Author: Natasha Boskic

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2.1 Children with Nervous System Disorders: Tourette Syndrome (TS)

Children with Tourette Syndrome (TS)

Tourette syndrome is a brain disorder. It involves involuntary verbal and/or motor tics (a tic is an involuntary oral or motor movement). The child has very little or no control over the tics. If the child tries to control the tics, they will come back with more intensity, so it is recommended to just let the tics happens. Tourette syndrome is much more common in boys than in girls. Tourette syndrome can be a lifelong condition. There is no cure. In some children, Tourette syndrome disappears early in the adult years. It usually starts in the middle childhood or teen years.

The tics in Tourette syndrome are not always the same. They sometimes change. A child whose tics are mainly eye blinking might suddenly start to clear his or her throat. Also, tics can be verbal (please see below) and then become motor (please see below). Tics can occur a few times a day or many times a day. Their intensity also varies. Tics can get worse if the child is under stress or emotional distress. Although emotional distress does not cause Tourette syndrome, it can make it worse.

Some of the symptoms of Tourette syndrome are:

    • Verbal tics:
      • Clearing the throat;
      • Barking;
      • Making funny and unusual noises;
      • Blurting out obscenities (for example, cursing);
      • Repeating words over and over again.

      Motor tics:

      • Blinking the eyes over and over;
      • Jerking (or moving) the head;
      • Shrugging the shoulders;
      • Touching others;
      • Smelling objects;
      • Flapping hands.

Some children with Tourette syndrome take medication that seems to make the tics happen less often  and makes them less severe. Others may need psychotherapy  if they are experiencing unusual stress in their lives. Another reason a child might require psycho-therapy is because Tourette syndrome often occurs with other disorders, including ADHD, autism and anxiety-based disorders.

Most children with TS have average intelligence. TS can sometimes exist alongside other disorders, such as:

Most children with TS lead perfectly typical lives. They attend school and participate in sports (Fig. 1) . They engage in all sorts of extra-curricular activities.

Some children with TS can benefit from the following services:

  • Special education services: if children with TS are also diagnosed with ADHD, or a learning disability, they may benefit from specialized instruction. This specialized instruction will be provided to them, by the regular education and special education teachers, through the Individual Education Plan (IEP) team;
  • Counseling: some children with TS have a negative self-esteem and low self-confidence (Fig. 2). Those who do could benefit from counseling sessions from the school counselor;
  • Psycho-therapy: some children with TS have an anxiety-based disorder, such as obsessive-compulsive disorder (OCD). Those who do benefit greatly from psychotherapy sessions with a clinical psychologist. Some may also benefit from anti-obsession medication that is usually prescribed by a psychiatrist;
  • Behavior intervention: children with TS could benefit from relaxation techniques that could help lower the frequency and intensity of their tics. Such techniques could include learning how to breathe deeply.
  • Sensory integration therapy: some children with TS have sensory integration difficulties. Those who do could benefit from the services of an OT with specialization in sensory integration therapy.

Children with Tourette syndrome are not usually placed on an Individual Education Plan (IEP) at school, unless they are diagnosed with another condition (please see above). But there are some things that the teacher can do, in order to make the child as happy as possible in the classroom. These are:

  • Making sure the child feels welcome and safe in the classroom;
  • Explaining Tourette syndrome to everyone in the classroom, and mentioning that tics are beyond the control of the child;
  • Allowing the child to leave the classroom for a bit if he or she feels that a serious tic is about to happen;
  • Making sure the child has enough space for complex motor tics he or she may have like jerky leg movements;
  • Letting the child to take exams in a separate room so he or she can concentrate and also so his or her classmates can concentrate.

For more information about Tourette syndrome, please visit the BC Ministry of Education’s Tourette syndrome website.

