ADDICTION

Official Definition
Addiction refers to a constant psychological and physiological need for a habit-forming thing; it is the condition of being
abnormally dependent on a substance of object. While historically this term has been paired with such things such a
nicotine or narcotics, more recently we see individuals with addictions to things such as video games, caffeine, the internet,
or sex. In Ontario, perhaps one the most widespread substances being abused among high school students are opioid drugs
used for pain management. These include oxycodone (Percocet, Percodan, OxyContin), codeine (ie. Tylenol 3) and
meperidine (ie. Demerol). As a result of their potential for abuse and dependence, these are classified as controlled
substances in Canada (Adlaf, 2010). Based the recent influx of non-medical usage of such substances in Ontario and WNY
secondary schools, opioid addiction is a relevant and harsh reality facing a secondary instructor. Professors from the
University of Toronto asked high school students the following question: “In the last 12 months, how often did you use pain
relief pills (such as Percocet, Percodan, Tylenol 3, Demerol, OxyContin, codeine) without a prescription or without a doctor
telling you to take them?” (Adlaf et al, 2010). The range was staggered, from 1-2 times, to over 40 times. In the end, over
20.6% of all student respondents reported having used such substances.
Opioid addiction is inextricably linked to discussions on ‘special education’ because it is an inevitable type of lens
from which students view their school life. Students addicted to opioids undoubtedly approach their daily rituals and
routines differently than the usual student. Additionally, with prolonged use these substances have the potential to alter a
student’s abilities and proclivities; these students will need some type of mediation or specific treatment administered from
a counselor or teacher.

Etiology (Causes)
Currently there are major questions pertaining to the causes of addiction in general. Primarily, the major questions concern
the relative roles of genetic and environmental factors. Typically, the illness begins with a conscious decision to use a
specific substance, or to partake in a specific activity. However, after prolonged and excessive use, changes in the brain
occur which turn the abuse into a ‘relapsing illness.’ Interestingly enough, individuals all handle, or are inflicted with
addiction in different ways. Some genetically predisposed individuals become ‘addicted’ almost immediately, with little to
no progression from abuse to dependency.
Typically, one of the most prominent risk factors for the development of addiction is having a family history of
addiction problems. Research suggests that the tendency to become alcoholic is inherited through genetic mutations. The
altered gene allows for exposure to addictive substances to ‘normalize’ the way that the brain works. This theoretically
leads to more frequent drug use. At the same time, it does seem that environmental influences (relationships, peer groups,
media consumed) play a significant role in the development of a drug dependency. Research suggests [quite logically] that
individuals who inherit genetic risk factors for addiction may be substantially more impacted by their environment.
Recent studies suggest that environment may have an increasingly important impact when discussing opioid
addiction among adolescents. Boyd, McCabe and Cranford report that between 1992 and 2002, opioid prescriptions
increased by 222%. (Boyd, McCabe, Cranford 2006). In addition, they found that abuse of such stimulants was directly
correlated to the number of prescription users in a students’ grade level. In a study of 13549 Canadian students, it is
reported that of the 7th, 9th, 10th, and 12th graders who were prescribed stimulants, 15% reported giving away medications.
7% reported selling their stimulant medications, 4.3% experienced theft, and 3% were forced to give someone their
medications. (Boyd, Mccabe, Cranford 2006). In their article Major Increases in opioid analgesic abuse in the United States:
concerns and strategies, Compton and Volkow theorize that such opioids are abused because of the influence of family and
social networks. Additionally in some areas they note that a ‘friendly sharing’ of such substances is commonplace.
Compton and Volkow believe that this leads to a false impression that self-treating is ‘normative and safe’ (Compton,
Volkow 2005). This false representation of prescription substances used by non-prescribed individuals inevitably lays the
foundations for substance abuse.

Characteristics
According to http://www.behavenet.com/capsules/disorders/subdep.htm (taking its information from DSM-IV and DSM-
IV-TR), characteristics of substance dependence area include:

1. Tolerance, as defined by either

a. A need for markedly increased amounts of the substance to achieve intoxication
b. Markedly diminished effect with continued use of the same amount of the substance

2. Withdrawal symptoms  the same (or closely related substance) must be taken to relieve symptoms such as mood
swings, anxiety, or dementia pertaining to a separation of self from the substance.
3. There is a persistent, vocal desire or effort to cut down or control substance us (this is often unsuccessful).
4. A great deal of time is spent in activities necessary to obtain the substance (visiting multiple doctors or driving long
distances, skipping class, spending time in conspicuous areas) or recovering from its effects (lack of attention, lack
of focus, lack of personal drive or initiative).
5. Social, occupation, or recreational activities are given up or reduced based on the substance use.

Instructional Strategies
The hardest part of determining instructional strategies for addicts is that typically addicts do not know if they are out of
control. The most basic form of instruction for individuals suffering addiction is to ‘intervene.’ An intervention assists an
addict in recognizing the extent of their problem. The instructor must be non-judgmental, non-critical, and open to failure. The
goal of an intervention is to bring the user to accept the reality of their addiction, and to recognize that they may need help.
Interventions can occur in a broad scope; they can range from simple discussions on the user’s dependency, to a full
scale confrontation along with the users family, peers, or mediators. Besides interventions, as a strategy teachers could lead
the student to a number of community resources available for their addiction. Additionally, teachers could converse with
students about their addiction, and ask questions which may help the student realize their problem, or allow the teacher to
get a better grasp on the student’s difficulty.
Adlaf et al. note that parents, teachers, and other adults need to be aware that adolescents frequently misuse opioid
medications (Adlaf et al. 2010). To recognize this is to pick up on language used, and dispositions displayed by the students
we will come into contact with. As instructors, we should pay attention to what students talk about, or how students act on
a day-to-day basis. At a Niagara Catholic secondary school, an instructor was made privy to news of a student abusing such
substances by the students’ peers within a classroom. Additionally, another instructor caught a student who was
distributing such substances simply by walking in to a conversation at the right time.
Although these students may not qualify for IEP’s or 504’s, students addicted to opioids can be subject to specific
counseling or intervention response teams. Often such students need to be made aware that their usage of and reliance on
prescription substances is not ‘recreational’ but can have adverse consequences on personal health, social awareness or
family life. Part of the issue is that these substances can be consumed so casually; counseling could put substance abuse into
a new perspective for a student, and reveal to the student some consequences of using that specific substance. This extends
to the domain of the students’ household in the sense that parents and social environment have a huge impact with regards
to how students view such substances. Considering that students inevitable take prescription opioids from their parents or
peers, parents must play a clear role in dispelling any dispositions towards the use of such substances.
Perhaps the simplest, most casual instructional strategy is opening ones own classroom to a discussion pertaining
to the uses and abuses of prescription medication. In such an atmosphere, students can reveal their thoughts and anxieties
pertaining to such substances, this could ultimately create a more open environment in which students feel comfortable
sharing their own experiences with the class, or in which students feel comfortable informing the teacher of any concerns
they may have with a classmate or peer.

Assistive Technology
With regards to assistive technology, the only real ones that could be brought into the classroom are things as simple as
calling on the student when facilitating classroom discussion. The has the potential to keep the student’s mind off of
whatever they may be dependent on, and give them an alternate focus. Part of the issue with addiction is that the user’s
mind is so preoccupied with the substance or object. To get the student thinking about something else, regardless of what
the topic may be, may have a positive psychological impact on an addict.

Community Resources
Centre for Addiction and Mental Health – http://www.camh.net

Based out of Toronto, the CAMH provides services to recovering addicts, as well as those wishing to learn more about
disorders pertaining to addiction and mental health. Additionally contains a number which individuals in distress can call.

Ontario Drug Rehabilitation - http://www.drug-rehab.ca/ontario.html

Recently ODR has pushed towards prescription drug addicts. Besides keeping individuals up to date with recent news and
statistics pertaining to prescription drug abuse, ODR also has a specific hotline designed to assist students who may find
themselves addicted to prescription drugs.

Media
http://www.youtube.com/watch?v=LF1OC6a1wp8 – Interview: Teens and Prescription Pulls

This is an incredibly important interview in terms of substance abuse among high school students. In it, a high
school senior discusses his own trials with prescription pills, as well as the struggles of his friends. The student, Luke
Wolske discusses important issues such as how students attain prescription pills, the ‘lifestyle’ surrounding such items, as
well as the motives behind doing these substances. Beyond this, Wolske gives insight into his own experiences starting with
drugs, progressing through different types of substances, and eventually dropping them altogether.

This is incredibly relevant in the sense that it is the first hand account of a high school student who was once deep
in the throes of addiction to prescription pills as well as harder drugs. Students can undoubtedly see some of their peers in
Wolske; every school has a student or a group of students who have taken such chances with illicit substances, and
eventually either done irreparable damage, or dramatically changed their lives to give them a higher standard of living.
Based on the Wolske’s account, students will be given an incredibly graphic insight into the world of opioid, as well as other
prescription users. Based on his account, students will be faced with the harsh reality pertaining to prescription drug use in
secondary schools. Although it may not be to this extent in other high schools, the insights offered can be appreciated by a
broad range of students, teachers and individuals in general.
 ANOREXIA
Official Definition
Anorexia nervosa, commonly referred to simply as anorexia, is one type of eating disorder. More importantly, it is also a
psychological disorder. Anorexia is a condition that goes beyond out-of-control dieting. A person with anorexia often
initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery and control. The drive to become
thinner is actually secondary to concerns about control and/or fears relating to one's body. The individual continues the
endless cycle of restrictive eating, often accompanied by other behaviors such as excessive exercising or the overuse of diet
pills, diuretics, laxatives, and/or enemas in order to reduce body weight, often to a point close to starvation in order to feel a
sense of control over his or her body. This cycle becomes an obsession and, in this way, is similar to any type of addiction.

Etiology (Causes)
Approximately 95% of those affected by anorexia are female, but males can develop the disorder as well. While anorexia
typically begins to manifest itself during early adolescence, it is also seen in young children and adults. In the U.S. and other
countries with high economic status, it is estimated that about one out of every 100 adolescent girls has the disorder.
Caucasians are more often affected than people of other racial backgrounds, and anorexia is more common in middle and
upper socioeconomic groups. According to the U.S. National Institute of Mental Health (NIMH), an estimated 0.5%-3.7% of
women will suffer from this disorder at some point in their lives.

Many experts consider people for whom thinness is especially desirable, or a professional requirement (such as athletes,
models, dancers, and actors), to be at risk for eating disorders such as anorexia nervosa.

Characteristics
This is a list of the many and varied signs of anorexia in teens. One of the essential signs of the disease is that the person
restricts what he or she eats, to the point where weight loss occurs. Here are some other signs:

- Refusing to maintain a normal and healthy body weight.

- Extreme fear of becoming fat or gaining weight.
- Continuous dieting.
- Excessive and compulsive exercising.
- Being obsessed with diets, calories, nutritional information, fat grams, etc.
- Being very restrictive of what he or she will eat (no carbohydrates, no fat, etc.)
- Avoiding food and eating or denying hunger.
- Developing rituals regarding food (eating food in a certain order, excessive chewing, etc.

Symptoms of the disease include the physical consequences of not eating enough calories or nutrients. These symptoms
include:

- Amenorrhea. The anorexic never gets her first period or her periods stop or become less frequent
- Muscle weakness and loss of muscle
- Bones that become brittle and osteoporosis develops
- Skin that becomes dry and hair can fall out
- A fine layer of hair grows over the body
- Weakness and tiredness
- Fainting
- Irritability, depression, withdrawal from friends and family
- Low blood pressure or low pulse

Instructional Strategies
One of the other things to be aware of is that there are people with certain personality types that might be prone to
developing anorexia. The anorexic might be a hard-driving perfectionist that gets good grades and excels in her after school
activities. She probably also has low self-esteem and has a need to control the people and things around her. These
personality traits might be obvious or they might be subtle, but they can point towards a tendency to anorexia.

Bottom Line: Don’t turn a blind eye on your students. Don’t be afraid to ask them if something’s wrong or to offer them
help.

Community Resources
ANAD: National Association of Anorexia Nervosa & Associated Disorders!www.anad.org
For ED professionals; promotes effective treatment, develops prevention initiatives, stimulates research, sponsors
international conference.

AED: Academy for Eating Disorders!www.aedweb.org

Distributes listing of therapists, hospitals, and informative materials; sponsors support groups, conferences,
advocacy campaigns, research, and a crisis hotline.

Eating Disorders Coalition for Research, Policy and Action!www.eatingdisorderscoalition.org

Our mission is to advance the federal recognition of eating disorders as a public health priority.
 IAEDP: International Association of Eating Disorders Professionals!www.iaedp.com
A membership organization for professionals; provides certification, education, local chapters, a newsletter, and an
annual symposium.

NEDA: National Eating Disorders Association!www.nationaleatingdisorders.org

The National Eating Disorders Association (NEDA) is the largest not-for-profit organization in the United States
working to prevent eating disorders and provide treatment referrals to those suffering from anorexia, bulimia and
binge eating disorder and those concerned with body image and weight issues.

Andrea's Voice
Andrea's Voice is intended to offer information and support

BodyImageHealth.org
Designed to promote healthy body image attitudes and prevent eating and weight concerns before they start.

Media
http://www.youtube.com/watch?v=RLYbSghCtXg
 ATTENTION DEFICIT DISORDER (ADD)
Official Definition
Attention deficit disorder (ADD) is a syndrome characterized by serious and persistent difficulties in the following three
specific areas:

1. Attention span.
2. Impulse control.
3. Hyperactivity (sometimes).

ADHD is a chronic disorder that can begin in infancy and extend through adulthood having negative effects on a
child's life at home, school, and within the community. It is conservatively estimated that 3 to 5 percent of our school-age
population is affected by ADHD.

Etiology (Causes)

Even though the exact cause of ADD remains unknown, research shows that it is a neurologically based medical problem.
There is no one "test" for determining if a person has this disorder. An accurate diagnosis requires an assessment conducted
by a well-trained professional usually a developmental pediatrician, child psychologist, child psychiatrist, or pediatric

Characteristics
ADD affects all areas of a child’s life: family, school, friends, sports teams and work.
The following are some characteristics of people with ADD:

• aggressive or violent behaviour: often, the feelings of failure can result in aggressive or violent behaviour at home
or in other settings
• withdrawal, anxiety and depression: a child may turn inward and try to isolate him/herself from the rest of the work, or
he/she may become anxious and depressed.
• low self-esteem: if the child has been unable to have positive experiences because of ADD or ADHD, he/she will likely have
trouble developing a healthy self-esteem.
• physical symptoms: a child with ADD at times may bury his/her feelings so deeply that they will come out in the form of
headaches, stomach or back aches, or pains in the hands or legs.

Due to the fact that ADD is very hard to diagnose, some people may be confused about the child's social behaviour. A
teacher may not investigate difficult or disruptive behaviour because he / she cannot see the underlying attention problems.
There are a couple of ways a child may try to mask his/her difficulty in the classroom or in a peer group are by:

• becoming the "class clown" or the "class bully"

• avoiding or refusing to become involved in activities where he/she is unsure of success.

Instructional Strategies
Adapt Curriculum and Instruction

• Provide more direct instruction and as much one-on-one instruction as possible

• Use guided instruction
• Teach and practice organization and study skills in every subject area
• Lecture less
• Design lessons so that students have to actively respond-get up, move around, go to the board, move in their seats
• Design highly motivating and enriching curriculum with ample opportunity for hands-on activities and movement
• Eliminate repetition from tasks or use more novel ways to practice
• Design tasks of low to moderate frustration levels
• Use computers in instruction
• Challenge but do not overwhelm
• Change evaluation methods to suit the child's learning styles and strengths

The following website provides some ideas for lesson plans:

http://www.lessontutor.com/ltlist.html

Assistive Technology
Assistive technology would have to be done on an individual basis; some children with ADD focus better when they can use
a laptop to do their work. Some however get too distracted on the computer because it is too busy and/or there is too much
information.
Some alternate options are things such as squishy seats or stress balls to help them sit still etc. Children whose fine
motor skills are poor also benefit from technology when writing out work.
Community Resources
Attention Deficit Disorder Association (ADDA). This website more specifically provides fact sheets, finding help and
support, and other resources available to families and teachers.

http://www.add.org/mc/page.do;jsessionid=9F1919B2F35AD356433B69BB90B1539D.mc0?sitePageId=92488

A second site which is extremely beneficial deals with helping children with ADD keep up with school expectations. It is
called “Time 4 Learning” and is an interactive student paced learning tool for teaching a child with ADD/ADHD.

http://www.time4learning.com/ADD.shtml

Media
This is an authentic video because the person speaking, (Michael Sandler) has attention deficit disorder. He speaks about his
personal experiences and how it was like for him as a teenager. He offers advice on how to concentrate, do homework, etc..
This short clip offers valid information, which is provided by someone who can best relate to people/children who have
ADD http://www.youtube.com/watch?v=ghBg44kel7o
 ADHD (Attention Deficit Hyperactivity Disorder)
Official Definition
Attention-Deficit/Hyperactivity Disorder (AD/HD) is a neurobiological disorder. Typically children with AD/HD have
developmentally inappropriate behavior, including poor attention skills, impulsivity, and hyperactivity. These
characteristics arise in early childhood, typically before age 7, are chronic, and last at least 6 months. Children with AD/HD
may also experience problems in the areas of social skills and self esteem.

Etiology (Causes)
The causes of ADHD are often debated among pediatricians, psychologists, and educational experts. Some people suggest
that alcohol and tobacco usage when pregnant may increase the likelihood of the condition but this and other biological
factors are debated and in many instances, the data is inconclusive. Current research may indicate that genetics may play an
important role, but much more research is needed to strengthen the argument. Despite common conceptions that television,
excessive sugar intake, and video games increase ADHD, the research does not suggest that these are primary causes. In
summary, ADHD seems to be caused by a various chemicals present in the pregnant mother and some genetic conditions.
Hopefully future research will uncover more causes that help doctors identify and reduce potential triggers for this
condition.

Characteristics
The primary symptoms of AD/HD are developmentally inappropriate levels of attention. These behaviours can manifest
themselves in home, school, peer networks, and other social relationships. The term ADHD is very wide "umbrella" that
covers many varying degrees of attention, hyperactivity, and impulsivity. Children with ADHD will exhibit a wide range of
behaviours within this spectrum. Some may tend to be more under-active than hyper, while others will be overly impulsive.
The three major subtypes of ADHD are 1. Predominantly inattentive type, 2. Predominantly hyperactive-impulsive, and 3.
Combined (inattentive, hyperactive, impulsive

Instructional Strategies
How does a student with ADHD differ from students without ADHD?
Students without ADHD are sometimes also difficult to motivate, but are less likely to exhibit the extremes found
in students with ADHD.

