Author: Natasha Boskic

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2.9 Children with Mental Illness: Phobias

Phobias

Children who have phobias are extremely afraid of certain objects, people or situations (please see below). There is no reason for the child to be afraid but he or she is anyway. Phobias are a form of anxiety. Seeing or thinking of the cause of the fear can cause severe anxiety in a child. It can also cause  a panic attack (see full Glossary). The phobia is out of the child’s control and could interfere in the child’s ability to lead a typical life.

Most adults who have phobias know that their fears are not rational, but many children do not. Children, especially younger children (7 years or younger), may truly believe there e is something to fear. Understanding that a fear is irrational does very little to remove the fear. The person continues to experience the phobia, despite knowing that he or she is not being irrational.

There are many types of phobias. The most common types are described below:

  • Agoraphobia: fear of being in an open place like the beach, a park or a street (Fig. 1). In severe cases, individuals with agoraphobia do not leave their home, at all (this usually happens to adults and some teenagers, but not children);

Figure 1. Beach
  • Social phobia: also known as social anxiety disorder. It will be discussed below;
  • Specific phobias, which are sub-divided into:
    • Animal type: fear of dogs, snakes, spiders (Fig. 2);

Figure 2. Spider web
  • Natural environment type: fear of thunder, lightning, heights, water;
  • Blood injection type: fear of blood and syringes;
  • Situational: fear of a certain places, such as bathrooms and elevators;
  • Other types: fear of certain types of individuals, such as clowns, or certain types of objects such as rings or dolls (Fig. 3);

clown

Figure 3. Clown

Symptoms of having a phobia include:

  • Avoiding the feared object;
  • Seeing a picture of the feared object could  start an extremely fearful reaction;
  • Hearing someone talk about the feared object could  start an extremely fearful reaction;
  • Seeing something that resembles the feared object could start an extremely fearful reaction. For example, a person with a phobia of snakes could have a panic attack just by seeing a snake-shaped necklace;
  • Being unable to have a typical life because of the intense fear that he or she is experiencing;
  • Having some or all of the physical symptoms of an anxiety-based disorder. Please see the introduction part to this section;
  • Having some or all of the mental symptoms of an anxiety-based disorder. Please see the introduction part of this section;
  • In children, other symptoms could include crying excessively, screaming, clinging to adults and having temper tantrums.

Social phobia is also known as social anxiety disorder, and its main symptoms are:

  • Being very scared of speaking in front of others;
  • Being very scared of being embarrassed when speaking with others;
  • Just thinking about speaking in front of others could start a panic attack (for example, right before a class presentation);
  • Being excessively self-conscious (that is, worrying about how one looks or dresses);

For some children with phobias, the classroom can be a very scary place (Fig. 4). A child with claustrophobia (fear of small spaces) may not like being in a classroom with the door closed. A child with agoraphobia (please see above) may be scared of not being able to get out of the classroom in case of an emergency. A child with social phobia may be scared that the teacher will ask him or her to answer a question in class. Whatever the phobia, children need to be reassured that they are safe and welcome in the classroom. Teachers can:

classroom

Figure 4. In the classroom
  • Be aware of the phobia and make sure the child does not experience the feared object in the classroom;
  • Be aware of the symptoms of an anxiety or panic attack and be ready to handle it if it happens;
  • Reassure the child that he or she is safe;
  • Be patient and accepting of the child to make the child feel welcome, and act as a role model for everyone else in the classroom;
  • Give the child more time for assignments and homework if needed.

A phobia is a type of anxiety disorder. It is a mental illness. It should be treated by a clinical psychologist or a psychiatrist. There are many treatment options for children who have phobias. The most common are listed below:

  • Behavioral therapy: in classic behavioral therapy, the child is slowly and gradually exposed to the feared object until the child realizes that there is no reason to be afraid and the fear goes away. For example, if a child is afraid of spiders the typical therapy process could include:
    • Mention the word “spider” in front of the child;
    • Talk about “spiders” with the child;
    • Show the child a picture of a spider;
    • Have the child watch a program that has spiders in it;
    • Have the child be in the same room with a spider that is in a cage;
    • Have the child be in the same room with a spider that is not in a cage;
    • Have the child “virtually” touch a spider (that is, through a computer screen or an electronic game);
    • Have the child get physically close to a spider;
    • Have the child touch a spider;
    • Have the child hold a spider (Fig. 5).
    • Cognitive/behavioral therapy: this type of therapy focuses on the cognitive and behavioral aspects of a phobia. It has two parts:
      • Cognitive: the child is taught how to turn his or her negative thoughts into positive ones. The child is also taught how to think rationally about the fear and how irrational it is;
      • Behavioral: the child is taught how to calm down and self-soothe (see full Glossary) , and eventually be around the feared object without panicking.
    • Medication: some medications, such as beta-blockers, anti-depressants and sedatives are sometimes prescribed to individuals with phobias. It is not clear whether or not these types of medications should be prescribed to children who are under ten years of age.

Figure 5. Holding a spider

Children with phobias may have a very tough time when they experience the object they fear. Some panic attacks are very acute. But when the child is not exposed to whatever he or she is afraid of, the child is typical in every way. Most children who have phobias who undergo therapy do overcome their phobias. Most grow up to lead happy and healthy lives.

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2.9 Children with Mental Illness: Anxiety-Based Disorders

Anxiety-Based Disorders

Many children have anxiety-based disorders. Each child may display different symptoms of anxiety, but they all seem share one thing: they worry. Everyone worries every now and then. Children with anxiety disorders worry all the time. Too much worrying becomes a disorder when the feelings of anxiety are so severe and intense they prevent a person from leading a typical life. Often there is no reason for a person to worry, yet he or she continues to do so.

