feet or squirms in seat. • Often gets up from seat when remaining in seat is expected. • Often runs about or climbs when and where it is not appropriate (adolescents or adults

may feel very restless). • Often has trouble playing or enjoying leisure activities quietly. • Is often "on the go" or often acts as if "driven by a motor". • Often talks excessively. Impulsivity• Often blurts out answers before questions have been finished. • Often has trouble waiting one's turn. • Often interrupts or intrudes on others (e.g., butts into conversations or games). • Some symptoms that cause impairment were present before age 7 years. • Some impairment from the symptoms is present in two or more settings (e.g. at

school/work and at home). • There must be clear evidence of significant impairment in social, school, or work

functioning. • The symptoms do not happen only during the course of a Pervasive Developmental

Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder, Dissociative Disorder, or a Personality Disorder).

B. Six or more of the following symptoms of hyperactivity-impulsivity have been present for at least 6 months to an extent that is disruptive and inappropriate for developmental level:


Treatment

• A child with ADHD faces a difficult but not insurmountable task ahead. In order to achieve his or her full potential, he or she should receive help, guidance, and understanding from parents, guidance counselors, and the public education system.


ADHD Treatment• Although there is no cure for ADHD, treatment can help control

symptoms.

• Stimulant medications:– amphetamines (examples include Dexedrine or Adderall)– methylphenidate (examples include Ritalin, Concerta, or

Metadate CD), are effective in controlling symptoms in children.

• Studies show that some children who receive behavioral therapy along with medication improve more than those who receive medication alone.


ADHD Treatment

• Often, extra support at home and at school and counseling help children find success at school and feel better about themselves.

• Doctors recommend that children be closely followed after they begin to take medications for ADHD.

• Side effects—including loss of appetite, headaches or stomachaches, tics or twitches, and problems sleeping—usually decrease after a few weeks on the medication, or the dosage can be lowered to offset them.



• Causes and prevalence of ADHD– There is no known absolute cause.– Possible causes are genetics; one or more

parents is also hyperactive.– Maternal smoking or drug use during

pregnancy may be a factor.



• Intervention strategies– Medication and behavior management

combined seems to be the best approach.– Medication

• Ritalin is the most common.• It helps a child control impulsivity and pay attention

in class.• It can cause sleep disorders, weight loss, and

increased blood pressure.• Parents and teacher rely on the medicine to fix the

behaviors.



• Special diets such as the Feingold Diet, which linked artificial food coloring and food additives with hyperactivity, have proven ineffective.

• Parents feed the child additive- and dye-free foods to lessen hyperactive behaviors.

• Nutrition is key, but eliminating foods does not solve the problem.



– Behavior management• Reward positive behaviors.• Evaluate the environment for behavior-

causing areas and correct.• Plan developmentally appropriate activities

for all children.



• Disorders that sometimes accompany ADHD– Learning disabilities– Oppositional Defiant Disorder– Conduct Disorder– Bipolar Disorder


Learning Disabilities

• What is a learning disability?– A disorder in one or more of the basic

psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in the imperfect ability to listen, think, speak, write, spell, or do mathematical calculations



• Learning Disabilities (LD) are neurologically-based processing problems.

• These processing problems can interfere with learning basic skills such as reading, writing, or math.

• They can also interfere with higher level skills such as organization, time planning, and abstract reasoning.



• The types of LD are identified by the specific processing problem.

• They might relate to getting information into the– brain (Input), – making sense of this information (Organization),– storing and later retrieving this information (Memory), – or getting this information back out (Output).


Learning Disabilities (continued)

• It states clearly that a learning disability is not the result of:– visual, hearing, or motor handicaps.– mental retardation.– emotional disturbance.– environmental, cultural, or economic

disadvantage.– second language learning.



• Non disadvantaged ruling– This excludes children who live in

environmental or economic disadvantage from being labeled learning disabled.

• Academic ruling– The definition states that there should be

difficulty in reading, writing, spelling, and mathematical calculations. At what age?



– Areas that children may show signs of future learning disabilities:• Perinatal stress• Genetic or environmental conditions• Developmental milestones• Attention and behavior



• Predicting learning disabilities– Observation of child– Matching observation to performance

measures– Caution: Children can develop skills in a

range; looking for deviations from the range is a sign of possible learning disability.



• Prerequisite skills– These are skills needed to enter school.– Often children with learning disabilities lack

these necessary skills to be successful in school.



– Examples• Sensorimotor difficulties (gross motor)

– Imperfect body control– Poor balance– Uncertain bilateral and cross-lateral movements– Inability to cross body midline– Faulty spatial orientation

• Sensorimotor difficulties (fine motor)– Problems in buttoning, lacing, snapping, cutting, pasting,

and stringing beads – Perseveration


Sensory-motor Difficulties

• Motor Disability: A student with motor problems might have difficulty with

• fine motor planning (coloring, cutting, writing, buttoning, zipping, tying) and/or with

• gross motor planning (running, jumping). • Some may have difficulty with visual-motor (eye-hand)

activities required when doing certain visual spatial tasks or when catching or hitting a ball.