Students with ADHD may simply block out key instructions because of external or internal stimuli, whereas
students without ADHD may actually hear or see the instructions but simply chose not to internalize them.

Students with ADHD may simply remove themselves from assignments and activities because they seem to
complicated.

To summarize: It is often difficult to separate students with ADHD from students without ADHD because there are many
factors that motivate a student to perform. We need to be careful when assessing students for this condition.

Characteristics and typical classroom observations:

• Inability to focus on the details of a task.
• Production of very messy or hurried assignments/activities.
• Easily distracted by random and seemingly irrelevant stimuli.
• Frequently abandoning one activity to begin another.
• Frequent shifts in conversations with students situated near or far from the student
• Inability to sustain focus during classroom tasks and assignments compared to other students at similar age
• Impatience and inability to wait for one's turn in activities
• Excessive physical movement when it is not appropriate
• Inability to demonstrate appropriate interpersonal communication norms
Teaching students with ADHD requires us to change some components of our lessons in order to accommodate their unique
needs and abilities.

Instructional Strategies can be broken down into the following key instructional strategies involving academic
instruction, behavioral interventions, and classroom activities.

Assistive Technology
For students with ADHD, assistive technology could play a vital role. Here a few examples of how software and hardware
could assist students with ADHD:
• Software that helps students organize homework and assignments
• Software that creates graphic organizers so students can organize course information
• Software that reminds students of good study habits
• Hardware that engages the student by allowing them to interact with it (SmartBoard)
• Hardware that allows the student to participate in class discussions in a structured way (computers
enabled with audio/visual capabilities)
• Hardware that enables the student to not feel overwhelmed by conflicting images (simplified version of
Windows running on a basic computer)
Community Resources
National Level:
http://www.help4adhd.org/ (comprehensive website)
http://www.cec.sped.org/ (great resources)
http://www.chadd.org/ (detailed links)
http://w3.addresources.org/ (resources listings)
http://school.familyeducation.com/learning-disabilities/add-and-adhd/34474.html (resources listing)
http://www.cdc.gov/ncbddd/ADHD/ (national level information)
http://www.adhdnews.com/states.htm (listings of resources by state)

Local Level:
http://ccf.buffalo.edu/resources_downloads.php (University at Buffalo)
http://www.nfschools.net/105610530171449317/site/default.asp (Niagara Falls City School District)
http://www.medicinenet.com/adhd_in_adults/buffalo-ny_city.htm (Psychologist at Niagara Falls Memorial
Medical Center)
http://organizedwisdom.com/Dr._Parmanand_K._Parikh,_ENT,_Niagara_Falls,_NY (Psychologist in Niagara
Falls, NY)

Media
The following video contains a good overview of the challenges associated with ADHD., I selected this video because it
contains a brief yet very accurate portrayal of a student who faces challenges because of his ADHD. He reminds me of
several students that I have observed that have similar challenges with remaining attentive in class and the problems that
that inattentive behavior causes.

The following is a rather comprehensive video on the treatment, management and

understanding of ADHD - UC Davis Lecture - Dr. Russell Barkley. http://www.youtube.com/watch?v=q3d1SwUXMc0I
chose this video because it contains a very comprehensive analysis of the overall condition of students with ADHD. At
almost eighty minutes in length it provides a detailed description of what we know about ADHD and how it impacts
learning and overall development.
 APRAXIA
Official Definition
The DSM –IV does not have a specific definition for apraxia. It does not list a particular definition, but apraxia can fall under
the category of a neurological disorder (problems with the brain) and a communication disorder (lack of ability to
communicate efficiently).

According to the medical dictionary (2010), apraxia is defined as a neurological condition characterized by loss of
the ability to perform activities that a person is physically able and willing to do. Apraxia is caused by damage done to the
brain that are correlated to conditions like head injuries, brain tumor, strokes, and even Alzheimer’s disease; damage done
by these particular conditions affects a person’s brain to properly give signals to the rest of their body.

According to author of the medical website Learning Disabilities, Ann Logsdon describes apraxia as a
“neurological disorder affecting the ability to control fine and gross movement and gestures. The disorder can also affect
communication skills. Apraxia can range from mild to severe. People with apraxia often cannot perform controlled,
purposeful movement, despite having the physical strength and intellectual thought and desire to do so. Apraxia is believed
to stem from disorders in the parietal lobes of the brain.” (Logsdon, 2010)

Etiology (Causes)
Apraxia is caused by particular conditions that affect particular parts of the brain which have a high control over our
movements. Apraxia is a result when damage occurs to the brains cerebral hemispheres.

According to Medical Dictionary (2010), these are the two halves of the cerebrum and are
the location of the brain activities such as voluntary movements. Apraxia causes a lapse in
carrying out movements that a person knows how to do, is physically able to perform, and
wants to do. A person may be willing and able to do something like bathe. However, the
brain does not send the signals that allow the person to perform the necessary sequence of
activities to do this correctly.

There are many types of apraxia an adult or child could be diagnosed with one of these
conditions.
The types of apraxia are:

Buccofacial or Orofacial Apraxia

This is when a person has a lack of ability to follow certain commands with lip and face movements such as
coughing, licking the lips, whistling, and winking. This is also known as facial-oral apraxia.

Limb-kinetic Apraxia
This is when a person does not have the ability to make precise movements with their arm(s) or leg(s).

Ideomotor Apraxia
This is when a person does not have the ability to perform movements in correlation to a certain verbal command.

Contructional Apraxia
This is when a person does not have the ability to copy, draw, or build simple figures.

Ideational Apraxia
This is when a person cannot perform a series of movements in a sequence such a having trouble getting dressed,
eating, or bathing.

Oculomotor Apraxia
This is when a person has difficulty moving their eyes.

Verbal Apraxia
This is when a person has difficulty coordinating their mouth and speech movements.

Characteristics
According to the National Institute of Deafness and Other Communication Disorders, “People with either a form of apraxia
of speech may have a number of different speech characteristics, or symptoms. One of the most notable symptoms is
difficulty putting sounds and syllables together in the correct order to form words. Longer or more complex words are
usually harder to say than shorter or simpler words. People with apraxia of speech also tend to make inconsistent mistakes
when speaking. For example, they may say a difficult word correctly but then have trouble repeating it, or they may be able
to say a particular sound one day and have trouble with the same sound the next day. People with apraxia of speech often
appear to be groping for the right sound or word, and may try saying a word several times before they say it correctly.
Another common characteristic of apraxia of speech is the incorrect use of prosody, that is, the varying rhythms, stresses,
and inflections of speech that are used to help express meaning.”

According to the National Institute of Deafness and Other Communication Disorders, “The severity of both
acquired and developmental apraxia of speech varies from person to person. Apraxia can be so mild that a person has
trouble with very few speech sounds or only has occasional problems pronouncing words with many syllables. In the most
severe cases, a person may not be able to communicate effectively with speech, and may need the help of alternative or
additional communication methods.”

Law and Education

There are many questions pertaining educational placements for children with apraxia. There is not right classroom
for children with apraxia. There a various resources that gives information about special education rights under federal law.
An excellent resource would be Apraxia –KIDS, which helps locate the best source of information to inform parents on
special education and federal law. The website apraaxia-KIDS state that, “In order to receive preschool or school age special
education services, the school district or designated appropriate agency has to evaluate your child in all areas of suspected
disabilities. If a child has been enrolled in a birth to three early intervention program, the planning for transition to
preschool should occur prior to the child’s third birthday. The school system will gather past and current information and
will then, with your signed consent, create an evaluation plan to fully evaluate your child.” (2010)

After an evaluation has occurred, there is a meeting to review the findings and a number of aspects are taken into
consideration, such as present level of functioning, steps of achieving goals, etc. When the steps have all been taken, an IEP
team discusses the students classroom placement; stated by the website apraxia-KIDS, “However, the legal order of these
steps may not occur and IEP teams may leap straight to determining a classroom placement and THEN ‘backward reason’
the needs, goals and services the child can have based on the placement.” (2010) The purpose of special education is to met a
child’s individual educational needs.

Instructional Strategies
All support strategies should be implemented under the guidance of a speech and language therapist. Therapy may include:

• speech-sound activities
• exercises to improve planning, sequencing and coordination of motor movements for speech production
• using rhythm and music to help develop sound combinations
• modelling motor movements used to produce specific sounds and words
• encouraging self-monitoring of speech production.

Assistive Technology
Some children respond well to multi-sensory therapy, including touch-cue system (PROMPT), customized speech/music
and occupational therapy. Also, for the parents they should check with the child's doctor about considering teaching the
child sign language or picture communication systems or assistive technology communication aids for very severe apraxia.
According to author of the medical website Learning Disabilities, Ann Logsdon describes apraxia some of the right
assistive technology for special education students:

• Low-tech devices - are non-electronic and have no complex parts. Some examples include pencil grippers and
picture communication systems.

• Medium-tech devices - include mechanical and electronic devices with moving parts that usually perform one
function. This includes items such as switch toys and calculators.

• High-tech devices - have complex electronics and computer components and have multiple uses and applications

Community Resources
http://www.nidcd.nih.gov/directory/: The National Institute on Deafness and Other Communication Disorders (NIDCD)
is one of the Institutes that comprise the National Institutes of Health (NIH). NIH is the Federal government's focal point for
the support of biomedical research. NIH's mission is to uncover new knowledge that will lead to better health for everyone.

Media
Below are two videos that describe what apraxia is. This first video is a news special discussing the effects of
apraxia on children and what this disability is all about, and the second video is a documentary about children with
apraxia and its effects and what can be done to better their disability:

http://www.youtube.com/watch?v=QKGGMfngRa4

http://www.youtube.com/watch?v=XNB0ihI2srQ
 ASPERGER SYNDROME
Official Definition
An autistic disorder most notable for the often great discrepancy between the intellectual and social abilities of those who
have it. Asperger syndrome is a pervasive developmental disorder that is characterized by an inability to understand how
to interact socially. Typical features of the syndrome also may include clumsy and uncoordinated motor movements, social
impairment with extreme egocentricity, limited interests and unusual preoccupations, repetitive routines or rituals, speech
and language peculiarities, and non-verbal communication problems.

Etiology (Causes)
The exact causes of Asperger’s syndrome are unknown, although Asperger’s research has identified several predisposing
factors. Sometimes referred to as high functioning autism, Asperger’s syndrome is one of the “milder” autism spectrum
disorders. Autism spectrum disorders (ASD) such as classic autism and childhood disintegrative disorder produce
symptoms that are more severe than Asperger’s symptoms.
Asperger’s symptom severity varies widely from individual to individual, and like other autism spectrum disorders,
Asperger’s is a lifelong condition

Characteristics
Some characteristics of Asperger’s syndrome are the following:

• Difficulty with Reciprocal Social Interactions

• Impairments in Language Skills
• Narrow Range of Interests and Insistence on Set Routines
• Motor Clumsiness
• Cognitive Issues
• Sensory Sensitivities

For more information on each see: http://school.familyeducation.com/learning-disabilities/behavior/56315.html

Instructional Strategies
Each case of asperger syndrome is different so there is no one specific strategy to teach the student. As each case of asperger
syndrome is different so is each strategies, the most notable strategies are keeping the student in small group activities or in
places with very few people in the room so they are able to keep on task. This is helpful because most students will find a
group or social setting to be very overwhelming, thus knocking them off task.

Assistive Technology
Assistive technologies would be allowing the student to do their work in a room with few people, creating an atmosphere
that isn’t cluttered or too busy as this may make the student feel overwhelmed.

Students with Asperger's Syndrome typically exhibit strengths in their visual processing skills, with significant weaknesses
in their ability to process information auditorily. Therefore use of visual methods of teaching, as well as visual support
strategies, should always be incorporated to help the child with Asperger's Syndrome better understand his/her
environment.

Community Resources
http://aspergers.meetup.com/cities/us/ny/buffalo/

The above website is the only community resource I found that I think is worthwhile this is more of a support group rather
than an actual resource this is a group where people in the area can meet up online and discuss the syndrome or potentially
even meet up with each other.

Media
http://www.youtube.com/watch?v=2sd5O5uM7Q0

This is a clip showing a mother speaking about her child with asperger syndrome.

http://www.youtube.com/watch?v=vg2IpyoCZQc

This one is a clip of an Australian man who is dealing with asperger syndrome you can notice that he never makes direct eye
contact with the camera, this is one of the symptoms of asperger syndrome. It is also noticed that he speaks in bursts, the
whole of the video is basically one big burst another symptom of asperger syndrome in this case it is showing social
awkwardness.
 BELL’S PALSY
Official Definition
Bell’s palsy is one of the most common types of facial paralysis that occurs temporarily when at least one of the two facial
nerves that control the muscles of the face, are damaged, inflamed, or swollen. Scientists believe that Bell’s palsy is caused
by viral meningitis or the “common cold sore virus”. Although Bell’s palsy most commonly affects one side of the face, in
rare cases it may affect both sides. Once an individual has been diagnosed with Bell’s palsy they are at higher risk for
obtaining this disorder again in the future.
This disorder is most common in individuals between the ages of 15-60 and affects approximately 40,000
Americans per year. (www.ninds.nih.gov). Typically, IDEA provides services for students with disabilities and
exceptionalities such as accommodations in the classroom and other services to provide these students with a free and equal
education as normal children. As a result, plans are created such as IEP’s and 504 plans. These plans provide the proper
tools and resources needed to receive an adequate education and they prevent the students from being excluded in their
right to a free and public education that is federally funded. For a student with Bell’s palsy, a 504 plan can be created that
addresses the needs and accommodations that student will need during the time they are infected with this disorder. An IEP
would not be necessary for a student with Bell’s palsy because their right to education would not be affected. They can
perform normally within a normal classroom with the proper accommodations. Also, their disorder is typically temporary
which differs from a student with a long-term or permanent disability.

Etiology (Causes)
The main cause of Bell’s palsy is an inflamed, swollen, or damaged facial nerve however, what directly causes these
disturbances in the nerves, is unknown. It is thought that the nerves are affected when an individual is infected with viral
meningitis or the “common cold sore virus”. Bell’s palsy has also been associated with flu-like illnesses, headaches, chronic
middle-ear infections, high blood pressure, diabetes, tumors, Lyme disease, skull fractures, or facial injuries. Every
individual is affected differently; this disorder ranges from severe to mild paralysis, to totally paralysis.
There is no treatment for this disorder, only prevention from the viruses that are thought to cause Bell’s palsy.
Bell’s palsy patients may usually recover on their own, within a few months, and others may suffer permanent paralysis.

Characteristics
Symptoms of Bell’s palsy are usually seen within 48 hours. Since the facial nerves control the major functions of the face,
many problems occur when diagnosed with Bell’s palsy. Characteristics include: twitching, weakness in the facial muscles,
drooping of the eyelid or corner of the mouth, drooling, dryness of the eye or mouth, impairments in taste and sight,
unusual tastes in mouth, excessive tearing in one eye, impaired speech, dizziness, difficulty eating and/or drinking, and
ringing in one or both ears. Other symptoms such as pain in or around the ear and sensitivity to sound may affect some
individuals.

Instructional Strategies
Students affected by Bell’s palsy may require accommodations to facilitate their learning in the classroom. These
accommodations might include:

• Giving the student extra time in class to take an exam or complete an assignment since their vision may be
impaired.
• Clearly stating assignments and expectations.
• Repeating aloud what is written on lecture notes and the white board.
• Allowing the students to use tape recorders to tape the lectures so they are able to go back to the recorder and listen
for something they might have missed in class due to impairments in hearing.
• Teaming the student up with another classmate so they can clarify notes and ask questions about the class.

Assistive Technology
There are few assistive technologies that are specifically for students with Bell’s palsy however, audio and visual devices
that will assist the student to see and hear better would be beneficial in the classroom until the student has recovered from
this disorder.

Community Resources
Children’s Craniofacial Association is an organization that aims to help families improve the quality of life for individuals
who suffer from facial disorders, permanently or temporarily. They provide physical, emotional, financial and medical
information about craniofacial disorders and encourage families to visit their website to gain information about a disorder
and network with other families.
Children’s Craniofacial Association
13140 Coit Road
Suite 517
Dallas, TX 75240
Toll-Free: 800.535.3643
Phone: 214.570.9099
Fax: 214.570.8811
E-mail CCA at: contactCCA@ccakids.com
http://www.ccakids.com/ct.asp
Institute of Neurological Disorders and Stroke http://www.ninds.nih.gov/disorders/bells/detail_bells.htm

Media
The following clips are documented by an 18-year-old girl named Breanna. She was diagnosed with Bell’s palsy her senior
year of high school. She shares four videos with us describing her five months with Bell’s palsy.

Clip 1 (week 8): In this clip, Breanna shares with us the characteristics she has with her Bell’s palsy.

http://www.youtube.com/watch?v=kpCTa-EP_E0

Clip 2 (week 9): In this clip, Breanna explains the treatments she has tried to help cure her Bell’s palsy. She also
describes the differences in her facial expressions and emotional expressions.

http://www.youtube.com/watch?v=sRZd_FG4-No&feature=related

Clip 3: In the third clip, Breanna talks further about treatments she has tried that have been successful and no so
successful. She shares her experience of having Bell’s palsy in high school during her senior year.

http://www.youtube.com/watch?v=Y7rKXc-9jfY&feature=related

Clip #4 (5 months): In this last clip, Breanna has shown significant improvements in her bell’s palsy.

http://www.youtube.com/watch?v=0ysNrQBOJiU&feature=related
 BLINDNESS
Official Definition
Blindness is defined as the loss of perception of light. It can either be a problem with a person's eyes directly
(physiological), or a problem with the way visual information is processed by the brain (neurological). Also,
blindness is not always classified by a person being completely blind, as visual impairment can occur at differing
levels of severity.

Etiology (Causes)
Blindness can be caused by disease, genetic defects, and injury.

