Author: Natasha Boskic

Categories
2.4 Children with Environmental Risk Conditions: Children who are Neglected

Children who are Neglected

Children who are neglected feel as if they have been abandoned by their parents or those who care for them. They are children whose parents are simply unavailable. The parents may be present physically, but they may be unavailable emotionally, and may fail to take basic care of their children (Fig. 1).

neglected boy

Figure 1. A neglected boy

Child neglect falls under two broad categories:

  • Physical neglect: children who are physically neglected are completely ignored by their primary caregivers. The primary caregiver fails to provide the child with the basic necessities of life. This includes:
    • Parent does not provide good supervision of the child: the child is left home alone, or allowed to play outside where it may not be safe;
    • Parent does not provide enough food (for example, the child may not be given enough food to eat);
    • Parent continuously fails to pick the child up from school, or continuously arrives to school very late;
    • Parent fails to provide child with basic healthcare. This is not related to income. The parent may be able to provide the child with healthcare, but chooses not to so. Parents who do so may fail to take the child to the dentist or to a pediatrician for regular check-ups and may choose not to take the child for immunization shots (not because the parent does not believe in the immunization of children, but because he or she simply cannot be bothered to take his or her child to the clinic).

    Emotional neglect: the parent may take care of the physical needs of the child, but completely ignore the child’s need for love, affection and security:

    • Parent does not pay attention to the child, does not interact with the child and never tells the child that he or she is loved;
    • Parent does not attend to the child when the child is sick or hurt;
    • Parent does not provide a safe base and sense of security to the child.

Some children who are neglected suffer from non-organic failure to thrive (see full Glossary). These are children who do not develop well because of emotional reasons. The child feels so left out and alone, almost abandoned, that he or she literally stops growing. These children usually appear much younger than their chronological age.

Some of the indicators of physical neglect include:

  • Child shows up for school with dirty clothes or inadequate clothing (for example, showing up for school in the middle of winter without a coat (Fig. 2));
  • Child shows up for school with no school supplies (such as pens and notebooks);
  • Child has poor dental hygiene;
  • Child is very dirty and sometimes smells bad because he or she has not showered or bathed in several days or weeks;
  • Child is always hungry, and may steal other children’s food;
  • Child is always sleepy, because he or she has not been getting enough sleep at home;
  • Child may be depressed, lethargic or apathetic (that is, the child may not display any feelings at all);
  • Child may show aggressive behavior towards him- or herself and/or others (for example, child may hit or bite him/herself, or others);
  • Child may destroy property (for example, child may destroy school property);
  • Child may engage in self-stimulatory (see full ECI Glossary) behaviors, such as rocking back and forth;

neglected boy

Figure 2. Physical neglect

Some of the indicators of emotional neglect include:

  • Child appears much younger than he or she actually is (non-organic failure to thrive (see full Glossary));
  • Child refuses to eat and may appear very weak or frail;
  • Child struggles with daily activities, such as playing and learning;
  • Child may be very apathetic (that is the child may not display any feelings at all) or withdrawn (that is, the child may keep to him or herself) ;
  • Child may be aggressive towards self and/or others (for example, the child may hit or bite him/herself or others);
  • Child may be very clingy (that is, he or she may not want to leave his or her mother’s side);
  • Child may form attachment to strangers, because he or she is starved for affection;
  • Child may show great fear of typical situations (such as outdoor spaces);
  • Child may appear overly anxious.

Physical and emotional neglect can have very negative effects on the developing child, especially in the following

  • Cognition and academics: many children who are neglected do not perform as well as their peers on tests of cognitive functioning (such as IQ tests) (see full Glossary). They struggle with attention and concentration skills. They also do not perform as well as their peers in almost all academics areas, such as reading, writing and math. This is either because they are too lethargic and apathetic to participate in classroom activities, or because they were never taught how to behave in a school setting;
  • Language and communication: many children who are neglected have poor language skills. They mostly use very simple language and may struggle with the understanding of complex and multi-step directions (for example: please go to the library, get a book and bring it here);
  • Social/emotional: many children who are neglected have difficulties with their social/emotional skills:
    • Social skills: they can be either too compliant (that is, they do everything they are told to do) or too defiant (that is, they do not do anything that they are told to do). They often do not know how to approach others, or how to react when others approach them, because they were never taught how. They are usually left alone at home, and therefore do not develop the social skills that most children develop just by interacting with their parents.
    • Emotional skills: many children who are neglected struggle with identifying and labeling of emotions, both in themselves and others. Most have very low self-esteem and very poor self-confidence. Some even feel that their lives are not worth living because they may think: “If my mother does not love me, who will?”
  • Mental health: many children who are neglected struggle the following mental health disorders:
    • Depression (Fig. 3);
    • Anxiety-based disorders, such as phobias;
    • Enuresis (lack of bladder control) and/or encropesis (lack of bowel control);
    • Suicidal thoughts and attempts;
    • Eating disorders (such as anorexia nervosa or bulimia nervosa);
    • Sleep disorders (such as not sleeping enough, or waking up frequently during the night).

depression

Figure 3. Depression

Children who are neglected need our help. Their needs are just as important as the needs of those who have been abused. Physical and especially emotional deprivation can destroy the psychological health of the child, making him or her completely helpless and hopeless. These children could greatly benefit from the following services:

  • Psychotherapy: this is what most children who are neglected need first and foremost. Most of them will need regular and sometimes intensive psychotherapy from a clinical psychologist. The psychologist will help them learn that they are worthwhile, that they matter and that they deserve everything good that life has to offer. The psychologist will also help them learn how to trust adults again. Family therapy may be recommended as well, if the child is still living with his or her biological family;
  • School counseling: some children who are neglected could benefit from regular sessions from the school counselor, in addition to the sessions that they may be getting from a clinical psychologist. The school counselor can help these children manage their behaviors and feelings at school;
  • Social worker: the social worker can help them with issues related to clothing and personal hygiene. The social worker can also make sure that the child has enough food to eat every day;
  • Special education services: some children who are neglected, especially those who display developmental delays, could benefit from the help of the school’s special educator. The special educator will teach these children how to pay attention and get organized in order to learn how to read, write and do math.

In the classroom, teachers need to be aware that children who are neglected may act differently than others. They may be very passive in the classroom, and may refuse to participate in classroom activities. They may also act out and attack others. Some may steal pens, pencils and other school supplies from others. Teachers need to understand that these children need as much help and attention as any other child in the classroom. He or she may need to give these children extra attention, at least in the beginning, in order to establish a relationship with them and gain their trust. It is highly recommended that  the teacher  and the school counselor (and psychotherapist, if possible) work together. The teacher may be the only constant in the child’s life, and his or her role cannot be under stated.