Anxiety-based disorders can have a negative influence on several developmental areas:

  • Cognitive skills: some children with anxiety disorders have low average IQ scores. That is not because of their cognitive abilities. It is usually because their excessive worrying prevents them from concentrating well. Some children may be scared to try new things and learn at a slower rate than their peers. In some children, the anxiety is so severe that it prevents them from paying attention and concentrating;
  • Academic skills: some children with anxiety disorders have trouble with academic skills. This is not because of an inability to learn, but because they are too worried to pay attention and learn. Some children have serious anxiety about taking tests. This keeps  them from performing well on school tests. Anxiety BC has put together a wonderful resource for these children, their families and teachers. It can be downloaded from the following website;
  • Social/emotional skills: children with anxiety disorders may have a low self-esteem and very little self-confidence. They may avoid social situations and activities, after school sports and hanging out with friends. Some may have very few friends and spend a good deal of their time alone.

There are many types of anxiety disorders. The most common ones are covered in this section.

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2.7 Children who are Gifted

Children who are Gifted

Children who are gifted often have needs that are not met. For some reason, people assume that if a child is gifted, he or she may not need specialized and individual education. But children who are gifted have needs that are real and must be addressed.

The definition of what it means to be gifted has changed a lot in the last few decades. The education and psychology communities have moved away from defining giftedness as just performing really well on an IQ test. We  now see giftedness as a wide range of skills and talents. To learn more about these relatively new theories and types of intelligence, please visit the zero to six part of this course. Please make sure to scroll all the way down to the bottom of this page, where talent is defined.

Children who are gifted usually display signs of giftedness very early in life. There are many signs of giftedness, and some of them are listed below (adapted from the BC Ministry of Education):

  • Learning many skills early, fast and on their own;
  • Being highly curious;
  • Constantly wanting to know how things work;
  • Having an unusually large vocabulary and using a lot of abstract terms;
  • Speaking in very complex sentences;
  • Having a great sense of humor;
  • Having a wide range of interests;
  • Being highly motivated and enthusiastic;
  • Being unusually sensitive to the needs of others;
  • May have explosive emotions;
  • Solving all types of problems;
  • Being highly creative;
  • Being able to see the same situation from a variety of angles;
  • Engaging in both inductive and deductive reasoning (that is, going from the specific to the general and also from the general to the specific, when solving problems);
  • Persevering (that is, not giving up until they finish what they are working on);
  • Having a good memory.

For more information about early signs of giftedness, please visit the following websites and listen to this audio clip from CBC news on early signs of giftedness.

Being gifted could have significant effects on all areas of development:

  • Cognitive skills: as listed above, children who are gifted often have highly advanced cognitive skills. They learn quickly and easily. They easily link newly learned information and concepts to information they already know, making it easier for them to remember everything that they learn. They are also great at generalizing what they learn from one situation or setting to another;
  • Academic skills: many parents of children who are gifted state that their children taught themselves how to read and write (Fig. 1). This could be because of highly sophisticated cognitive skills, or because of very advanced language skills (one of Gardner’s multiple intelligences). In school, children who are gifted perform really well and finish assignments early. Others may underperform, because they are bored;

Reading and writing

Figure 1. Reading and writing
  • Language and communication: some children who are gifted are great at making jokes. They learn new words every day and have extremely sophisticated expressive language skills. They sometimes struggle with the pragmatics of language (such as waiting for their turn before they speak), because they have so much to say and not enough time to say it;
  • Social/emotional: children who are gifted may struggle with social skills because of their advanced development. However, this is the exception rather the norm. Many children who are gifted are quite popular and have a lot of friends. Many of them are great at identifying emotions in themselves as well as in others. Many also have a very high sense of empathy towards others.

Children who are gifted need help in order to reach their full potential. There is a wide variety of educational options for children who are gifted. Some of these options are listed below (adapted from the BC Ministry of Education):

  • Acceleration: putting a child in a grade that is higher than his or her chronological age, or giving the child a curriculum that is more advanced
  • Telescoping: allowing the student to spend less time to cover the curriculum, than his or her peers, because he or she is able to finish the curriculum much faster than everyone else. When the child is done with the curriculum for a grade level, he or she moves on to the curriculum of the next grade level: for example, a child who is very good at math can cover the grades 9 and 10 curricula in one year;
  • Engaging in independent study: the child chooses a topic that is of great interest to him or her and pursues it in his or her free time. The child researches the topic and could end up presenting what he or she has learned to the entire classroom.

It is crucial that the needs of children who are gifted be addressed, be it in the regular classroom or in a special classroom for the gifted. People often cite individuals who are highly gifted and their contribution to humanity, but often forget that these gifted individuals had teachers. So, in the regular classroom, the regular education teacher and the special educator will work together to make sure that the needs of the child who is gifted are addressed and take care of.

Giftedness does not occur in a vacuum. Some children who are gifted are advanced in many developmental areas. But others are only advanced in some areas (for example: math). Still others can be advanced in one area but really struggling in another. For instance, some children who are gifted also have ADHD or a learning disability.  And let us not forget those who have great talents. Not all talents can be measured with an IQ test. Some children may have great singing voices, some are really good dancers (Fig. 2), while others may be great with words, may paint really well or be good at sports. They are just as gifted as those who are good with math!

Dancers

Figure 2. Dancers
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2.6 Other Types of Disorders: Learning Disabilities

Children with Learning Disabilities (LD)

Children with learning disabilities (LD) experience difficulties when processing certain types of information. It takes them longer than others to learn new things, especially abstract information. Since reading, writing and math are all abstract tasks, children with LD struggle to develop one or more of these essential academic (and life) skills (Fig. 1).

academic skills

Figure 1. Academic skills

LDs are not usually diagnosed before a child is 9 or 10 years of age. But the signs of a possible LD can be seen in the preschool years. To learn about these signs, please visit the zero to six part of this course.

