Posts from — February 2011

Infants and children are more profoundly impacted by environmental risk conditions than adults. Think about a baby living an environment with purple paint on the floor—the baby crawls in the paint, she put her hands in her mouth to explore and learn about things. The baby has a smaller lung capacity so when she inhales, the toxins cause more damage to the tiny lungs. Babies have smaller digestive tracts so digestion of toxins is more severe and the baby’s skin is more exposed to the environment. The impact of some environmental risk conditions must be considered within the understanding of the way an infant or child lives his or her life.

Description

Some environmental risk conditions are temporary, such as displacement from war or natural disasters. These can either be short term or long term experiences. The more long term a child lives with environmental risk conditions, the higher the risk created.

WHO (World Health Organization) lists the following key environmental risks for children:

• Unsafe water;
• Air pollution (indoor and outdoor);
• Poor food hygiene;
• Poor sanitation and inadequate waste disposal;
• Vector-borne diseases;
• Exposure to chemicals (agricultural chemicals, pesticides used for public health, industrial and consumer uses, industrial chemicals, petrochemicals, chemicals in consumer products, persistent toxic substances, natural toxins and others);
• Injuries.

In addition, children’s health is endangered by other environmental risk factors, such as: poor housing, environmental degradation, UV radiation, heavy traffic and the so-called “emerging” threats (e.g. global climate change, ozone depletion, exposure to endocrine disrupting compounds, and others), and in various settings, such as home, schools, playground, streets, fields and workplaces.

Intervention Options

Environmental risk conditions are often experienced when children live in poverty, neglect and abuse-linked. We need to address the needs of the entire family, such as safe housing and clean drinking water.

We also need to address the individual developmental needs of a child who has been exposed to environmental toxins. A child may have brain damage or sensory impairments, learning disabilities or a compromised immune system. This child and family will miss out on community experiences due to higher rates of illness, may or may not be able to attend preschool or require a specialized services and placement.

Children with sensory losses have difficulty with seeing (vision losses; blindness), hearing (hearing losses; deafness), or both senses, with varying degrees of vision and hearing (deaf-blindness) (see full Glossary).

Sensory losses may be present at birth as a consequence of a genetic or congenital condition. Sometimes, injury or trauma, or poor environmental conditions (see full Glossary) may also result in sensory loss.

Infants and young children with sensory losses have fewer opportunities than their peers for what is called “casual” or “incidental learning” (see full Glossary). Early intervention is critical to ensure these children’s optimal development¹.

Parents and caregivers need to find out about the unique developmental traits of children with sensory losses.  Knowing about what is new in research and technology will allow them to better access resources and learn about intervention strategies.

Specific intervention options and programs exist for the child and their family that you will find in each section below (visual impairments, hearing losses, and for those who are deaf and blind). At the same time, early intervention consultants work with families through the  Infant Development Program/Aboriginal Infant Development Program /Supported Child Development Program/Aboriginal Supported Child Development Programs of BC. These early intervention and support child development programs support families in many ways, including helping coordinate the different services offered to them.

1 Resources: http://www.parentcenterhub.org/repository/deafblindness/

Description

Children with hearing losses, or hard of hearing include those with hearing loss and children who are deaf (see full Glossary). Hearing loss may be present at birth or it may occur at any stage throughout the individual’s life.

While children with hearing loss or hard of hearing may respond to different sounds, or auditory stimuli (see full Glossary), including speech, children who are deaf cannot receive sound in all or most of its forms. In British Columbia, Canada, children with hearing loss or hard of hearing and children who are deaf are eligible for early intervention and special needs educational and vocational support from birth until age 19 years (BC Ministry of Child and Family Development).

Characteristics

Children with hearing losses or hard of hearing can only hear sounds at a certain level of loudness or intensity, and at a certain level of frequency or pitch in one or both ears. The degree of hearing loss might vary, from slight, to mild, to moderate, to severe, and profound. These ranges depend on a child’s ability to hear speech in others, or how loud and intensely their own speech is produced.