Characteristics
Visual impairments tend to be more perceptive with their other four senses. This is an automatic coping mechanism the
human body develops for those with any type of sensory impairment

Instructional Strategies
Teachers will be faced with students coping with different types of visual impairment, but there are a few general strategies
that can be followed in order to accommodate for these students. A good way to communicate with people who are blind is
to be very descriptive, not only about what is being taught, but also about the classroom environment, and any visual cues
that they are missing out on. Also, it is good to allow the student to ask questions at any time, without making them feel
centered-out

Assistive Technology
There are several assistive technologies available for those with visual impairment
• if the student is only partially (but legally) blind, both Apple and Windows computers have voice-over
technology built in, that will dictate anything that is happening on the computer
• computers are able to adjust the size of anything appearing on the screen, which can also be assistive to
those with partial blindness
• there is also a program known as MacSpeech Dictate, which allows voice control of a computer, and serves
as an alternate to typing
• Braille technology is a great adaptation of traditional text on a computer, and can be anything from a
Braille embossing machine, to a Braille computer monitor. www.afb.org

Community Resources
The American Foundation for the Blind is a great resource for those who are blind, as well as the friends and family around
them. The website is full of information and assistive technology guides. There is a section on the website committed to
relaying any pertinent news about blindess. They are a non-profit organization committed to improving the lives of blind
people and their families and the foundation strives to answer any possible questions blind people (and their families) may
have, while referring them to assistive technology and other associations to aid them

Media
This video is great because it puts any viewer in the shoes of a person who is blind. It leaves them no choice but to
experience what blind people experience every day, in the absence of assistance.

http://www.youtube.com/watch?v=5h8Y7XsZyPk
 BODY DYSMORPHIC DISORDER, specifically MUSCULAR DYSMORPHIA

Official Definition
The DSM-IV does not have a definition for Muscular Dysmorphia in particular. It lists a definition for Body Dysmorphic
Disorder (BDD) which it describes as a condition marked by excessive preoccupation with an imaginary or minor defect in a
facial feature or localized part of the body.

The Encyclopedia of Mental Disorders suggests that since the publication of DSM-IV in 1994, some psychiatrists have
suggested that a subtype of BDD exists, which they term Muscle Dysmorphia. Muscle Dysmorphia is marked by excessive
concern with one's muscularity and/or fitness. BDD and Muscle Dysmorphia can both be described as disorders resulting
from the patient's distorted body image. Body image refers to the mental picture individuals have of their outward
appearance, including size, shape, and form. It has two major components: how the people perceive their physical
appearance, and how they feel about their body.

Etiology (Causes)
The causes of BDD fall into two major categories, neurobiological and psychosocial.
• NEUROBIOLOGICAL CAUSES. Research indicates that patients diagnosed with BDD have serotonin levels that
are lower than normal. Serotonin is a neurotransmitter— a chemical produced by the brain that helps to transmit
nerve impulses across the junctions between nerve cells. Low serotonin levels are associated with depression and
other mood disorders.
• PSYCHOSOCIAL CAUSES. Another important factor in the development of BDD is the influence of the mass
media in developed countries, particularly the role of advertising in spreading images of physically "perfect" men
and women. Impressionable children and adolescents absorb the message that anything short of physical perfection
is unacceptable. They may then develop distorted perceptions of their own faces and bodies.
o A young person's family of origin also has a powerful influence on his or her vulnerability to BDD.
Children whose parents are themselves obsessed with appearance, dieting, and/or bodybuilding; or who
are highly critical of their children's looks, are at greater risk of developing BDD.
o An additional factor in some young people is a history of childhood trauma or abuse. Buried feelings
about the abuse or traumatic incident emerge in the form of obsession about a part of the face or body.
This "reassignment" of emotions from the unacknowledged true cause to another issue is called
displacement. For example, an adolescent who frequently felt overwhelmed in childhood by physically
abusive parents may develop a preoccupation at the high school level with muscular strength and power.

Characteristics
Symptoms of BDD include:

• Ritualistic behavior. Ritualistic behavior refers to actions that the patient performs to manage anxiety and that take
up excessive amounts of his or her time. Patients are typically upset if someone or something interferes with or
interrupts their ritual. In the context of BDD, ritualistic behaviors may include exercise or makeup routines,
assuming specific poses or postures in front of a mirror, etc.
• Camouflaging the "problem" feature or body part with makeup, hats, or clothing. Camouflaging appears to be the
single most common symptom among patients with BDD; it is reported by 94%.
• Abnormal behavior around mirrors, car bumpers, large windows, or similar reflecting surfaces. A majority of
patients diagnosed with BDD frequently check their appearance in mirrors or spend long periods of time doing so.
A minority, however, reacts in the opposite fashion and avoids mirrors whenever possible.
• Frequent requests for reassurance from others about their appearance.
• Frequently comparing one's appearance to others.
• Avoiding activities outside the home, including school and social events.

The loss of functioning resulting from BDD can have serious consequences for the patient's future. Adolescents with
BDD often cut school and may be reluctant to participate in sports, join church- or civic-sponsored youth groups, or hold
part-time or summer jobs. Adults with Muscle Dysmorphia have been known to turn down job promotions in order to have
more time to work out in their gym or fitness center. Economic consequences of BDD also include overspending on
cosmetics, clothing, or plastic surgery.
The usual age of onset of BDD is late childhood or early adolescence; the average age of patients diagnosed with the
disorder is 17. Ironically, even though BDD begins in childhood or adolescence, most research and treatment studies to date
have been done on adults aged 35 and older. BDD has a high rate of co-morbidity, which means that people diagnosed with
the disorder are highly likely to have been diagnosed with another psychiatric disorder— most commonly major depression,
social phobia , or obsessive-compulsive disorder (OCD). The standard treatment regimen for BDD is a combination of
medications and psychotherapy. Surgical, dental, or dermatologic treatments have been found to be ineffective.

Instructional Strategies
At this time, no Instructional Strategies were found while researching this topic. It is difficult to find Instructional
Strategies for a disorder that not many people are aware of or many believe is about physical appearance. As Body
Dysmorphia stems from other psychological disorders, it could best be dealt with by using strategies for those other
psychological disorders, such as depression, social anxiety and various mood disorders.
As a science, physical education or social sciences teacher, this disorder can be discussed in a variety of ways. For
example, this disorder could be discussed while teaching anatomy or health class. In courses such as family studies or food
and nutrition, this topic could also be approached from a psychological perspective, discussing etiology, prevalence and
coping strategies. The topic of eating disorders has been discussed in such classes and continues to gain recognition and
awareness. By incorporating the topic of Body Dysmorphia in such discussions, teachers can help to not only teach students
about what exists among their fellow students but also help to identify their current students who may be suffering from the
disorder.
Schools can collaborate to prepare student assemblies to discuss such topics so that students have a chance to learn
about disorders that they would otherwise not be aware of. By doing this as a group, students will not be singled out be
teachers who suspect them of being affected, as well as realize that this is important enough that an assembly has been
arranged to learn about it. Students may not even be aware that they have the disorder and demonstrating the characteristics
in a video may help them identify that they may have a problem. With the use of videos, teachers and administrators can
deliver the message to students in a fair, non-judgemental way while also keeping them engaged by using visual aids.
Having speakers such as fitness experts, nutritionists and other health care providers who come and speak to
students can also be beneficial. Students may realize that these people are experts in their fields and may take the
information seriously. It is important that students realize that the disorder does exist and the experts who take the time to
come to talk about their experiences are trying to convey a really important message.

Assistive Technology
There is no assistive technology for this disorder at this time other than using visual aids such as Youtube videos
and educational videos to bring awareness of the disorder to the limelight.

Community Resources
www.aacap.org

http://www.camh.net/About_Addiction_Mental_Health/Child_Youth_Family_Resources/index.html

http://www.nimh.nih.gov/health/index.shtml

http://www.kidshelpphone.ca/Teens/Home.aspx

http://www.bodyimagecoalition.org/directory_educate1.html

Media
http://www.youtube.com/watch?v=W4j1obXY_2o

http://www.youtube.com/watch?v=Y0EdA4ACk54
 CEREBRAL PALSY

Official Definition
DSM IV Definition: Cerebral palsy is defined as a group of non-progressive, but often changing, motor impairment
syndromes secondary to lesions or anomalies of the brain arising at any time during brain development. Children with
postnatally acquired cerebral palsy are included. The impairment of motor function may result in paresis, involuntary
movement, or in-coordination. It does not include motor disorders that are transient, that result from progressive disease of
the brain, or that are due to spinal cord abnormalities/injuries.

Dictionary Definition: Cerebral palsy is a term used to describe a group of chronic conditions affecting body movements and
muscle coordination. It is caused by damage to one or more specific areas of the brain, usually occurring during fetal
development or infancy. It also can occur before, during or shortly following birth. Cerebral palsy occurs in about 2 to 2.5
out of every 1,000 people

Etiology (Causes)
Cerebral palsy is caused by a brain injury or problem that occurs during pregnancy, birth, or within the first 2 to 3 years of a
child’s life. Cerebral palsy can be caused by:

• Problems from being born too early (premature birth).

• Not getting enough blood, oxygen, or other nutrients before or during birth.
• A serious head injury
• A serious infection that can affect the brain, such as meningitis
• Some problems passed from parent to child (genetic conditions) that affects brain development.

Cerebral palsy causes reflex movements that a person can't control and muscle tightness that may affect parts or all of the
body. These problems can range from mild to severe. Mental retardation seizures and vision and hearing problems can
occur.

Characteristics
An inability to fully control motor function, particularly muscle control and coordination. Depending on which areas of the
brain have been damaged, people with cerebral palsy may experience one or more of the following:
* Muscle tightness or spasm
* Involuntary movement
* Disturbance in gait and mobility
* Abnormal sensation and perception
* Impairment of sight, hearing or speech
* Seizures

How students with Cerebral Palsy differ from typical human growth and development patterns
In cerebral palsy, faulty development or damage to motor areas in the brain impair the body's ability to control movement
and posture. This results in a number of chronic neurological disorders.
Cerebral palsy is caused by damage to the motor control centers of the developing brain and can occur during pregnancy,
during childbirth or after birth up to about age three.

The earliest indicator that a child has Cerebral Palsy is a delay in achieving standard developmental milestones. Most
children roll over by 4 months, sit independently by 5 months and crawl by 7 months of age. Parents may wish to consult a
pediatrician if their child misses these milestones by more than several months.

Instructional Strategies & Assistive Technology

While a large number of students with CP receive specialized pull-out services such as physical, occupational, or speech
therapy, their regular education teachers will still need to ensure that the classroom is organized in a manner that does not
create any significant physical obstacles for the child.

Some students with CP are either wheelchair-bound or require walking devices, teachers should set up the classroom so that
plenty of space is available for the student to move around the room and to sit comfortably at a desk. Items that may
interfere with the safety of a CP child should be placed out of reach. Students who struggle with communication should
have the option of using assistive technological equipment in the classroom. Teachers can also modify assignments that
require a good deal of writing or request the assistance of an aide or student mentor.

Perhaps most importantly, educators who are responsible for teaching children with cerebral palsy should demonstrate a
great deal of emotional support and patience. Encouraging a CP child with positive academic feedback, assisting the student
in developing friendships with general education peers, and communicating frequently with parents and therapists are all
ways that teachers can inspire confidence and success in students with cerebral palsy.
A person with cerebral palsy has to cope with disabilities and handicaps. A disability is a physical loss of function such as
being unable to walk, having difficulty with hand control or speech. A handicap is the degree to which that disability puts
you at a disadvantage in daily life. For instance, someone who is very short-sighted may be considered to have a disability,
but she is unlikely to consider this a handicap if she has corrective lenses. A disability may prevent someone with CP from
climbing stairs, but this will only be a handicap if the building she wants to enter is not wheelchair accessible.

CP is not a life-threatening condition and, in itself, is no barrier to leading a long and productive life. People with CP enjoy
satisfying careers, university education, social life, and become parents. Some limitations are unavoidable, but very few
people manage to achieve their dreams of becoming olympic athletes, concert pianists or brain surgeons.

Some key elements to minimizing the handicapping effects of cerebral palsy are:

(1) Attitudes: It is very hurtful to have someone pat you on the head if you are sitting in a wheelchair, or to walk away
because they cannot understand what you are trying to say to them. Prejudice and teasing can be very damaging. A good
sense of self-esteem is required to cope with these negative attitudes. Children can also be handicapped if they are over-
protected and become too dependent. People with disabilities are people first and should never be described by negative
labels like "wheelchair-bound", "spastic", or "afflicted with cerebral palsy". All people share similar needs, desires, and
responsibilities.

(2) Access: You cannot lead an independent life if public buildings, washrooms and transportation are not accessible. To
have a good career you need educational opportunities. To have a satisfying social life you need access to recreational
facilities and opportunities to develop friendships.

(3) Maintaining Physical Health: A lifestyle that involves regular exercise and proper nutrition is important for everyone,
including those with disabilities. A good general fitness level will help with range of motion and flexibility, and exercise to
improve cardiovascular fitness can improve endurance and help offset age-related changes that lead to fatigue. A nutritious,
high-fibre, low-fat diet will help avoid problems with constipation and weight gain and will increase energy levels. Having
cerebral palsy does not make you immune to other conditions. People with CP are as likely as anyone else to contract heart
disease, cancer or diabetes. Sometimes a change in the body can be put down to an effect of CP when it is actually a different
condition.

(4) Aging and Cerebral Palsy: Most treatment and research programs concern children with CP and little research has so far
been done on aging with a disability. CP affects individuals in different ways and it is hard to generalize about the effects of
aging. Although people with cerebral palsy are considered to have a normal life span, the physical challenges of CP may
intensify with age (such as increased spasticity, fatigue, loss of strength and declining mobility), and these physical
challenges can in turn lead to increased stress and anxiety. Adults with cerebral palsy may consider a number of strategies to
cope with the effects of aging.

(5) Maintaining Mental Health: The importance of learning skills to increase independence and self-confidence throughout
an individual's lifetime cannot be over-emphasized. The stresses associated with aging will be lessened if a person is able to
maintain a positive personal attitude, if he is involved in meaningful activities, and if he has developed a supportive
environment. He needs confidence to seek information, to plan for age-related changes, and to be an active participant in his
health care and lifestyle choices.

Community Resources
The United Cerebral Palsy Associations, 1660 L Street, NW, Suite 700, Washington, DC 20036; (800) 872-5287
Website: http://www.ucp.org/ E-Mail: info@ucp.org
UCP is a national organization for people with cerebral palsy and their families. Through its local chapters, it provides a
variety of services, including information and referral, parent support, advocacy, and educational and work programs for
people with cerebral palsy. Fact sheets on selected issues related to cerebral palsy are available, as well as publications from
a variety of publishers and organizations. Many publications can be downloaded from the web site for no charge.

Cerebral Palsy International Research Foundation, 1025 Connecticut Avenue, Suite 701, Washington, DC, 20036;
202-496-5060 Website: http://www.cpirf.org E-Mail: nmaher@cpirf.org
The Cerebral Palsy International Research Foundation (CPIRF) is a not for profit 501(c)3 organization dedicated to funding
research and educational activities directly relevant to discovering the cause, cure and evidence based care for those with
cerebral palsy and related developmental disabilities. CPIRF, formerly known as the United Cerebral Palsy Research and
Educational Foundation, Inc., (CPIRF is no longer affiliated with UCP) was founded in 1955 and its 50 year history has been
the nation’s principal non-government agency sponsoring research and education for cerebral palsy.

Media
http://www.youtube.com/watch?v=qMSrpZi_6WM
http://www.novita.org.au/Content.aspx?p=582
 HEARING IMPAIRMENT
Official Definition
Students who are deaf can also be referred to as hearing impaired. Those students who experience a loss in hearing generally
still have some of their frequency left as they are able to make out loud and obvious vibrations from various sound barriers.
One’s hearing loss can be inherited by their parents. If both parents carry the dominate gene that causes hearing loss, it its
most likely that the child will be born with a hearing impairment. In most cases one’s hearing loss has a major impact on
their speech, and they are unable to communicate vocally to the same degree as someone who does not have a hearing loss.
It is very difficult for those with hearing loss to detect certain aspects of speech, for example high frequency consonants “s”,
“t”, and “th”. Thus, people who do experience hearing impairments rely on American Sign Language in order to
communicate their thoughts and ideas.

Characteristics
In the majority of cases, those who are deaf or experience a hearing loss do not differ in their physical appearance. Many of
times it is difficult to tell who would have a hearing impairment because the actual ‘disability’ as society would label it is
internal. However, the characteristics to determine if one may have a hearing impairment will include: the individual to
appear physically un-coordinated in many activities such as running, continually ask for statements to be repeated, have no
response to when they are being called upon.
The social and emotional characteristicd that one may find in a student with a hearing impairment, especially in
students under the age of 18, include: isolation from many peers, frequently misunderstands their peers, may use physical
contact for getting attention, may be over noisy in a social setting, may demonstrate aggressive behaviour due to
experiencing frustration, may have difficulty negotiating with others in decision-making/problem-solving situations,
restless in large group activities, may appear bored and/or lethargic at times, may act impulsively, and may lack self
confidence.

Instructional Strategies
Some instructional strategies that teachers can keep in mind while instructing those who are deaf/ or have a hearing
impairment can include an aid within the class room to help deaf/hearing impaired students understand the lesson. Also,
the use of having what the teacher says, or the main points in his/her lesson up on a power point, smart board, or overhead
will allow the student with the hearing impairment to follow along with the lesson at hand and make them feel included in
the classroom environment.
Finally, the teacher can have the student sit close to the front where he/she will be able to detect some sound that
the teacher makes and will also be able to read his/her lips. These strategies can be categorized into two main headings:
Auditory-Verbal Approach and the Oral Approach.