LD is a neurological disorder. It appears that the brains of those who have LDs are “wired” differently than those of typically developing children. That is, children with LD process information differently than others. LDs are lifelong conditions. Children learn how to live with a learning disability and can certainly learn how to read, write and do math, but the learning disability itself does not go away.

There are many types of learning disabilities. The most common types are described below:

Dyslexia: a disorder of reading. Children who have dyslexia have trouble understanding written words and often struggle with phoneme awareness (see ECI Glossary). Children with dyslexia struggle when it comes to understanding what individual words are made of. They also struggle when it comes to understanding what they are reading. For example, the word “blue” is made of a blend of two consonants, “bl”, the long vowel sound “u” −and when they write this word they need to add the silent “e” at the end.”

Because dyslexia is a language-based disorder, many children with dyslexia are usually late reaching language development milestones;

Dysgraphia: a disorder of writing and spelling. Children with dysgraphia find it difficult to write and spell correctly. They also find it difficult to write within the limits of a certain space. They often struggle with punctuation (Fig. 2)  (for example, using commas);

struggling at school

Figure 2. Struggling at school

Dyscalculia: a disorder of math. Children with dyscalculia struggle with all types of math operations, from the simplest to the most complex ones (Fig. 3). This means that they may know and write the numbers, but cannot understand how to use them when adding or subtracting. For example, if asked to add “15 + 5 = 20” they may not make any sense of this statement unless they work with objects and count them one by one.

doing math

Figure 3. Struggling with math

Auditory processing disorder: the child has difficulty processing information that is presented to him or her orally, despite having typical hearing;

Visual processing disorder: the child has difficulty processing information that is presented to him or her visually, despite having typical vision.

It is not uncommon for a child to have more than one learning disability. That is, a child can have both dyslexia and dyscalculia. Also, some children with LD also have difficulties with attention or ADHD.

LDs can have a serious impact on the development of the child:

  • Cognitive skills: children with LD have typical intelligence. In fact, this is needed for the diagnosis of a learning disability. The child has typical intelligence, but still struggles with reading, writing and/or math. Their academic skills are not at the same level with their cognitive skills. However, LD does affect the child’s cognition and this is why many children with LD tend to have IQ scores (see full Glossary)  that are in the low typical range. Some children with LD struggle when learning certain concepts, especially those that are abstract (for example, knowing what term like justice means);
  • Academic skills: LDs clearly have a serious impact on a child’s academic skills. How academic skills are impacted by a learning disability will depend on the type of learning disability the child has. This is because following instructions in class is hard for them. Many times their work is incomplete and homework becomes a struggle at home.
  • Language and communication skills: many children with LD have language skills that are simpler than those of their peers. They sometimes struggle with following directions and may also struggle with multi-step commands. Their expressive language skills appear to be less advanced than those of their peers, as they tend to mostly speak in simple sentences. Because of processing difficulties, many children with LD also struggle with pragmatic language. Some children’s learning difficulties are not language based. These children excel in oral language skills, and show high reasoning skills and listening comprehension skills. At the same time, they continue to struggle making sense of words when reading and have trouble putting words together in sentences and writing paragraphs when writing. Some of them have a hard time with word problems in math when they have to follow more than one step to solve the problems unless someone reads the word problem out loud and guides them from one step to the next. For example, “Lisa picked 10 apples; then, she got 3 more from her friend.  Later on she ate two apples, how many apples were left?”
  • Social/emotional difficulties: some children with LD struggle with both social and emotional issues:
    • Social skills: some children with LD have social skills that are less developed than those of their peers. They struggle with personal space (as defined by their culture) and may have eye contact difficulties (as defined by their culture). Some do not know how to start or end a conversation and many find it difficult to wait for their turn before they say something. Many do not have a lot of friends;
    • Emotional skills: some children with LD struggle with the ability to identify emotions, both in themselves and others. Many have negative self-esteem and little or no self-confidence. Some have explosive emotions. That is, they tend to struggle with impulse control and may have limited executive functional skills (see full Glossary);
  • Motor skills: some children with LD struggle with both fine motor and gross motor difficulties. They may appear clumsy when they move and may constantly run into objects and people. Others may have fine motor difficulties (especially those who have dysgraphia) which prevent them from fully participating in writing, drawing and painting activities;
  • Mental health: many children with learning disabilities also have a mental health disorder. This includes depression and anxiety-based disorders.

Children with LD are usually placed in the regular classroom, which is where they belong. They have an Individualized Education Plan (IEP) (see full Glossary), and could benefit from the following in and out of school services:

    • Special education: the special educator or resource teacher will help the regular education teacher accommodate children with LD into the regular classroom. He or she will help the child with LD improve his or her reading, writing and math skills (Fig. 4). He or she will also assist the regular education teacher in making adaptations for the child with LD. This could include the following:

special education

Figure 4. Working with special educator
    • Breaking up what the child has to do into smaller tasks;
    • Giving them more time to do what they need to do;
    • Using simple language when communicating with them;
    • Encouraging them to use graphic organizers, which could make what they have to learn more clear;
    • Giving them outlines of lesson, with important words already highlighted;
    • Giving them frequent breaks.
    • School psychologist: The school psychologist will complete a full evaluation with the child and interview parents and teacher(s) to find out about the child’s specific difficulties and how to provide support for the child throughout his or her school years. The school psychologist will work with parents and other professionals in the School Based Team, including the child’s teachers, school administrators and other professionals that are listed below. In British Columbia, children who receive a diagnosis of learning disabilities are eligible for special needs support, including an Individualized Educational Plan or IEP and receive a special needs designation;
    • Speech and language pathology (SLP): the SLP will help the child with language-based LD improve all aspects of his or her language skills. Reading and writing are language-based skills, so improvement in language could result in an improvement in reading and writing. The SLP will also help the child with LD learn the pragmatics of language;
    • Occupational therapy: the OT will help the child who has LD to improve his or her fine and gross motor skills, as well as his or her coordination and balance;
    • School counselor: the school counselor could help the child with LD manage his or her emotions, and adjust to the fact that he or she learns differently than others;
    • Clinical psychologist: if the child with LD also has a diagnosis of a mental illness, such as depression, then regular sessions with a clinical psychologist may be warranted.