Hearing losses can be bilateral (both ears) or unilateral (one ear). Children with a hearing loss greater than 90 decibels (dB) are considered deaf. Audiograms determine the degree of hearing loss. An audiogram is a graph on which a person’s ability to hear different pitches (frequencies) at different volumes (intensities) of sound is recorded (www.cohandsandvoices.org).

These children need specialized education support or assistance to support their optimal development and learning.

Hearing loss has also been described as conductive, sensori-neural, mixed or central.

• Conductive hearing loss refers to hearing sounds in a limited way because the sound cannot travel within the ear channel;
• Sensori-neural hearing loss refers to hearing sounds in a limited way because the auditory nerve cannot understand or interpret to the brain the sounds coming through the ear channel;
• Mixed or central hearing loss indicates that the hearing is limited because both the central or inner ear and the auditory nerve are damaged.

Where does hearing loss come from (Fig. 1)?

Figure 1. Hearing Loss

Many times no one can determine the cause for hearing loss (see full Glossary). Hearing loss can be the result of genetic or hereditary, pre-, peri- or post-natal factors. See the list of syndromes and conditions, and also refer to the sections on Children with Biological Risk, Children with Established Risk Conditions and Children with Genetic Disorders and Children with Nervous System Disorders.

Signs of hearing loss or hard of hearing may be present since birth. The Early Hearing Screening Program in BC provides important information on the advantages of newborn screening, as well as testimonials for parents.  PHSA – BC Hearing  provides information on what to do if your infants fails the newborn hearing screening. Step by step guidelines are provided such at: support from a Guide by Your Side (parent), introduction to all the home guidance and preschool programs for children who are deaf or hard of hearing; enrolment in the program that best fits your child’s communication needs and ongoing assessment of hearing status including amplification needs and the necessary referrals to specialized teams such as the Cochlear Implant Team of if atypical development is suspected to the Hearing Loss team at Sunny Hill Health Centre for Children (inter-professional team assessments including the developmental paediatrician/family consultant initially leading to a full inter-professional psycho-educational assessment prior to kindergarten.

Sings of Hearing Loss or Hard of Hearing

When the hearing loss has not been detected at birth, early signs of hearing loss or hard of hearing in babies (birth to 12 months) include the following:

• By age 1 month: Not startling when hearing a noise;
• By age 3 months:  Not  turning head in response to a sound;
• By age 6 months: Not responding to vocalizations (cooing, gurgling sounds);
• By age 12 months: Not vocalizing (e.g. one- to two syllable utterances, or “first words” , e.g., “ma,” “bah”, or “ma-ma”, “da-da.”);

Some of the signs of hearing loss during the toddler, preschool and school years include the following:

• Children look as if they are less responsive and they do not hold their attention for even a few minutes;
• Many of them may be slow to learn new words, or have difficulty with their speech (unclear or changing sounds, e.g. “w” instead of “l”).
• Children with hearing loss or hard of hearing already in kindergarten and primary school grades find it hard to learn to read and write (see full Glossary) as they cannot blend sounds together.
• Sounds in words or understand idioms (see full Glossary), like “catching up.”

Intervention Options

Intervention for hearing loss may start after birth, as soon as the loss has been detected. Children who are either hard of hearing or deaf generally need some form of special education services in order to receive an adequate education.

For infants and young children consultation with an early intervention consultant or deaf and hard of hearing consultant regarding ways to stimulate the child and possible medical check-ups and interventions is helpful.

Intervention options for children with hearing loss or who are hard of hearing include the following:

Amplification Systems

• Amplification for unilateral hearing loss (one hearing aid or none)
• Bilateral hearing loss in mild to moderately severe range usually wear two hearing aids
• Bilateral moderately severe to profound hearing loss range are possible cochlear implant candidates, and those in the bilateral moderately severe to profound who are not cochlear implant candidates may not wear any hearing aids and rely on sign language
• FM systems are used in tandem with hearing aids in school classrooms and some homes

For preschool and primary school age children, intervention strategies include:

• Regular speech, language, and auditory training froma specialist;
• Amplification systems;
• Working with a sign language interpreter with parents and service providers who work with children who are deaf or who live with hearing loss;
• Seating arrangements in class that help the child to do lip reading with his teachers and peers;
• Captioned films/videos (see full Glossary);
• Ensuring that  teacher and peers receive training in other communication methods, such as sign language (ASL) (Fig. 2);
• Counselling.