Most individuals with Tourette syndrome grow up to lead happy, healthy and fulfilling lives (Fig. 1). They are usually well-adjusted people who hold all types of jobs.

happy

Figure 1. Happy life
see References
http://www.bced.gov.bc.ca/specialed/awareness/67.htm
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001744/
http://www.tsa-usa.org/
Categories
2.1 Children with Nervous System Disorders: Fetal Alcohol Spectrum Disorder (FASD)

Fetal Alcohol Spectrum Disorder (FASD)

FASD is a group of disorders caused by prenatal exposure to alcohol. When a pregnant woman drinks, she could be doing considerable damage to her fetus. There are factors that seem to protect some fetuses from the damaging effects of alcohol. Such protective factors are not fully understood but seem to include a healthy diet and freedom from stress. This is why not all women who drink give birth to children who have FASD. The medical community appears to be divided on what a “safe level of drinking while pregnant” is. Some physicians state that it is ok to drink alcohol from time to time while pregnant. Others recommend complete abstinence (Personal Communication, Dana Brynelsen, 2012).

Prenatal exposure to alcohol can damage the development of many fetal organs, especially the brain. Different parts of the brain grow during different times during pregnancy. So drinking alcohol at any time during pregnancy may cause serious and irreversible brain damage.

FASD is a spectrum disorder. This means that different children will have different symptoms. Some children will exhibit serious learning and behavioral difficulties and others may only exhibit minor ones.

FASD is one of the leading causes of intellectual disabilities (mental retardation) in children. It is 100% preventable. That is, if a woman does not drink alcohol during pregnancy, her baby will not get FASD. This is very important to note because the incidence of FASD is 1 in 100 births. In some populations this rate can be as high as 1 in 4 births (Personal Communication, Dana Brynelsen, 2012).

The most serious disorder under the umbrella of FASD is Fetal Alcohol Syndrome (FAS). Some children with FAS have distinct facial features (Fig. 1) that could disappear or become less pronounced as the child gets older. Some of these features are:

fatal alcohol syndrome

Figure 1. Fatal alcohol syndrome
  • Smaller head;
  • Flat mid-face;
  • Short nose;
  • Think upper lip;
  • Indistinct philtrum;
  • Eyes that are somewhat almond-shaped.

FASD can and does affect all areas of development:

  • Most children with FASD have some type of cognitive impairment. Some will have an intellectual disability (see full Glossary)  while others may have a learning disability. Many struggle with paying attention, concentrating and remembering things. Most will struggle with learning how to read, write and perform math operations. Most will have difficulties with their working memory and many will find it difficult to understand complex and/or abstract concepts;
  • Many children with FASD struggle with cause and effect. That is, they do not seem to understand the consequences of their actions. For instance, a child with FASD may not fully understand that the reason their peer does not want to play with them anymore is because they keep hitting this peer. Many children with FASD also struggle understanding the concept of danger. For example, many children with FASD do not understand that if they cross the street without looking both ways, they may get hit by a car. That is why many of them appear to be serious risk-takers;
  • Many children with FASD have imperfect language skills. They have a smaller vocabulary than their peers and seem to use very simple sentences when communicating with others. They struggle with understanding complex and multi-step directions. Children with FASD also struggle with pragmatic language. They often miss out on social cues. Many do not understand the concept of personal space (according to their culture);
  • Many children with FASD have serious behavioral difficulties. They throw severe temper tantrums (that is, they may get down on the floor and cry and yell at others) (Fig. 2) and really struggle with impulse control. They sometimes engage in socially-inappropriate behavior (the inappropriateness of a certain behavior will vary from culture to culture) and struggle with the understanding and recognition of feelings, both in themselves and others;

temper tantrum

Figure 2. Temper tantrum
  • Some children with FASD experience difficulties with fine and gross motor skills. They may appear clumsy when they walk and run and may struggle when they hold pens, pencils and paint brushes;
  • Some children with FASD will have difficulties with sensory integration;
  • Some children with FASD will struggle with all aspects of adaptive functioning. They may be very late to get toilet trained. They may need help with eating and drinking, even in kindergarten (they will experience these difficulties even if they come from a culture that encourages independent eating and drinking as early as possible). Many will also need help getting dressed and taking a bath;
  • Some children with FASD may experience high levels of anxiety.

Also, some children with FASD may have hearing and/or vision difficulties. They may also have medical problems, especially with their heart, liver and/or kidneys.