To learn more about neglect, please visit the emotional abuse section of the birth to six course.

see References
Crosson-Tower, C. (2009). Understanding Child Abuse and Neglect (8th Ed.). Boston, MA: Prentice Hall.
Jenny, C. (2010). Child Abuse and Neglect. New York, NY: Harper Collins.
McCoy, M. L. & Keen, S. M. (2009). Child Abuse Neglect. New York, NY: Psychology Press.
http://www.nlm.nih.gov/medlineplus/childabuse.html
Categories
2.4 Children with Environmental Risk Conditions: Emotional Abuse

Emotional Abuse

Emotional abuse is defined as when a person tries to hurt or scar the child emotionally on purpose. Emotional abuse includes the following acts:

  • Telling the child that he or she is bad;
  • Constantly screaming at  the child (Fig. 1);
  • Constantly making fun of the child;
  • Constantly threatening the child;
  • Not giving the child love and affection;
  • Telling the child that he or she is worthless;
  • Threatening to give the child away;
  • Threatening the child;
  • Telling the child that they wish he or she was never born;
  • Blaming the child for the parents’ own failures;
  • Asking the child to take care of the adult who is supposed to take care of them.

scream

Figure 1. Screaming

Children who are emotionally abused need help just as badly as those who are physically abused. Emotional abuse has no physical symptoms (such as scars or bruises). But it has many behavioral symptoms, and they include the following:

  • Child may be extremely withdrawn or very shy (Fig. 2);
  • Child may be very aggressive towards self or others;
  • Child may be very clingy and may form attachment to strangers;
  • Child may so starved for affection so he or she will hug or kiss anyone;
  • Child may be afraid of almost anything and/or anyone (Fig. 3);
  • Child may strictly conform to rules, because of fear of what might happen if he or she disobeys the rules;
  • Child may sleep a lot, or not enough (he or she may fall asleep in class, in the middle of a lesson);
  • Child may have an eating disorder (such over-eating or under-eating);
  • Child may rock back and forth;
  • Child may be extremely whiny;
  • Child may wet him or herself;
  • Child may constantly say bad things about his or herself (for example: I am bad, I am clumsy, I am good for nothing).

shy

Figure 2. Withdrawn or shy

afraid

Figure 3. Afraid

Emotional abuse can have negative effects on the development of the child, especially in the following areas:

  • Cognition and academics: many children who are emotionally abused do not perform as well as their peers on tests of cognitive functioning (such as IQ tests) (see full Glossary). They struggle with attention and concentration skills. They also don’t perform as well as their peers in almost all academics areas, like reading, writing and math. This may be because they are too lethargic and apathetic (that is, they may not care about anything) to participate in classroom activities and therefore learn.  It may also be because they are too scared to try and learn anything because of a fear of failure. Others may under-perform in school because of learned helplessness (see full Glossary) and an inability to pay attention and concentrate on academic tasks;
  • Language and communication: many children who are emotionally abused have delayed language skills. They mostly use very simple language and may struggle with the understanding of complex and multi-step directions;
  • Social/emotional: many children who are emotional abused have difficulties with their social/emotional skills:
    • Social skills: they can be either too compliant or too defiant, and may have very immature social skills (for example, they may act like a younger child would).
    • Emotional skills: many struggle with identifying and labeling emotions, both in themselves and others. Most have very low self-esteem and very poor self-confidence;
  • Mental health: many children who are emotionally abused struggle the following mental health disorders:

Children who are emotionally abused need a lot of help. Their needs are sometimes missed because they do not display physical symptoms as children who are physically abuseddo. But they need help just as much as those who are physically abused. Like physically abused children, most children who are emotionally abused do not qualify for an Individual Education Plan (IEP) at school. But they could certainly benefit from the following services:

  • Psychotherapy: this is what most children who are emotionally abused need first and foremost.  Most of them will need regular and sometimes intensive psychotherapy from a clinical psychologist. The psychologist will help them come to terms with what has happened, help them understand that it was not their fault, and help them learn to trust adults again. Family therapy may be needed as well, if the child is still living with his or her biological family;
  • School counseling: some children who emotionally abused could benefit from regular sessions from the school counselor, in addition to the sessions that they may be getting from a clinical psychologist. The school counselor could help them these children manage their behaviors and feelings at school;
  • Special education services: some children who are emotionally abused, especially those who are behind their peers, cognitively and/or academically, could benefit from the help of the school’s special educator. The special educator will teach the child how to pay attention and get organized,  how to concentrate, and also how to read, write and do math.

In the classroom, teachers need to be aware that children who are emotionally abused often behave differently than others. They may be very passive in the classroom, and may refuse to participate in any classroom activities. These children may also be unwilling to trust their teachers, at least in the beginning, because they may be afraid of adults. It is important to note that teachers can do a lot to help these children with the healing process. There is a reason why, at the start of the abuse, many children choose to tell their teacher that they are being abused. Teachers are usually seen as a source of trust and safety, and that is why many children go to them with their personal problems. Therefore, it is highly recommended that a teacher do everything in his or her power to reach the child who is emotionally abused. Working with the school counselor (and psychotherapist, if possible) is highly recommended. The teacher may be the only constant in the child’s life, and his or her role cannot be under stated.To learn more about emotional abuse, please visit the emotional abuse section of the birth to six course.

see References
Crosson-Tower, C. (2009). Understanding Child Abuse and Neglect (8th Ed.). Boston, MA: Prentice Hall.
Jenny, C. (2010). Child Abuse and Neglect. New York, NY: Harper Collins.
McCoy, M. L. & Keen, S. M. (2009). Child Abuse Neglect. New York, NY: Psychology Press.
http://www.nlm.nih.gov/medlineplus/childabuse.html
Categories
2.2 Children with Biological Risk Conditions: Low Birth Weight (LBW)

Low Birth Weight (LBW)

Most newborns weigh between 2500 and 3500 grams when they are born. When a baby’s birth weight is less than this, he or she is considered to have Low Birth Weight (LBW).

LBW can be further sub-divided into the following categories:

  • Low birth weight: 1500g-2500g;
  • Very low birth weight: 801g-1499g;
  • Extremely low birth weight: below 800g.

Many children who are born with low birth weight are also born premature. Many of these children have serious medical conditions and are placed in the neonatal intensive care unit immediately after birth. Some are unable to breathe on their own and may need the help of a machine to breathe and stay alive. This could be because they are born with immature lungs (Fig. 1).