Despite the fact that many children with LD also have ADHD, and/or a mental health disorder, most grow up to become healthy and happy adults, who are active and fully-contributing members of society (Fig. 5).

Fully-contributing member of society

Figure 5. Fully-contributing member of society
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2.6 Other Types of Disorders: ADHD

Children with Attention Deficit Hyperactivity Disorder (ADHD)

Children with ADHD struggle with attention difficulties. Many can initially pay attention to a topic, but most cannot maintain that attention for more than a few minutes. Many people think that ADHD is mainly a school or academic difficulty. It is actually much more than this. ADHD can have an impact on every aspect of the child’s life. They may find it difficult to follow up with conversations with others and may find it difficult to pay attention to a speech.

The DSM-IV-TR (2000) (see full Glossary) classifies the symptoms of ADHD into three broad categories: inattention, hyperactivity and impulsivity. Inattention must be present, if a child is to be diagnosed with ADHD. When it comes to hyperactivity and impulsivity, only one should be present, in order for a diagnosis of ADHD to take place (Fig. 1):

ADHD

Figure 1. ADHD
  • Inattention, which includes (but is notlimited to) the following symptoms:
    • Difficulty paying attention for more than a few minutes;
    • Difficulty following directions and instructions;
    • Often forgetting to do something;
    • Often losing things.
    • Hyperactivity, which includes (but is not limited to) the following symptoms:
      • Having difficulty sitting still for more than a few minutes;
      • Fidgeting and squirming in one’s seat;
      • Running or moving around excessively.
      • Impulsivity, which includes the following symptoms:
        • Blurting out answers before hearing the question;
        • Having difficulty waiting in line or for his or her turn;
        • Constantly interrupting others.

The child must exhibit ADHD symptoms for at least six months, before a diagnosis can be made.  Some of the symptoms must be present in more than one setting (APA, 2000).

Although many children with ADHD display some of the symptoms of ADHD before seven years of age, most do not get diagnosed with ADHD before they are 8 or 9 years old.

ADHD can have a tremendous impact on most developmental areas, as can be seen below:

  • Cognitive development: some children with ADHD reach certain cognitive milestones later than other children, because it is so difficult for them to pay attention and learn. Although most have typical intelligence, they tend to score on the lower end of the typical intelligence spectrum on IQ tests (see full Glossary). Some may appear not to know a certain color or concept, only because they quickly give answers to questions, before they actually hear the question. In other words, they sometimes give answers to questions they do not even know;
  • Academic skills: many children with ADHD perform less well than their peers in almost all academic areas. Many learn how to read, write and do math later and at a much slower rate than their peers because of attention, hyperactivity and impulsivity difficulties;
  • Social/emotional skills: some children with ADHD struggle with both social and emotional development, again because of attention difficulties:
    • Social skills: many children with ADHD struggle with social skills, because it can be difficult for them to listen to others, wait for their turn and sit still. Some do not have a lot of friends;
    • Emotional skills: some children with ADHD have  negative self-esteem (how a child feels about him/herself) and low self-confidence. They may not have a lot of friends and are sometimes embarrassed when they miss out on something because they did not pay proper attention to it;
    • Mental health issues: some children with ADHD experience a lot of anxiety because of their attention difficulties. In fact, there appears to be a higher rate of depression and anxiety-based disorders in children and teens who have ADHD.

Some children with ADHD also have a learning disability. Many are also gifted.

ADHD is not just an academic disorder. It has an impact on every aspect of a child’s life. Many children with ADHD have Individualized Education Plans (IEPs) (see full Glossary) in school to adapt their work in terms of shorter activities or extensions when needed. The school’s special educator can usually help the child with ADHD function well in a regular classroom. The special educator usually works very closely with the regular education teacher in order to make the classroom less distracting to the child with ADHD (perhaps by hanging fewer items on the walls and giving the child special seating). The special educator can also help the child with ADHD manage and improve his or her attention, hyperactivity and impulsivity skills by teaching him or her specific strategies that they can use in the classroom. Some examples of such strategies include:

  • Giving them graphic organizers (Fig. 2) and outlines of what needs to be done in class;

graphicorganizer

Figure 2. Graphic organizer
  • Allowing them to take frequent breaks;
  • Breaking down what they have to do into smaller steps or chunks;
  • Giving them an hour glass (Fig. 3), which can show them how long they have to wait, before they can take a break;

hour glass

Figure 3. Hour glass
  • Giving them “stress” toys, such as objects that they can hold in their hands and squeeze. This (Fig. 4)  appears to release some of the energy that these children have inside them. In high school, some students with ADHD engage in knitting during class. Again, this takes away that enormous energy that some of these students have, therefore allowing them to pay attention to what is happening in class;
  • Giving them checklists of what they need to take home or to school every day.

stress toy

Figure 4. Stress toy

Children with ADHD who also struggle with a mental illness or disorder may need regular sessions with a licensed clinical psychologist as well as the school counselor.

Some children with ADHD are prescribed medication to help them regulate their attention and impulsivity. The issue of placing children with ADHD on medication is somewhat controversial. Ultimately only parents can decide whether or not they would like to place their child on such medication. Parents need to know what the side and long-term effects of these medications are before they make their decision. Also, medication alone is never enough. Children with ADHD, even if placed on medication, will still need to learn how to pay attention, sit still and calm down.