Assistive Technology
Students who are deaf require assistive technology within the classroom in order to help them keep up with their academic
progress. Some significant examples of useful assistive technology within the classroom include:

• Personal frequency modulation (FM) systems: they are radio systems that function based on special frequencies. It
was assigned by the Federal Communications Commission. The speaker uses a microphone and the student would
wear a receiver. The sounds channels through the hearing aid, and then the student is able to participate.
• Induction Loop Systems: this is a wire that gets perminatly installed, in most cases under a carpet, and connects to
the microphone of which the speaker operates. When the teacher speaks, it sends a signal through the wire which
creates an electromagnetic field in the room. This piece of technology is usually used with large groups of students.
• Text telephones: This piece of assistive technology is very interesting and interactive. It allows phone conversations
to be typed between the teacher and the student within the classroom. This relates to the Computerized speech
recognition which is another piece of equipment that translates the teacher’s speech into a word document so that
it can be read by the student.
• Note Taking: This is a traditional method of assistive technology. This form allows for an assistant in the classroom
taking written notes for the hard of hearing student so that the student can concentrate on the sound and lip
movement of the teacher.
 • Talking Calculators: These pieces of assistive technology help students when they need to recite numbers or
symbols easily when certain keys are pressed. They also can read back answers to completed problems.
• Pictures, Photographs, and Objects: Using these in the classroom give students who are hard of hearing a chance to
develop their own thoughts and opinions without having to concentrate so intensely on what the teacher is saying.
• CD-based (text)books, electronic books
• Closed-captioning television
• Headphones (to keep the listener focused, adjust sound, etc.)
• Personal Reading Machines: These pieces of assistive technology instantly scan the document being read and help
hard of hearing students with their pronunciation of words and syllables
• Vibrotactile systems

Community Resources
Alexander Graham Bell Association for the Deaf and Hard of Hearing
The association is a nonprofit membership organization that was established in 1890 to empower people who are deaf
or hard of hearing to function independently by promoting universal rights and optimal opportunities to learn to use,
maintain, and improve all aspects of their verbal communications, including their abilities to speak, speechread, use
residual hearing, and process both spoken and written language.
American Association of People with Disabilities
The American Association of People with Disabilities is the largest nonprofit, nonpartisan, cross-disability organization
in the United States.
Deaf Initiative in Information Technology (DIIT)
The Deaf Initiative in Information Technology (DIIT) is a project of the Applied Computer Technology Department
(ACT), of the National Technical Institute for the Deaf at the Rochester Institute of Technology.; This project provides
retraining workshops to deaf and hard-of-hearing adults already in the national
workforce or preparing for employment in the information technology field,
clusters these workshops into a certificate program, and modifies the
workshops into undergraduate courses.
Disability Rights Education and Defense Fund
Founded in 1979 by people with disabilities and parents of children with
disabilities, the Disability Rights Education and Defense Fund, Inc. (DREDF) is
a national law and policy center dedicated to protecting and advancing the civil
rights of people with disabilities through legislation, litigation, advocacy,
technical assistance, and education and training of attorneys, advocates,
persons with disabilities, and parents of children with disabilities.
National Association of the Deaf
NAD is a national consumer organization representing people who are deaf
and hard of hearing.
National Information Center for Children and Youth with Disabilities
The Center is a clearinghouse for information on disabilities and disability-
related issues concerning children and youth (birth to age 22).
Canadian Council for Exceptional Children The Canadian Council for Exceptional Children is a national non-profit
organization that works to improve the educational opportunities offered to exceptional children. They advocate for the
development of responsible legislation and high standards of practice in educating children with special needs.
 DIABETES
Official Definition
Diabetes can be broken down into two categories: Type 1 Diabetes and Type 2 Diabetes.

Type 1 diabetes is usually diagnosed in children and young adults, and was previously known as juvenile
diabetes. In type 1 diabetes, the body does not produce insulin. Insulin is a hormone that is needed to convert
sugar, starches and other food into energy needed for daily life. Only 5-10% of people with diabetes have this form
of the disease. With the help of insulin therapy and other treatments, even young children with type 1 diabetes can
learn to manage their condition and live long, healthy, happy lives.

Type 2 diabetes is the most common form of diabetes. Millions of Americans have been diagnosed with type 2
diabetes, and many more are unaware they are at high risk. Some groups have a higher risk for developing type 2
diabetes than others. Type 2 diabetes is more common in African Americans, Latinos, Native Americans, and Asian
Americans, Native Hawaiians and other Pacific Islanders, as well as the aged population.

In type 2 diabetes, either the body does not produce enough insulin or the cells ignore the insulin. Insulin is
necessary for the body to be able to use glucose for energy. When you eat food, the body breaks down all of the
sugars and starches into glucose, which is the basic fuel for the cells in the body. Insulin takes the sugar from the
blood into the cells. When glucose builds up in the blood instead of going into cells, it can lead to diabetes
complications.

Etiology (Causes)
The following list contains some possible etiologies or causes of diabetes:

• Hereditary or Inherited Traits : It is strongly believed that due to some genes which passes from one
generation to another, a person can inherit diabetes. It depends upon closeness of blood relationship as
mother is diabetic, the risk is 2 to 3%, father is diabetic, the risk is more than the previous case and if both
the parents are diabetic, the child has much greater risk for diabetes.
• Age : Increased age is a factor which gives more possibility than in younger age. This disease may occur at
any age, but 80% of cases occur after 50 year, incidences increase with the age factor.
• Poor Diet (Malnutrition Related Diabetes) : Improper nutrition, low protein and fiber intake, high intake
of refined products are the expected reasons for developing diabetes.
• Obesity and Fat Distribution : Being overweight means increased insulin resistance, that is if body fat is
more than 30%, BMI 25+, waist grith 35 inches in women or 40 inches in males.
• Sedentary Lifestyle : People with sedentary lifestyle are more prone to diabetes, when compared to those
who exercise thrice a week, are at low risk of falling prey to diabetes.
• Stress : Either physical injury or emotional disturbance is frequently blamed as the initial cause of the
disease. Any disturbance in Cortiosteroid or ACTH therapy may lead to clinical signs of the disease.
• Drug Induced: Clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel)
and ziprasidone (Geodon) are known to induce this lethal disease.
• Infection : Some of the strephylococci is suppose to be responsible factor for infection in pancreas.
• Sex : Diabetes is commonly seen in elderly especially males but, strongly in women and those females
with multiple pregnancy or suffering from (PCOS) Polycystic Ovarian Syndrome.
• Hypertension : It had been reported in many studies that there is direct relation between high systolic
pressure and diabetes.
• Serum lipids and lipoproteins : High triglyceride and cholesterol level in the blood is related to high
blood sugars, in some cases it has been studied that risk is involved even with low HDL levels in
circulating blood.

Characteristics
A student with diabetes may have display the following characteristics that a “typical” student would not:

Type 1 Diabetes: Frequent urination, unusual thirst, extreme hunger, unusual weight loss, extreme fatigue and irritability.

Type 2 Diabetes: Any of the type 1 symptoms, frequent infections, blurred vision, cuts/bruises that are slow to heal,
tingling/numbness in the hands/feet, recurring skin, gum, or bladder infections .(Often people with type 2 diabetes have no
symptoms)
Teacher Role
As a teacher, you can help by: supporting self-care by capable students, providing easy-access to diabetes supplies,
ensuring students eat snacks at a scheduled time and make sure snacks are available to treat low blood sugar, allowing
students reasonable time to make up missed homework or tests, learning about diabetes and complying with the individual
student’s 504 and health care plans.
Other Classroom Tips: Keep a contact sheet of trained diabetes staff at your desk for emergencies, create a diabetes info
sheet for substitute teachers, learn signs and responses to low/high blood sugar levels, allow blood glucose monitoring and
free access to bathrooms/water during class, teach your class about diabetes, and let parents know, in advance, changes to
the class schedule (field trips, special events, etc.)

Warning Signs
Children with diabetes may display the following warning signs. It is the teacher’s job to take these signs seriously. The
most immediate concerns in managing type 1 diabetes are:
• Hypoglycemia = low blood glucose

• Hyperglycemia = high blood glucose

• Ketoacidosis (key-toe-ass-i-DOE-sis) = ketone (acid) build up in the blood because there is not enough
insulin in the body

The symptoms of mild hypoglycemia include: sudden change in behavior (lethargic, confused, uncoordinated, irritable,
nervous), sudden change in appearance (shaky, sweaty, pale or sleepy), complaints of headache or weakness.
The teacher should respond by:
1. Give the student a quick-acting sugar equivalent to 15 grams of carbohydrate (Examples: 4 oz. of juice, ½ a can of
regular soda, or 3-4 glucose tablets, ask parents to provide you with what works best for their child).

2. Check blood glucose (BG) level 10 to 15 minutes later

3. Repeat treatment if BG is below student’s target range

The symptoms of severe hypoglycemia include: Inability to swallow, seizure or convulsion, and/or unconsciousness,
This is the most immediate danger to kids with diabetes
The teacher should respond by: Positioning student on side, contact school nurse or trained diabetes staff, administer
prescribed glucagon, call 911, call student’s parents.
The symptoms of hyperglycemia include: Increased thirst, frequent urination, nausea, blurry vision, and/or fatigue.
The teacher should respond by: Allow free and unrestricted access to liquids and restrooms, allow student to administer
insulin or seek a trained staff person to administer, encourage student to test blood glucose levels more frequently.
Instructional Strategies
EVERY CHILD WITH DIABETES IS DIFFERENT.
Each and every child with diabetes may have different symptoms of low blood sugar. Although many of the
symptoms may be similar, they will not always be the same. Situations that can affect your student’s blood sugar
are: insulin, food intake, exercise, illness, stress and/or any changes in routine. Soon you will get to know your own
student’s unique individuality and their typical reactions to low blood sugar.
DON’T DRAW UNNECESSARY ATTENTION TO YOUR STUDENT’S CONDITION.
Your student with diabetes may have to eat snacks periodically in the classroom. In addition to your student’s
designated snack time, remember that he or she MUST eat whenever they feel low. This is imperative, especially if
the student is unable to have his or her blood sugar level checked first. This is NOT a choice for the child with
diabetes, but a necessity!
PROVIDE INCONSPICUOUS AND GENTLE REMINDERS.
Pay close attention to your student’s regular snack time. Not all children (especially the very young) can tell time,
or are going to remember their snack time. If you haven’t noticed them eating, pass them a note or work out a
special “password” between the two of you that reminds them of their snack time.
DO NOT PUT A “LABEL” ON THE STUDENT WITH DIABETES.
Never single a child with diabetes out as the “diabetic” kid. First and foremost, the child with diabetes needs and
wants to feel unique and special, just like every other student in your class.
DO NOT SYMPATHIZE: EMPATHIZE.
A child with diabetes does not want or need your sympathy. These children need understanding, acceptance and
support. Educate yourself in every way possible about diabetes. Learn how it may affect them and have
compassion for how they must live their lives each and every day.
ALWAYS BE PREPARED.
Always carry a quick and portable snack WHENEVER you and your student with diabetes leave the classroom or
the school grounds. This is especially important during fire drills, earthquake drills, field trips, special
presentations and/or assemblies. A small can of juice together with crackers may work best.
USE THE BUDDY SYSTEM.
If your student with diabetes tells you he or she feels low, then give the student a quick-acting carbohydrate snack
such as fruit juice, regular soda, or glucose tabs. If your student needs to see the nurse, ALWAYS send a “buddy”
(someone who won’t object) with them. Never leave a child alone or sent anywhere alone when experiencing low
blood sugar.
ALLOW UNRESTRICTED BATHROOM BREAKS.
When given the opportunity, let the child with diabetes know that it’s okay to go to the bathroom WHENEVER
necessary and have a water bottle when blood sugar is high. If their blood sugar is running high, their body’s
natural response is to eliminate the extra glucose by using the bathroom. Don’t make them feel embarrassed by
having to ask you for permission.
BE PATIENT.
Be patient if the student with diabetes has minor problems with organization. High and/or low blood sugar levels
may make it difficult for them to concentrate at times. You may have to repeat some things, especially if they’ve
been to the nurse’s office during class time.
KEEP THE LINES OF COMMUNICATIONS OPEN.
Always work as a team with the student, caregivers, school nurse and other educators. If there is a special school
party or occasion where “treats” are to be served, let the family know in advance, if possible. This allows the family
to discuss the options with the child so that he or she can make responsible choices. Often, many treats can be
worked into the child’s meal plan.
KNOWLEDGE IS POWER.
Learn as much as you can about diabetes in children. Consider completing a training to enable you to perform
essential key diabetes care tasks such as blood glucose monitoring and insulin and glucagon administration. Your
willingness to learn about diabetes and being prepared to perform care tasks or provide supervision as necessary
will ensure a safe classroom

Assistive Technology
One assistive technology that may be very beneficial to students with diabetes is a video camera/ voice recorder. Should a
student need to excuse themselves for extended periods of time, they may miss substantial amounts of class lectures.
Therefore, by being able to record the teacher’s lecture, they can revisit it at the later time to ensure that they received the full
notes. Other accommodation ideas for students with diabetes include:
• (Hypo/Hyperglycemia) Allow for storage of medications, such as insulin and/or food, provide an area to test
blood sugar levels, provide an area to administer medications (insulin), provide appropriate containers for
needles/syringe disposal, provide a rest area for reorientation after hypo/hyperglycemic episode, and allow
frequent breaks for food as needed
• Neuropathy (Nerve damage): Modify job tasks requiring fine finger dexterity, provide protective clothing and
equipment, and eliminate or reduce the need to use sharp objects
• (Fatigue or Weakness): Allow frequent rest breaks, reduce or eliminate strenuous activities, provide anti-fatigue
mats or padded carpeting, provide a rest area with cot, allow flexibility to sit or stand, and allow job sharing
Media
http://www.diabetes.org/living-with-diabetes/parents-and-kids/diabetes-care-at-school/school-staff-trainings/training-
resources.html
http://www.ehow.com/how_5620045_student-diabetes-succeed.html
http://www.diabetes.org/
HTTP://WWW.YOUTUBE.COM/WATCH?V=VXPMCQV0OIS
 DOWN SYNDROME
Official Definition
A chromosomal abnormality that leads to mild to moderate mental retardation and, at times, variety of hearing, skeletal,
and heart problems. It is also called Trisomy 21, is a condition in which extra genetic material causes delays in the way a
child develops both mentally and physically. It affects about 1 in every 800 babies. The physical features and medical
problems associated with Down syndrome can vary widely from child to child. While some kids with DS need a lot of
medical attention, others led healthy lives.

Etiology (Causes)
Down syndrome is the most common cause of mental retardation and malformation in a newborn. Down syndrome occurs
because of the presence of an extra 21st chromosome.
Chromosomes are the materials that store people's genetic information. Each person inherits 23 chromosomes from their
mother and twenty three chromosomes from their father. Sometimes an accident occurs and one of the parents gives an extra
chromosome. When the extra chromosome happens to be chromosome number 21, Down Syndrome occurs.

Characteristics
Children with Down syndrome have a widely recognized characteristic appearance; however, not all individuals with Down
Syndrome will show all these characteristics. Some of the common characteristics are: decreased muscle tone at birth,
asymmetrical or odd-shaped skull, round head with flat area at the back of the head, small skull, slanting eyes, small mouth
with protruding tongue, broad short hands, single crease on the palm, retarded growth and development, delayed mental
and social skills (mental retardation).

Medical consequences related to Down syndrome (again, not all medical characteristics are present in each individual with
down syndrome):
• The inability to reach normal growth and development.
• Congenital heart defects in infants.
• Early mortality.
• Acute lymphocytic leukemia.
• Gastrointestinal abnormalities.
• May have an obstruction of the esophagus and obstruction of the duodenum.
• Faster aging process. There is also a tendency to develop diseases of aging, such as Alzheimer's, at a relatively
early age.

Instructional Strategies
Instructional strategies for students with Down syndrome will vary depending on the severity of their condition, how they
are affected by it and the individual needs of the child. Some examples are:

• Employ cooperative learning strategies wherever possible to promote effective learning by all students.
• Consider all members of the classroom when you organize the physical environment. Find ways to meet needs of
each student.
• Set goals that are realistic for the student.
• Assign tasks that are personally relevant, carefully sequenced from easy to difficult, and allow the learner to be
highly and frequently successful.
• Recognize the student’s strengths and weaknesses, provide incentives for performance, and establish necessary
rules for behaviour; maintain high expectations.
• Explain required tasks in terms of concrete concepts.
• Be specific when giving instructions.
• When giving instructions briefly summarize and ask student what is to be done.
• When praising, be specific and emphasize "you" rather than "I."
• Give constant praise and feedback, especially when the student is learning a new task.
• An EA (educational assistant) is often in the classroom to provide the student with one-on-one support.

Assistive Technology
Assistive technology will vary to fit the need of the student with Down syndrome but some examples are:
• The student may use sign language along with vocalization to express him or herself.
• Computer programs that are interactive, that read out loud to the student, that break apart text and pair the text
with visual images.

Community Resources
Down Syndrome Association of Toronto
Suite 303, 40 Wynford Drive
Toronto, ON M3C 1J5
http://dsat.ca/

Down Syndrome Parent Group of Western New York

716-832-9334 or http://www.dspgwny.org/contact_us.html
 DEPRESSION AND BIPOLAR DEPRESSION

Official Definition
“Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt
or low self-worth, disturbed sleep or appetite, low energy, and poor concentration. These problems can become chronic or
recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities.
At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850,000 lives every year.”
(World Health Organization, 2010)
DSM-IV for Major Depressive Disorder:
“A. Five (or more) of the following symptoms have been present during the same 2-week period and represent a change from
previous functioning; at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.
Note: Do note include symptoms that are clearly due to a general medical condition, or mood-incongruent delusions or
hallucinations.

(1) depressed mood most of the day, nearly every day, as indicated by either subjective report (e.g., feels sad or empty) or
observation made by others (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2) markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated by
either subjective account or observation made by others)

(3) significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or
decrease or increase in appetite nearly every day. Note: In children, consider failure to make expected weight gains.

(4) insomnia or hypersomnia nearly every day

(5) psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness
or being slowed down)

(6) fatigue or loss of energy nearly every day

(7) feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-
reproach or guilt about being sick)

(8) diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed
by others)

(9) recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide
attempt or a specific plan for committing suicide
B. The symptoms do not meet criteria for a Mixed Episode.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of
functioning.

D. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a
general medical condition (e.g., hypothyroidism).

E. The symptoms are not better accounted for by Bereavement, i.e., after the loss of a loved one, the symptoms persist for
longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness,
suicidal ideation, psychotic symptoms, or psychomotor retardation.”(DSM-IV)

Etiology (Causes)
There is no specific cause of depression, but there is evidence that depression is inherited. There also exists evidence that
points to a biochemical imbalance in the brain. Lastly the environment may be a cause of depression as well. High stress
from a job or a death of a loved one, abuse, neglect, maltreatment, or a major illness may have an impact on where
depression comes from.

Characteristics

• Agitation, restlessness, and irritability

• Dramatic change in appetite, often with weight gain or loss
• Extreme difficulty concentrating
• Fatigue and lack of energy
• Feelings of hopelessness and helplessness
• Feelings of worthlessness, self-hate, and inappropriate guilt
• Inactivity and withdrawal from usual activities, a loss of interest or pleasure in activities that were once enjoyed

Instructional Strategies
 1. Don't ignore depressed students. It shows that you don't care and invites the students to give up, guaranteeing
their failure. Draw them out in class discussion and do whatever it takes to stimulate their minds so that they don't,
in turn, learn to ignore you.
2. Let them know that you care, but without getting too personal. Help them to update any missing assignments, or
set up extra study time - whether they accept your efforts or not all depends upon the severity of the depression.
The fact that you've proven you care can make all the difference in the world.
3. Never give up on the student - regardless of how long they haven't wanted to put forth any effort in your class.
Students can tell when a teacher no longer believes in them and expects them to fail, and it only ends up making
the situation worse than necessary.

