Title: A Parents Guide to Elementary School Children
1A Parents Guide to Elementary School Children
- Judith Aronson-Ramos, M.D.
- Developmental Behavioral Pediatrics
2What do we know?
- 1 out of 5 children will have a mental health or
behavioral concern - 1/110 children will have and Autism Spectrum
Disorder - 5-7 of school age children have ADHD
- 5 of school age children have Learning
Disabilities
3The Chicken or The Egg
- Learning Disorders
- Emotional/Behavioral Problems
4Disorders and Concerns
- Specific Learning Disabilities
- ADHD
- Autism Spectrum Disorder
- Specific Disorders of Behavior and Emotion
- Neurological Conditions
- Chronic Illness
- Parenting the impact on all of the above
5Problems in Learning
- Learning Disabilities (LD) are neurologically-base
d processing problems which can interfere with
learning basic skills such as reading, writing,
or math. They can also interfere with higher
level skills such as organization, time planning,
and abstract reasoning. - Types of LD are identified by specific processing
problems. - They might relate to getting information into the
brain (Input), making sense of this information
(Organization), storing and later retrieving this
information (Memory), or getting this information
back out (Output). - Specific types of processing problems might be in
one or more of these four areas- - INPUT
- OUPUT
- ORGANIZATION
- MEMORY
6What are the clues of a learning disability in
preschoolers and early elementary school children?
- Communication delays, such as slow language
development or difficulty with speech. Problems
understanding what is being said or problems
communicating thoughts. - Poor coordination and uneven motor development,
such as delays in learning to sit, walk, color,
and using scissors. Later watch for problems
forming letters and numbers. - Problems with memory and routine for example,
not remembering specifics of daily activities and
not understanding instructions or remembering
multiple instructions. - Delays in socialization including playing and
relating interactively with other children. - For an excellent checklist by age follow this
link http//www.ncld.org/images/stories/Publicati
ons/Forms-Checklists-Flyers-Handouts/ldchecklist.p
df
7Grades 1-5
- Problems learning phonemes (individual units of
sound) and graphemes (letters, numbers). Problems
learning how to blend sounds and letters to sound
out words - phonics. - Problems remembering sight words.
- Difficulty with reading comprehension.
- Problems forming letters and numbers.
- Problems with basic spelling and grammar.
- Difficulties learning math skills and doing math
calculations. - Difficulty remembering facts.
8Grades 1-5
- Some types of LD are not apparent until middle or
high school when demands increase and assignments
are more complex, new areas of weakness may
become apparent. - Losing or forgetting materials, or doing work and
forgetting to turn it into the teacher. - An inability to plan out the steps and time lines
for completing projects, especially long-term
projects. - Difficulty organizing thoughts for written
reports or public speaking. - Difficulty organizing materials (notebook,
binder, papers), information, and/or concepts - Poor or no sense of time.
9If there is suspicion of LD.
- The diagnostic process is called a
"psycho-educational" evaluation. Under education
law, public schools must provide this evaluation,
but this may not happen immediately (RTI). An
evaluation may also be done privately. There are
three parts to this evaluation. The tests used
may vary with each school system or by clinician
(MA,PHD) - An assessment of potential, usually done through
an IQ test. - A battery of achievement tests to assess skills
in reading, writing, and math. - A battery of tests to assess processing skills.
These tests examine possible problems with input,
integration, and output of information.
10What is the difference between a learning
disability, a developmental delay, and a
developmental disability?
- Someone is learning disabled if there is a large
discrepancy between intellectual ability and
achievement. The person with a learning
disability may have low or high intelligence the
person simply learns below intellectual
capability because of a processing disorder. - A developmentally delayed child is one who is
younger than five years old and who is behind
schedule in attaining milestones. A
developmentally delayed child usually reaches the
developmental milestones eventually. - The developmentally disabled child has a severe
and chronic physical or mental impairment that
limits success in several major life areas.
Examples of developmental disabilities include
mental retardation, cerebral palsy, epilepsy,
autism and others.