Figure 2. Sign Language

Communication

People with hearing loss or hard of hearing use oral or manual communication, or a combination of the two. Oral communication includes:

1. Speech;
2. Lip reading;
3. Residual hearing.

Manual communication involves:

1. Signs
2. Finger spelling

• Mode of communication varies with normally developing unilateral hearing loss children using oral communication; bilateral HL children using oral communication only or assisted by some sign language in the more significant hearing loss range unless they have cochlear implants where oral communication is stressed.
• You can see that every child requires individual assessment to ensure that the child’s communication needs and the family’s agreement on communication style match
• Children with atypical development on top of hearing loss are more complicated to assess and may be more reliant on total communication (oral, sign, gesture, body language)

Total Communication (see full Glossary) is a method of instruction for people with hearing loss or hard of hearing. It combines the oral method plus signing and fingerspelling.

Websites

• BC Family Hearing Resource Society at: http://www.bcfamilyhearing.com/
• Deaf Children Society of BC at: http://www.deafchildren.bc.ca/
• Children’s Hearing and Speech Centre of BC at: http://childrenshearing.ca/
• Cochlear Implant Services at BC Children’s Hospital at: http://www.bcchildrens.ca/Services/ClinicalDiagnosticFamilyServices/Audiology/cochlear-implant-svs/default.htm
• Hearing Loss Team at: http://www.bcchildrens.ca/Services/ClinicalDiagnosticFamilyServices/Audiology/audiology-services/audiologycareteam.htm
• Colorado Hands and Voices see Road Map for Parents

To learn about hearing losses or hard of hearing in the middle childhood years, please visit the six to 12 part of this course.

Description

The term visual losses refers to children who are partially sighted/low vision, as well as children who are legally blind and totally blind. A visual impairment refers to the impact of losing sight and not to the eye condition or eye disorder (see full Glossary) itself.

• Partially sighted or low vision are terms used when the child has limited vision. The child cannot read at a normal viewing distance, even when they wear eyeglasses or contact lenses. Some of the children will require special education support at school. In British Columbia, a child with vision 20/70 will qualify to receive special needs support[1].
• The World Health[2] organization considers these five categories for visual impairments

1 = 20/200

2 = 20/400

3 = 5/300

4 = light perception only

5 = no light perception

• Legally blind means that the child has less than 20/200 vision in the better eye or a very limited field of vision
• Totally blind students have no vision left, and they need to learn via Braille (Fig. 1) or other non-visual media.

Figure 1. The Braille Alphabet

Characteristics

The effect of visual problems on a child’s development depends on several factors. These include:

• How severe the loss of sight is;
• The type of vision loss;
• How early the condition appeared in the child’s life;
• The developmental level of the child:

o   Many children who have multiple disabilities may also have visual impairments. These may result in other delays (e.g.,  motor, cognitive, and/or social developmental delays).

o   In addition, since the child cannot see their parents or peers, they will not be able to imitate and understand others in what is called social behaviours (see full Glossary) and nonverbal cues (see full Glossary).

Intervention Options

Children with moderate to severe visual impairments may require additional support for their motor development. Physiotherapy and/or occupational therapists may work with the child, family and their service providers in preschool and /or school. In British Columbia, children with visual impairments who require additional support may be referred to the Provincial Visual Impairment Program offered through BC Children’s Hospital and Sunny Hill Health Care Centre.

Educational Implications

Children with visual impairments should be assessed early so that they can benefit from early intervention programs. Technology in the form of computers and low-vision optical and video aids help many children with vision impairments (at different levels) to participate in regular class activities. Large print materials, audio recordings of books, and Braille books (Fig. 2) are available.