Some children with FASD display positive features which include:

  • Having creative, musical and artistic abilities;
  • Being friendly and affectionate;
  • Being gentle and compassionate;
  • Being funny and having a sense of humor;
  • Being persistent and hard working;
  • Being interested in and caring for animals;
  • Being fair;
  • Being good story-tellers.

Children with FASD could benefit from the following services:

  • Special education: most children with FASD will be placed on an IEP, when they start attending school. They will benefit from the help of the school special educator, who will help them with all aspects of their academic skills. Special educators can also help children with FASD learn how to pay attention, understand cause and effect, and improve their concentration skills;
  • Physiotherapy: children with FASD will benefit greatly from physiotherapy. The PT will help them improve their gross motor skills and will help them improve their sense of balance;
  • Occupational therapy: OTs can help children with FASD improve their fine motor skills. OTs can help children improve the dexterity in their fingers, hold a pen or pencil properly, and use eating utensils. OTs with special training in sensory integration therapy can help children with FASD deal with any sensory processing difficulties they may have;
  • Speech and language pathology (SLP): many children with FASD will benefit greatly from speech therapy. SLPs will help children with FASD improve their receptive and expressive language skills. They will also help them understand social cues and therefore improve their pragmatic skills;
  • Behavior intervention (BI): BIs will help children with FASD learn how to improve their impulse control and minimize the frequency and intensity of their temper tantrums. They will also help these children understand cause and effect relations;
  • Mental health: some children with FASD will benefit from psycho-therapy sessions, especially if they experience high levels of anxiety.

Children with FASD struggle with many aspects of development but they can and do improve with loving care and early intervention. With structured support, many of them can be successfully integrated into regular classrooms, where they belong.

see References
http://www.fasdoutreach.ca/
http://www.fasdoutreach.ca/elearning/learning-about-fasd
http://www.bced.gov.bc.ca/specialed/awareness/53.htm
http://www.fasdcenter.samhsa.gov/
http://www.child-encyclopedia.com/en-ca/home.html
http://www.gov.mb.ca/healthychild/fasd/fasdearly_en.pdf
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2.1 Children with Nervous System Disorders: Spina Bifida

Children with Spina Bifida

As noted in the birth to six section of this course, spina bifida is a neural tube defect. The neural tube, which later develops into the spinal cord, fails to close properly during the first few weeks of pregnancy. The result could be spina bifida. The severity of spina bifida will depend on where the damage to the spinal cord is. If the damage (also called a lesion) is higher up on the spinal cord, the damage will be serious. If it is lower on the spinal cord, the damage will be less severe. The damage could range from minor loss of control over movement to paralysis. Some children with spina bifida also experience loss of sensation in some of their limbs.

Children with spina bifida usually experience delays in the development of their gross motor skills. They often need casts or walkers, in order to move around independently. When they are older, they may start using a wheelchair (Fig. 1) because moving around makes them very tired, very quickly.

in a wheelchair

Figure 1. In a wheelchair

There are many types of spina bifida. To view these types, please visit the birth to six spina bifida section of this course.

Many children with spina bifida also have hydrocephalus. In hydrocephalus, cerebro-spinal fluid, which is the fluid found in the skull, fails to drain properly. As a result, the child’s head may appear very big . The presence of excessive cerebro-spinal fluid in the brain can cause nausea, dizziness, blurred vision, severe headaches, brain damage, and in rare and severe cases, death. Because of that, excessive cerebro spinal fluid needs to be drained from the brain. Many children with hydrocephalus will need a shunt. The shunt is a surgical device that is installed in the child’s brain, and that will drain the excessive fluid from the child’s brain.

Many children with spina bifida also have incontinence issues. Many of them do not have full control of their bladder and bowel movements. Because of that, many children with spina bifida carry colostomy bags with them. Colostomy bags provide an alternative for disposal of waste that is coming out of the body. For more information about solutions to incontinence issues, please visit the website of the Spina Bifida Association.