Community Resources
• http://www.depression.com/
Has lots of information about depression and its’ many forms.
• http://www.mentalhealth.org
A website devoted to a broad overview of many mental health problems including depression.
• http://www.dbsalliance.org
An organization that is dedicated to helping with depression and bipolar disorders.
• http://www.depression.com/web_resources.html
A list of various other resources that can assist with depression and bipolar

Media

• http://www.youtube.com/watch?v=IeZCmqePLzM
o What it is
• http://www.youtube.com/watch?v=H4Scdf9trQ0
o Effects on a boy from Boy Interrupted
 DYSCALCULIA
Official Definition
According to the DSM-IV manual, students with a mathematics disorder have problems with their math skills. Their math
skills are significantly below normal considering the student’s age, intelligence, and education. As measured by a
standardized test that is given individually, the person's mathematical ability is substantially less than you would expect
considering age, intelligence and education. This deficiency materially impedes academic achievement or daily living. If
there is also a sensory defect, the mathematics deficiency is worse than you would expect with it.

Etiology (Causes)
At the moment, researchers are not sure exactly what causes dyscalculia. Previously, dyscalculia had been associated with
everything from low IQ to bad teaching. As of now, there are several working theories to understand the disorder.

Heredity: New research is suggesting that dyscalculia might be a brain based disorder with a familial genetic
disposition.

Neurological: Dyscalculia has been associated to lesions in the temporal and parietal lobes of the cerebral cortex.

Memory: Conflicting research suggests that dyscalculia might be linked to a memory deficit. Some research has
found a reduced short term memory in students can make it difficult to remember calculations. Other research
suggests dyscalculia might actually be linked to a working memory deficit.

Characteristics
How might a student with dyscalculia differ from a ‘typical’ child.
It is important to understand dyscalculia occurs across the whole IQ range. Student with dyscalculia often have
average or above average language acquisition, but struggle in areas of mathematic logic and reasoning, time, and
measurement.

A student who has dyscalculia often have difficulty with abstract concepts of time. Students have trouble placing
events on a timeline or reading analogue clocks. Students with dyscalculia also often have difficulties estimating the
passage of time, and may be either chronically late or early.

Another common characteristic of students with dyscalculia is difficulty with direction and distance. They often
have problems differentiating from right and left, and have difficulty rotated a map to face North. Another common obstacle
is estimating an object’s distance.

Frequent difficulties in arithmetic also arise. A student who suffers from dyscalculia might have difficulty using
the signs +, -, x, and ÷. This can lead to difficulties using the multiplication tables, division tables, or can even interrupt
simple mental arithmetic.

Similarly, students with dyscalculia often have trouble grasping simple mathematical concepts, rules, formulas, or
sequences. This can lead to the inability to sequence numbers, the transposing of numbers (ie. 48 to 84), and difficulties in
sequential processing.

Many of these characteristics might begin to appear in the students everyday life. For example, a student who had
dyscalculia might have difficulty making change or estimating the cost in a shopping basket. They might have difficulty
keeping score, or might be unable to grasp the rules or sequence of a game. Furthermore, students with dyscalculia might
even have trouble remembering the sequence of dance steps, or directions from a play in sports.

Dyscalculia is often compounded with many other social and emotional problems. Low latent inhibition is often
reported, resulting and over-sensitivity to noise or light. Students who suffer from dyscalculia often have low self-esteem,
depression, conduct disorder, and increased dropout rate. Dyscalculia is often misinterpreted as ADHD.

Instructional Strategies
There are a wide variety of instructional strategies that have been reported to assist students whole suffer from dyscalculia.
Below is a sample of these strategies:
• Individual tutoring with a math expert had shown to benefit students with dyscalculia
• Educational aids that focus on math skills can also be of assistance
• Give the student graph paper to keep numbers in their correct columns
• Provide a student with a calculator for more complicated math functions and teach the student to use it.
• Do not penalize student’s grade for the reversing of numbers.
• Allow students to use fact sheet(s) and/or chart(s) (i.e.,multiplication table).

Assistive Technology
The potential for use of assistive technology for students with dyscalculia is limited at the moment. below is a list of the
technologies that might be used to aid students with dyscalculia.
 Calculator:
Students with dyscalculia often suffer from simple arithmetic errors. These errors often prevent them from
preforming higher level math and functioning. By allowing these students the use of a calculator on tests and
assignments, students with dyscalculia are able to focus on the math problem at hand, rather than the arithmetic
behind it.

Graph Paper:
Students with dyscalculia often have trouble organizing their numbers. By allowing the use of graph paper, students
are able to organize numbers in columns, and minimize the occurrence of transposing numbers.

Community Resources
These resources might assist both educators and parents in understanding and assisting students with dyscalculia
Dyscalculia.org: Math Learning Disability Resource
Provides information in symptoms, remediating, and community resources
The Dyscalculia Forum
Provides information on basic facts and new research
http://www.dyscalculiaforum.com/news.php
NLD Ontario
Shares characteristics students with dyscalculia might have in the classroom
http://www.nldontario.org/articles/dyscalculia.html
LDinfo
Suggests strategies educators might use to assist students with dyscalculia
http://www.ldinfo.com/dyscalculia.htm

Media

What is dyscalculia?
Click on this link to see a short video on dyscalculia.
http://www.youtube.com/watch?v=cBajVoq2gu0
It introduces dyscalculia, and outlines the some of the struggles individuals with dyscalculia might face.

Who has dyscalculia?

http://www.youtube.com/watch?v=vWzCsI180cc&feature=related
This video display famous individuals who have been diagnosed with dyscalculia.

How might students cope with dyscalculia?

Below a student shares how she copes with being a student who has dyscalculia.
http://www.youtube.com/watch?v=urXzMuU-bik
 DYSGRAPHIA
Official Definition
Dysgraphia (or agraphia) is a deficiency in the ability to write, regardless of the ability to read, not due to intellectual
impairment. People with dysgraphia usually can write on some level, and often lack other fine motor skills and may be
cross dominant, finding tasks such as tying shoes difficult. It often does not affect all fine motor skills. They can also lack
basic grammar and spelling skills (for example, having difficulties with the letters p, q, b, and d), and often will write the
wrong word when trying to formulate thoughts (on paper). In childhood, the disorder generally emerges when the child is
first introduced to writing. The child may make inappropriately sized and spaced letters, or write wrong or misspelled
words despite thorough instruction. Children with the disorder may have other learning disabilities, but they usually have
no social or other academic problems. Cases of dysgraphia in adults generally occur after some neurological trauma.
Dysgraphia may also be diagnosed in a person with Tourette syndrome, ADHD or an autism spectrum disorder such as
Asperger syndrome. The DSM IV identifies dysgraphia as a "Disorder of Written Expression" as "writing skills (that) ...are
substantially below those expected given the person's ...age, measured intelligence, and age-appropriate education."

Etiology (Causes)
A few people with dysgraphia lack only the fine-motor coordination to produce legible handwriting, but some may have a
physical tremor that interferes with writing.

In most cases, however, several brain systems interact to produce dysgraphia.

Some experts believe that dysgraphia involves a dysfunction in the interaction between the two main brain systems that
allows a person to translate mental into written language (phoneme-to-grapheme translation, i.e., Sound to symbol, and
lexicon-to-grapheme translation i.e.. Mental to written word).

Other studies have shown that split attention, memory load, and familiarity of graphic material affect writing ability.

Typically, a person with illegible handwriting has a combination of fine-motor difficulty, inability to re-visualize letters, and
inability to remember the motor patterns of letter and time.
1. Emotional factors arising from dysgraphia often exacerbate matters.
2. At an early age, these students are asked to forego recess to finish copying material from the board, and are likely
to be sent home at the end of the day with a sheaf of unfinished papers to be completed.
3. They are asked to recopy their work, but the second attempts often no better than the first.
4. Because they are often bright and good at reading, their failure to produce acceptable work is blamed on laziness or
carelessness.
5. The resulting anger and frustration can prevent their ever reaching their true potential.

Characteristics
Dysgraphia can interfere with a student's ability to express ideas. Expressive writing requires a student to synchronize
many mental functions at once: organization, memory, attention, motor skill, and various aspects of language ability.

Automatic accurate handwriting is the foundation for this juggling act. In the complexity of remembering where to put the
pencil and how to form each letter, a dysgraphic student forgets what he or she meant to express.

Dysgraphia can cause low classroom productivity, incomplete homework assignments, and difficulty in focusing attention.

Symptoms Include:
• Generally illegible writing (despite appropriate time and attention given the task)
• Inconsistencies: mixtures of print and cursive, upper and lowercase, or irregular sizes, shapes, or slant of letters
• Unfinished words or letters, omitted words
• Inconsistent position on page with respect to lines and margins.
• Inconsistent spaces between words and letters
• Cramped or unusual grip, especially:
• Holding the writing instrument very close to the paper, or
• Holding thumb over two fingers and writing from the wrist
• Strange wrist, body, or paper position
• Talking to self while writing, or carefully watching the hand that is writing
• Slow or laboured copying or writing - even if it is neat and legible
• Content which does not reflect the student's other language skills
What are different types of dysgraphia?

While dysgraphia may be broadly classified as follows, there are many individual variations that affect both treatment and
prognosis:
• In dyslexic dysgraphia, spontaneous written text is illegible, especially when the text is complex. Oral spelling is
poor, but drawing and copying of written text are relatively normal. Finger-tapping speed (a measure of fine motor
speed) is normal, but drawing is very problematic.
• In motor dysgraphia, both spontaneous written and copied text may be illegible, oral spelling is normal, and
drawing is usually problematic. Finger-tapping speed is abnormal.
 • In spatial dysgraphia, people display illegible writing, whether spontaneously produce or prepared. Oral spelling
is normal. Finger-tapping speed is normal, but drawing is very problematic.

Instructional Strategies
Prevention, remediation, and accommodation are all important elements in the treatment of dysgraphia.

Many problems can be prevented by early training. Young children in kindergarten and grade one should learn to form
letters correctly; kinesthetic memory is powerful and incorrect habits are very difficult to eradicate.

Muscle training and over-learning good techniques arc both critical for the remediation of dysgraphia. Specifically designed
exercises are needed to increase strength and dexterity. A specialist can recommend the most appropriate plan of exercises.

Writing strategies for 'dysgraphic' students:

1. Outline your thoughts. It is very important to get the main ideas down on paper without having to struggle with
the details of spelling, punctuation, etc. Try writing just one key word or phrase for each paragraph, then go back
later to fill in the details.

2. Draw a picture of a thought for each paragraph.

3. Dictate your ideas into a tape recorder then listen and write them down later.

4. Really practice keyboarding skills! It may be difficult at first, but after you have learned the pattern of the keys,
typing will be faster and clearer than handwriting.

5. Use a computer to organize information and check spelling. Even if your keyboarding skills aren't great, a
computer can sure help with the details.

6. Continue practicing handwriting. As frustrating as it may be, there will be times throughout your life that you will
need to be able to write things down and maybe even share your handwriting with others. It will continue to
improve as long as you keep working at it.

7. Talk to yourself as you write. This may provide valuable auditory feedback.

Assistive Technology
 DYSLEXIA
Official Definition
Students with dyslexia require intensive instruction to use of phonological information when processing written and oral
language. The major components of phonological deficits involve phonemic awareness, sound-symbol relations, and storage
and retrieval of phonological information in memory. Problems with phonemic awareness are most prevalent and can
coexist with difficulties in storage and retrieval among children with dyslexia who have phonological deficits.

Etiology (Causes)
Dyslexia is caused by an impairment in the brain’s ability to translate images received from the eyes or ears into the
understandable language. Dyslexia can also be a genetic disability.

Characteristics
There are numerous characteristics that teachers and parents can become aware of. These include: letter and number
reversals, difficulty copying from the board and/or book, difficulty distinguishing between left and right as well as
difficulty with notational skills. Adolescents with dyslexia also have a general disorganization of their written work and
have poor memory skills even if it involves a favourite book and/or movie.
Students with dyslexia often avoid tasks that involve reading and writing and when they do engage in such tasks,
they often experience great difficulty. In addition, such students experience difficulty finding the actual words to express
their thoughts, summarizing work and answering open-ended test questions. Other characteristics include slow production
at completing assigned tasks, lack of social skills as well as poor coordination and difficulty with organized sports/games.

Instructional Strategies
Students with dyslexia often benefit from a multisensory instructional approach where they can use their senses of touch,
hearing and sight to complete assigned tasks. Furthermore, one-on-one instruction with a teacher and/or therapist provides
students with immediate guidance and feedback in order to assist them in correcting their errors quickly. Teachers can
allows students with dyslexia additional time to complete assigned tasks and tests.
Alternative assessments such as oral presentations/tests can be given as opposed to paper and pencil tests.
Teachers can also grade such students based on the content of the completed assignment rather than on language mechanics.
In addition, teachers can limit/eliminate copying tasks in order to avoid any difficulties experienced by students with
dyslexia.

Assistive Technology
There are numerous assistive technologies that students with dyslexia can take advantage of in order to assist them with
their reading, writing and speaking. These include remedial reading software such as audio books, tapes and publications
that students can listen to using computers.
A student who has difficulty writing can compose a school report by dictating it and having it converted to text by
special speech recognition or word prediction software. Screen synthesizer or screen readers can be used read aloud texts to
students. Graphic organizers and outlining programs such as Inspiration and Draft Builder help students who have trouble
organizing and outlining information as they begin a writing project.
Media
Dyslexia Success Tips: Kids/Teens: http://www.youtube.com/watch?v=0Gq_ShwRssU

This media clip is useful for adolescents with dyslexia in providing them with helpful tips to assisting them accomplish their
daily tasks. Some of the tips include maintain self-esteem through creativity as well as improving their time management
skills.

The Short Bus Part Two: http://www.youtube.com/watch?v=l7z0VHuaoc4&feature=related

This video clip is an introduction to a documentary on normalcy in American culture. The clip features a young adult who
went to Brown University despite having dyslexia. He now travels the United States of American speaking to children and
adolescents about his experiences as a students with dyslexia growing up and his accomplishments.

Community Resources
http://www.dyslexia-parent.com/

This website provides adolescents with dyslexia, their families and educators with numerous links and resources for dealing
with dyslexia. It provides educators and families with defining the symptoms, assistivetechnologies, instructional strategies
and accommodations. It provides adolescents with dyslexia with tips, a discussion board, and assistive technologies to
consider.

http://www.interdys.org/

This is the website for the International Dyslexia Association (IDA) which is a non-profit and educational organization
dedicated to researching and treatment of language-based learning disabilities such as dyslexia. This website provides
students with dyslexia, parents, and educators with the latest research news and treatment options available, support
groups, a discussion forum as well as information regarding access to one of their branches worldwide.
 EPILEPSY
Official Definition
Epilepsy is a disorder that results from the generation of electrical signals inside the brain, causing recurring seizures.
Seizure symptoms vary. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others
have full-fledged convulsions.

http://www.nlm.nih.gov/medlineplus/ency/article/000694.htm

Seizures ("fits," convulsions) are episodes of disturbed brain function that cause changes in attention or behavior. They are
caused by abnormally excited electrical signals in the brain.

Sometimes a seizure is related to a temporary condition, such as exposure to drugs, withdrawal from certain drugs, a high
fever, or abnormal levels of sodium or glucose in the blood. If the seizure or seizures do not happen again once the
underlying problem is corrected, the person does NOT have epilepsy. (This is important info. To get from the school nurse)

In other cases, permanent injury to or changes in brain tissue cause the brain to be abnormally excitable. In these cases, the
seizures happen without an immediate cause. This is epilepsy. Epilepsy can affect people of any age.

Epilepsy may be idiopathic, which means the cause cannot be identified. This matters quite a bit in terms of what medical
jargon is helpful for teachers to understand. Idiopathic is a common term used for teenagers.

These seizures usually begin between ages 5 and 20, but they can happen at any age. People with this condition have no
other neurological problems, but sometimes have a family history of seizures or epilepsy.

Etiology (Causes)
Epilepsy has no identifiable cause in about half of those who have the condition. In the other half, the condition may be
traced to various factors.
1. Genetic influence. Some types of epilepsy, which are categorized by your type of seizure, run in families, making it
likely that there's a genetic influence. Researchers have linked some types of epilepsy to specific genes, though it's
estimated that up to 500 genes could be tied to the condition. For some, genes are only part of the cause, perhaps by
making a person more susceptible to environmental conditions that trigger seizures.

2. Head trauma sustained during a car accident or other traumatic injury can cause epilepsy.

3. Medical disorders. Events like strokes or heart attacks that result in damage to the brain also can cause epilepsy.
Stroke is responsible for up to one half of epilepsy cases in those over age 65.

4. Dementia is a leading cause of epilepsy among older adults.

5. Diseases like meningitis, AIDS and viral encephalitis can cause epilepsy.

6. Prenatal injury. Fetuses are susceptible to brain damage caused by an infection in the mother, poor nutrition or
oxygen deficiencies. This can lead to cerebral palsy in the child. About 20 percent of seizures in children are
associated with cerebral palsy or other neurological abnormalities.

7. Developmental disorders. Epilepsy can be associated with other developmental disorders, such as autism and
Down syndrome.

Characteristics
Epilepsy is a disorder that results from the generation of electrical signals inside the brain, causing recurring seizures.
Seizure symptoms vary. Some people with epilepsy simply stare blankly for a few seconds during a seizure, while others
have full-fledged convulsions.

A solitary seizure doesn't mean you have epilepsy. At least two unprovoked seizures are required for an epilepsy diagnosis.
Even mild seizures may require treatment, because they can be dangerous during activities like driving or swimming.
Treatment — which generally includes medications and sometimes surgery — usually eliminates or reduces the frequency
and intensity of seizures.

What do teachers need to know about medication? How might a science teacher come around with a great lesson about
the brain?
See this PowerPoint http://www.mayoclinic.com/health/brain/BN00033

This power point lesson on the brain could even be incorporated

into a psychology lesson in more senior grades and if taught on
the smart board with the students, offers links in order to delve
more into epilepsy as an example of what can happen in the
brain.

Epilepsy affects 1 in every 100 students. Despite years of

teaching experience, you may never have known any of your
students to have a seizure disorder. This apparent contradiction
is usually due to the hidden nature of the disorder and the
variety of forms it takes.
Aside from seizures themselves, there are no outward physical
signs that make children with epilepsy identifiable. Epilepsy
itself should not impact their normal growth and development.
They are as active and interested in the same experiences as
their peers.

Early recognition and treatment is important because children

with epilepsy can face problems in school.
These include:

• Learning disabilities
• Safety risks
• Behaviour problems
• Social problems
Chronic absenteeism

For a detailed description of the symptoms associated with a specific type of seizure, see:

• Absence (petit mal) seizure

• Generalized tonic-clonic (grand mal) seizure
• Partial (focal) seizure

The Role of the Teacher…

The teacher plays a central role in the acceptance and self-development of the child who has seizures in the classroom.