Figure 2. Reading a Braille book

Students with visual impairments may need extra help with special equipment and modifications to the typical classroom activities to emphasize listening skills, communication, orientation and mobility, vocation/career options, and daily living skills. Students with multiple disabilities that include visual impairments have a greater need to receive services from different professionals working in a team (see full Glossary). These children may require more intensive support on self care (like eating and toileting) and daily living skills (like crossing the street and catching a bus.

Resources

Provincial Resource Centre for the Visually Impaired (British Columbia, Canada) http://www.prcvi.org/related.aspx

The Texas School for the Blind and Visually Impaired – Resources for Infants and Toddlers www.tsbvi.edu/attachments/1051_infantvh.doc

The World Health Organization – Visual Impairments Report http://www.who.int/blindness/GLOBALDATAFINALforweb.pdf

To learn about visual impairments in the middle childhood years, please visit the six to 12 part of this course.

[1] BC SPECIAL EDUCATION SERVICES: A MANUAL OF POLICIES, PROCEDURES AND GUIDELINES http://www.bced.gov.bc.ca/specialed/special_ed_policy_manual.pdf#page=143

[2] http://www.who.int/blindness/GLOBALDATAFINALforweb.pdf

Description¹

Deaf-blindness refers to children who have some degree of loss in both vision and hearing.  This means that both their seeing and hearing skills are limited. How severe the loss is and how much the eyes or ears function varies for each child.

In the US, the IDEA (see full Glossary) public law on special needs describes deaf-blindness (see full Glossary) as a condition that requires special educational attention. Children who are deaf and blind need unique attention because they have fewer chances for “casual” learning, or natural ways to learn compared to other children who do not have these sensory impairments.

A program that serves children who are “blind” or children who are “deaf” will not address the children who are deaf and blind because their needs are more complex. This is why parents and professionals are directed to consult the National Consortium of Deaf Blindness. This agency has the most complete information for parents and professionals in terms of information and resources.² There is also the Canadian Deaf Blind association.

To learn about deafblindness in the middle childhood years, please visit the six to 12 part of this course.

1 see References
2 see References

“Disability” and “Disorder”

The term disability means a limitation in a functional activity or in a socially defined role.

The term disorder means an abnormality or disruption of a normal function, such as speech.

Children with Attention Deficit /Hyperactivity Disorders and/or with learning disabilities are considered to have a “high incidence” (see full Glossary) condition. It is generally apparent only after age 5 and during the school years and are present in 5-10% of elementary school children¹. Some people call them “invisible disabilities” because they are not obvious to others like physical and motor or genetic conditions.

In terms of the children’s daily needs and intervention “high incidence” conditions have a lower level of intensity (see full Glossary). They are ‘mild’ to ‘moderate’ in their impact (see full Glossary) to families and service providers.

1 References: Coleman et al., 2006; Hebbeler et al., 2007, Kierans et al.2000; The Advocacy Institute, 2006).

By age one year, typically developing toddlers listen to rhymes and songs. By age two, they love short stories, and by three years of age, they start following simple instructions. By age four children engage in play with others, complete short activities, like building with blocks, drawing, or modeling with play-dough for at least 5-10 minutes.

Some children find it challenging to focus on one task. They may also appear to have so much energy that engaging in one activity is almost impossible. There is a difference between children who are very curious and/or active and children who will only engage in these activities with one on one support.

This difference is important to note, because it can help parents and service providers observe a child and seek professional information about attention-deficit/hyperactivity disorder (ADHD). This is a condition that impacts approximately 5%1 or 1 in every 20 children (between ages 3 and 9 years) in North America . It is often connected to learning disabilities, behavioral difficulties and giftedness.

Description

Attention-deficit/hyperactivity disorder (ADHD) is a common neurobehavioral (see full Glossary) disorder. It relates to the brain’s chemistry and anatomy (Fig. 1).

Figure 1. Brain Difference

The symptoms of ADHD fall into the following categories: inattention, hyperactivity/impulsivity, and a combination of the two.