Many children with spina bifida have typical intelligence. Some may have learning and attention difficulties. Many will have gross motor difficulties and/or delays.

School-age children with spina bifida could benefit from the following services:

  • Special education services: most children with spina bifida will need the help of a special educator. The special educator will collaborate with the regular education teacher and ensure that the child is fully integrated into the regular classroom. Some children with spina bifida will have aides and others will not. Whether or not a child will have an aide will depend on the severity of his or her symptoms. The special educator will help children with spina bifida with any learning and/or attention difficulties they may experience;
  • Physiotherapy  (PT): most children with spina bifida will need the help of a physiotherapist. The PT will help the child improve his or her gross motor skills and use assistive devices (see full Glossary). Assistive devices include walkers and wheelchairs. The physiotherapist will also help the regular education teacher make the classroom as inclusive as possible (Fig. 2), for a child with walkers or in wheelchairs;

inclusive classroom

Figure 2. Inclusive classroom
  • Nurse: nurses will sometimes serve on the child with spina bifida’s Individualized Education Plan team. They will help everyone working with the child to recognize the signs of shunt malfunction. For information about shunt malfunction, please visit the following website. They will also help with the child’s colostomy bag and incontinence difficulties;
  • School counselor: some children with spina bifida experience anxiety and feel sad. They may have low self-esteem and little self-confidence. The school counselor can help children with spina bifida deal with feelings of sadness or anxiety;
  • Psychotherapist: some children with spina bifida are so anxious that they end up with a diagnosis of an anxiety disorder. Others may qualify for a diagnosis of depression. When that happens, the child will need the help of a psychotherapist.

Most children with spina bifida perform quite well in the regular classroom. Most also grow up to be healthy and happy adults who are fully contributing members of society.

see References
Lutkenhoff, M. (2008). Children With Spina Bifida (2nd Ed.). Bethesda, MD: Woodbine House.
http://www.bced.gov.bc.ca/specialed/awareness/63.htm
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2.0 Children with Genetic Disorders: Down Syndrome

Down Syndrome

Children with Down syndrome usually need support all their lives. As you may have seen in the Birth to 6 part of this course, Down syndrome  is a chromosomal disorder that usually affects every aspect of a child’s development.

Children with Down syndrome generally have delays in all areas of development. Some of these delays get more pronounced, or visible, when the children get older. Below is a brief description of how Down syndrome affects different developmental areas in children who are between the ages of 6 and 12 years (Fig. 1):

Down Syndrome

Figure 1. Down Syndrome
  • The development of cognitive skills: children with Down syndrome have cognitive skills that are behind those of their typically developing peers. They tend to be slower to process information. They do not seem to use their working memory as efficiently as others do. It is also believed that children with Down syndrome struggle when it comes to generalizing what they learn from one situation to another, and have trouble linking new information to information stored in their long term memory.
  •  Children with Down syndrome are very concrete thinkers. They need to see, hear, feel and touch something before they can learn it. In other words, children with Down syndrome learn best when they are given information in a multi-sensory fashion (Fig. 2). Children with Down syndrome may be able to solve simple, single-step problems on their own, but they often need help with a multi-step or completely new problem.

