Inclusion of Students with Neurobiological Disorders

Created by:Created by:

Jim Messina, Ph.D.Jim Messina, Ph.D.

Connie Messina, Ph.D.Connie Messina, Ph.D.

NeurobiologicalNeurobiological ConditionsConditions? ?

Attention Deficit Hyperactivity Disorder Attention Deficit Hyperactivity Disorder (ADHD) - with Inattention and/or Impulsivity(ADHD) - with Inattention and/or Impulsivity

Specific Learning Disability with Auditory, Specific Learning Disability with Auditory, Visual or Kinesthetic Processing ProblemsVisual or Kinesthetic Processing Problems

Autistic Spectrum Disorder - PDD, MSD, Autistic Spectrum Disorder - PDD, MSD, Globally Delayed, AutisticGlobally Delayed, Autistic

Related Conditions:Related Conditions:

Central Auditory Processing Disorder Central Auditory Processing Disorder (CAPD)(CAPD)

Sensory Integration DisorderSensory Integration Disorder Motor Planning DisorderMotor Planning Disorder Self Regulatory DisorderSelf Regulatory Disorder Dyslexia/Reading DisorderDyslexia/Reading Disorder Neurological Conditions: Epilepsy, Neurological Conditions: Epilepsy,

Tourette SyndromeTourette Syndrome

ImpactImpact of these of these conditions:conditions:

• neurologically based behavioral issue neurologically based behavioral issue keeping a child from developing keeping a child from developing normally normally

• lack of full coordination of gross and lack of full coordination of gross and fine motor skillsfine motor skills

• lack of complete age appropriate lack of complete age appropriate speech, language and communications , speech, language and communications ,

• impaired self-esteem.impaired self-esteem.

Our Goal Today Our Goal Today

To learn more about neurobiological To learn more about neurobiological conditionsconditions

To identify treatment approaches to To identify treatment approaches to these conditionsthese conditions

To identify ways to include children with To identify ways to include children with neurobiological conditions within typical neurobiological conditions within typical classroomsclassrooms

Attention Deficit Attention Deficit Hyperactivity DisorderHyperactivity Disorder

Inattention - Traditionally Inattention - Traditionally known as ADD known as ADD

Impulsivity - Traditionally Impulsivity - Traditionally known as Hyperactivityknown as Hyperactivity

Inattention - Inattention - DistractibilityDistractibility

doesn’t seem to listendoesn’t seem to listen fails to finish assigned tasksfails to finish assigned tasks often loses thingsoften loses things can’t concentratecan’t concentrate easily distractedeasily distracted daydreamsdaydreams requires frequent redirectionrequires frequent redirection can be very quiet and missedcan be very quiet and missed

Impulsivity Impulsivity Behavioral DisinhibitionBehavioral Disinhibition

rushing into thingsrushing into things careless errorscareless errors risk takingrisk taking taking darestaking dares accidents/injuriesaccidents/injuries impatienceimpatience interruptionsinterruptions

Hyperactivity - Hyperactivity - OverarousalOverarousal

restlessnessrestlessness ““can’t sit still”can’t sit still” talks excessivelytalks excessively fidgetingfidgeting ““always on the go”always on the go” easy arousaleasy arousal lots of body movementlots of body movement

ADHD ADHD CharacteristicsCharacteristics

InattentionInattentionImpulsivityImpulsivityOveractivityOveractivity

Different Names for ADHD Different Names for ADHD Through the years:Through the years:

1902 Defects in moral character1902 Defects in moral character 1934 Organically driven1934 Organically driven 1940 Minimal Brain Syndrome1940 Minimal Brain Syndrome 1957 Hyperkinetic Impulse Disorder1957 Hyperkinetic Impulse Disorder 1960 Minimal Brain Dysfunction (MBD)1960 Minimal Brain Dysfunction (MBD) 1968 Hyperkinetic Reaction of Childhood (DSM 1968 Hyperkinetic Reaction of Childhood (DSM

II)II) 1980 Attention Deficit Disorder - ADD (DSM 1980 Attention Deficit Disorder - ADD (DSM