Figure 1. Born with immature lungs

Some of the reasons for low birth weight include:

  • Prenatal exposure to alcohol and/or drugs;
  • Prenatal exposure to nicotine (cigarettes);
  • Mother following a severely restricted diet while pregnant;
  • Maternal infection during pregnancy;
  • Mother being under a tremendous amount of stress throughout her pregnancy;
  • Being a mother who is either over 40 or under 18;
  • Additional reasons for low birth weight are unknown. Some mothers who have healthy pregnancies and get excellent prenatal care give birth to premature babies. The reasons for this are unknown.

Some children who are born with LBW develop just fine. Others are slow to reach most developmental milestones. Of those who were slow to reach these milestones, some eventually catch up with their typically developing peers, while others do not. Those who do not may end up with the following characteristics:

  • Delays in cognitive development: some children with LBW continue to show delays compared to their peers in all areas related to cognitive development. They may be slower to respond to others. They may process information slowly and seem to struggle with abstract and/or complex terms and directions;
  • Delays in the development of academic skills: some of these children will need help in all academic areas, including reading, writing and math;
  • Delays in the development of language and communication skills: some of these children may be late to achieve language and communication milestones. They may struggle with their language skills even after they reach school age. Some may have a vocabulary that is smaller than that of their typically developing peers;
  • Delays in the achievement of motor milestones: many of these children are late to sit up, walk and run. When they reach school age, they may appear a bit clumsy. They may struggle with activities that involve the use of their large muscles (for example, using the slides and swings on the playground). Others may experience fine motor difficulties such as difficulties with writing (Fig. 2);
  • Delays in the development of social/emotional skills: some of these children will struggle in social situations, and may not know how to respond to others. This may be caused by their slightly immature cognitive and language skills.

writing

Figure 2. Difficulty with writing

Some children who are born with LBW may end up with one (or more) of the following diagnoses:

Many children born with LBW, especially those with extremely low birth weight, will need the help of highly specialized medical professionals. They may have trouble with their kidneys and/or heart. It is also worth noting that children born with extremely LBW have fewer chances of survival than children who are born with LBW.

Because of the difficulties described above, some children who are born with LBW could benefit from the following services:

  • Special education assistance: in school, some of these children may require the help of the school’s special educator. These children are not usually placed on an Individual Education Plan (IEP) unless they are diagnosed with one of the conditions listed above. But that does not mean that they do not need help. They may need a lot of help with academic skills, paying attention, and following directions. They can often get this help from the school’s special educator;
  • Speech and language pathologist (SLP): some of these children may continue to need the help of an SLP well into their school years. That is because some them are behind their peers in all aspects of language, especially when it comes to expressive and receptive language skills. An SLP will help these children improve their receptive and expressive language skills, and increase the size of their vocabulary;
  • Behavioral interventionist (BI): some of these children may need help managing their behavior. Some may engage in extreme behaviors, such as severe temper tantrums. They may need the help of a BI  to learn how to manage these extremes in behavior;
  • Occupational therapy (OT): some of these children may have sensory integration difficulties. Those who do may need the help of an OT who would help them with these difficulties. OTs can also help children who are born premature improve their fine motor skills;
  • Vision specialist: some of these children will have vision problems and their vision may need to be monitored by an ophthalmologist. Those who do not have vision problems may still need regular visits with an ophthalmologist, even if their vision is fine. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend  it;
  • Hearing specialist: some of these children will have hearing problems and their hearing may need to be monitored by an audiologist. Those who do not have hearing problems may still need regular visits with an audiologist, even if their hearing is fine. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend it;
  • Orthopedist: some of these children will need the services of an orthopedist or orthopedic surgeon because of problems with their bones;
  • Cardiologist: some of these children may have heart problems and may need to be monitored closely by a pediatric cardiologist.

Although some children who are born with LBW, and especially extremely LBW, continue to experience difficulties well into their middle childhood years, many others do not. Many do catch up with their peers fully and go on to lead very fulfilling, healthy and happy lives.

see References
http://www.successby6ottawa.ca/lbwfpn/english/
http://jama.ama-assn.org/content/287/2/270.full.pdf
Categories
2.4 Children with Environmental Risk Conditions: Sexual Abuse

Sexual Abuse

Sexual abuse is defined as the sexual assault and/or sexual exploitation of a minor. Here are a few examples of sexual abuse (Fig. 1):

Figure 1. Sexual abuse
  • Rape;
  • Group rape;
  • Sodomy;
  • Incest;
  • Penetration of a genital or anal area with a foreign object;
  • Molestation and fondling;
  • Forcing the child to perform sexual acts on an adult;
  • Forcing the child to watch while others engage in sexual acts;
  • Forcing the child to perform in front of a camera;
  • Forcing the child to engage in pornography (that is, filming the child while engaged in sexual acts).

Sexual abuse has many symptoms. They include:

  • Enuresis (no control over bladder);
  • Encropesis (no control over bowel);
  • Eating disorders (over or under eating);
  • Having fears and phobias;
  • Being extremely anxious;
  • Being extremely sad;
  • Age-inappropriate sexual behavior (for example, talking about sexual positions);
  • Regression (such as bed-wetting or thumb-sucking);
  • Being very curious about matters related to sex;
  • Drinking alcohol and/or using illicit drugs;
  • Being suicidal;
  • Complaining of headaches or stomach aches (these are usually psychosomatic (see full Glossary) in nature);
  • Setting fires to property;
  • Being very aggressive;
  • Engaging in self-mutilation (that is, hurting oneself on purpose);
  • Being extremely withdrawn;
  • Acting in sexually provocative ways (for example, coming on to peers and adults);
  • Being tired all the time;
  • Bleeding from the vaginal or anal areas;
  • Refusing to dress up for sports;
  • Difficulty sitting or walking due to pain in the genital or anal areas;
  • Crying without provocation;
  • Finding it very difficult to pay attention and concentrate (Fig. 2).