• In addition, this child might have difficulty with vestibular function, manifested by weak upper trunk muscles and possibly by difficulty learning to ride a bike.

• Finally, some may show tactile sensitivity, not liking to be held or cuddled or not liking cloths that are felt to be too rough.

• This total clinical picture of motor problems is called Sensory Integration Dysfunction.



– Cognitive disorders• Trouble organizing• Abstract thought is difficult• Poor memory• Problems with generalizing information



– Visual and auditory perception problems– Information is primarily brought into the brain through

the eyes (visual perception) and ears (auditory perception). An individual might have difficulty in one or both areas.

• Visual discrimination

• Visual orientation

• Visual memory

• Visual tracking

• Visual-motor integration

• Auditory perception problems


Visual Perception

• One might have difficulty distinguishing subtle differences in shapes (called graphemes).

• They might rotate or reverse letters or numbers (d, b, p, q, 6, 9); thus misreading the symbol.

• Some might have a figure-ground problem, confusing what figure(s) to focus on from the page covered with many words and lines.

• They might skip words, skip lines, or read the same line twice.• Others might have difficulty blending information from both eyes to

have depth perception.– They might misjudge depth or distance, bumping into things or having difficulty

with tasks where this information is needed to tell the hands or body what to do.

• If there is difficulty with visual perception, there could be problems with tasks that require eye-hand coordination (visual motor skills) such as catching a ball, doing a puzzle, or picking up a glass.


Auditory Perception

Also called Receptive Language

• The individual might have difficulty distinguishing subtle differences in sound (called phonemes)

• Might have difficulty distinguishing individual phonemes as quickly as normal.

• Either problem can result in difficulty processing and understanding what is said.

• Individuals might have difficulty with what is called auditory figure-ground. – They have difficulty identifying what sound(s) to listen to when

there is more than one sound.



– Language deviations• Receptive language• Expressive language

– Social skills deficits• Bullying• Withdrawn• Aggressive• Overdependent



• Response to intervention– This allows a teacher to intervene with a child

without there being a required discrepancy between ability and achievement.

– Tiered approach• Screening and group interventions• Target and short-term interventions• Intensive instruction



• Program considerations– All children will show signs of learning

disabilities at one time or another.– Children need environments that are positive

and developmentally appropriate.– Schedules need to be consistent.– Tasks need to be broken down into smaller

chunks of information.


Behavior Disorders

• Behavior is extreme, chronic, and unacceptable.

• Experts who work with these children prefer the term behaviorally disordered because it places the focus on the observable aspect of the children’s problems: the behavior that is causing problems in school and at home.


Behavior Disorders (continued)

• The term emotional or behavioral disorder means a disability characterized by behavioral or emotional responses in school so different from appropriate age, cultural, or ethnic norms that they adversely affect educational performance.



• Emotional and behavioral disorders can co-exist with other disabilities.



• This category may include children or youths with schizophrenic disorders, affective disorders, anxiety disorder, or other sustained disorders of conduct or adjustment when they adversely affect educational performance in accordance with section (I) (Forness & Knitzer, 1992, p. 13).



• Severe depression– This is categorized by low self-esteem, poor

school performance, lack of friends, inability to cope with daily routines.

– Some children with depression have parents who suffer from depression.



• Anxiety– People who experience excessive fear, worry,

or uneasiness.– Some fears may even become phobias.– Fears are normal, but when taken to the

extreme, they can cause multiple maladaptive behaviors.


Anxiety Disorders

• Panic Disorder—Repeated episodes of intense fear that strike often and without warning. – Physical symptoms include

• chest pain, • heart palpitations, • shortness of breath, • dizziness, • abdominal distress, • feelings of unreality, and • fear of dying.


• Obsessive-Compulsive Disorder—Repeated, unwanted thoughts or compulsive behaviors that seem impossible to stop or control.

• Post-Traumatic Stress Disorder—Persistent symptoms that occur after experiencing or witnessing a traumatic event such as rape or other criminal assault, war, child abuse, natural or human-caused disasters, or crashes.– Nightmares, flashbacks, numbing of emotions,

depression, and feeling angry, irritable or distracted and being easily startled are common.

– Family members of victims can also develop this disorder.


Phobias

Two major types: • social phobia

– People with social phobia have an overwhelming and disabling fear of scrutiny, embarrassment, or humiliation in social situations, which leads to avoidance of many potentially pleasurable and meaningful activities.

• specific phobia– People with specific phobia experience extreme, disabling, and

irrational fear of something that poses little or no actual danger; the fear leads to avoidance of objects or situations and can cause people to limit their lives unnecessarily.