III) with-hyperactivity without-hyperactivity III) with-hyperactivity without-hyperactivity residual typeresidual type

Names for ADHDNames for ADHD

1987 Attention-Deficit Hyperactivity Disorder 1987 Attention-Deficit Hyperactivity Disorder Undifferentiated Attention Deficit Disorder Undifferentiated Attention Deficit Disorder (DSM III-R) (DSM III-R)

1994 Attention-Deficit/Hyperactivity Disorder 1994 Attention-Deficit/Hyperactivity Disorder (DSM IV) (DSM IV) 314.01: ADHD, 314.01: ADHD, Combined Type Combined Type 314.00: ADHD, Predominantly Inattentive 314.00: ADHD, Predominantly Inattentive type 314.01: ADHD, Predominantly type 314.01: ADHD, Predominantly Hyperactive -Impulsive TypeHyperactive -Impulsive Type

TREATMENT OF ADHDTREATMENT OF ADHD

MEDICATING with STIMULANT MEDICATING with STIMULANT MEDICATIONS:MEDICATIONS:

RITALINRITALIN CYLERTCYLERT DEXEDRINEDEXEDRINE ADDERALLADDERALL

PlusPlus

Plus these interventions:Plus these interventions:

PARENT TEAMPARENT TEAM HOME MODIFICATIONSHOME MODIFICATIONS PARENT-TEACHER TEAM PARENT-TEACHER TEAM 504 PLAN MODIFICATIONS504 PLAN MODIFICATIONS CONSISTENCY OF PARENT - CONSISTENCY OF PARENT -

TEACHER - DOCTOR TEAMTEACHER - DOCTOR TEAM UNCONDITIONAL LOVE FROM ALL UNCONDITIONAL LOVE FROM ALL

ADULTSADULTS

Learning DisabilityLearning Disability

Definition: A learning disability is a Definition: A learning disability is a disorder that affects a person’s ability to disorder that affects a person’s ability to either interpret what is seen and heard or either interpret what is seen and heard or to link information from different parts of to link information from different parts of the brain. These limitations can show up in the brain. These limitations can show up in many ways - as specific difficulties with many ways - as specific difficulties with spoken and written language, coordination, spoken and written language, coordination, self-control, or attention. Such difficulties self-control, or attention. Such difficulties extend to school work and can impede extend to school work and can impede learning to read or write or do math.learning to read or write or do math.

Learning DisabilitiesLearning Disabilities

Neurological in originNeurological in origin impede person’s ability to store, impede person’s ability to store,

process or produce informationprocess or produce information affect ability to readaffect ability to read affect ability to speakaffect ability to speak affect ability to compute mathaffect ability to compute math impair socializationimpair socialization

LD Symptoms: LanguageLD Symptoms: Language

Pronunciation problemsPronunciation problems slow vocabulary growthslow vocabulary growth lack of interest in storieslack of interest in stories poor spellingpoor spelling delayed decodingdelayed decoding poor reading comprehensionpoor reading comprehension trouble following directionstrouble following directions lack of verbal participation in classlack of verbal participation in class

LD Symptoms: MemoryLD Symptoms: Memory

Trouble learning numbers, Trouble learning numbers, alphabet & days of the weekalphabet & days of the week

slow acquisition of new skillsslow acquisition of new skills poor memory for routinespoor memory for routines slow recall of factsslow recall of facts organizational problemsorganizational problems

LD Symptoms: AttentionLD Symptoms: Attention

Trouble sitting stillTrouble sitting still extreme restlessnessextreme restlessness impersistence at tasksimpersistence at tasks impulsivityimpulsivity inconsistencyinconsistency poor self-monitoring, insatiabilitypoor self-monitoring, insatiability great knowledge of triviagreat knowledge of trivia careless errorscareless errors

LD Symptoms: Fine Motor LD Symptoms: Fine Motor SkillsSkills

Trouble learning self-help skillsTrouble learning self-help skills clumsinessclumsiness reluctance to draw, trace or colorreluctance to draw, trace or color poor pencil grasppoor pencil grasp poor letter formationpoor letter formation fist-like or tight pencil graspfist-like or tight pencil grasp