five senses

Figure 2. Five senses
  • The development of academic skills: children with Down syndrome will usually need help in all academic areas. Many of them struggle with the basics of reading, writing and math. They will need specialized and highly individualized help in order to learn how to read, write and learn math.
    • When it comes to reading, children with Down syndrome will need to be taught how to read in very concrete and multi-sensory ways. They will need repeated instruction and it will usually take them much longer to learn the basics of reading.
    • Children with Down syndrome will also need a lot of help in order to learn how to write. Since they continue to struggle with poor fine motor skills (please see motor development section below), their writing and spelling skills may not be very good. They will learn how to write and spell, but they will do so at a slower rate.
    • Math is another area in which many children with Down syndrome will struggle. Math instruction will need to be intensive and highly concrete. When they get a little older, children with Down syndrome will need to be taught how to use math in real-life situations, such as buying what they need from a store.
    • The development of communication skills: children with Down syndrome will usually continue to have difficulty in the communication domain. Most of them are able to get their point across to others quite well, but they appear to do so in very simple and concrete ways. Most of the time, they use very simple sentences and they often struggle with articulation. This could be because of muscle weakness in the oral/motor area of development (please see motor section below).
    • Children with Down syndrome can usually follow simple commands, but may need help understanding and following complex and multi-step directions (for example, “First go to your room, then get the book, then give it to Dad”). Although quite social, many children with Down syndrome struggle with the pragmatic side of language. That is, many of them may not understand personal space (as it relates to their culture), or the fact that they sometimes have to wait for their turn to communicate to someone.
    • The development of motor skills: children with Down syndrome walk, run, go up and down stairs and can usually use all playground equipment (Fig. 3) (for example: slides, monkey bars and swings). They may be slower than their peers, but they can usually participate in most motor-based and physical education activities. The fine motor skills of children with Down syndrome may present them with problems, especially when it comes to writing or typing on a keyboard. They may not have enough dexterity (that is, good fine motor control of the muscles of their fingers to write or draw as fast as their peers, but they are able to do so.
    • The oral/motor area in children with Down syndrome may also continue to be a bit delayed compared to their typically developing peers. This can be seen in children who continue to struggle with articulation and chewing. Some may continue to drool, because they do not have a lot of control of their oral/motor muscles. However, most children with Down syndrome can write, draw and eat independently.

playground

Figure 3. Playground
    • The development of social and emotional skills: many children with Down syndrome are a joy to their parents and anybody who knows them. However, they may appear to be stubborn sometimes. This could be the result of their inability to get their point across. Although quite friendly, children with Down syndrome will need help with their social skills. They may not know how to approach others in socially acceptable ways and may appear socially immature. Their emotional skills may also be delayed because many of them struggle with identifying their emotions and those of others.
    • The development of adaptive skills: children with Down syndrome are usually able to get dressed and undressed independently. Some may struggle with small buttons and tying shoe laces because of fine motor difficulties. Some may need to be reminded to wash their hands after a meal, or to brush their teeth before they go to bed. They may forget to scrub every part of their body when taking a shower or a bath and may need reminders. They may also need to be reminded to brush their hair before they leave the house. But most children with Down syndrome are usually able to get a simple snack on their own (for example, make a peanut-butter and jam sandwich), and they often help their parents with household chores (Fig. 4). Young early-maturing girls with Down syndrome may need to be taught what to do and how to care for themselves in terms of hygiene when they start to menstruate.

chores

Figure 4. Chores

Most children with Down syndrome attend regular schools and many of them are fully integrated into a regular classroom. They all have Individualized Education Plans (or IEPs) and some have a school support worker or educational assistant (or EA) who helps them in the classroom. Most children with Down syndrome will be on a modified IEP as opposed to an adapted one. This means that they will have to achieve different and simpler learning outcomes (adapted IEP) than their typically developing peers.

Most children with Down syndrome who are between the ages of 6 and 12 will benefit from the following services:

  • Special education assistance: children with Down syndrome will need the help of a special educator at their school. This special educator will serve on their IEP team, offer suggestions to their teacher, and may come into the classroom to help integrate them into it.
  • Speech therapy: most children with Down syndrome will continue to need speech therapy services to keep working on all aspects of their communication skills.
  • Occupational therapy: some children with Down syndrome may need continued help from an occupational therapist who will help them improve and develop their fine motor and oral/motor skills.
  • Physiotherapy: some children with Down syndrome may need continued help from a physical therapist to improve their gross motor skills.
  • Some children with Down syndrome will get diagnosed with hearing loss at some point in their lives. If that happens, they will need the help of an audiologist.
  • Some children with Down syndrome will get diagnosed with vision loss, or conditions like nistagmus (see full Glossary) and strabism (see full Glossary) at some point in their lives. If that happens, they will need the help of an ophthalmologist.
  • Please click here for more information on vision impairments and conditions or hearing loss for children with Down Syndrome.