Figure 2. Difficult to concentrate

Sexual abuse affects many areas of development, especially:

  • Cognitive and academic skills: some children who are sexually abused do not perform well on standardized assessments, such as IQ tests (see full Glossary). Some do not do well because they do not care. Others do not do well because the fear in which they live prevents them from thinking clearly. Some children who are sexually abused may perform less well than their peers on some academic tasks because the constant fear in which they live prevents them from performing well;
  • Social/emotional skills: some children who are sexually abused really struggle with their social/emotional skills:
    • Emotional skills: some children who are sexually abused have immature emotional skills. They may react in extreme ways to regular and simple situations (such as being grounded). They may struggle when it comes to identifying emotions, both in themselves and others. Some have very negative self-esteem and very poor self-confidence;
    • Social skills: some children who are sexually abused have poor social skills. They may interrupt others and refuse to wait their turn. Others may be eager to please and may do anything that is asked of them, making it easy for others to take advantage of them. Some act in very sexually-provocative ways, that is, they try to seduce others;
  • Language and communication skills: the language skills of some children who are sexually abused may be rather simplistic and very concrete. They may struggle with complex or multi-step directions (such as: please go to your room, get the book and bring it back to me). They may also struggle with certain complex and abstract terms (like justice and freedom). Also, they sometimes use language that is very sexual in nature and that most children their age do not use (for example, they may talk about orgasms);
  • Mental health: most children who are sexually abused need the help of a psychotherapist. Many of them are severely depressed and may suffer from anxiety-based disorders. Others may be suicidal.

The onset of sexual abuse sometimes triggers sudden changes in behavior in the child who is being sexually abused. When a teacher (or someone else) notices that a child’s performance has changed in school in very drastic ways, this could be an indication that they are being sexually abused. Changes in behavior include a sudden drop in grades, and suddenly becoming withdrawn and shy.

Some children end up being diagnosed with a sexually transmitted disease (such as AIDS or syphilis). Some children have genital or anal areas that appear to have been the subject of trauma. The areas may have bruising, bleeding, lacerations and abrasions.

Children who are sexually abused need our help, empathy and support. Many feel dirty and many blame themselves for what has happened to them. It is crucial that a child be reassured that what has happened to them is not their fault. Some children are told that this has happened to them because of the way they act or dress. It is very important that these children be reassured that this is completely false and that they did not do anything to trigger the assault that was committed against them.

Children who are sexually abused do not usually qualify for special education services at school and most of them will not have an Individual Education Plan (IEP). But they do need help, especially from the following professionals:

  • Psychotherapy: this is what most children who are sexually abused need the most.  Most of them will need regular and sometimes intensive psychotherapy from a clinical psychologist. The psychologist will help them come to terms with what has happened to them, help them understand that what happened to them was not their fault, and help them learn to trust adults again. If the child still resides with his or her biological family, family therapy may be recommended as well;
  • School counseling: some children who are sexually abused  benefit from regular sessions from the school counselor in addition to the sessions that they may be getting from a clinical psychologist. The school counselor could help these children manage their behaviors and feelings at school;
  • Special education services: some children who are sexually abused, especially those who are behind their peers cognitively or academically, could benefit from the help of the school’s special educator. The special educator will teach the child how to pay attention and get organized, in order to learn how to read, write and do math.

In the classroom, teachers need to be aware that children who are sexually abused often behave differently than others. They may not like it when someone touches them, even gently. These children may be unwilling to trust their teachers, at least at first, because they may be suspicious of adults, especially male teachers. It is important to note that teachers can do a lot to help these children with the healing process, as long they are not the ones committing the abuse. Many children choose to tell their teacher that they are being abused. This is because teachers are usually seen as a source of trust and safety. This is why many children go to them with their personal problems. Therefore, it is highly recommended that a teacher do everything in his or her power to reach the child who is sexually abused. Collaboration with the school counselor (and psychotherapist, if possible) is highly recommended. The teacher may be the only constant in the child’s life, and his or her role cannot be under-stated.

To learn more about sexual abuse, please visit the sexual abuse section of the birth to six course.

see References
Crosson-Tower, C. (2009). Understanding Child Abuse and Neglect (8th Ed.). Boston, MA: Prentice Hall.
Jenny, C. (2010). Child Abuse and Neglect. New York, NY: Harper Collins.
McCoy, M. L. & Keen, S. M. (2009). Child Abuse Neglect. New York, NY: Psychology Press.
http://www.nlm.nih.gov/medlineplus/childabuse.html
Categories
2.4 Children with Environmental Risk Conditions: Physical Abuse

Physical Abuse

Physical abuse is defined as any non-accidental injury inflicted on a child. In other words, a child gets hurt, physically, and it is not due to an accident. Physical abuse is intentional. The person who is physically abusing the child intends to hurt the child physically.

Physical abuse has physical and behavioral symptoms.

The physical symptoms include:

  • Bruises, contusions, abrasions (scrapes) and/or lacerations (cuts);
  • Hot water burns (that is, putting a body part in hot or scalding water);
  • Cigarette burns;
  • Burns caused by shoving the child against a hot object (like a heater);
  • Bike marks;
  • Head injuries (such as concussions);
  • Damage to internal organs;
  • Broken bones and fractures (Fig. 1);

 broken arm

Figure 1. Broken bones and fractures

All children get hurt at one point or another in their lives. Sometimes it may be difficult to tell whether or not an injury is accidental. Some signs that the injury is not accidental include:

  • The location of the injury: injuries from abuse are usually located on the back side of the body;
  • The type of injury: for example, clear lines around a hot water burn are an indication that this is an intentional act. Most children and adults move when they come into contact with hot water, so the marks between the burned and non-burned areas tend to be blurry. When a child’s hand or foot is held in hot water the child is unable to move and the result is a clear line between the burned and non-burned areas;
  • Having different injuries at different stages of healing: this could indicate abuse because  it means that the child has been seriously hurt more than once.

Physical abuse also has behavioral characteristics, which include:

  • Being very scared when someone makes a sudden move;
  • Being very passive and lethargic, and even displaying no feelings at all;
  • Being very active and aggressive;
  • Wearing many layers of clothing, in order to hide bruises (even on warm or hot days);
  • Refusing to participate in sports;
  • Being frequently absent from school;
  • Being clingy and forming attachments to strangers;
  • Not liking it when others touch him or her;
  • Talking about ending his or her life and being extremely sad (Fig. 2);
  • Not caring about school or grades;
  • Engaging in self-mutilation (that is, physically hurting his or herself).