11Criteria of an LD
- All of the following are necessary symptoms of an
official learning disability - Average or above average intelligence (as
measured by the IQ score) - Significant delay in academic achievement
- Severe information processing deficits
- Uneven pattern of cognitive development
throughout life - A disparity between measured intellectual
potential (IQ score) and actual academic
achievement - The learning disability persists despite
instruction in standard classroom situations
12Types of LD
- Dyslexia Difficulty processing language. Problems
reading, writing, spelling, speaking. - Dyscalculia Difficulty with math. Problems doing
math problems, understanding time, using money. - Dysgraphia Difficulty with writing. Problems
with handwriting, spelling, organizing ideas. - Dyspraxia (Sensory Integration Disorder)
Difficulty with fine motor skills. Problems with
handeye coordination, balance, manual dexterity. - Auditory Processing Disorder Difficulty hearing
differences between sounds. Problems with
reading, comprehension, language. - Visual Processing Disorder -Difficulty
interpreting visual information. Problems with
reading, math, maps, charts, symbols, pictures.
13LD doesnt explain everything that makes learning
hard..
- Difficulty in school doesnt always stem from a
learning disability. Anxiety, depression,
stressful events, emotional trauma, and other
conditions affecting concentration make learning
more of a challenge. - ADHD Attention Deficit Hyperactivity Disorder
(ADHD), while not considered a learning
disability, can certainly disrupt learning.
Children with ADHD often have problems with
sitting still, staying focused, following
instructions, staying organized, and completing
homework. - Autism Difficulty mastering certain academic
skills can stem from unique sensory processing,
difficulty understanding abstract ideas and
emotions, or a unique learning style. Children
with ASD may also have trouble making friends,
reading body language, communicating, and making
eye contact.
14ADHD
- 20 of school aged children
- Three types of ADHD Inattentive, Hyperactive
Impulsive and Combined - Diagnosed at age 6
- Rule out things that mimic ADHD- Anxiety,
Depression, LD - Performance must be impaired to be diagnosed
15DSM IV Criteria
- Inattention
- Often does not give close attention to details or
makes careless mistakes in schoolwork, work, or
other activities. - Often has trouble keeping attention on tasks or
play activities. - Often does not seem to listen when spoken to
directly. - Often does not follow through on instructions and
fails to finish schoolwork, chores, or duties in
the workplace (not due to oppositional behavior
or failure to understand instructions). - Often has trouble organizing activities.
- Often avoids, dislikes, or doesn't want to do
things that take a lot of mental effort for a
long period of time (such as schoolwork or
homework). - Often loses things needed for tasks and
activities (e.g. toys, school assignments,
pencils, books, or tools). - Is often easily distracted.
- Is often forgetful in daily activities. Â
16Hyperactivity
- Often fidgets with hands or feet or squirms
in seat when sitting still is expected. - Often gets up from seat when remaining in seat is
expected. - Often excessively runs about or climbs when and
where it is not appropriate (adolescents or
adults may feel very restless). - Often has trouble playing or doing leisure
activities quietly. - Is often "on the go" or often acts as if "driven
by a motor". - Often talks excessively.
- Â
17Impulsivity
- Often blurts out answers before questions have
been finished. - Often has trouble waiting one's turn.
- Often interrupts or intrudes on others (e.g.,
butts into conversations or games).
18Additional Criteria
- Some symptoms that cause impairment were present
before age 7 years. - Some impairment from the symptoms is present in
two or more settings (e.g. at school and home). - There must be clear evidence of clinically
significant impairment in social, school, or work
functioning. - The symptoms are not due to a Pervasive
Developmental Disorder, or other Mental or
Neurologic disorder.