The definition of ADHD includes the following: 1) Difficulties with attention persist –they not just appear and disappear; 2) High levels of activity are present, to the point that the child does not seem to have control on their own; 3) A tendency to be impulsive, or to react without thinking, that does not seem to change as the child grows 4) These symptoms have to be observed for at least six months; most of them show up by the time the child turns 7 years old.

ADHD begins in childhood and symptoms can continue into adulthood. While some children outgrow ADHD, as many as 60% continue to have features of ADHD as adults.

Intervention Options

• Infant Development and Supported Child Development consultants can be involved with young preschool and school-age children who have difficulties sustaining attention and who show signs of hyperactivity.

• Intervention options include strategies that can be followed at home and at preschool/school with parents and teachers and other service providers;
•  To help with inattention, daily routines set with visual reminders support the child to be independent on one or more of the following:

1. What to bring to –from school (snack, clothing, materials);
2. Time and daily schedules.
3. Support to invite the child to self-regulate hyperactive and impulsive behavior includes the use of social stories and reward system for completion of activities without interrupting, and for any example of pro-social behaviours, among others.
4. Self-regulation is key for success in all children; children with ADHD benefit the most when they are provided with effective strategies to work on self-regulation skills, supported by their parents and teachers/other service providers.

• A pediatrician is usually involved with young children diagnosed with attention deficit hyperactive disorder and, in consultation with a child psychiatrist they may prescribe medication

To learn about ADHD in the middle childhood years, please visit the six to 12 section of this course.

Description

Young children use their five senses to learn about the world.  Children with learning differences are the same as other children in their preferred ways of learning and  are children with average to above average intelligence.

These children may find it hard to understand some of the information presented to them, or difficulties with processing and/or using it. Preschool children may show some early indicators of learning disabilities.

During preschool years, they may find it challenging to do one or more of these activities:

• Assembling a puzzle (6-10 pieces);
• Sorting and matching objects by colors, shapes, sizes;
• Sequencing pictures in a story retrieving words in songs.

By the time these children enter kindergarten, these children may find it hard to do the following tasks:

• Tell their complete name;
• Tell at least some of their personal/family information;
• Point at body parts;
• Matching and naming colors and shapes;
• At age 5 years they may confuse their right and left hand and have difficulties with directions.

As these children complete grade one, they may have difficulties counting to 20, telling a short story, reciting the ABC’s, or with other activities that require sequencing.

Learning difficulties become learning disabilities once children start more formal learning that involves reading, writing and mathematics.

When provided with the appropriate support, children with learning differences may develop their full learning potential. Specific and individualized strategies (see Intervention) allow children to be successful at reading, writing, math, and understanding the steps needed to complete daily tasks requiring guidelines, and engage in other projects such as art or music.

Special Needs

The term “special needs” refers to the child who requires individual educational support and/or specialized medical intervention to assist in the acquisition of basic developmental and/or academic skills (Coleman, 2006, p. 376).

Intervention Options

An Individualized Educational Plan (IEP) is designed for a child with identified special needs. It is revised every year with the parents and teaching/administrative staff of the child’s preschool or school.

Grey Area[1]

Inclusion/Inclusive systems

“Inclusion” (see full Glossary) means acceptance and participation of the child in preschool, school, high school so that they can develop to their fullest potential. Inclusive programs provide specialized and individualized support for the unique needs of each participating child.

Many children with learning disabilities or Learning differences are also diagnosed with language-based or communication disorders as described in this section (please click on link provided).

To learn about learning differences/disabilities in the middle childhood years, please visit the six to 12 part of this course.

________________________

[1] References: Gilliam, W.S., Meisels, S.J., & Mayes, L. C. (2005). Screening and surveillance in early intervention systems. In Guralnick, M.J. (Ed.), The developmental systems approach to early intervention, pp.73-98. Baltimore: Paul H. Brookes.

Children who are gifted have been the focus of many discussions among teachers and psychologists. These children follow the expected milestones in their early years of development.

Parents of children who end up identified as gifted have noticed differences since the very early years in the way their children learn.