Figure 2. Being extremely sad

Physical abuse can affect many areas of development, especially:

  • Cognitive and academic skills: some children who are physically abused do not perform well on standardized assessments, such as IQ tests (see full Glossary). Some do not do well because they do not care. Others do not do well because the fear in which they live prevents them from thinking clearly. Some children who are physically abused do not perform as well as their peers on some academic tasks. That could be because the constant fear in which they live prevents them from performing well on these tasks;
  • Social/emotional skills: some children who are physically abused struggle with their social/emotional skills:
    • Emotional skills: some children who are physically abused have immature emotional skills. They may react in extreme ways to regular and simple situations. They may struggle when it comes to identifying emotions, both in themselves and others. Some  have negative self-esteem and poor self-confidence;
    • Social skills: some children who are physically abused have poor social skills. They may interrupt others or refuse to wait their turn. Others may be very eager to please and will do anything that is asked of them, making it easy for others to take advantage of them and even bully (see full Glossary) them;
  • Language and communication skills: the language skills appear to be rather simplistic and very concrete. They sometimes struggle with complex or multi-step directions  and may not understand certain complex terms;
  • Mental health: most children who are physically abused need the help of a psychotherapist. Some of them are severely depressed and may suffer from anxiety-based disorders, such as post traumatic stress disorder (see full Glossary). Others may be suicidal.

Children who are physically abused may not qualify for an Individual Education Plan (IEP) at school. They could, however, benefit from the following services:

  • Psychotherapy: this is what most children who are physically abused need.  Most of them will need regular and sometimes intensive psychotherapy from a clinical psychologist. The psychologist will help them come to terms with what has happened to them, help them understand that what happened to them was not their fault, and help them learn to trust adults again. If the child is still in the custody of the biological parents, family therapy (see full Glossary) may be recommended as well;
  • School counseling: some children who are physically abused could benefit from regular sessions with the school counselor in addition to the sessions they may be getting from a clinical psychologist. The school counselor can help these children manage their behaviors and feelings at school;
  • Special education services: some children who are physically abused, especially those who may be performing less well than their peers cognitively or academically, could benefit from the help of the school’s special educator. The special educator will teach the child how to pay attention and get organized in order to learn what they need to learn.

Children who are physically abused need our help and compassion. They need to learn that not all adults are bad. They need to know  there are adults who care about them and whom they can trust. These needs are very important and need to be addressed in order for the healing process to start.

In the classroom, teachers need to be aware that children who are physically abused often behave differently than others. They may not like it when someone makes a sudden move and may be scared when there is a change in the class routine. These children may be unwilling to trust their teachers, at least at first, because they may be afraid of all adults. It is important to note that teachers can do a lot to help these children with the healing process. There is a reason why many children choose to tell their teacher that they are being abused. Teachers are usually seen as a source of trust and safety. This  is why many children go to them with their personal problems. Therefore, it is highly recommended that a teacher do everything in his or her power to reach the child who is physically abused. Collaboration with the school counselor (and psychotherapist, if possible) is highly recommended. The teacher may be the only constant in the child’s life, and his or her role cannot be under-stated.

It is important to note that there is huge controversy in Canadian society as to what constitutes physical abuse. For example, 50% of Canadians consider spanking child abuse, and 50% consider this discipline necessary to raising well-behaved children (Dana Brynelsen, personal communication, 2012).

To learn more about physical abuse, please visit the physical abuse section of the birth to six course.

see References
Crosson-Tower, C. (2009). Understanding Child Abuse and Neglect (8th Ed.). Boston, MA: Prentice Hall.
Jenny, C. (2010). Child Abuse and Neglect. New York, NY: Harper Collins.
McCoy, M. L. & Keen, S. M. (2009). Child Abuse Neglect. New York, NY: Psychology Press.
http://www.nlm.nih.gov/medlineplus/childabuse.html
Categories
2.4 Children with Environmental Risk Conditions: Abuse and Neglect

Child Abuse and Neglect

Child abuse and neglect (Fig. 1) is a serious environmental risk factor. It affects all aspects of the child’s development. Children who are abused and/or neglected experience a variety of conditions that have a tremendously negative effect on their development as well as their physical well-being.

Figure 1. Child abuse and neglect

To get more information child abuse and neglect, please visit the birth to six part of this course.

Child abuse falls into three broad categories:

Child neglect falls into the following categories:

see References
Crosson-Tower, C. (2009). Understanding Child Abuse and Neglect (8th Ed.). Boston, MA: Prentice Hall.
Jenny, C. (2010). Child Abuse and Neglect. New York, NY: Harper Collins.
McCoy, M. L. & Keen, S. M. (2009). Child Abuse Neglect. New York, NY: Psychology Press.
http://www.nlm.nih.gov/medlineplus/childabuse.html
Categories
2.2 Children with Biological Risk Conditions: Born Premature

Born Premature

In this section, the most common biological risk conditions will be briefly described. You will learn about the characteristics of these conditions. You will also learn about the most common intervention options. To learn more about biological risk, please refer to the birth to six section of this course.

In this course, biological risk conditions will include the following:

  • Premature birth;
  • Small for gestational age;
  • Low birth weight;
  • Having a low Apgar score;

Premature birth: children born at or before 37 weeks of gestation are considered premature infants. Premature infants often spend time in the neonatal intensive care unit and may need additional medical treatment before they can go home. Some of these babies cannot breathe on their own when they are born and may need help breathing from machines. Others may have pressing medical conditions, such as cardiac problems (Fig. 1).

cardiac problems

Figure 1. Cardiac problems

Small for Gestational Age (SGA): children who were born SGA babies that were carried to term but who were born very small. They may look like a preterm baby because they are very small and have low birth weight, but they are not born prematurely. They simply did not grow as well or as fast as they should have while in utero. This is called intra-uterine growth retardation by professionals in the medical field. There are a number of reasons a child may be small and may include:

  • Prenatal exposure to alcohol and/or drugs;
  • Prenatal exposure to nicotine (cigarettes);
  • Mother following a severely restricted diet while pregnant;
  • Maternal infection while pregnant;
  • Mother being under extreme amounts of stress throughout her pregnancy;
  • Being born to a mother who is over 40 or under 18 years of age;
  • Sometimes the causes of being born SGA are unknown.

Children who are born premature and/or are SGA are considered at biological risk developmentally because they were born under less than ideal situations. Some children develop well. Others are slow to reach developmental milestones, such as sitting and walking. Some have medical conditions, others do not. As they grow older, many children who are born premature and/or are SGA catch up with their typically developing peers in all aspects of development. Others do not. Those who do not can have the following characteristics:

  • Delays in cognitive development: some children continue to display delays, compared to their peers, in all areas related to cognitive development. They may be slower to respond to others, may process information slowly and may seem to struggle with abstract and/or complex terms and directions;
  • Delays in the development of academic skills: some of these children will need help in all academic areas, including reading, writing and math;
  • Delays in the development of language and communication skills: some children may be late to achieve language and communication milestones. They may struggle with their language skills, even after they reach school age. Some may have a smaller vocabulary than that of their typically developing peers;
  • Delays in the achievement of motor milestones: many children are late to sit up, walk and run. When they reach school age, they may appear a bit clumsy. They  may struggle with activities that involve the use of their large muscles (for example, using the slides and swings on the playground). Others may experience fine motor difficulties, such as difficulties with writing;
  • Delays in the development of social/emotional skills: some of these children will struggle in social situations and may not know how to respond to others. This may be caused by their slightly immature cognitive and language skills.