Sufficient knowledge and understanding of what epilepsy is will allow the teacher to educate the other students and
influence the way in which children respond to this disorder.

Instructional Strategies
1. Children with "absence" seizures frequently blank out during the day causing them to miss relevant instructions
and content. Try to repeat instructions several times or use a consistent 'step-by-step' strategy for them to follow.

2. Establish a 'buddy system' for the child with seizures. The buddy can answer questions, and provide missed class
work and homework.

3. Ask the child with epilepsy if they would prefer to sit at the front of the class to aid in concentration.

4. Use physical prompts (pointing to a page, writing on the blackboard) to help keep the student oriented.
 5. After a seizure the child may be too exhausted to write a test or give a presentation to the class. While it is important
to maximize the amount of instruction time by keeping the child in the classroom it may also be necessary to
modify expectations based on seizure activity.

6. Try to make the child's experience as 'normal' as possible. It is important not to be overprotective, or to allow
exemptions or restrictions in the early years to damage a child's emotional growth.

7. Do not allow the child to carry out any activity more than 1 m (3') off the ground, e.g. gym class, in the playground.

1. Children should be allowed to go swimming, but with adult supervision.

Scholastic Achievement

Most children with epilepsy are otherwise normal; however, as a group their risk for problems with learning is increased
threefold. Approximately 9 percent of children with epilepsy have I.Q.s below 70, a percentage that is three times greater
than in the general population.

Children who achieve seizure control relatively quickly with few side effects and no cognitive impairments generally have
the best chance for average or above average educational achievement. However, it is worth noting that children with
epilepsy with average I.Q. may not achieve up to their potential, and attention problems have been identified across the
spectrum. Loss of school time because of previously undiagnosed seizures or medical tests may also affect performance,
even among children who are otherwise doing well.

Students with epilepsy are at increased risk for academic underachievement, particularly in the basic skills of reading,
language, and arithmetic. Many of them are found to be significantly behind their peers in academic achievement levels,
ranging from 16 percent below grade in reading to 50 percent in general knowledge. In addition, children with epilepsy
have been found more likely to have impairment of self-concept and behavior than are children with asthma. Children with
severe epilepsy are also likely to experience social rejection from peers.

Social Issues: Teachers & School Nurses Promote Understanding

Teacher attitude is an important factor in a child’s social adjustment at school; programs for the school community form an
important part of most Epilepsy Foundation programs in local areas. Such programs generally focus on teacher awareness of
seizure symptoms, seizure management, and full integration of the child within the community. School nurses also play an
important role in the management of the child with epilepsy at school, especially in dispensing of antiepileptic medication
during the school day, and in educating the rest of the school community about epilepsy.

Education Rights

Gaining access to needed educational services is often difficult for parents of children with epilepsy. The Individuals with
Disabilities Education Act (IDEA) is a federal law which states that every child with a disability is entitled to a free,
appropriate education in the least restrictive setting. Children with epilepsy may be entitled to special education and related
services under the Act if having epilepsy affect their educational performance. Every state has laws providing for some kind
of educational services for children with disabilities.

Students of all ages may face obstacles to participation in educational programs, sports, or housing programs. The
Americans with Disabilities Act (ADA) forbids discrimination against qualified students with disabilities by educational
institutions, including colleges and universities.

Assistive Technology
Technology Insight: neuroengineering and epilepsy—designing devices for seizure control:

http://www.nature.com/nrneurol/journal/v4/n4/full/ncpneuro0750.html

Summary:

Despite substantial innovations in antiepileptic drug therapy over the past 15 years, the proportion of patients with
uncontrolled epilepsy has not changed, highlighting the need for new treatment strategies. New implantable antiepileptic
devices, which are currently under development and in pivotal clinical trials, hold great promise for improving the quality
of life of millions of people with epileptic seizures worldwide. A broad range of strategies to stop seizures is currently being
investigated, with various modes of control and intervention. The success of novel antiepileptic devices rests upon
collaboration between neuroengineers, physicians and industry to adapt new technologies for clinical use. The initial results
with these technologies are exciting, but considerable development and controlled clinical trials will be required before these
treatments earn a place in our standard of clinical care.
Also in other studies the use of assistive technologies such as computer access for on-line updates of classes missed for
example or even to confirm or update activities missed in class are beneficial for teenagers with epilepsy. Having access to
this type of technology also assists that teenager with not feeling left out due to what they may have missed while at school
or if they missed school altogether.

Community Resources
The following organizations are good resources for information on epilepsy:
• American Epilepsy Society - www.aesnet.org
Epilepsy Foundation of America® is the national agency dedicated to the welfare of the more than 3 million people
with epilepsy in the U.S
• http://epilepsyfoundation.ning.com/
 FETAL ALCOHOL SYNDROME
Official Definition
The DSM-IV does not have a definition for fetal alcohol syndrome, nor does IDEA, however I did find a good definition that
explains the causes of fetal alcohol syndrome. FAS is a pattern of mental and physical birth abnormalities found in some
children of mothers who drank excessively during pregnancy. Alcohol (wine, beer, or liquor) is the leading known
preventable cause of mental and physical birth defects in the United States. When consuming alcohol during pregnancy, a
woman risks giving birth to a child who will pay the price, experiencing both mental and physical deficiencies, for his or her
entire life.

Etiology (Causes)
The ultimate cause is alcohol intake by the pregnant mother. However, alcohol itself may not be directly responsible for all
(or any) of the features of FAS. What may be responsible are byproducts generated when the body metabolizes ("burns")
alcohol. The end result is a decrease in the number of brain cells (neurons), abnormal location of neurons (due to disturbance
of their normal migration during fetal development), and gross malformation of the brain.

Characteristics
Children born with fetal alcohol syndrome often have a large number of visual characteristics such as a small head
circumference, a low weight at birth, developmental delays, and organ dysfunction. They tend to have quite a few facial
abnormalities such as smaller eye openings, flattened cheekbones, an indistinct philtrum, which is the underdevelopment of
the groove located between the nose and upper lip. Some other characteristics of fetal alcohol syndrome also include poor
coordination or fine motor skills, poor socialization skills, behavioral problems including hyperactivity, inability to
concentrate, stubbornness or anxiety. Children with fetal alcohol syndrome often experience a vast number of learning
difficulties as well, such as poor memory, inability to understand concepts such as time, poor language skills, and poor
problem-solving skills

This is an image depicting some of the facial abnormalities a child with fetal alcohol syndrome may have.

A Breakdown by Age

Early Childhood (1-5 yrs):

Children of this age often experience speech or gross motor delays, tactile sensitivity or insensitivity,
erratic sleeping and eating habits, lack of stranger anxiety, rage, and poor or limited abstracting ability.

Elementary Years (6-12):

Children of elementary school age are often immature, volatile and impulsive, socially isolated and
emotionally disconnected. They also tend to display a high need for stimulation.

Adolescent years (13-18 yrs):

Children of this age have a lack of personal boundary, in addition to poor judgment skills and memory
skills, they are often isolated or depressed, lack social skills, are unable to link action and consequence, and do not
learn from mistakes.

Instructional Strategies
Common areas of concern in the classroom:
Distractibility: Make a quiet working area like a carrel or an office for the student to work in. Arrange desks to minimize
distractions, but do not only move the desk of the student with FAS/E. When talking directly to the student, be sure to say
his or her name
Easily frustrated: Avoid long periods of deskwork (these children must move). Be as consistent as possible. Re-learning and
change are very difficult. Be specific, yet brief. Tell them step-by-step, one step at a time. Use short sentences, simple words,
and always be concrete.

Poor attention: Use multi-sensory instruction (visual, olfactory, kinesthetic, tactile, and auditory). Increase supervision with
the emphasis on positive reinforcement. When giving verbal instruction, write down the main points on an overhead or on
a board.

Lack of organizational skills: Post all rules and schedules. Repeatedly go over the rules and their meanings aloud, at least
once a day.

Problems with concrete thinking: Concepts paired with a visual representation may be easier to learn and retain. Use a lot
of repetition. Don’t ask “why” questions as they are abstract.

Assistive Technology
The following are different kinds of technology a teacher could implement in their classroom depending on how much
money is available in the budget:

"Low -Cost" Technology:

• Organize classroom materials in closed boxes or in cabinets to avoid clutter. Use in/out baskets for work.
• Keep all students’ work in one binder rather than in several separate notebooks and colour code the materials.
• Use one workbook or three-ring binder, with separate colour coded duo tangs and colour coding for subject areas.
• Use soothing colors; remove distractions.
• Define and organize a space that belongs to the student. Have all the students sit on mats on the floor and use
masking tape to define an individual area for each one (do not single out the student with FAS/E differently from
the other students).

“Mid-Cost” Technology:

• Learning through art and music activities may use the student’s strengths and is often an area where a student with
FAS/E will shine. Teachers can play music during class or allow them to listen to music individually.
• Use photographs to show where things belong.

Community Resources
ttp://hamiltonfasdtaskforce.com/The Hamilton Task Force on Fetal Alcohol Spectrum Disorder (FASD) is a standing
committee comprised of voluntary community members who provide leadership and information to the Hamilton
community on issues related to FASD. The purpose, for each participating member, is to support the enhancement of the
community’s ability to address a wide range of needs for affected individuals, families and the community. Through a
portion of a grant from the Ontario Trillium Foundation, some funding has been directed toward increasing the City of
Hamilton’s capacity to provide training, consultation and mentoring related to FASD.
FASlink (Fetal Alcohol Spectrum Disorders Information, Support & Communications Link) http://www.faslink.org

The Fetal Alcohol Support Network was formed by a group of parents who were struggling with the lack of professional
knowledge and supports in the FASD field. FASlink online began as a FASD discussion forum in 1995. In 1999 FASlink was
merged with the FASN website under the direction of Bruce Ritchie and the combined name became FASlink Fetal Alcohol
Disorders Society. FASlink's website contains more than 130,000 searchable FASD related documents and serves more than
400,000 visitors annually. The FASlink Discussion Forum, with more than 650 members, compiles the papers and
discussions into the FASlink Archives. Their membership is worldwide but most are in Canada and the USA, from the most
remote locations to urban centers.

Media

Click on this link to se a short video

http://www.youtube.com/watch?v=2AMW9J8ye68
This video provides viewers with a great description of FAS and its effects, diagnosis, treatment, images of children
with FAS, causes, symptoms, and prevention.
 FRAGILE X
Official Definition
According to the National Fragile X foundation, Fragile X is a family of genetic conditions, which can impact individuals
and families in various ways. These genetic conditions are related in that they are all caused by gene changes in the same
gene, called the FMR1 gene. Fragile X is considered a single gene disorder. There are three categories Fragile X:

Fragile X syndrome (FXS), the most common cause of inherited mental impairment. This impairment can range from
learning disabilities to more severe cognitive or intellectual disabilities. (Sometimes referred to as mental retardation.) FXS is
the most common known cause of autism or "autistic-like" behaviors. Symptoms also can include characteristic physical and
behavioral features and delays in speech and language development.

Fragile X-associated tremor/ataxia syndrome (FXTAS) is a condition that affects balance, tremor and memory in some older
male gene carriers.

Fragile X-associated primary ovarian insufficiency (FXPOI) is a problem with ovarian function that can lead to infertility
and early menopause in some female gene carrier

Since Fragile X syndrome is genetically linked to the X chromosome it is more likely to happen in males than females. While
1 in 3600 to 4000 males in the world are born with the full mutation only 1 in 4000 to 6000 females in the world are born with
the full mutation for Fragile X. However, only 50% of females develop Fragile X fully while close to 100% of males do.

Etiology (Causes)
Fragile X is a genetic disease passed down on the X chromosome. It is caused by the expansion in the repeated sequence of
DNA in the promoter region. Those with fragile X have 200-800 CGG repeats as opposed to 2 CGG repeats. This is called a
trinucleotide repeat. When this repeat is too long it doesn’t make its RNA so RNA doesn’t make the protein called FMR1.
This protein is important for proteins for the development of the brain. Those with Fragile X lack FMRP, (brake for protein
making). In the amygdala, the anxiety center of the brain, the connections get too strong due to the lack of the FMRP. In the
cortex and hippocampus of the brain the connections are too weak and conflict with a person with Fragile X’s ability to think
and contain short term memories.

Characteristics
Students with Fragile X are good at some modes of thinking but have some trouble in other modes of thinking. They are
very good experiential learners.

Known as Gestalt learners, they are more than capable of repeating what they
see. Therefore they are great imitators and good visual learners. They are very
good at some kinds of thinking but have trouble with other kinds. Although
students with Fragile X may need breaks and transition time, they respond well
to redirection. Overall, students with Fragile X are seen as enthusiastic, funny,
and fun-loving individuals that are trying to fit in with their peers.

Typically, babies with Fragile X meet all of the infant milestones. However, they
start to differ in the toddler years. The Individuals with Disabilities ACT (IDEA)
made an amendment to provide early intervention for infants and toddlers with
disabilities and their families. This service can be provided in a home, school, or
hospital. A large head, long face, and long protruding ears are often prominent.
It may be noticed that their muscle lacks tone and their feet are flat. Other than
the physical attributes, the main differences in a child with Fragile X are with their ability to control their anxiety, utilize
their short-term memory, control their impulses, and focus for long periods of time.

Instructional Strategies
IDEA legislation includes two fundamental requirements: that the child will receive a free appropriate public education
(FAPE) in the least restrictive environment (LRE). This means that students with Fragile X or other disabilities have the right
to be in mainstream or general classroom as much as possible. Students with Fragile X will often be extremely motivated to
learn but only be able to focus for a few minutes. It is hard for them to stay focused but they can easily be redirected.
Sometimes it will appear that they are not focused when they are doing such things as rolling on a ball when they are
focused. They may appear this way often due to their lack of eye contact. One of the major symptoms of note is the anxiety
caused by the lack of the FMR1 gene. Anxiety can easily lead to panic and shutdown. Due to this risk of shutdown, students
need to constantly be refocused. However, teachers must be careful how they address the student, they do not like to be
singled out. They are generally shy and don’t like the focus of attention to be on them. Students with Fragile X tend to be
extremely impulsive. They are constantly hand flapping, hand rubbing, biting, spinning objects, and making noises. This can
be very disruptive to the classroom. Specifically, female students with Fragile X have difficulty in math and are extremely
shy.

Students with fragile X can be very successful and make great progress if given the right type of education, support system,
and social network. Knowing the characteristics of students with Fragile X makes it easier for teachers to adjust their
teaching appropriately. This process often involves a team of teachers other than the general classroom teacher.
Team Teaching
- Social Worker
- Occupational Therapist
- Speech/ Language Pathologist
- Reading Specialist
- Special Education Teacher

Motivators

- Alternate quiet and active activities-be flexible in demands for sitting still, use frequent movement breaks
- Use music and movement to motivate and teach concepts
- Use favorite toys, activities, praise, and music as motivators and to ease transitions
- Let the child hold things
- Build on the strengths and interests of the individual child

Educational Modifications and Adaptations

Characteristic: Anxiety & Shut Downs

- Don’t let frustration escalate; allow break for regrouping and calming
- Provide a personal work space and an area for the child to go to regroup
- Provide instruction in which the student with fragile x can contribute without the attention of all the other students
- Don't ask for/require direct responses
- Sensory Integration Theory Breathing Techniques, Squeeze balls, Chewing Straws
- Deep Pressure Massage
- Exercises such as wall push ups
- Consistent Routine

Characteristic: Visual Learner/ Gestalt Learner

- Pictures of days activities in sequence displayed in the classroom

- Pictures of classmates and their class work or jobs
- Pictures of vocabulary being taught
- Signs for proper behavior
- Visual aids to complement what is being discussed in class
- Acting out concepts for the child to later imitate in their head
- Color Coding for memorization
- Using Hand gestures cues and Kinesthetics
- Touch screen

Characteristic: Disruptive behavior/ Impulsivity (hand slapping, noise making, etc)

- Make lessons in which they can get more consistent gratification to prevent the student from be impulsive
- Use consistent reinforces
- Use stern voice/affect to convey displeasure; be firm
- According to Karen Riley, PhD, time out is affective with students with Fragile X ages 3-13)
- Token system

Characteristic: Lack of focus

- Give the student all the things to do with one concept at the same time because they learn best through learning a
group of things together
- Special pencil grips to help fine motor focus
- Specially shaped mouse for the computer
- Adapted key board
- Talking dictionary
- Color coded folders
- Highlight tape for instructions or important ideas
- Rulers
- Special Ball chair
- Large print sheets
- Abbreviated worksheets
- Color Coding Notes
- Break tasks down into manageable segments
- Repeat directions or material as necessary
Characteristic: Difficulty in math

- Adapted sheets with enlarged visuals and fewer math problems

- Math Line
- Abacus
- Calculator with large keys
- Talking Calculator
- Talking watches and clocks
- Calculator with print out

Assistive Technology
IDEA states that assistive technology is defined as “Any item, piece of equipment, or product system, whether acquired
commercially off the shelf, modified, pr customized, that is used to increase, maintain, or improve functional capabilities of
children with disabilities” It is recommended that a teacher or IEP team start with low technology and move to high
technology as needed. The device should be chosen based on the specific characteristics and behaviors of the individual. Not
all students with Fragile X will benefit from the same technology. Finding the right technology may include a long process of
trial and error. Technology is split up into no technology, low technology, and high technology.

No Tech- includes strategies instead of equipment

- Seating placement
- Attention strategies

Low tech- includes simple devices such as

- Pencil grips
- Visual timers
- Simple Voice Communication Aids (VOCA’s)
- Socials scripts
- Visual schedules

High tech- includes elaborate technology such as

- Computers
- Touch screens
- Adapted key boards
-
Examples of assistive technology used for goals

Goal: For the student to improve their social interaction

- Topic Board with words and pictures (LT)

- Visual of turn-taking steps (LT)
- Voice Output Communication Aid (VOCA) (LT or HT)

Goal: Write Writing

- Pencil grip (LT)

- Special key board and mouse (HT)

Goal: Focus

- Special Ball chair (LT)

- Large print sheets/ Abbreviated worksheets (LT)
- Ensure only one person at a time is talking (in the room(NT)

Media
http://www.youtube.com/watch?v=wGdH1M5lCVY&feature=related (short clip)
A quick overview of autism in the classroom and characteristics of children with Fragile X

http://www.fragilex.org/html/understanding_fragilex.htm (Short movie)

The story of a teenage boy with autism. He and his teachers share his personal stories.

Community Resources

Fraxa Research Foundation: FRAXA is a national, nonprofit organization run by parents and medical professionals. In
1994, three parents of children with fragile X syndrome founded FRAXA because fragile X research is drastically
underfunded. FRAXA funds medical research aimed at finding a specific treatment.