Autistic Spectrum DisorderAutistic Spectrum Disorder

Symptom complex with different Symptom complex with different ideologiesideologies

Delays in understanding (RECEPTIVE) & Delays in understanding (RECEPTIVE) & use (EXPRESSIVE) of languageuse (EXPRESSIVE) of language

Unusual responses in sensory stimuliUnusual responses in sensory stimuli Resistance to change & insistence on Resistance to change & insistence on

routinesroutines Difficulties with typical social interactionsDifficulties with typical social interactions

Traditional Symptoms of Traditional Symptoms of AutismAutism

SOCIAL AND EMOTIONAL SOCIAL AND EMOTIONAL UNRELATEDNESSUNRELATEDNESS

INTOLERANCE TO CHANGE-RIGIDITYINTOLERANCE TO CHANGE-RIGIDITY STEREOTYPED BEHAVIOR-ROUTINES, STEREOTYPED BEHAVIOR-ROUTINES,

RITUALS, ATTACHMENT TO OBJECTSRITUALS, ATTACHMENT TO OBJECTS ABSENCE OR DELAY OF LANGUAGE OR ABSENCE OR DELAY OF LANGUAGE OR

COMMUNICATION SKILLSCOMMUNICATION SKILLS LACK OF EYE CONTACTLACK OF EYE CONTACT

Emerging Symptoms of Emerging Symptoms of AutismAutism

IMPAIRED SMALL MOTOR SKILLS, IMPAIRED SMALL MOTOR SKILLS, INCLUDING DYSPHASIA AND APRAXIAINCLUDING DYSPHASIA AND APRAXIA

IMPAIRED MOTOR PLANNINGIMPAIRED MOTOR PLANNING AUDITORY PROCESSING DISTURBANCEAUDITORY PROCESSING DISTURBANCE FLUCTUATING SENSORY FLUCTUATING SENSORY

DYSREGULATION BOTH HYPO AND DYSREGULATION BOTH HYPO AND HYPER, INCLUDING: HEARING, TASTE, HYPER, INCLUDING: HEARING, TASTE, SMELL, TOUCH, SENSE OF BALANCE, SMELL, TOUCH, SENSE OF BALANCE, SENSE OF POSITION IN SPACE, ETCSENSE OF POSITION IN SPACE, ETC. .

Emerging symptoms of Emerging symptoms of AutismAutism

GASTROINTESTINAL DYSFUNCTION-DIARRHEA, GAS, ETC.GASTROINTESTINAL DYSFUNCTION-DIARRHEA, GAS, ETC. EATING DISORDER - SEVERE DIETARY SELF-LIMITATION, EATING DISORDER - SEVERE DIETARY SELF-LIMITATION,

CHEWING, SWALLOWING PROBLEMSCHEWING, SWALLOWING PROBLEMS FOOD AND/OR ENVIRONMENTAL HYPERSENSITIVITY - FOOD AND/OR ENVIRONMENTAL HYPERSENSITIVITY -

ALLERGIES, BEHAVIORAL REACTION TO FOODS AND DIETARY ALLERGIES, BEHAVIORAL REACTION TO FOODS AND DIETARY AND ENVIRONMENTAL CHEMICALSAND ENVIRONMENTAL CHEMICALS

HYPERACTIVITYHYPERACTIVITY HYPOTONIA-LOW MUSCLE TONE, SOFT EARS, DOUBLE HYPOTONIA-LOW MUSCLE TONE, SOFT EARS, DOUBLE

JOINTED, UPPER BODY WEAKNESSJOINTED, UPPER BODY WEAKNESS SLEEP DISORDERSSLEEP DISORDERS

GARLIC V.S. ONIONGARLIC V.S. ONION

RULES OF THUMB:RULES OF THUMB: GARLIC’S ODOR OUTDOES ONION’S ODOR GARLIC’S ODOR OUTDOES ONION’S ODOR

SO TREAT GARLIC FIRSTSO TREAT GARLIC FIRST RULE OUT A GARLIC ISSUE AND TREAT IT RULE OUT A GARLIC ISSUE AND TREAT IT

PRIOR TO ADDRESSING THE ONION ISSUESPRIOR TO ADDRESSING THE ONION ISSUES LACK OF SUCCESS IN TREATING ONION MAY LACK OF SUCCESS IN TREATING ONION MAY