Some children who were born premature, especially those who were born very premature (below 30 weeks of gestation), and those who were born very small for their gestational age, may have one (or more) of the following diagnoses:

Some children who are born premature and/or are SGA will continue to have medical difficulties. Many will need to see specialists in the medical field well into their school and even high school years.

Because of the difficulties described above, some children who were born premature and/or were SGA could benefit from the following services:

  • Special education assistance: in school, some of these children may require the help of the school’s special educator. These children are not usually placed on an Individual Education Plan (IEP) unless they are diagnosed with one of the conditions listed above. But that does not mean that they do not need help. They may need a lot of help with academic skills, paying attention, and following directions. They can often get this help from the school’s special educator;
  • Speech and language pathologist (SLP): some of these children may continue to need the help of an SLP well into their school years. That is because some children continue to display language delays compared to their peers, especially when it comes to expressive and receptive language skills. An SLP will help these children improve their receptive and expressive language skills and increase the size of their vocabulary;
  • Behavioral interventionist (BI): some of these children may need help managing their behavior. Some may engage in extreme behaviors, such as severe temper tantrums, and may need the help of a BI in order to learn how to manage these extremes in behavior;
  • Occupational therapy (OT): some of these children may struggle with sensory integration. Those who do may need the help of an OT who would help them with these difficulties. OTs can also help children who are born premature improve their fine motor skills;
  • Vision specialist: some of these children will have vision problems. Their vision may need to be monitored by an ophthalmologist. Those who do not have vision problems may still need regular visits with an ophthalmologist even if their vision is fine. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend it;
  • Hearing specialist: some of these children will have hearing problems and their hearing may need to be monitored by an audiologist. Those who do not have hearing problems may still need regular visits with an audiologist, even if their hearing is fine. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend it;
  • Orthopedist: some of these children will need the services of an orthopedist or orthopedic surgeon because of problems with their bones;
  • Cardiologist: some of these children may have heart problems and may need to be monitored closely by a pediatric cardiologist (Fig. 2).

 cardiologist

Figure 2. Pediatric cardiologist

Some children who are born premature and/or are SGA continue to experience difficulties well into their middle childhood years. Many others do not. Many do catch up with their peers fully and go on to lead very fulfilling, healthy and happy lives (Fig. 3).

Figure 3. Happy life
see References
http://www.lifeslittletreasures.org.au/
http://www.childrenshospital.org/az/Site1616/mainpageS1616P0.html
http://www.nlm.nih.gov/medlineplus/prematurebabies.html
Categories
2.3 Children with Established Risk Conditions: Autism

Children with Autism Spectrum Disorder (ASD)

Autism Spectrum Disorder (ASD) is an umbrella term that describes a group of disorders that have a serious impact on all aspects of the child’s development. It especially affects the areas of communication and social skills. ASD is a lifelong condition that does not have a cure. Children with ASD benefit greatly from a variety of early intervention services. Because ASD is a spectrum disorder, some children will be more seriously affected by this disorder than others.

The causes of ASD are not known. There are many theories about the causes of ASD, but none have been proven. It is believed that ASD may have a genetic component because it sometimes runs in families and because it affects more boys than girls. It is also believed that ASD may be the result of both genetic (see full ECI Glossary) and environmental (see full ECI Glossary) factors.

ASD has a serious impact on almost all aspects of the child’s life:

  • Language and communication skills: children with autism struggle with language. Many of them learn how to talk much later than their peers, and a small percentage never talks at all. Some develop language skills and then lose them, while others engage in echolalia (that is, repetitive speech that has no apparent meaning). Children with ASD also struggle with the pragmatic part of language. It is very difficult for them to get their point across to others. Children with ASD are sometimes unable to hold a conversation with others because they either do not stick to a topic, or keep talking about a subject, even when it is clear that the person they are talking to has lost interest in the topic. According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM) (2000) (see full Glossary), a child must have significant difficulties with language and communication if he or she is to be diagnosed with ASD;
  • Social/emotional skills: this is an area of great difficulty for children with ASD.
    Most children with ASD have serious difficulties with social skills and find it very difficult to interact with others, both children and adults. They struggle with eye contact (if appropriate to establish eye contact with others in one’s culture) and may not understand personal space (if culturally appropriate to do so); for example, parents have described their child as being almost “on top of their faces” every time they need to communicate something. They have difficulty waiting for their turn and do not like it when there are changes to their routine, especially when there is no prior warning.
    Children with ASD often struggle with emotions and it may be difficult for them to identify their emotions, as well as the emotions of others. According to the current Diagnostic and Statistical Manual of Mental Disorders (DSM) (2000), a child must have significant difficulties with social skills if he or she is to be diagnosed with ASD;
  • Cognitive skills: some children with ASD have difficulties with cognitive skills. Some have an intellectual disability, while others may have a learning disability. Many struggle with attention and concentration skills, and most will need help when it comes to learning how to read, write and engage in math. Some children with ASD will struggle with cause and effect relations (for example, the reason why this child is crying is because he fell down and hurt himself; or the reason why you need to go out with your jacket is because it is cold outside)  and may not understand the concept of danger (for example, they may not know that it is not safe to cross the street, unless they look both ways first);
  • Motor skills: many children with ASD will achieve motor milestones later than other children. They may sit up and walk later than their peers. Some will experience difficulty with their fine motor skills;
  • Adaptive skills: some children with ASD will need help with dressing/undressing, bathing and brushing hair, even when they reach middle childhood;
  • Sensory difficulties: some children with ASD have sensory integration (see full ECI Glossary) difficulties. They may be have too much sensitivity, or “hyper-sensitivity,” or little or no sensitivity, that is, hypo-sensitivity to any of the five senses. For example, some children do not like it at all when they hear the siren of an ambulance, because they may be hyper-sensitive to the sense of hearing. Also, some only eat crunchy foods, because they may be hypo-sensitive to the sense of taste;
  • Repetitive stereotypic and/or self-stimulatory (see full ECI Glossary) behaviors: children with ASD engage in repetitive stereotypical behaviors, such as lining cars, rocking back and forth, and repetitively turning the light switch off and on. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM) (2000) (see full Glossary), a child must engage in such repetitive and stereotypical behaviors if he or she is to be diagnosed with ASD.