19Not all types of ADHD look alike
- Inattention spacey, day dreamers, forgetful
- Can be overly helpful
- Bias against boys
- Poor sense of time
- Carless
- Disorganized
- Distractible
20Hyperactive - Impulsive
- Over active
- Cant wait in line
- Calls out
- Fidgeting
- Distracted
- Impulsive
- Interrupts
21Combined Type
- Consistent pattern of both inattentive and
hyperactive impulsive symptoms - The majority of elementary age children with ADHD
have combined type - Hyperactivity diminishes over time
- Inattention can worsen over time as demands
increase
22Neurobiology of ADHD
- Neurobiological differences in children with ADHD
leading to executive functioning deficits
(organizing, planning, reasoning, attention) - Anatomic Physiologic Differences in the Brain
Pre-frontal cortex volume and perfusion
smaller right frontal lobe connections between
basal ganglia (movement) and other areas overall
decreased blood flow to certain brain regions
23Neurobiology of ADHD
- Dopamine and Catecholamine Transporter Genes
- Size of different brain structures
- Research supports familial transmission
24ADHD at home
- An organized family with structure and routine
at home, and calm, respectful manner of
interacting with each other. - A behavioral program with clear rules, frequent
and immediate positive reinforcement for target
behaviors, and immediate consequences for
specified negative behaviors - A consistent schedule so that children know what
is expected of them and can plan for transitions. - Modeling time management and self-control.
25More Tips
- Review and rehearse where things seem to always
be a problem (morning routines, etc.) - A minimum of noise and confusion during homework
time or bedtime. - Children need to bee aware that a transition is
coming, when the current activity will end, what
will happen next, and what they are expected to
do to be ready. - Provide outlets for excessive energy.
26ADHD Resources
- CHADD www.chadd.org
- http//www.helpforadd.com
- National Resource Center for ADHD
http//www.help4adhd.org - Tufts University https//research.tufts-nemc.org/h
elp4kids/teachers/default.asp - Reach Institute www.thereachinstitute.org
27Parents Role in Diagnosis and Treatment of ADHD
- You may be asked to complete a questionnaire such
as the Connors, Vanderbilt, SNAP and others - You may be asked to permit an observation at
school or home - You may be asked for samples of your childs
school work or old report cards - You may be asked to assess effectiveness of
medication
28ADHD Medications
- Stimulants, Non-stimulants, Alpha Agonists
- Common Side Effects Vary depending upon the
medication class stimulants- decreased appetite,
difficulty falling asleep, irritability,
headache alpha agonists somnolence,
constipation non-stimulants nausea, abdominal
pain, mood changes - Duration of Action variable depending on
preparation - Interactions few with other medications
- Missed doses may be symptomatic immediately
- Red Flags for Parents dehydration, extreme
physical activity, illness, unusual behaviors
29Biological ConceptsMost drugs in
psychopharmacology work by affecting the
communication between neurons in the brain.
30Is it Autism?
- Difficulties in the following areas
- Communication
- Social interaction
- Repetitive Behaviors/Restricted Interests
31- Cognitive abilities range from gifted to severely
challenged. - Autism is a Pervasive Developmental Disorder
- PDDs include PDD-NOS, Autism, Aspergers
Syndrome, Retts Syndrome, and Childhood
Disintegrative Disorder
32DSM IV Criteria
- THERE IS NO ONE TEST TO DIAGNOSE AUTISM WE BASE
diagnosis on a combination of history,
observation, assessment language, motor,
cognitive skills and ruling out other disorders
that may mimic autism. - The diagnosis can be made by a neurologist,
developmental pediatrician, child psychiatrist or
school system team. Some clinicians use tools
such as the ADOS, CARS, GARS, SRS, SCQ other base
their diagnosis on history and observation alone.
- Many ways to diagnose but the diagnostic criteria
are
33- 6 total from 1-3 at least 2 from 1 and 1 each
from 2 and 3 - 1. Qualitative Impairment in Social Interaction
(at least 2) - Nonverbal skills eye contact, body posture,
facial expressions - Peer Relationships not developmentally
appropriate - No Spontaneous joint attention
- No social or emotional reciprocity
- 2.Qualitative Impairment in Communication
- Delay or lack of language
- Poor conversational skills
- Idiosyncratic language
- No make believe or imitation
- 3.Restricted and Repetitive Behaviors, Interests,
or Activities Preoccupations, Inflexible
routines, Motor Mannerisms, Parts not the whole
34How Do We Know?