Most children who have ADHD continue to struggle with some of the symptoms of ADHD well into their adulthood. Although they may continue to need help, most end up leading very happy and fulfilling lives (Fig. 5).

happy life

Figure 5. Happy life
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2.5 Children with Sensory Impairments: Deaf/Blind

Children Who are Deaf/Blind

Children who are deaf/blind have significant sight and hearing loss. They do not have functional vision or hearing. Neither of these two essential senses can be used as a primary way to learn.

Children who are deaf/blind use some of the same techniques uses by  children who are deaf or children who are blind. They use Braille (see full Glossary) (Fig. 1) in order to read, and use sign language to communicate with others. When they want to get a message across, they use American Sign Language (ASL), and sign just like any child who is deaf. When they want to understand what others are trying to tell them, they have someone who “speaks” ASL sign into the palm of their hand. It is amazing to watch someone sign into the hand of a person who is deaf/blind, who then responds by signing on his or her own.

using braile

Figure 1. Using Braille

Deaf/blindness usually has serious effects on all areas of development:

  • Cognitive and academic skills: most children who are deaf/blind take a long time to reach developmental milestones. They take longer to learn about colors and shapes. They also take longer to learn how to read, write and do math. Some struggle with attention difficulties. Others find it difficult to learn new and abstract concepts;
  • Language and communication: children who are deaf/blind take a long time to achieve most language and communication milestones. They often struggle with pragmatic communication. Many do not speak orally. Instead, they sign;
  • Motor: many children who are deaf/blind take a long time to reach developmental milestones. They can’t see, so reaching is delayed. So are sitting up and walking. Some children struggle with fine motor skills;
  • Social/emotional: some children who are deaf/blind have difficulties with their social/emotional skills:
    • Social skills: because they cannot see or hear, children who are deaf/blind cannot rely on some of the methods that their sighted and/or hearing peers rely on. They cannot establish eye contact with others, nor can they read someone else’s body language. They often miss out of sarcastic remarks, because they cannot hear the tone of the person who is talking;
    • Emotional skills: many children who are deaf/blind take a long time to learn about emotions. They often struggle when it comes to identifying emotions, both in themselves and others. Some may have negative self-esteem, because they may not have a lot of friends;
    • Adaptive: children who are deaf/blind take a long time to learn most adaptive skills, including:
      • Dressing and undressing by themselves
      • Eating and drinking by themselves;
      • Bathing, showering and grooming;
      • Toilet training;
      • Sensory: because they are missing two of the five senses, some children who are deaf/blind have certain types of mannerisms. These mannerisms sometimes look like the self-stimulatory behaviors (see ECI Glossary) some children who have autism engage in. This includes rocking back and forth or moving their heads around. Children who are deaf/blind sometimes do these things because they are not getting enough sensory stimulation from their environment. That is because they are not getting any, or are getting very little stimulation from two of the five senses.

Children who are deaf/blind could benefit from the following services:

    • Special educator with special training in the education of the deaf/blind: this person will use specific and highly specialized methods (please see below to reach and teach the child who is blind. This person will also help these children learn how to use Braille if they do not already know how. Some of the highly specialized methods that are used only with children who are deaf/blind include:
      • Hand under hand method: the educator places his or her hand under the hand of the child who is deaf/blind. This way the child can feel what the educator is doing (Fig. 2);
      • Hand over hand method: the educator places his or her hand over the hand of the child, or perhaps on his or her elbow, in order to allow them to do as much as possible by themselves;
      • Speech and language pathologist (SLP): the SLP will help children who are deaf/blind with all areas of language. They will help the child with receptive and expressive language, which are learned through sign language. They can also help them with pragmatic language;
      • Occupational therapist (OT): OTs can help children who are deaf/blind reach motor milestones. OTs with special training in sensory integration can help children who are deaf/blind with any difficulties they may be experiencing with sensory integration.

hand under hand method

Figure 2. Hand under hand method

General strategies for working with those who are deaf/blind (adapted from the Provincial Outreach Program for the Deaf/blind):

      • It is important that language be used when we are attempting to teach a child who is deaf/blind anything. Language can be oral or signed. Children need to be exposed to language if they are to develop it;
      • Children who are deaf/blind can tell a lot by someone’s touch. We must be very careful about the way we touch children who are deaf/blind because the wrong touch could send the wrong message;
      • It is very important that we do as much as possible with the child who is deaf/blind rather than for him or her. This is the one true way towards independence;
      • It is crucial that children who are deaf/blind learn the concepts behind certain skills. A skill is about what we do. A concept is about understanding what we do, so skills are not enough. Children need to develop the concepts behind them too.

The vast majority of children who are deaf/blind catch up with their seeing and hearing peers in all areas of development. They attend school and go to university. Many get jobs and live on their own.

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2.5 Children with Sensory Impairments: Visual Impairments

Children Who are Blind or Have Low Vision

Children who cannot see at all or who have some vision but not enough to make sense of the world are considered visually impaired (Fig. 1).

visually impaired

Figure 1. Visually impaired

A visual impairment can be determined in two ways (for more information about the definition of visual impairments, please visit the birth to six part of this course:

  • How well a child sees or visual acuity: perfect vision is 20/20. This means that a person can clearly see at a distance of 20 feet what they are supposed to see at 20 feet;
  • How much peripheral vision a child has or visual field: when looking straight ahead, a child should be able to see part of his environment, to the left and the right;

When a child cannot see clearly, or does not have enough peripheral vision after correction (with glasses or contact lenses) or surgery, he or she is considered visually impaired. Vision loss can be congenital (present at birth) or adventitious (vision is lost later in life, due to illness, accident, injury or trauma). Although most children who are visually impaired do have some vision left, many cannot use their vision in order to make sense of the world. In other words, they do not have functional vision.

There are many types of vision loss, some of which are listed below1:

  • Refractive errors, such as myopia (nearsightedness), hyperopia (far sightedness), and/or astigmatism;
  • Cataract: resulting from clouding of the lens of the eye;
  • Glaucoma: resulting from too much pressure in the eye;
  • Retinitis pigmentosa: starts with night blindness and usually progresses to loss of peripheral vision.