Some children with Down syndrome may also get diagnosed with a number of medical conditions. They appear to be more susceptible to these conditions  than the general population. Some of these medical conditions include:

  • Eczema (see full Glossary) and other skin conditions;
  • Heart and cardiac problems;
  • Thyroid problems;
  • Orthopedic problems;
  • Certain types of cancer, including Leukemia;
  • Autism

Should this happen, children with Down syndrome will need help from highly specialized professionals in the medical field.

Finally, children with Down syndrome can and should be included in all aspects of typical life. They may need a little bit of help, but they are quite capable of engaging in most of the same activities as their peers.

see References
Bruni, M. (2006). Fine Motor Skills for Children With Down Syndrome: a Guide for Parents and Professionals. Bethesda, MD: Woodbine house.
Skallerup, S. J. (Ed.). (2008). Babies with Down Syndrome (3rd Ed.). Bethesda, MD: Woodbine House.
Oelwein, P. L. (1995). Teaching Reading to Children With Down Syndrome: a Guide for Parents and Teachers. Bethesda, MD: Woodbine House.
http://www.nads.org/
http://www.bced.gov.bc.ca/specialed/awareness/43.htm
http://www.dsrf.org/
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2.1 Children with Nervous System Disorders: Epilepsy

Children with Epilepsy

As can be seen from the birth to six section of this course, epilepsy  is a disorder that can have serious impact on the development of children. In epilepsy, children can experience different types of seizures (see full Glossary). Some seizures involve loss of consciousness (for example: tonic clonic, formerly known as grand mal) and others do not (for example, absence seizure, formerly known as petit mal). Some seizures involve the entire brain (known as generalized seizures), others involve part of the brain (known as partial seizures). For more information about the different types of seizures that children with epilepsy may experience, please visit the epilepsy section of the zero to six part of this course.

The term co-morbidity is used when a person has more than one serious disorder that has a negative impact on their functioning and development. Co-morbidity is common in children with epilepsy. Some conditions that appear to be co-morbid with epilepsy include autism, some types of intellectual disabilities and cerebral palsy. Some children with epilepsy also have difficulties with vision and hearing.

Some children with epilepsy have seizures that are fully controlled by medication. Others have seizures that may not be fully controlled by medication. These children will continue to have seizures, despite being on strong medications.

Some children with epilepsy grow up quite typically, while others do not. Those who do not develop typically may have learning and attention difficulties and may need special education services in school. In some cases, children with epilepsy start out by developing typically. They then suffer brain damage as a result of repeated, serious and uncontrolled seizures. Because of the damage done to the brain, the development of these children is negatively altered, sometimes forever. This is why some parents may resort to alternative methods for the treatment of epilepsy in their children (please see below).

School-aged children with epilepsy could benefit from the following services:

  • Special educator: the special educator will help children with epilepsy with any learning and/or attention difficulties they may have. They will offer the regular education teacher specific tips and strategies on how to fully include these children in the classroom;
  • School nurse (Fig. 1): the nurse will help children with epilepsy manage their medication. He or she will explain the side effects of the medication to the team that is working with the child. He or she will also prepare the teacher for what might happen and how he or she should respond, should a child with epilepsy experience a serious (for example a tonic clonic) seizure in the classroom;
  • School counselor: some children with epilepsy have a low self-esteem and could benefit from sessions with the school counselor;
  • Psychotherapist: some children with epilepsy experience a lot of anxiety and may therefore qualify for a diagnosis of an anxiety disorder. Others are sad enough to qualify for a diagnosis of depression. When that happens, children with epilepsy will need psycho-therapy services from a clinical psychologist.

school nurse

Figure 1. School nurse

Other Types of Treatments

In rare cases, when the seizures are quite severe and uncontrollable, children with epilepsy may receive alternative treatment options to help control or at least minimize the impact of the seizures on their brain. Such treatment options include:

  • The Ketogenic Diet: a diet that is very high in fat content. It is controversial (because of the high fat content) but is sometimes used to control extremely severe and frequent seizures;
  • Brain surgery (Fig. 2): in extremely rare cases in which the seizures are severe and frequent enough to cause brain damage, brain surgery is performed. In such instances, the part of the brain that is causing the seizures can be removed. In other instances, the corpus callosum (which is the area that connects the right and left hemispheres) is removed, in order to prevent the seizures from moving from one part of the brain to the other.