There are many types of ASD. Although these types are different from one another, they all include the three core characteristics of ASD: social difficulties,  communication difficulties, and stereotypic repetitive behavior, to one degree or another. The types are:

Autism: it is the most common type of ASD. Children with autism typically exhibit all the developmental characteristics listed above. Most children with autism are diagnosed before the age of three years;
Asperger syndrome: children with Asperger syndrome usually have typical intelligence and language skills. That is why they are sometimes diagnosed after the age of 3 years. They do however struggle with the social and communicative aspects of language. They also engage in stereotypic and/or repetitive behaviors and some of them are fascinated with numbers (Fig. 1);
Rett disorder: children with Rett syndrome start out by developing typically. Then, between the ages of six months and two years, the brain of children with Rett syndrome stops developing. At this time, these children lose many of the skills that have been previously learned. Brain development will resume eventually, but lost skills will need to be re-taught. Rett syndrome mostly affects girls, who for some reason often wring and unwring their fingers (that is, they keep moving their fingers);
Childhood disintegrative disorder (CCD): mostly a boy’s disorder, CDD is a disorder that appears to develop later on in a child’s life. Children with CDD start out developing typically, then sometime in the early or middle childhood years they start to lose previously acquired skills, such as talking. These skills will need to be re-learned;
Pervasive developmental disorder-not otherwise specified(PDD-NOS): children who display some of the symptoms of ASD but not others, and do not fit into any of the other categories are sometimes given the diagnosis of PDD-NOS. They have typical intelligence and are usually diagnosed later in life, usually during the middle childhood years.

numbers

Figure 1. Fascinated with numbers

ASD sometimes exist with a number of other conditions (called co-morbidity). They include:

There is variety of intervention options for children with ASD. Children with all types of ASD can benefit greatly from these intervention options. They include:

      • Behavior intervention (BI) (see full ECI Glossary): many children with ASD benefit greatly from behavior intervention therapy. There are many types of behavior intervention therapies, and most of them rely on the principles of Applied Behavior Analysis.
      • Speech and language pathology  (SLP): SLPs can greatly help children with ASD learn how to talk and communicate with others. They can also have them with pragmatic language;
      • Occupational therapy (OT): OTs can help children with ASD improve their fine motor skills. OTs with special training in sensory integration therapy can help children with ASD with any sensory integration (see full ECI Glossary)  difficulties they may be experiencing;
      • Physiotherapy (PT): PTs can help children with ASD improve their gross motor skills. They can also help them with any difficulties with balance that they may be experiencing;
      • Relationship Development Intervention (RDI): to read about RDI, please refer to the ASD section of the zero to six part of this course;
      • Floortime™: this is an intervention program developed by Stanley Greenspan, in which parents are taught how to meet their children “where they are” in order to connect with them, interact with them, and eventually teach them what they need to be taught. To learn more about floor time, please visit the following website;
      • Other therapy options include music and dance therapy and putting the child on a special diet. To learn about these options, please visit the ASD section of the birth to six part of this course;
      • Special education: children with ASD will have an Individual Education Plan (IEP) (see full Glossary) and most of the time they will have a special education assistant  present with them in the classroom all or most of the time. The school’s special educator  will serve on their IEP team and will offer them help in all areas of academic development. The special educator will work closely with the regular educator in order to help the child adapt to his or her classroom (Fig. 2).

helping a child

Figure 2. Helping a child

Many children with ASD are fully integrated into regular classrooms, where they may have part/time or full/time assistants and that is where they belong. The successful integration of children with ASD does not come easily and should be planned ahead, but it must and should be done, because all children, including children with ASD, belong in the regular classroom with everyone else (Fig. 3).

classroom

Figure 3. In a regular classroom
see References
Categories
2.2 Children with Biological Risk Conditions: Low Apgar Scores

Children with Low Apgar Scores

The Apgar test, the first test ever given to babies, is usually given to newborns one and five minutes after birth (Fig. 1). It aims to measure how well a newborn is doing in the following areas:

after birth

Figure 1. A few minutes after birth
  • Skin color/complexion (a maximum of 2 points);
  • Pulse rate (a maximum of 2 points);
  • Reflex (a maximum of 2 points);
  • Muscle tone (a maximum of 2 points);
  • Breathing (a maximum of 2 points).

The highest score a child can get is 10/10. A score of 3 or below is considered critically low. Babies with low scores may be taken to the neonatal intensive care unit for more testing. A score of 7 or more is considered good. In rare cases, when the baby continues to struggle in the above-mentioned areas, the Apgar test may be done again at 10 minutes after birth.

It is important to note that a low Apgar may or may not be followed by delayed development. However, a range of other assessments are now used in the newborn and early infancy period. Some reference should be made to these tests because some of them are more comprehensive and have greater predictive powers for children with significant delay, for example, the Brazelton Neonatal Assessment Scale.  Low scores on some of these tests mean that some children should be followed very closely and carefully assessed as they grow older.

Many children who are born premature or small for gestational age, or who were born with low birth weight, have low Apgar scores.

To learn more about the Apgar score, please visit the zero to six section of this course.

Some children with low Apgar scores develop just fine. Others are slow to reach most developmental milestones. Of those who were slow to reach these milestones, some eventually catch up with their typically developing peers, while others do not. Those who do not may end up with the following characteristics:

  • Delays in cognitive development: some of these children continue to perform less well than their peers in all areas related to cognitive development. They may be slower to respond to others, may process information slowly and seem to struggle with abstract and/or complex terms and directions;
  • Delays in the development of academic skills: some of these children will need help in all academic areas, including reading, writing and math;
  • Delays in the development of language and communication skills: some of these children may be late to meet language and communication milestones. They may struggle with their language skills, even after they reach school age. Some may have a vocabulary that is smaller than that of their typically developing peers, and others may struggle with grammar;
  • Delays in the achievement of motor milestones: many of these children are late to sit up, walk and run. When they reach school age, they may appear a bit awkward, and may struggle with activities that involve the use of their large muscles (for example, using the slides and swings on the playground). Others may experience fine motor difficulties, which would be expressed in difficulties with writing;
  • Delays in the development of social/emotional skills: some of these children will struggle in social situations, and may not know how to respond to others. This may be caused by their slightly immature cognitive and language skills.

Some children with low Apgar scores may have trouble with their kidneys, bones and sometimes with their heart. This is because the low Apgar score may be the result of an infection or other medical complication; for example, they breathe in meconium, that is, their own waste. These children will need the help of highly specialized medical professionals.