Some vision impairments are degenerative. This means they get worse with age. Others are degenerative by nature and vision loss gets worse, even in children (for example: glaucoma). Also, some children have a visual impairment that is stable; that is, it does not change. Others have visual impairments that fluctuate. That is, the child can see better or worse on different days (Fig. 2).

blind

Figure 2. Blind

Vision loss or low vision can have serious effects on the development of the child:

  • Cognitive and academic skills: children who are blind or have low vision often reach developmental milestones later than their sighted peers. It is not easy (though certainly not impossible) to explore objects and play with them when you cannot see them. It is also not easy to move around and explore your environment if you cannot see it. Children who are blind or have low vision may also struggle with academic skills, such as reading, writing and math. Children who are blind usually learn how to read by using Braille (see full Glossary) (Fig. 3), and those who have low vision usually use large-print books, or special equipment that makes the font of books larger. Some children who are blind or have low vision struggle with the development and understanding of certain concepts and need to be taught certain skills over and over again;

reading braille

Figure 3. Reading Braille
  • Motor skills: most children who are blind or have low vision will reach motor milestones later than their sighted peers. For instance, it is very difficult to start reaching for objects (which starts at around 4 months of age in sighted children) when you cannot see them. It is also difficult to crawl and cruise (see full Glossary) (which can happen at around 10 to 12 months in sighted children), if you cannot see where you are going. Most children eventually do catch up with their sighted peers;
  • Language and communication: many children who are blind or have low vision experience difficulties with language. Many have language skills that are less advanced than those of their sighted peers. They sometimes struggle with concept development and may have difficulty understanding abstract words (such as freedom or justice);
  • Adaptive: some children who are blind or have low vision may struggle with adaptive development. They may struggle with tying their shoe laces, making sure they are wearing the same socks or shoes on both feet, and bathing and grooming. They can be taught how to manage these difficulties by a vision specialist;
  • Social/emotional: some children who are blind struggle with both social and emotional issues:
    • Social issues: because they cannot see or cannot see well, many children who are blind or have low vision engage in what is referred to as “blind mannerism.” This term refers to behaviors such as rocking back and forth. Some children who are blind or have low vision may engage in such behaviors because they are not getting enough stimulation through their various senses. Some children who are blind or have low vision may not know when to enter or leave a conversation because they cannot see the “social cues” that are being given to them by others. Speech and Language Pathologists (SLPs) can teach these children how to recognize these cues;
    • Emotional issues: some children who are blind or have low vision struggle with having low self-esteem and little self-confidence. Most usually overcome these difficulties in their adult years, if not earlier;

Because of these difficulties, children who are blind or have low vision could benefit from the following services:

  • Orientation and mobility specialist: this person will help the child who is blind or has low vision “orient” him or herself in physical space  and then move from one place to the next (mobility) with little or no assistance. The orientation and mobility specialist will also teach the child who is blind or has low vision how to interact with his or her seeing eye dog, if he or she has one, and how to use his or her cane, if he or she has one;
  • Speech and language pathologist: the SLP could help children who are blind or have low vision learn pragmatic language;
  • Special educator with special training in visual impairments(sometimes called an itinerant teacher): this person will help the child who is blind or has low vision with any academic difficulties he or she may be experiencing. The special educator will also help these children with any adaptive equipment they may have (for example, a special device that turns regular words into Braille). The special educator will also help the regular education teacher accommodate the child who is blind or has low vision into his or her classroom, and change the physical setting of the classroom, in order to make it “blind friendly.” For example:
    • The physical set up does not change unless the child who is blind or has low vision is informed first;
    • The child is seated in the place that provides him or her with the most amount of light possible;
    • The child is given enough space to keep his adaptive equipment with him or her.

Some children who are blind or have low vision start their academic lives by attending special schools for the blind. There, they learn how to read Braille, and use canes or seeing eye dogs. They also learn how to orient themselves in their environment in order to become as independent as possible.

Here is a list of what most children who are blind or have low vision need, in order to be as independent as possible:

  • Books in Braille (see full Glossary) (Fig. 4): if they use Braille and books in large print if they have low vision. Children with low vision could also benefit from special devices that can increase the font of any book or document (Fig. 5);
  • Canes: canes help children who are blind or have low vision move around in their environment, without running into things or people;
  • Seeing eye dogs: the seeing eye dog will help the child who is blind or has low vision get to where he or she needs to be in as little time as possible (Fig. 6).

braille book

Figure 4. Braille book

increasing font size

Figure 5. Increasing font size

seeing eye dog

Figure 6. Seeing eye dog

Most children who are blind or have low vision catch with their peers in all aspects of life and development. They grow up to be healthy and happy adults who can hold full time jobs and live totally independently.

see References
1 To see what someone with a specific type of visual impairment sees, please visit the following website: http://www.kent.gov.uk/adult_social_services/your_social_services/services_and_support/sensory_disabilities/deafblind_information/types_of_visual_impairment.aspx
Categories
2.5 Children with Sensory Impairments: Hearing Impairments

Children Who Are Deaf or Hard of Hearing

Children who cannot hear well enough in order to make sense of what they are hearing are labeled as having a hearing impairment. Some of these children may not be able to hear at all. Others  may be able to hear some sounds, but they are unable to make sense of what they hear because the sounds they hear are very low or distorted. In other words, they do not have functional hearing. Hearing is usually measured in decibels (see full Glossary), and it measures the child’s ability to hear low as well as high sounds. A hearing test is usually administered by an audiologist (Fig. 1).

audiologist

Figure 1. Audiologist

Hearing loss can be classified in many ways:

  • Bilateral versus unilateral: bilateral hearing loss means  the child has hearing loss in both ears. Unilateral means the child has hearing loss in only one ear;
  • Pre-lingual versus post-lingual: pre-lingual means the child has had trouble hearing either since birth, or after birth but before he or she started to talk. Post-lingual refers to children who have lost their hearing after they learned how to talk.