- Red Flags No social smile and back and forth
exchanges with caregivers by 2-3 months. - No notice of when caregivers leave or enter a
room by 6-9 months of age. - Not responding to his or her name when called
once or twice at nine months or later. - Lacking in back and forth play with teachers,
caregivers or other children. We call this skill
joint attention and it is a critical component of
engaging with others. - No pointing or babbling at nine months or later.
- No functional words at 15 months or later.
- Repetitive and non-purposeful play dumping
toys, lining things up, stacking at the expense
of creative and imaginative use of objects. - Limited or no eye contact.
35More Signs
- Repetitive body movements or posturing can be
hand flapping, finger twisting, spinning,
rocking, all of these are done to an excessive
degree. - Unable to be redirected at 15 months or later due
to an intense fixation with an object or
interest we sometimes call this sticky
attention. - Unable to sit or engage in expected activities
for age from 12 months on. - Prolonged difficulties with separation from
caregivers, or extreme upset at changes in
routine. - Viewing or inspecting objects from unusual angles
laying down to look at spinning wheels or
objects, using peripheral vision, fixating on
moving objects that are not toys such as fans,
wheels, washing machines etc. All of these things
are done to excess not just in an exploratory
way. - Not comprehending instructions, directions, or
tasks that are clearly age appropriate. - For more information on red flags visit
www.firstsigns.org
36Subtle Signs of ASD
- Fixated narrow areas of interest
- No friends
- Inability to pick up on social cues
- Black and white or very rigid thinking
- Extreme upset over changes in routine
- Poor contact, indiscriminately social, not
understanding implied rules of social conduct
37What We Dont Know
Are Autistic Traits found in the general
population and Autism Spectrum Disorders are an
imbalance of these traits? Is it genetic,
environmental, an interplay of both? We know
there are different types of autism, are there
different causes? What are the unknown metabolic
factors that may worsen or improve ASD? Where are
all the adults with ASD? The hidden hoard? Are we
investing enough resources in care for the adult
population with ASD? Can we predict which
children will progress and develop greater
skills?
38New Theories Autistic Traits are Common
- MANY CHILDREN HAVE MILD AUTISTIC "SYMPTOMS"
WITHOUT EVER HAVING ENOUGH PROBLEMS TO ATTRACT
SPECIALIST ATTENTION, SAY UK RESEARCHERS. - THE INSTITUTE OF CHILD HEALTH TEAM SAYS DIAGNOSED
CHILDREN HAVE SEVERE VERSIONS OF CHARACTER TRAITS
PROBABLY SHARED BY MILLIONS OF OTHERS. - THE 8,000 CHILD STUDY FOUND EVEN THESE MILD
TRAITS COULD IMPAIR DEVELOPMENT. - BOYS - WERE MOST LIKELY TO BE AFFECTED, THE US
JOURNAL STUDY FOUND. - SCIENTISTS HAVE UNDERSTOOD FOR SOME TIME THAT THE
"AUTISTIC SPECTRUM" COVERS A WIDE RANGE OF
CHILDREN. - Fuzzy Boundary between normal andabnormal
39Mood
- Is he/she moody or is it more serious?
- Is it hormones?
- Is it a phase?
- How do I know if there is a more serious
emotional or psychiatric problem?