American Association on Intellectual and Developmental Disabilities: http://www.aamr.org/

Professionals working to support individuals with intellectual and developmental disabilities. This organization provides
membership with newsletters, conferences, training, and information on different disabilities

M.I.N.D. Institute: The M.I.N.D. Institute is an interdisciplinary institute dedicated to conducting research and providing
clinical programs that focus on neurodevelopmental disorders. Their vision is to become a national resource for the study
and treatment of neurodevelopmental disorders, including FXS. Leading scientists, physicians, and educators in the fields as
diverse as molecular genetics and clinical pediatrics have joined together to better understand behavior, development, and
the brain function

The National Fragile X Foundation

The National Fragile X Foundation was founded in 1984 to provide support for families impacted by fragile X, and for the
educators, therapists, and doctors who work with them. It's website contains over 1200 pages of content.
The Hagerman Laboratory: http://wizard1.ucdavis.edu/
The Hagerman laboratory is engaged in basic (molecular genetics) and treatment-related research for the fragile X family of
disorders. Our goal is the development of effective therapies for those disorders.

National Association of State Directors of Developmental Disabilities Services

http://www.nasddds.org/MemberAgencies/index.shtml
This organization gives links to publications, meetings, alternative resources and state agency contact information .
 GENERALIZED ANXIETY DISORDER

Official Definition
Generalized anxiety disorder (GAD) is an anxiety disorder that is characterized by excessive, uncontrollable and often
irrational worry about everyday things that is disproportionate to the actual source of worry. It is a common chronic
disorder characterized by long-lasting anxiety that is not focused on any one object or situation. Those suffering from
generalized anxiety experience non-specific persistent fear and worry and become overly concerned with everyday matters. This
excessive worry often interferes with daily functioning, as individuals suffering GAD typically anticipate disaster, and are
overly concerned about everyday matters such as health issues, money, death, family problems, friend problems,
relationship problems or work difficulties.

DSM-IV Definition
Generalized anxiety disorder is characterized by excessive anxiety and worry about a variety of topics (such as work,
school, family, health) occurring more days than not for at least six months. People with GAD find it difficult to control
their worry, and often experience other related symptoms including restlessness, irritability, and muscle tension.

Anxiety disorders, which include Generalized Anxiety Disorder, Panic Disorder, Phobias, Obsessive-Compulsive Disorder,
and Post-Traumatic Stress Disorder, are among the most common mental health problems of childhood and adolescence. As
many as 1 in 10 young people may suffer from an anxiety disorder. About 50 percent of children and adolescents with
anxiety disorders also have a second anxiety disorder or other mental or behavioral disorder such as Depression. Among
adolescents, more girls than boys are affected.

Generalized anxiety usually does not cause people to avoid situations, and there isn’t an element of a "panic attack"
involved in the prognosis, either. It’s the thinking, thinking, thinking, dwelling, dwelling, ruminating, ruminating, and inability to
shut the mind off that so incapacitates the person. At other times, thoughts seem almost non-existent because the anxious
feelings are so dominant. Feelings of worry, dread, lack of energy, and a loss of interest in life are common. Many times there is
no "trigger" or "cause" for these feelings and the person realizes these feelings are irrational. Nevertheless, the feelings are
very real. At this point, there is no "energy" or "zest" in life and no desire to want to do much.

Some people with generalized anxiety have fluctuations in mood from hour to hour, whereas others have "good days"
and "bad days". Others do better in the morning, and others find it easier at the end of the day. These anxiety feelings and
moods feed on themselves, leading the person to continue in the pattern of worry and anxiety – unless something powerful
breaks it up.

Media
“What is Generalized Anxiety Disorder?”
http://www.youtube.com/watch?v=NPWFXZJ59Js&feature=player_embedded
Specific information with respect to children and adolescents who suffer from GAD is quite limited, but this video provides
a very good description of the way that GAD manifests itself. It provides teachers with basic, helpful information.

“Generalized Anxiety Disorder and Me”

http://www.youtube.com/watch?v=eaYTkKK010Q&feature=player_embedded
This video provides a description based on a young man’s personal difficulties with GAD. The individual featured is not
too much older than an adolescent. This may help educators understand the way that students with GAD feel and approach
situations from a more “authentic” source (a sufferer himself).

Etiology (Causes)
GAD may be caused by both biological and psychological factors, but it is not known for certain whether anxiety disorders are
caused by biology, environment, or both. The presence of GAD has previously been linked to abnormalities in a number of
different brain chemicals, particularly those known to be associated with fear and emotional responses. Moreover, the
symptoms of GAD appear to worsen during periods of stress. Although some studies have reported that GAD runs in
families – young people are more likely to have an anxiety disorder if their parents have anxiety disorders - others have not found
this connection. In addition, researchers have found that a person's basic temperament may play a role in some childhood and
adolescent anxiety disorders. For example, some young people tend to be very shy and restrained in unfamiliar situations.
This may be a sign that the child or adolescent is at risk for developing an anxiety disorder.

Characteristics
Individuals with generalized anxiety disorder may display the following characteristics or traits:

General Symptoms
 constant worrying or obsession about small or large concerns (exaggerated worry and tension, even though
 there is little or nothing to provoke it; extreme or undue concern about health issues, money, family problems, or
difficulties at school/work)
 restlessness and feeling keyed up or on edge
 inability to fully relax (difficulty settling down enough to have a quiet, reflective time to calm down, relax, and feel
some peace and tranquility)
 propensity to be in a state of constant motion
 easily-startled
  difficulty concentrating, or mind "going blank"
 high levels of self-consciousness in some situations
 fear of not being able to escape from enclosed spaces
 anticipation of disaster
 trouble falling asleep or staying asleep

Physical Manifestations
The symptoms of Generalized Anxiety Disorder may be revealed through physical symptoms such as:
 trembling or twitching
 headaches
 fatigue
 irritability
 sleep disturbances
 muscle tension or muscle aches
 sweating, nausea, or diarrhea
 shortness of breath or rapid heartbeat
 frustration
 quickness to startle
 difficulty swallowing
 lightheadedness
 having to go to the bathroom frequently
 hot flashes

Although they don’t avoid certain situations as a result of their disorder, people with GAD can have difficulty carrying
out the simplest daily activities if their anxiety is severe.

*Symptoms in children and adolescents to watch for in the classroom:

In addition to the symptoms and other conditions above, children and adolescents may have excessive worries about:
performance at school or sporting events
being on time (punctuality)
teacher approval
being perfect and doing things perfectly
doing tasks and/or working with others
a variety of classroom situations
earthquakes, nuclear war, or other catastrophic events

A child with the disorder may also:

be unable to explain his/her worry
be unable to stop worrying
not want to come to school
feel overly anxious to fit in
lack confidence and have low self-esteem
redo tasks because they aren't perfect the first time
require a lot of reassurance about performance

* These characteristics may be seen in combination with other conditions such as ADHD and/or learning disorders, or they may be side
effects from medication.

The years of highest risk for developing the disorder are between childhood and middle age.

Many people with generalized anxiety disorder can't recall when they last felt relaxed or at ease.

These children may lose friends and be left out of social activities.

A Teacher’s Role
Anxious students may lose friends and be left out of social activities. They commonly experience academic failure and low
self-esteem. Because many young people with this disorder are quiet and compliant, the signs are often missed. Teachers
and parents should be aware of the signs of anxiety disorder so that treatment can begin early, thus preventing academic,
social, and vocational failure.

*Teachers should be attentive to the following warning signs:

frequent absences
refusal to join in social activities
isolating behavior
many physical complaints
excessive worry about homework or grades
falling grades
frequent bouts of tears
 frustration
fear of new situations
drug or alcohol abuse

Many of these children are not noticed because they do not cause obvious classroom disruptions.

"...if I had a good day...and it wasn't too stressful, I had to find something else to worry about 'cause it didn't feel right..."
~ from a person who suffers with generalized anxiety disorder.

Instructional Strategies

The following interventions may help lesson anxiety in the classroom:

 have students check in with you at the beginning of the day to help transition from home to school
 find a “safe place” that the student can go to during the school day
 encourage and monitor small group activities
 let the student have extra time when beginning new activities
 keep the student's workload at a reasonable level (reduce school work load when necessary, and reduce homework
when possible)
 work with the student to make sure assignments are written down correctly; have the student check with you, or
check with the student to make sure that assignments have been written down correctly – many teachers will
choose to initial an assignment notebook to indicate that information is correct
 encourage follow-through on assignments or tasks, yet be flexible on deadlines (be flexible about due dates for
assignments, especially worrisome ones)
 post a daily schedule where it can be seen easily so students know what to expect.
 keep as much of the child’s regular schedule as possible
 encourage school attendance (to prevent absences, modify the child’s class schedule or reduce the time spent at
school)
 have alternate calming types of activities the child might engage in, and encourage any relaxation techniques they
might know or use
 teach and encourage the use of coping statements
(see http://sites.google.com/site/resourcefulteachingedu539/social-emotional/who-we-are/instructional-
strategies-and-accomodations/anxiety-coping-statements)
 praise any positive efforts taken to address anxiety issues
 consider adaptations to lessons for this student when possible; modify or adapt the curriculum to better suit the
student’s learning style
 consider using technology when appropriate to help with motivation – many students will benefit from easy access
to appropriate technology, which may include applications that can engage student interest and increase
motivation (e.g., computer-assisted instruction programs, CD-ROM demonstrations, videotape presentations)
 ask parents what works at home

Assistive Technology As mentioned above, “Assistive Technology” in the classroom may take the form of:

 a posted daily schedule

 computer-assisted instruction programs
 CD-ROM demonstrations
 videotape presentations

Because individuals with generalized anxiety disorder may also find comfort in playing video games, it may be helpful to
incorporate some sort of electronic games, if possible.

Community Resources
Dr. Robert T. Muller, Clinical Psychologist
114 Maitland Ave.
3rd Floor
Toronto, ON
(416) 939-6491
rmuller@psychotherapytoronto.ca
http://www.psychotherapytoronto.ca/#

Anxiety and Stress Disorders Clinic of York Region

10815 Yonge Street
Suite 200
Richmond Hill, ON
(905) 770-5593
 GIFTED AND TALENTED
Official Definition
There is no universal definition for deeming a student to be “gifted and talented” and it can vary from state to state.
However, the federal definition of gifted and talented according to the No Child Left Behind Act of 2001 is as follows:

“The term ‘gifted and talented,’ when used with respect to students, children, or youth, means students, children, or youth who
give evidence of high achievement capability in areas such as intellectual, creative, artistic, or leadership capacity, or in specific
academic fields, and who need services or activities not ordinarily provided by the school in order to fully develop those
capabilities.” (Title IX, Part A, Section 9101(22)).

Etiology (Causes)
It is impossible to determine “causes” for giftedness. The biggest argument is nature vs. nurture; are children who are gifted
born or made? Intelligence is no longer believed to be fixed at birth, which contributes to the nurture side of the argument.
According to this argument, any child could be challenged or trained to learn and retain knowledge at an exceptional rate
with the right amount of education, resources, and support.
However, the brain goes through physical and chemical changes when stimulated or challenged, and this can attest
to the nature side of the argument. A student who is gifted and talented could be observed and monitored through the use
of digital imaging devices and scans to verify that their brain experiences more/less or different physical and chemical
changes and patterns when stimulated compared to a student of “average” or “below average” intelligence. (Also refer to
the media section to watch a video about these differing opinions from psychologists and students who are classified as
gifted and talented or “prodigies.”)

Characteristics
Most often students who are gifted and talented are misdiagnosed or dual-diagnosed to have other learning disabilities
because of the characteristics they show. Students usually exhibit an above average talent in at least one of the following
areas: Creative Thinking, General Intellectual Ability, Visual/Performing Arts, Leadership, and Specific Academic Ability.
Their above-average ability, task commitment, and creativity are specifically what make them different from the “typical”
student in the classroom.

The following characteristics may demonstrate a student with an above average talent in the area of Creative Thinking:
 Independent thinker
 Exhibits original thinking in oral and written expression
 Develops several solutions to a given problem
 Possesses a sense of humor
 Creates and invents easily
 Challenged by creative tasks
 Improvises often
 Does not mind being different from the crowd
The following characteristics may demonstrate a student with an above average talent in the area of General Intellectual
Ability:
 Formulates abstractions
 Processes information in complex ways
 Extremely observant
 Excited about new ideas
 Enjoys hypothesizing
 Learns rapidly
 Uses a large vocabulary
 Overly inquisitive
 Self-starter
 Extraordinary processing speed
 Difficulty completing dull and routine material
 Frequent step-skipping

The following characteristics may demonstrate a student with an above average talent in the area of Visual/Performing
Arts:
 Outstanding in sense of spatial relationships
 Unusual ability for expressing self, feelings, moods, etc., through art, dance, drama, music
 Good motor coordination
 Exhibits creative expression
 Desire for producing “own product” (not content with mere copying)

The following characteristics may demonstrate a student with an above average talent in the area of Leadership:
 Often assumes responsibility
 Extremely high expectations of self and others
 Fluent, concise self-expression
 Foresees consequences and implications of decisions
 Good judgment in decision making
 Likes structure
 Well-liked by peers
  Self-confident
 Very organized

The following characteristics may demonstrate a student with an above average talent in the area of Specific Academic
Ability:
 Exceptional memorization ability
 Advanced comprehension of the content
 Acquires basic-skills knowledge quickly
 Widely read in special-interest area
 High academic success in special-interest area
 Pursues special interests with enthusiasm and vigor
 Intense passion or interest in any given topic (sometimes seen as obsession)

Instructional Strategies
- Teachers can utilize a number of different strategies to instruct students who are gifted and talented within
their normal curriculum. Gifted education has also shown to significantly improve learning experiences for all
students of varying intellectual abilities. Students who are gifted especially need differentiation of the
curriculum at all levels. According to Susan Winebrenner’s book, Teaching Gifted Kids in the Regular Classroom,
differentiation has five elements: content, process, product, environment, and assessment.

- In regards to differentiation of content, it is not necessarily what the student is being taught, but also on how
the information is organized, important questions and issues that are raised, and the depth and complexity of
research in a given study. Students who are gifted and talented are candidates for this type of differentiation
when they are already aware of the content that their peers are going to be learning, or they are able to learn it
at a faster pace.

- Differentiation of process is necessary so that students who are gifted and talented can use other methods to
make sense of concepts, generalizations, and/or the required standards by spending extra time on tasks that
are more complex or abstract than what their peers are working on. Students may use different learning styles
or a multiple intelligence approach to research information on their own.

- Products should be differentiated for students who are gifted and talented because many often resist the
traditional written assignment since their minds work faster than their hands can write or type. Students who
are gifted and talented, especially in the area of Creative Thinking, are much more willing to create their own
product of the information, whether it is an exhibition or performance.

- The environment may be differentiated for students who are gifted and talented by allowing them to work in
an independent study area and giving them flexible time limits to complete their products. These students
should also be provided with opportunities to work with mentors and complete more in-depth research. This
type of differentiation would be most beneficial to students who are gifted and talented in the area of Specific
Academic Ability.

- Assessment should be differentiated so that students who are gifted and talented can have consistent
opportunities to show mastery and gain feedback on their work, especially since many of these students have
extremely high expectations for themselves. For students who show many characteristics in the area of
Leadership, they may also be encouraged to create their own rubrics and assessments for independent projects.

(Also refer to the following section describing assistive technology.)

Assistive Technology
One major assistive technology for students who are gifted and talented would be a portable word processor (laptop) that
allows students to work independently and at their own pace. This would be considered a “high-cost” technology and
would depend on the amount of money available in the budget, but it is especially great for students who are twice
exceptional, meaning they are gifted and talented but also have a learning disorder.

Working on a laptop may help students with their spelling since they have many great ideas but they think or write too fast
to spell correctly. Voice-to-text technology on the computer may also be ideal for students who can verbally explain
themselves very well but have difficulty putting it into writing. Access to the internet also provides students with a way of
gaining more knowledge and resources, access to mentors, a source of social interaction with other individuals who are
gifted, and various independent learning experiences.

If there is not enough money in the budget for a resource such as this, there are “low-cost” or “middle-cost” technologies
that can be used in the classroom as well. Having supplies for creating their own posters, photo albums, portfolios, binders,
file folders, etc. will allow students to exhibit their creativity and organization. Having a film or digital camera or camcorder
may also allow students to differentiate their learning by creating skits, educational or promotional advertisements, or
photographic essays. Many assistive technologies could help students who are gifted and talented promote their
independence but also move on in their education showing their creativity and moving at their own pace.
Community Resources
The following colleges and universities have development programs specifically geared towards students of all ages, with
many options for middle and high school students. Programs take place on weekends or during summer vacations and can
lead to many scholarship opportunities for students as well.

Center for Talent Development (CTD)

Northwestern University
www.ctd.northwestern.edu

Talent Identification Program (TIP)

Duke University
www.tip.duke.edu

Center for Talented Youth (CTY)

Johns Hopkins University
www.cty.jhu.edu

Rocky Mountain Talent Search

University of Denver
www.du.edu/education/ces/rmts.html

The following websites are also good resources for students who are gifted and talented and support for their
families. These resources also provide programs for students who want or need additional education during
their summer vacation.

New York State Summer School of the Arts

www.emsc.nysed.gov/nysssa

Summer Institute for the Gifted (SIG)

www.giftedstudy.com

The Davidson Institute for Talent Development

www.Davidson-Institute.org

The Hollingworth Center for Highly Gifted Children

www.hollingworth.org

The Association for the Education of Gifted Underachieving Students (AEGUS)

www.aegus1.org

Media
The short news documentary, “Are gifted children born or made?” highlights psychologists and young adults who
are described as “child prodigies.” The psychologists wholeheartedly believe that child prodigies are born with
natural talents that no one else has or can acquire. The young males who are singing and dancing “prodigies” are
offended with the label because they feel it diminishes all of the hard work and effort they put in to their areas of
talent. They explain that they are blessed to have parents who can support them financially and emotionally and
with such support they have flourished in their fields. They believe that anyone of any talent level can achieve to
these higher levels with the right amount of outside support. This video shows the major differences in views of
nature vs. nurture when it comes to the etiology of giftedness.

The video can be accessed at this link: http://www.youtube.com/watch?v=sOBdYEbaSyo.

.
 MITOCHONDRIAL DISEASE
Official Definition
The term “Mitochondrial disease” refers to a group of disorders. Each of these conditions involves a problem with
mitochondria. Mitochondria are tiny structures inside almost every cell in your body; all the way from your skin to
the organs inside your body. Their main job is to use the food and oxygen that enter the cells to make energy.
Almost all of the energy your body needs for daily life and growth comes from mitochondria.