brain surgery

Figure 2. Brain surgery

Most children with epilepsy have seizures that are fully controlled with medication. Many of them do quite well in the regular classroom, which is where they belong. At the same time, children with epilepsy have the right for assistance in the classroom with a school support teacher or educational assistant. They will receive a medical designation in the school system and will have the right to have an Individualized Educational Plan with the classroom and resource teacher. Some of them may require some adaptations, for example, in physical education lessons climbing may not be recommended. Most will grow up to be healthy and happy adults (Fig. 3) who are contributing members of society.

happy adults

Figure 3. Happy adults
see References
http://www.epilepsyfoundation.org/
http://www.bced.gov.bc.ca/specialed/awareness/49.htm
Categories
2.1 Children with Nervous System Disorders: Cerebral Palsy

Children with Cerebral Palsy (CP)

CP is a central nervous system disorder (see full Glossary). When a child has CP, his or her brain is unable to fully control muscles and movement, because of injury or damage to one of more if its parts. CP is non-progressive. This means it does not get worse with age. However, lack of early intervention could lead to stiffer muscles and more restricted movement. This is not due to of the CP itself, it is the result of lack of environmental support. Early intervention is therefore crucial for all children with CP.

Some of the causes of CP are known. CP can result from injury to the brain pre- (before), peri- (during), or post-natally (after the birth):

  • Pre-natal reasons include: maternal infection, drug and alcohol use and genetics (see full Glossary);
  • Peri-natal reasons include: anoxia, which is lack of oxygen to the brain during labor;
  • Post-natal reasons: severe trauma to the head (for example, a car accident), near-drowning accidents and severe physical abuse, including shaking the baby.

There are many ways of classifying CP. It can be classified according to the location of brain injury. It can also be classified according to how the injury is affecting movement. Please refer to the cerebral palsy section of the birth to six course, in order to learn more about the different types of cerebral palsy.

Because CP is a central nervous system disorder, about 50% of children with CP also have an intellectual disability (formerly known as mental retardation). Other children with CP can have the following co-morbid (that is, co-existing) disorders:

Children with CP can benefit from the following services:

  • Special education services (Fig. 1): most children with CP will have an Individualized Education Plan (IEP) at school. The special educator will serve on the IEP team. The special educator, along with other members of the team, will assist the regular education teacher in planning an individualized program for the child with CP;

Special education services

Figure 1. Special education services
  • Physiotherapy (PT): the physio-therapist will help the child with CP improve his or her gross motor skills. The PT will help the child with CP increase his or her range of motion and learn how to use adaptive equipment, such as wheelchairs or walkers;
  • Occupational therapist (OT): the OT will help the child with CP improve his or her fine motor and oral/motor skills. He or she will help the child with CP improve the dexterity in his or her fingers and use adaptive equipment (see full Glossary) (such as adaptive spoons and pencils). The OT can also help children with CP improve the muscles in the oral/motor area (these are the muscles that surround the mouth). OTs with special training in sensory integration therapy (see ECI Glossary) will help children with CP with any sensory difficulties they may be experiencing;
  • Speech and language pathologist (SLP):  SLPs will help children with CP improve all aspects of their communication skills: they will help them improve their receptive  and expressive  language skills, and will also help them with articulation difficulties (which could be resulting from difficulties in the oral/motor area);
  • Vision specialist: some children with CP have vision problems. In these cases, regular check-ups with an ophthalmologist (Fig. 2) are highly recommended;
  • Hearing specialist: some children with CP have hearing difficulties. In these cases, regular check-ups with a hearing specialist are highly recommended;
  • School counselor: some children with CP have low self-esteem and little self-confidence. In such cases, regular visits with the school counselor could prove very useful;
  • Mental health professional: if a child with CP is overly anxious or sad, they may need help from a clinical psychologist CP).