40Mood Disorders
- Anxiety Disorders Generalized, Separation,
Social, Selective Mutism, Shy - Depressive Disorders MDD, Dysthymia,
- Adjustment Disorders with mood problems
- Situational Mood Problems
- OCD disorder vs. phase degree of symptoms,
inference in functioning, duration - Bipolar Disorder - rare
41Chronic Illness
- Asthma
- Diabetes
- Cystic Fibrosis
- Cancer
- Obesity
- Chronic Ear and Sinus Infections
- Allergies
- Genetic Syndromes
42Neurological Conditions
- Cerebral Palsy
- Tourettes Syndrome
- Genetic Disorders - Downs Syndrome, Fragile X
- Metabolic Diseases
- Epilepsy
43Disruptive Behaviors
- ODD Oppositional Defiant Disorder
- In children with Oppositional Defiant Disorder
(ODD), there is an ongoing pattern of
uncooperative, defiant, and hostile behavior
toward authority figures that seriously
interferes with the youngster's day to day
functioning.Â
44Symptoms of ODD may include
- excessive arguing with adults
- active defiance and refusal to comply with adult
requests and rules - deliberate attempts to annoy or upset people
- blaming others for his or her mistakes or
misbehavior - often being touchy or easily annoyed by others
- frequent anger and resentment
- mean and hateful talking when upset
- seeking revenge
45What causes ODD ?
- The symptoms are usually seen in multiple
settings, but may be more noticeable at home or
at school. Five to fifteen percent of all
school-age children have ODD. - The causes of ODD are unknown, but many parents
report that their child with ODD was more rigid
and demanding than the child's siblings from an
early age. - Biological and environmental factors may have a
role such as alcohol or tobacco use during
pregnancy Â
46Treatment of ODD
- Parenting
- Behavioral Therapy
- Structured Behavioral Plans at school
- Parent-Child Relationship training
- Use of medications for severe behavioral
disturbance
47Conduct Disorder
- Children and adolescents with this disorder have
great difficulty following rules and behaving in
a socially acceptable way. They are often viewed
by other children, adults and social agencies as
"bad" or delinquent, rather than mentally ill.
Many factors may contribute to a child developing
conduct disorder, including brain damage, child
abuse, genetic vulnerability, school failure, and
traumatic life experiences.
48Conduct Disorder
- Incidence 2 of children and teens
- Aggression to people and animals
- Destruction of Property
- Deceitfulness, lying, or stealing
- Serious violations of rules
- often stays out at night despite parental
objections - runs away from home
- often truant from school
49Treatment of CD
- Treatment of children with conduct disorder can
be complex and challenging. Treatment can be
provided in a variety of different settings
depending on the severity of the behaviors.
Adding to the challenge of treatment are the
child's uncooperative attitude, fear and distrust
of adults.
50Outcome for CD
- Two types of CD childhood onset (before age 10
yrs) and adolescent onset - CD is highly resistant to treatment. It follows a
clear developmental path with indicators that can
be present as early as the preschool period.
Treatment is more successful when initiated early
and must include medical, mental health, and
educational components as well as family support.
- CD may result in anti-social personality types,
criminal behavior, and sociopathic behaviors as
children they often end up in the juvenile
justice system
51Family
- Divorce
- Chronic Conflict
- Different parenting styles
- Chaos
- Adoption
52How do we insure success?
- Working as a team
- Good communication between teachers and parents,
parents and children and parents with each other - Eliminating denial and defensiveness
- Demystifying difficulties
- Deviance vs. Difference
- Patience vs. Panic
53Why Are There So Many Books on Parenting?
- Google parenting and you will find 79 million
references - Since the 1900s there had been an exponential
increase in parenting experts concurrent with a
growing incidence of behavior problems,
dysfunctional families, childhood onset
psychiatric and developmental disorders - What is going on here?
54Pitfalls According to the Professionals
- Limit setting where did it go?
- Overprotection - has become indiscriminate
- Nag-Lecture-Yell-Repeat Nag-Lecture-Yell
- Genuine praise is lacking
- Stifling emotions
- Punishment doesnt fit the crime
- Praising events and activities
over the child
55Societal Cultural Changes Have Altered Family
Life
- 1.Demographic-loss of the neighborhood, suburban
sprawl, self-enclosed homes, - 2. Family Structure divorce, loss of family
time, single parent households, harried schedules - 3. Culture computers, cell phones, video games,
electronic immersion
56Changes contd
- 4. Political and Economic Issues Geopolitical
stress and Global Recession - 5. Environmental and Nutritional influences
- 6. NDD Where are the electrical outlets at the
park?
57THANK YOU!!
- www.draronsonramos.com
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