There are many levels of hearing loss (BC Ministry of Education):

  • Minimal: hearing loss is between 16 and 25 decibels. The child is able to hear relatively well without a hearing aid, especially in quiet places. In loud or crowded places, the child may miss out on parts of conversation. A hearing aid may be used but not all the time;
  • Mild: hearing loss is between 26 and 40 decibels. The child has some residual hearing but is usually  not able to hear well and participate in discussions and conversations without a hearing aid. This is especially true if the child is in a loud setting, such as the classroom;
  • Moderate: hearing loss is between 41 and 55 decibels. Hearing aids (or other amplification devices, please see below) are essential. The child may be able to hear bits and pieces of conversations, but it would be a struggle;
  • Moderate to severe: hearing loss is between 56 and 70 decibels: the child is unable to hear anything and make sense of it without the help of a hearing aid;
  • Severe: hearing loss is between 71 and 90 decibels. The hearing loss is quite serious and the child needs a hearing aid all the time;
  • Profound: hearing loss of more than 91 decibels. The child is practically completely deaf and does not usually rely on his or her sense of hearing in order to obtain information from the environment.

There are also many types of hearing loss. To learn about these types, please visit the birth to six portion of this course.

Having a hearing loss could have a serious impact on almost all areas of development:

  • Cognitive: some children with hearing loss may be less advanced than their typically developing peers. Most will eventually catch up. During the elementary school years, some children with hearing loss may have reading and writing skills that are behind those of their hearing peers. This is most likely the result of the child’s difficulty with language (please see below), as reading and writing are language-based tasks;
  • Language and communication: many children with hearing loss have less than perfect language skills. The reason for this is obvious: one must hear language in order to develop it. Because they cannot hear language, or at least hear it well enough to make sense of it, many children who are deaf are quite late reaching language development milestones. They struggle with expressive and receptive language, as well as pragmatic language. Their articulation may not be perfect because they need to hear it in order to say it right;
  • Social/emotional: some children who are deaf have low self-esteem. Some feel isolated at school because their peers often do not speak their language (American Sign Language). Some may experience difficulties with their social skills as well, as it is not always easy to function in a world that relies so much on oral language;
  • Motor: some children who are deaf reach motor milestones later than their hearing peers. Most eventually catch up, and by school age many children who are deaf have motor skills that are comparable to those of their hearing peers.

Some children with hearing loss start their academic lives attending schools for the deaf. In these schools, they learn how to use American Sign Language (ASL) (Fig. 2),  which becomes their primary language. In fact, children who are deaf and who speak ASL (which is the sign language system that is used in the United States and all of Canada except Quebec) are considered English Second Language (ESL). That is because their first language is ASL. ASL is a regular language, just like English, with its own rules of syntax and morphology. The grammatical rules of ASL are not similar to the rules of English. In fact, they are completely different. Sometime during the elementary school years, these children will eventually start attending regular schools with their hearing peers.

sign language

Figure 2. Sign language

Children who are deaf are perfectly capable of functioning well in a hearing world. But they do need help. They need help in order to understand others and in order for others to understand them. The most common devices available to children who are deaf are:

  • Hearing aid: the hearing aid is an amplification device. It makes the sounds that are in the child’s environment louder. The child can adjust the loudness level of his or her hearing aid. Hearing aids used to be quite bulky. Some are now very small, fit inside the ear, and may not be noticed at all by those who do not know that the child is wearing a hearing aid. The trouble with some hearing aids is that they amplify ALL sounds, which sometimes makes it hard for a child who is wearing them to hear others well (because of interference). Hearing aids are the most commonly used hearing device by children and adults who are deaf (meaning they have no functional hearing) or hard of hearing (Fig. 3)  (meaning they have some functional hearing);

hearing aid

Figure 3. Hearing aid
  • FM system: the FM system is sometimes referred to as “Auditory Training Equipment.” It consists of two parts: the microphone that the teacher or anyone communicating with the child wears, and a receiver that the child wears in his or her ear. The teacher speaks into the microphone and the sound comes out of the receiver. The advantage of the FM system is that it brings the sound directly to the child, without the distraction of other sounds that may be in the classroom;
  • Lip reading: many children who are deaf read lips. They are able to make sense of what others are telling them by listening to them (through any device they may be using) and by reading their lips. In the classroom, the teacher needs to make sure that he or she is always facing the child when communicating something to the classroom, otherwise the child who is deaf may miss out on what he or she is saying. Those communicating with a child who is a lip reader should always remember not to cover their mouths or over-enunciate, when speaking with the child;
  • Sign language interpreter (Fig. 4): some children who are deaf may have a sign language interpreter with them in the classroom. The sign language interpreter will translate what the teacher and other children are saying to the child (that is, he or she will transform speech into sign) and will transform what the child who is deaf is signing, into speech, so the teacher and classmates can understand what the child is saying. If the child has a sign language interpreter, it is essential that those talking to the child look at him or her and not the interpreter during a conversation.

Figure 4. Sign Language Interpreter

For information about other available options for children who are deaf or hard of hearing, please visit the birth to six part of this course.

Children who are deaf could use help from the following professionals:

  • Special educator with special training in hearing loss: the special educator will help the child who is deaf or hard of hearing with all matters related to academic development;
  • Speech and language pathologist: the SLP will help the child who is deaf or hard of hearing learn how to use ASL, how to make the most of wha hearing they might have, and learn how to use language in social situations.