Because of the difficulties described above, some children with low Apgar scores could benefit from the following services:

  • Special education assistance: in school, some of these children may require the help of the school’s special educator. These children are not usually placed on an Individual Education Plan (IEP) unless they are diagnosed with one of the conditions listed above. But that does not mean they do not need help. They may need a lot of help with academic skills, paying attention, and following directions. They can often get this help from the school’s special educator;
  • Speech and language pathologist (SLP): some of these children may continue to need the help of an SLP, well into their school years. That is because some them continue to perform less well than their peers, in all aspects of language, especially when it comes to expressive and receptive language skills. An SLP will help these children improve their receptive and expressive language skills, as well as increase the size of their vocabulary;
  • Behavioral interventionist (BI): some of these children may need help managing their behavior. Some may engage in extreme behaviors, such as severe temper tantrums, and may need help in order to learn how to manage these extremes in behavior;
  • Occupational therapy (OT): some of these children may struggle with sensory integration difficulties. Those who do may need the help of an OT who would help them with these difficulties. OTs can also help children who are born premature improve their fine motor skills;
  • Vision specialist: some of these children will have vision problems and their vision may need to be monitored by an ophthalmologist. Those who do not have vision problems may still need regular visits with an ophthalmologist. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend it;
  • Hearing specialist (Fig. 2): some of these children will have hearing problems and their hearing may need to be monitored by an audiologist. Those who do not have hearing problems may still need regular visits with an audiologist, even if their hearing is fine. This is usually just a precaution, but some general practitioners and/or pediatricians will recommend  it;
  • Orthopedist: some of these children will need the services of an orthopedist or orthopedic surgeon because of problems with their bones;
  • Cardiologist: some of these children may have heart problems and may need to be monitored closely by a pediatric cardiologist.

hearing

Figure 2. Hearing specialist

Although some children with low Apgar scores continue to experience difficulties well into their middle childhood years, many others do not. Many do catch up with their peers, fully and go on to lead very fulfilling, healthy and happy lives.

see References
http://kidshealth.org/parent/pregnancy_center/q_a/apgar.html
http://www.nlm.nih.gov/medlineplus/ency/article/003402.htm
http://pediatrics.aappublications.org/content/117/4/1444.full
Categories
2.1 Children with Nervous System Disorders: Traumatic Brain Injury (TBI

Acquired Brain Injury or Traumatic Brain Injury (TBI)

Children with TBI may display different symptoms, but they all have one thing in common: they have suffered a trauma to the head that made their brain bounce against their skull (Fig. 1).

head

Figure 1. Skull

Causes of TBI are numerous and they include:

  • Trauma to the head caused by a car accident;
  • Trauma to the head caused by being hit with a deadly weapon or other object;
  • Falling and hitting one’s head;
  • Trauma caused to the head because of engagement in a “violent” sporting event (for example, hockey);
  • Child abuse.

The symptoms of TBI can be mild or severe, depending on the seriousness and location of the injury to the brain:

Mild effects include:

  • Brief loss of consciousness (a few minutes);
  • Feeling dizzy and disoriented;
  • Headaches;
  • Blurred vision;
  • Fatigue;
  • Trouble sleeping;

Long term effects include:

  • Prolonged loss of consciousness (a few minutes to hours);
  • Slurred speech;
  • Confusion;
  • Loss of coordination;
  • Having little control over hands and feet;
  • Convulsions;
  • Losing control over bladder or bowel.

The effects of TBI can be long term and could impact every aspect of a child’s life:

  • In serious cases, the child’s cognitive and academic abilities may be delayed, and he or she may have to be re-taught previously-learned skills. A child’s ability to pay attention and concentrate may be seriously compromised, sometimes forever;
  • The child may lose some of his or her language and communication skills and may need to re-learn these skills;
  • The child may feel very isolated and alone, and may end up having a very low self-esteem;
  • The child’s motor skills, both gross and fine, may be delayed, and he or she may need to re-learn how to walk or write;
  • The child’s adaptive skills may be quite impaired, and he or she may need to be re-taught how to brush his or her teeth, or tie his or her shoe laces;
  • Some children will experience difficulties with sensory integration (see ECI Glossary).

Children with TBI could therefore benefit from the following services:

  • Special education: many school-aged children with TBI have an Individual Education Plan (IEP). The school special educator will therefore help them re-acquire any skills they may have lost, as a result of their injuries. The special educator will also help the regular education teacher use methods that are appropriate for the child’s level of function;
  • Occupational therapy (OT): the OT will help children with TBI learn or re-learn how to use utensils, pens and pencils (Fig. 2) and other equipment requiring the use of fine motor skills. The OT will also help children learn or re-learn how to tie their shoe-laces, use scissors and other materials used in school. OTs with special training in sensory integration therapy will help children with TBI with any sensory processing difficulties they may have;

writing

Figure 2. Using pen and pencils
  • Physiotherapy (PT): the PT will help children with TBI regain as much control as possible over their gross motor skills. PTs will help these children learn or re-learn how to walk (with or without adaptive equipment, such as a walker or a cane), run, go up and down the stairs, establish a sense of balance and sit upright;
  • Speech and language pathology: SLPs will help children with TBI re-learn how to talk if they have lost that ability. They may also help these children regain as much control as possible over their oral/motor muscles (that is, the muscles around the mouth);
  • Mental health services: some children with TBI will need extensive psychotherapy, in order to come to terms with what has happened to them. In such cases, a licensed psychologist will provide them with regular psychotherapy sessions;
  • School counseling: some children with TBI may need several sessions with the school counselor in order to learn how to re-adjust to being in school after a prolonged absence caused by the child’s hospitalization;
  • Medical services: most children with TBI will need to be followed quite closely by a medical doctor who specializes in traumatic brain injuries. How long they will need to be seen by such a doctor will depend on the extent of their injury and their speed of recovery;
  • Behavior intervention (BI): some children with TBI will need the help of a BI. BIs can help children with TBI deal with the physical manifestations of out of control emotions, such as severe temper tantrums.Although some children with TBI suffer life-long injuries, others recover fully. Regardless of whether or not recovery is full and complete, most children with TBI can lead full lives, if given the love and support that they need and deserve (Fig. 3).

love and support

Figure 3. Love and support
see References
http://www.mayoclinic.com/health/traumatic-brain-injury/DS00552/DSECTION=treatments-and-drugs
http://www.tbirecovery.org/?gclid=CJ-Z24id764CFeYbQgoduxd5KA
http://www.traumaticbraininjury.com/

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