Generalized Anxiety Disorder

• Constant, exaggerated worrisome thoughts and tension about everyday routine life events and activities, lasting at least six months.

• Almost always anticipating the worst even though there is little reason to expect it; accompanied by physical symptoms, such as fatigue, trembling, muscle tension, headache, or nausea.


Autism Spectrum Disorders

• Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDDs), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others.

• These disorders are usually first diagnosed in early childhood and range from a severe form, called autistic disorder, through pervasive development disorder not otherwise specified (PDD-NOS), to a much milder form, Asperger syndrome.

• They also include two rare disorders, Rett syndrome and childhood disintegrative disorder.


Autism

• a brain disorder that affects 3 of every 1000 children 3-10 years old,

• often results in a lifetime of impaired thinking, feeling and social functioning—our most uniquely human attributes.

• typically affects a person's ability to communicate, form relationships with others, and respond appropriately to the external world.

• becomes apparent in children generally by the age of 3.


Autism Characteristics

Some or all of the following characteristics may beobserved in mild to severe forms: • Communication problems (e.g., using and understanding

language);

• Difficulty in relating to people, objects, and events;

• Unusual play with toys and other objects;

• Difficulty with changes in routine or familiar surroundings; and

• Repetitive body movements or behavior patterns.


Autism Characteristics

• Children with autism or PDD vary widely in abilities, intelligence, and behaviors.

• Some children do not speak; others have limited language that often includes repeated phrases or conversations.

• People with more advanced language skills tend to use a small range of topics and have difficulty with abstract concepts.

• Repetitive play skills, a limited range of interests, and impaired social skills are generally evident as well.

• Unusual responses to sensory information -- for example, loud noises, lights, certain textures of food or fabrics -- are also common.


Pervasive Developmental Disorders/Autism Spectrum Disorders

– Usually present by age three– Abnormal social interaction– Impaired communication– Peculiar interests and behaviors


Pervasive Developmental Disorders/Autism Spectrum Disorders (continued)

• Autism– Early sign is not wanting to be cuddled or

held.– Rarely making eye contact.– Treating people like inanimate objects.– Rigid requirements of sameness are typical.– Self-stimulating behaviors like spinning,

rocking, and head banging are common.


Pervasive Developmental Disorders/Autism Spectrum Disorders (continued)

• Problems that may accompany ASD– Fragile X syndrome, sensory problems,

mental retardation, and tuberous sclerosis sensory problems

– Acute sense of touch with regards to clothing– Oblivious to pain


Childhood Onset Schizophrenia

• Major characteristics are tantrums and bizarre behaviors or postures.

• Rejection and withdrawal from social contacts.

• Mood swings are unpredictable.

• They use language to talk to self, and it is rather difficult to decode.


Other Forms of ASD

• Rett’s disorder– Present in females– Results in the loss of motor skills,

predominantly the hands– Speech also halts


Other Forms of ASD (continued)

• Asperger’s disorder– Lack of social skills– Difficulty in social relationships– Poor concentration– Restricted interests– Normal IQ– Normal language development


Intervention

• Applied behavior analysis– Intensive one-on-one interactions for over 40

hours a week– Predictable routines– Effective instructional strategies– Appropriate curricular content


Intervention (continued)

• Dietary intervention– Removal of dyes and glutens

• Chelation– Removal of metals from the child’s blood


Eating and Elimination Disorders

• Pica– The craving of nonfood items

• Soiling and wetting– Persistent wetting may be a sign of an

infection.– Child may have an intestinal virus.– Diabetics have trouble with bladder control.– Strange bathrooms may cause an undue

stress on a child.



• Pica– The craving of nonfood items

– The persistent eating of nonnutritive substances for a period of at least one month.



• Soiling and wetting– Persistent wetting may be a sign of an

infection.– Child may have an intestinal virus.– Diabetics have trouble with bladder control.– Strange bathrooms may cause an undue

stress on a child


Prader-Willi Syndrome

• (PWS) is an inherited disorder genetic disorder which is generally caused by a deletion in Chromosome 15.

• The features of this disorder includes short stature, mental retardation or learning disabilities, incomplete sexual development, characteristic behavior problems, and an insatiable appetite.


Elimination Disorders

• Elimination disorders occur in children who have problems going to the bathroom -- both defecating and urinating.

• Although it is not uncommon for young children to have occasional "accidents," there may be a problem if this behavior occurs repeatedly for longer than 3 months, particularly in children older than 5 years.


Elimination Disorders

Two types of elimination disorders:• Encopresis is the repeated passing of feces

into places other than the toilet, such as in underwear or on the floor. – This behavior may or may not be done on

purpose. • Enuresis is the repeated passing of urine in

places other than the toilet. – Enuresis that occurs at night, or bed-wetting, is the

most common type of elimination disorder. – As with encopresis, this behavior may or may not be

done on purpose.

chapter 8 learning and behavior disorders

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