Children who are deaf or hard of hearing may reach developmental milestones later than their hearing peers. But most turn into completely well-adjusted and happy adults who participate fully in every aspect of typical life.

see References
Categories
2.5 Children with Sensory Impairments

Children with Sensory Impairments

 

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

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

Infants and young children with sensory impairments have fewer opportunities than their peers for what is called “casual” or “incidental learning” (see ECI 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 impairments.  Knowing about what is new in research and technology will allow them to better access resources and learn about intervention strategies.

Resources: http://www.nichcy.org/Disabilities/Specific/Pages/Deaf-Blindness.aspx
Categories
2.4 Children with Environmental Risk Conditions: Poverty

Poverty

The term “environmental risk” covers a variety of factors that place children at a risk for developmental delay. To learn more about environmental risk, please visit the zero to six section of this course.

Poverty is considered a big environmental risk factor. It regularly appears to be a determining factor in the developmental outcome of children. Please visit the poverty section of this course in order to learn about the definition of poverty (Fig. 1).

living in poverty

Figure 1. Living in poverty

Children who grow up in poverty face many risk factors, including:

  • Living in an unsafe environment;
  • Moving frequently;
  • Not having a lot of stimulating material in the home (for example: books and toys, or anything that is relevant to one’s culture);
  • Not being able to spend a lot of time with parents because they may have two and sometimes three minimum-wage jobs;
  • Living with a single parent;
  • Not having enough nutrition;
  • Not having access to health care.

Children growing up in poverty may have delays in many developmental and academic areas. The delays usually result from the environment in which the child lives. These delays can be found in the following areas:

  • Cognitive skills: some children who live in poverty experience certain delays in the acquisition of basic cognitive skills. They may struggle with attention and concentration and may take longer than their peers to learn basic concepts such colors and shapes.  Children may struggle with such tasks simply because he or she is hungry. In a school environment, children who live in poverty may have difficulty solving problems and processing information;
  • Academic skills: studies generally show that many children who live in poverty are delayed in most academic areas. They often struggle with reading and writing and math. They may not know how to play with certain toys or materials available in the classroom because they have not been exposed to them. Often, they score lower on standardized norm-referenced tests, such as IQ tests (see full Glossary). This may or may not indicate a cognitive delay. That is, some children perform poorly on an IQ test because they are cognitively delayed. Others may perform poorly because they are not familiar with some of the content of IQ tests. Because of that, the standardized test scores of children who live in poverty should interpreted with extreme caution;
  • Language and communication skills: studies show that many children who live in poverty have immature language and communication skills. They appear to have a smaller vocabulary than their peers and often use very simple terms and words when communicating with others. They may struggle with complex and multi-step directions. They may not understand the pragmatic rules of language;
  • Motor skills: although most children who live in poverty appear to have adequate motor skills, some do not. Some experience difficulties with activities that require the use of fine motor skills, such as writing and drawing. Others may have gross motor difficulties, which can be manifested in awkward movement and poor balance;
  • Social/emotional skills: some children who live in poverty experience great difficulties in the social emotional area of development:
    • Social skills: some children who live in poverty may have inappropriate social skills (please note that these skills are culture-dependent). They may not know that they sometimes have to wait for their turn, stand in line, or share a toy or book with others. Some may interrupt others during a conversation and others may use inappropriate language when communicating with children and adults;
    • Emotional skills: some children who live in poverty experience difficulties with their emotional skills. They may find it difficult to understand and recognize their own emotions, as well as those of others. They may have poor self-esteem and very little self-confidence. This could be the result of feeling that they are not as good as others because they have very little while others have a lot. In severe cases, emotional difficulties could lead to difficulties with mental health;
    • Adaptive skills: most children who grow up in poverty are perfectly capable of dressing and undressing themselves. Some may struggle with hygiene and cleanliness, but that is usually because they have not been taught how to groom themselves;

    Mental health difficulties: some children who grow up in poverty may struggle with depression  and different types of anxiety-based disorders.

Children who grow up in poverty can benefit from  a lot of help. They are usually children who can achieve anything that they put their mind to. When they do not it could be because of lack of opportunity, not lack of ability. Children who grow up in poverty do not usually qualify for special education services in school, but they could benefit from services from the following professionals:

  • Special educator: the school’s special educator can teach children who grow up in poverty essential learning skills that they may not have learned at home. They can teach them how to be organized, pay attention and concentrate. They can coach them on how to finish their homework, and will often help them with reading, writing and math;
  • Speech and language pathologist: the SLP can help children who grow up in poverty improve their language and communication skills. They will help them increase the size of their vocabulary, and improve their language and communication skills. They may also help them with pragmatic language;
  • Occupational therapists (OTs) and physiotherapists (PTs): OTs and PTs can help those children who struggle with fine and gross motor difficulties improve their large and small muscle skills;
  • School counselor: some children who grow up in poverty may need counseling sessions with the school counselor. The school counselor can help them adjust to being in school and teach them how to behave in socially acceptable ways. They can also help these children with any difficulties they may be having at home;
  • Psychotherapist: some children who grow up in poverty may struggle with depression and/or anxiety. In such cases, regular psychotherapy sessions with a clinical psychologist may be helpful.

There is nothing that children who live in poverty cannot achieve. Many thrive when given a chance. It is the duty of everyone working with these children to ensure that they are given all the stimulation that they need, in order to grow up to be healthy and happy adults.

see References
Berk, L.E. (2012). Infants and Children: Prenatal Through Middle Childhood (7th Ed.). Boston, MA: Allyn and Bacon.
Boyle, J. R. & Danforth, S. (2001). Cases in Special Education (2nd Ed.). Boston, MA: McGraw Hill.
Jensen, E. (2009). Teaching With Poverty in Mind: What Being Poor Does to Kids’ Brains and What Schools Can Do About it. Alexandria, VA: ASCD.
Rawlinson, R. (2011). A Mind Shaped By Poverty. New York, NY: IPublishing.

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