For many years, the use of an IQ test was needed to identify a child as gifted.

More recently, the work of psychologists like Howard Gardner and Joseph Renzulli have provided other ways to define giftedness.

Gardner defines intelligence as “multiple,” in contrast to the traditional belief of “one” intelligence. As he describes it, an intelligence is a biological and psychological potential to solve problems and/or create products that are valued in one or more cultural contexts. With this definition and these criteria, Gardner identified seven relatively autonomous capacities that he named the multiple intelligences: linguistic, logical-mathematical, musical, spatial, bodily-kinesthetic, interpersonal, and intrapersonal. In more recent writings, Gardner added an eighth (naturalist) intelligence and continues to speculate about a possible ninth (existential) intelligence.

Renzulli looks at the connections between the learner, the teacher and the curriculum. After an extensive look at the  research studies of gifted individuals, Renzulli concluded that giftedness involves the interaction of three sets of characteristics: above average intellectual ability, creativity and task commitment. This interaction may result in giftedness in general performance areas such as mathematics, philosophy, religion or visual arts, or in the performance areas as specific as cartooning, map-making, play-writing, advertising or agricultural research.

The Many Dimensions of Giftedness

Description

“A gifted person is someone who shows, or has the potential for showing, an exceptional level of performance in one or more areas of expression.” (National Association for Gifted Children NAGC).

The term giftedness refers to the many abilities of a child, in one or more areas of development. This description does not depend on only one measure or index of intelligence. Approximately five percent of the student population (ages 5 – 18) has the potential to be identified as gifted.

Many people believe that gifted children develop “faster” or “differently.”  This is a mistaken idea, or a “misconception” (see full Glossary). However, what makes these children gifted is their ability to learn at accelerate faster rate. That is, they do learn new information faster than their peers, however, their developmental milestones occur in a similar way.

Intervention Options

Teachers trained in gifted education provide special support for children. Intervention options include using teaching models that value creative thinking, art, exploring nature, and using the child’s senses to learn. These models are a little bit different from the regular school models that concentrate on learning skills and drills, like reading, writing and mathematics. Examples include:

• Using the Multiple Intelligence Model (Fig. 1)
• Implementing the Three Ring Model
• Mentoring by finding individuals in the child’s community with special talents who share with young children their passions and support them in their expanding their knowledge and individual talents.

Figure 1. Multiple Intelligence Model

Interventions for children who are gifted and with learning disabilities/ADHD.

Many children with learning disabilities and attention deficit disorder are also gifted. It is important to understand the characteristics and needs of these children, because their unique abilities may be disguised with mis-behaviour, difficulties with attention or lack of interest. Many of them do not achieve to their full potential, and they are at a higher risk to drop-out of school. Professionals use the term “gifted under achievement¹” to refer to these specific characteristics.

Talent*

Talent is considered to be a personal gift. Few people have talents! Someone with talent has the natural ability, or aptitude, to do certain things; for example, a child with musical talent will learn to sing or play instruments at a very early age and with little and no training. Talent is not the same as a skill – like learning a certain musical piece after practicing for a while.

To learn more about children who gifted in the middle childhood years, please see the six to 12 part of this course.

1 Resource: Alina Morawska, Matthew R. Sanders (2008). Parenting gifted and talented children: What are the key child behaviour and parenting issues? Australian and New Zealand Journal of Psychiatry, 42, 819_827.

With the medical technology we have today, many diseases and disorders¹ can be overcome with medicine, rest, and time. However, some illnesses won’t go away in the near future, if ever. It is estimated that up to 31% of children suffer with an illness or disability that is “prolonged” and “interferes with daily functioning,” that is, a chronic illness.

Parenting a child who is chronically ill can be very stressful for a family.  The family needs to deal with many medical appointments and financial costs are very high. The stress on family relationships may sometimes be too much. Each child and family is unique in how they deal with these stressors.

Some children may require ongoing special family and school support, as there are many ways for families to support their child with chronic illness. At the same time, different resources exist to help families raising a child with a chronic illness.

1 see References