ophthalmologist

Figure 2. Ophthalmologist

Most children with CP are fully integrated into regular classrooms, where they do quite well. Children with cerebral palsy have the right for assistance in the classroom with a school support teacher or educational assistant. Depending on the type of cerebral palsy, they will receive a designation in the school system and will have the right to have an Individualized Educational Plan with the classroom and resource teacher. Some of them may require some adaptations that will help them with their intellectual, language and/or motor work.  Many grow up to lead fulfilling lives.

see References
Martin, S. (2006). Teaching Motor Skills to Children with Cerebral Palsy and Similar Movement Disorders: A Guide for Parents and Professionals. Bethesda, MD: Woodbine House.
http://cerebralpalsy.org/
http://www.bced.gov.bc.ca/specialed/special_ed_policy_manual.pdf#page=48
http://www.bced.gov.bc.ca/specialed/awareness/31.htm
http://www.bced.gov.bc.ca/specialed/awareness/33.htm
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2.0 Children with Genetic Disorders: Fragile X Syndrome

Fragile X Syndrome

Fragile X syndrome is a chromosomal condition in which part of the X chromosome is either deleted or broken. As you can see from the description of Fragile X syndrome in the 0 to 6 course, this disorder can affect boys and girls very differently. Girls have two X chromosomes and boys have one. If something happens to a girl’s X chromosome, she will have another X chromosome to make up for what went wrong with the first X chromosome, at least partly. Because boys have only one X chromosome, they are usually more seriously affected by the disorder than girls.

Here is how fragile X syndrome generally affects girls:

Here is how fragile X syndrome generally affects boys:

  • They may have serious learning difficulties and/or learning disabilities;
  • They may have a mild to moderate intellectual disability;
  • They may have serious attention difficulties and may get a secondary diagnosis of ADHD;
  • They may struggle with language and communication;
  • They may have mild to severe sensory processing difficulties;
  • They may struggle with social/emotional issues, such as having difficulty making friends and having low self-esteem;
  • They may have anxiety-based disorders, and may end up with a secondary diagnosis of an anxiety disorder;
  • They may have distinct features such as long faces, large and outward-facing ears, and flat feet;
  • They may have low muscle tone and may struggle with fine motor difficulties.

About 25% of children with fragile X syndrome also have epilepsy.

Children with fragile X syndrome can usually benefit from the following services, both at home and in school:

  • Special education services: children with fragile X syndrome will need the help of a special educator, if they are to succeed in school. They can and should be included in regular classrooms, but the regular education teacher will need help from the Individualized Education Plan team in general, and the special educator in particular, in order to accommodate these children into the regular classroom;
  • Speech therapy: children with fragile X syndrome will continue to benefit from speech therapy services. Speech therapists can help children with fragile X syndrome improve their expressive and receptive language skills, and their articulation and pragmatic skills;
  • Occupational (OT) and physiotherapy (PT): children with fragile X syndrome who have fine motor difficulties or low muscle tone will continue to benefit greatly from the help of an OT or a PT;
  • Sensory integration therapy: children with fragile X syndrome who have sensory processing difficulties will usually continue to benefit from the help of an OT who has special training in sensory integration therapy;
  • Counseling or psychotherapy: some children with fragile X syndrome experience a lot of anxiety. Because of that many of them will benefit from counseling sessions from the school counselor. If their anxiety is severe, they may need full-fledged therapy from a psycho-therapist;
  • Behavior intervention: children with fragile X syndrome may sometimes need the help of a behavior interventionist. That is because some of them have difficulty controlling their emotions and behaviors and may act out or have serious temper tantrums.

Most children with fragile X syndrome are fully included in the regular classroom with or without an aide and they usually have an IEP. They are also usually fully included in every aspect of their families’ lives (Fig. 1).

family

Figure 1. Family
see References
Carvajal, I. F. & Aldridge, D. (2011). Understanding Fragile X Syndrome. London, England: Jessica Kingsley Publications.
Weber, J. D. (Ed). (2000). Children Sith Fragile X Syndrome. Bethesda, MD: Woodbine House.
http://www.fraxa.org/

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