BE BECAUSE GARLIC WAS NOT IDENTIFIEDBE BECAUSE GARLIC WAS NOT IDENTIFIED ONGOING SETBACKS MAY BE DUE TO THE ONGOING SETBACKS MAY BE DUE TO THE

POWER OF THE GARLIC’S STRENGTH AND POWER OF THE GARLIC’S STRENGTH AND INCAPABILITY OF DE-POWERING ITINCAPABILITY OF DE-POWERING IT

Onion Rule Outs:Onion Rule Outs:

Seizure Disorder or other neurological Seizure Disorder or other neurological issueissue

Vision acuity problemVision acuity problem Hearing problemHearing problem Metabolic problemMetabolic problem Genetic problemGenetic problem Each other ADHD, SLD, ASDEach other ADHD, SLD, ASD Child Psychiatric ProblemChild Psychiatric Problem

1. Classroom 1. Classroom ModificationsModifications

Establish rules in classroomEstablish rules in classroom Reinforce rules in classroomReinforce rules in classroom Be consistentBe consistent Interact with student by: eye Interact with student by: eye

contact, call name, finger on desk, contact, call name, finger on desk, touchingtouching

Place student: in front, near positive Place student: in front, near positive peers, in low distracting areaspeers, in low distracting areas

2. Classroom 2. Classroom ModificationsModifications

Evaluate and structure environmentEvaluate and structure environment Reduce external visual and auditory Reduce external visual and auditory

stimulistimuli Repeat and have student paraphrase Repeat and have student paraphrase

directionsdirections Give short directionsGive short directions Use predetermined signalsUse predetermined signals Multiple modalitiesMultiple modalities

3. Classroom 3. Classroom ModificationsModifications

Natural and logical consequencesNatural and logical consequences Develop learning contracts with Develop learning contracts with

studentstudent Use environmental clues: prompts, Use environmental clues: prompts,

steps, written lists, schedulessteps, written lists, schedules Demonstrate acceptable ways to Demonstrate acceptable ways to

communicate displeasure, anger, communicate displeasure, anger, frustration and pleasurefrustration and pleasure

4. Classroom 4. Classroom ModificationsModifications

Earphones and study carrelsEarphones and study carrels Reduced AssignmentsReduced Assignments Longer time for testingLonger time for testing Read test to studentRead test to student Assignment books and organizersAssignment books and organizers Keep Notebook for parent teacher Keep Notebook for parent teacher

communications after each class daycommunications after each class day

5. Classroom 5. Classroom ModificationsModifications

Computer games and programsComputer games and programs Peer Buddy Tutors and HelpersPeer Buddy Tutors and Helpers Classroom Shadow, 1 on 1 AssistantClassroom Shadow, 1 on 1 Assistant Progress notes to parentsProgress notes to parents Quarterly conferences with parentsQuarterly conferences with parents Parents selection of teacher for next Parents selection of teacher for next

school yearschool year Medications monitoringMedications monitoring

What it takes for inclusion to What it takes for inclusion to workwork

Unconditional love of the childUnconditional love of the child Willingness to extend oneselfWillingness to extend oneself Openness to doing things differentlyOpenness to doing things differently Working with the parents as a teamWorking with the parents as a team Admitting when you are lostAdmitting when you are lost FlexibilityFlexibility Willingness to changeWillingness to change

What it takes for inclusion to What it takes for inclusion to workwork

Getting outside helpGetting outside help Openness to other’s inputOpenness to other’s input EnthusiasmEnthusiasm Optimism - “We Can” AttitudeOptimism - “We Can” Attitude Determination to make it workDetermination to make it work Commitment to the process and to Commitment to the process and to

the childthe child

Inclusion Works If You Inclusion Works If You Work at itWork at it

Serving Kids from A Serving Kids from A to Z !to Z !