Each condition is the result of a genetic mutation – a specific change in the genetic material of the mitochondria.
The mutation causes the mitochondria to fail.

When mitochondria fail, less and less energy is made in the cells. The cells may stop working or die. Depending on
where the affected cells are, parts of the body may not function properly and many health problems can result. The
symptoms of Mitochondrial disease can range from mild to severe.

Etiology (Causes)
Mitochondrial disease is a genetic disease, meaning that most people are born with it. It is inherited or passed
down from one or both parents. In some rare cases, the disease is caused by a “spontaneous mutation”, meaning
that it occurs randomly at or before conception, despite parents’ healthy genes.

Characteristics
Symptoms of Mitochondrial Disease can range from mild to severe and the level of severity could mean that some
students will not appear as though they have the disease. It could be more apparent at home. Some signs and
symptoms include:

• developmental delay or regression in development

• seizures
• migraine headaches or strokes
• muscle weakness
• poor muscle tone
• poor balance
• painful muscle cramps
• unable to keep up with peers (low endurance)
• chronic fatigue
• stomach problems (vomiting, heartburn, acid reflux, pain)
• loss of vision or blindness
• loss of hearing or deafness
• heart, liver or kidney disease at a young age
• parts of the body are shaky (tremors)

These are only some of the many symptoms that students with Mitochondrial disease can experience on a day-to-
day basis. It is the teacher’s job to understand that even though they may look “normal” their insides are weak,
tired and unable to keep up with other students’ abilities or educational responsibilities.

Instructional Strategies
There are two main strategies that can be used for the student with Mitochondrial Disease.
1. Extra Time: These particular students are having trouble with getting around campus and it may affect
their social and emotional state when added homework is assigned. Allow extra time for everything only
when they ask. They want to seem as normal as possible and fit it. Having to give them extra time may
allow for abuse of that allotted time. Time exemplars include extra time for assignments, lateness to class
and note taking.
2. Ask Questions: In every subject in school, teachers try to have as many hands on experiences as possible.
Leaving the classroom, going on field trips or going for walks could be the highlight of a student work
week. For a student with Mitochondrial Disease, this is a huge nightmare. Always ask if that student
would be comfortable with the assignment and provide accommodations such as resting periods and lots
of liquids. Encourage the student that these are necessary parts of the educational experience but do not
force them to do such things.

Assistive Technology
Since symptoms can range from mild to severe, technology and modifications would also vary from no assistance
or many different types. The following are some examples of assistive technology that could be used for a student
with mitochondrial disease:
• Computers (for slow writers or note takers)
• Educational Assistant (students with wheelchairs)
• Speech Therapist or Physiotherapist (for those who have suffered seizures or strokes)
Community Resources
MitoCanada
P.O. Box 732,
Winnipeg Beach, MB R0C3G0
www.mitocanada.org

Neuromuscular and Neurometabolic Centre of Hamilton Health Sciences

1200 Main St W.
Hamilton, ON. L8N 3Z5
905-521-2100
http://www-fhs.mcmaster.ca/pediatrics/neuromuscular_neurometabolics.html

Media
http://www.youtube.com/watch?v=6cIviLZ8-TM&feature=related
This is a video of the hit TV series “Glee” singing the song “Imagine” by John Lennon. It is performed by a Glee
Club from a school which students are hearing impaired. The reason this song represents students with
Mitochondrial Disease is because the symptoms of the disease could include hearing loss and the fact is that the
lyrics represent exactly what students who suffer are feeling. They imagine a world where everyone is equal,
where no one is different and everyone is on the same playing field. Glee is an amazing show that encompasses
many different situations into the show to incorporate as many real-life situations as possible.

This documentary can be found on HBO.

 MUSCULAR DYSTROPHY
Official Definition
The term "muscular dystrophy" covers over 40 separate neuromuscular disorders which have in common the progressive
and irreversible wasting of muscle tissue. Some of these diseases are known as dystrophies, the wasting of the muscles from
within themselves. Others are atrophies, wasting arising from a disorder originating in the nerve system which causes loss
of the ability to use muscles. Various Myopathies, Peripheral Nerve and Metabolic Disorders also fall into the realm of
disorders covered by the MDA's program. These neuromuscular disorders (NMDs) are generally, incorrectly, termed
"muscular dystrophy."

Etiology (Causes)
The etiology of muscular dystrophy is an abnormality in the genetic code for specific muscle proteins. They all are classified
according to the clinical phenotype, the pathology, and the mode of inheritance.

Characteristics
The most important thing to keep in mind when working with students who have MD is that their “ability” to think and
participate within the educational setting is often limited by the way in which they are “framed” by their physical disability.

Because Muscular Dystrophy causes muscle weakness that slowly gets worse over time. Students with Muscular Dystrophy
have several physical disabilities that characterize them including:

Delayed development of muscle motor

skills

Difficulty using one or more muscle groups

Drooling

Eyelid drooping (ptosis)

Frequent falls

Problems walking (delayed walking)

In some cases students with Muscular

Dystrophy suffer from mild retardation on
top of the previously mentioned physical
symptoms.

Instructional Strategies
Every student with muscular dystrophy should have an Individualized Education Plan that is updated with psycho-
educational testing, teacher reports and an annual parent conference. Each child should receive adequate services based on
measured rather than assumed capabilities. Information from a physical therapist on the child's medical team should be
taken into consideration in order for an adaptive physical education program and/or physical therapy to be provided as
part of school services.

Dealing with a progressive, chronic illness requires some form of coping on the part of a child with muscular dystrophy. The
pervasive impact of such a disease can make individual guidance and counseling a very important aspect of the child's
school experience. In some instances, the teacher may be able to provide for the child's needs in this area. In others,
coordination of classroom experience with additional individualized counseling may be appropriate. The child's emotional
needs are certainly a necessary consideration in providing services in the school setting.

Being a regressive disorder, symptoms of Muscular Dystrophy can worsen from day-to-day, week-to-week, and year-to-
year. Teachers need to be aware of any issues these students may have and track them for regression. Being aware of the
issues that a student with Muscular Dystrophy is having allows for the proper measures to be taken to ensure that learning
is as easy as it can be.

Assistive Technology
Adaptive equipment may include items such as feeding utensils and special cups, a foam rubber cylinder that fits over a
small pen or pencil to make it easier to grasp, tape recorders, jar openers, and devices to aid buttoning and zipping.
Although these devices are not familiar to most people, a teacher who is familiar with adaptive equipment can facilitate
acceptance and use of these "tools" that encourage the child's independence.

For students that have difficulty with stairs, elevators and ramps need to be present in the school to make travel around the
building and from class to class easier.

Community Resources
The Muscular Dystrophy Association is the non-profit health agency dedicated to curing muscular dystrophy, ALS and
related diseases by funding worldwide research. The Association also provides comprehensive health care and support
services, advocacy and education.

Through its national advocacy program, MDA works to make life better for people with muscular dystrophy and related
muscle diseases by providing representation in matters of public policy and research advancement, nationally and
internationally; and facilitating active involvement in these areas by the people it serves.

To register with MDA if you have a neuromuscular disease, make a clinic appointment and find out more information about
other services for people and families affected by a neuromuscular disease in MDA's program contact
jhairston@mdausa.org.

MDA has an office in Buffalo, New York which is located at 5500 Main Street. They can be reached 716-626-0035 or
buffalo@mdausa.org.

Media
http://www.youtube.com/watch?v=6wLnR7GJakY&feature=related

This video does a terrific job of explaining muscular dystrophy as well as making it relatable for students as it describes
what to expect from classmates who suffer from muscular dystrophy. Although the video is somewhat elementary it is
loaded with pertinent information and is not too childish for adolescent students.
 MULTIPLE SCLEROSIS

Official Definition
The DSM-IV does not have a definition however, the Multiple Sclerosis Society of Canada defines MS an autoimmune
disease that affects the central nervous system (CNS), which is made up of the brain, spinal cord, and optic nerves. When a
person has MS, the immune system, which usually works to protect the body from disease-producing organisms, mistakenly
attacks the body’s own tissue.

The primary target of this attack is myelin, the protective coating around the nerve cells in the CNS that facilitates nerve
conduction. The nerve cells themselves can also be damaged. The attacks on myelin produce scarring at multiple sites in
the CNS, and it is these scars that give the disease its name. The scars, in turn, begin to slow or interrupt the transmission of
nerve impulses, resulting in the symptoms of MS.

Multiple sclerosis has long been regarded as a young person's disease with the majority of people being diagnosed between
the ages of 20 and 40. However, younger sufferers are now coming to light, and 5% of the total number of MS cases involve
children under 16.

Etiology (Causes)
Doctors still don't understand what causes MS, but there is interesting data that suggest that genetics, a person's
environment, and possibly even infection may play a role.

Environment: MS occurs most commonly in those living in northern climates, including anywhere north of Denver or
Philadelphia in North America. MS is also common in Northern Europe and Japan. Where you spend the first 15 years of
your life plays a crucial role in your odds of developing MS. Tropical and southern regions are considered low risk. If at age
15 or older you moved from the south to a high-risk area in the north, you are still considered to be at low risk for the
disease. If you moved before age 15, you would then have a higher risk. There is some early evidence that sunlight exposure
and high levels of Vitamin D may decrease the chance of developing MS. However, further research is required before
supplements can be recommended for this purpose.

Infections: Researchers believe that many autoimmune diseases are provoked by some kind of infection that strikes people
who have a certain genetic makeup. Many bacteria carry proteins that can mimic the cells of the body. This can trick your
body's defenses into attacking your own tissues, even after the infection has gone. Recently, researchers have been looking at
viruses as possible triggers, especially those that cause chickenpox and herpes.

Genetics: Women are 2 to 3 times more likely to get the disease than men. Family history increases the risk of developing
MS. The closer the relationship, the higher the risk. For example, if your identical twin develops the illness, your chances are
about 30%. However, research has shown that there is no single "MS gene." It will take many more years to understand the
role of genetics.

Characteristics
Problems with vision, co-ordination and balance seem to be the predominant symptoms with children and the vast majority
of youngsters are diagnosed with relapsing-remitting MS meaning they have attacks followed by periods of feeling totally
well. As children grow, other common affects of MS include fatigue, tingling sensations, difficulty walking, hearing and
memory loss.

How a student with MS may differ for a "typical" child.

Just like adults, children with Multiple Sclerosis can lead completely normal lives. Because they contract the disease at a
young age doesn't necessarily mean they will end up with any symptoms sooner. In fact studies show that the disease could
be less aggressive in children.

Often loss of vision is one of the first noticeable signs of MS. It is common for a child to lose partial or complete vision is one
eye. Because of the vision loss, teachers may be the first to notice that something is wrong and call the parents. Sometimes
that’s how the problem is identified.

One big difference is the potential impact of MS on a child’s thinking. That has much more complicated ramifications in kids
than in adults, because most adults are functioning at a set level. Children are on the ascendant curve of their development.
If that is affected then the consequences are much more significant than in people who are not facing the challenge of trying
to learn for hours on a daily basis. There’s actually data that shows if you had MS early in life, you’re more likely to face
academic problems. So if a child is diagnosed early, academic problems can be identified and addressed sooner.

Furthermore, these children may have trouble with “working memory”—the ability to hold information in mind while
working on it. This ability is necessary, for example, when performing mathematical computations that require “carrying”
numbers, or other more complex operations. Also, the speed at which information is processed can be adversely affected,
necessitating longer time to think about responses in general. MS patients may become fatigued very easily when
performing demanding tasks (either physical or cognitive). This fatigue may exacerbate attentional problems as well as other
cognitive deficits.
Instructional Strategies
Students with Multiple Sclerosis may have difficulty commuting to and from class, taking class notes, and finishing exams in
the allotted amount of time. They may also have difficulty-carrying books and need assistance when utilizing the library
facilities.

Depending on the severity of the symptoms, students may need assistance moving around and taking notes. If note taking
is a problem, provide the student with a laptop or cassette recorder. If technology doesn't help, provide your student with a
handout including notes. When taking tests, students may need more time to finish and may benefit from taking the test in a
quiet spot outside of the classroom.

For students who have difficulty concentrating during a task, provide written instructions when possible. Allow periodic
rest breaks so the student can reorient and if possible, allow the student to have a self-paced workload.

Another tool to help students stay organized and on task are memory aids. Students with MS may benefit from the use of
schedulers or organizers, organization software, timers, and by providing more structure to assignments and deadlines.

Assistive Technology
Students with Multiple Sclerosis who suffer from fine motor limitations may struggle using the keyboard and/or mouse.
Possible accommodations for these students include providing key guards and typing aids and providing speech
recognition.

Additional modifications for students with MS include:

• Implementing ergonomic principles and ergonomic workstation adaptations with articulating keyboard trays,
monitor risers, glare guards, foot rests, adjustable chairs, anti-fatigue matting, and adjustable workstations.
• Providing alternative input devices and mice, alternative keyboards, one-handed keyboards, expanded
keyboards, or miniature keyboards; providing on-screen keyboards and word prediction software.
• Word processing may be the most important application of assistive technology for students with mild
disabilities. Many of these students have been identified as needing assistance in the language arts, specifically
in writing. Computers and word processing software enable students to put ideas on paper without the
barriers imposed by paper and pencil. Writing barriers for students with mild disabilities include mechanics:
spelling, grammar and punctuation errors; process: generating ideas, organizing, drafting, editing, and
revising; and motivation: clarity and neatness of final copy, reading ability, and interest in writing.

Community Resources
Young Persons with MS: A Network for Families with a Child or Teen With MS is a support network that provides
multiple program options for families living with a child or teen who has been diagnosed with multiple sclerosis.

They can help you learn about the disease, as well as how to manage the symptoms and adapt to the changes that MS
brings to a family's life. They will help keep families informed about the newest and most exciting MS research, as scientists
work toward a better understanding of the disease, improved treatments, and eventually, the cure.

National Multiple Sclerosis Society

Toll Free: 1 866 KIDS W MS (1 866 543-7967)
E-mail: childhoodms@nmss.org

The Multiple Sclerosis Society of Canada is here to help. No one need face MS alone. In communities across Canada, our
volunteers and staff provide information, support, educational events and other resources for people with MS and their
families. Researchers funded by the MS Society are working to develop new and better treatments. Their ultimate goal is the
cure for MS.

The National MS Society is a collective of passionate individuals who want to do something about MS now—to move
together toward a world free of multiple sclerosis. They help each person address the challenges of living with MS through
our 50-state network of chapters. The Society helps people affected by MS by funding cutting-edge research, driving change
through advocacy, facilitating professional education, and providing programs and services that help people with MS and
their families move their lives forward. The National MS Society has a Facebook page with approximately 47,000 members.
The members are a great resource! They are more than happy to answer your questions.
www.facebook.com/nationalmssociety

JAN - The Job Accommodation Network is a service provided by the U.S. Department of Labor's Office of Disability
Employment Policy (ODEP). The Website provides accommodation suggestions for many disabilities. It is geared to the
workplace but many of the suggestions can apply to school.
Media
http://www.youtube.com/watch?v=32U66gvBqqA
This clip, created by National MS society, features teens speaking frankly about what it is like to live day to day with
Multiple Sclerosis. If you visit the site, be sure to read the comments below the video. Many young people living with MS
have written heart felt comments.
 OBSESSIVE COMPULSIVE DISORDER (OCD)

Official Definition
The DSM-IV definition of obsessive-compulsive disorder states that "an anxiety disorder, where it is defined as
obsessions and/or compulsions that cause marked distress, are time-consuming, or interfere with functioning.
Obsessions are defined as recurrent and persistent thoughts, impulses or images that are experienced as invasive
and ego-dystonic and that cause anxiety or distress. Compulsions are defined as ritualistic behaviors or mental acts
that the person feels driven to perform in response to an obsession or according to rules that must be rigidly
applied. The behavior or mental act is aimed at preventing or reducing distress or preventing some dreaded event
or situation and is recognized as excessive or unreasonable". Obsessive Compulsive disorder begins in late
adolescence and has a prevalence rate of 1.9% to 2.8%

Etiology (Causes)
Researchers and mental- health professional do not know the causes of OCD. Several theories suggest a biological
basis for OCD and there are studies that are exploring the possibility. The Positron emission transaxial tomography
(Pett) and other brain imaging techniques have indicated that there may be some brain abnormalities in the frontal
lobe and the basal ganglia that cause OCD symptoms. There are other studies that indicate abnormalities in certain
neurotransmitters may be involved. One neurotransmitter that may be involved is the serotonin. The serotonin
helps regulate mood aggression, and impulsivity. The neurons that respond to serotonin are found throughout the
brain and especially in the frontal lobes and the basal ganglia (Barlow, pg21). Recent preliminary testing of the
brain has shown that someone with OCD has significantly less white matter than someone who does not have OCD
(http://www.nimh.nih.gov/publicat/ocd.cfm, 07/17/2003).

OCD is sometimes brought on by depression, eating disorders, drug abuse disorder, personality disorder, attention
deficit disorder or another anxiety disorder. Co-existing disorders can make it difficult to diagnose and treat OCD.
Other theories about the cause of OCD that are not incompatible with biological explanations focus on the
interaction between behavior, environment, beliefs, attitudes, and how information is processed
(http://www.nimh.nih.gov/publication/ocd.cfm, 07/17/2003).

Researchers are still not clear on whether OCD is hereditary, although preliminary scientific data has shown a
genetic link. One study for genetic cause has been found in twin studies. It has been observed that OCD in pairs of
identical twins is greater than fraternal twins. A higher incidence of OCD within a certain family tree than is
expected simply at random. A higher rate among children with OCD verses those without have also been observed
(Penzel, pg 322). As of now no gene has been identified with OCD and there is no genetic test. It is very difficult to
find and interview relatives of one with OCD, as well being able to properly diagnose one for OCD based only on
an interview (Penzel, pg 323).

Characteristics
People with OCD may be plagued by persistent, unwelcomed thoughts or images, or by the urgent need to engage
in certain rituals. They may be obsessed with germs or dirt, and wash their hands over and over. They may be filled
with doubt and feel the need to check things repeatedly.

Some common obsessions are:

Fear of being contaminated by germs or dirt or contaminating others

• Fear of causing harm to yourself or others

• Intrusive sexually explicit or violent thoughts and images
• Excessive focus on religious or moral ideas
• Fear of losing or not having things you might need
• Order and symmetry: the idea that everything must line up “just right.”
• Superstitions; excessive attention to something considered lucky or unlucky

Some common compulsions are:

• Excessive double-checking of things, such as locks, appliances, and switches.

• Repeatedly checking in on loved ones to make sure they’re safe.
• Counting, tapping, repeating certain words, or doing other senseless things to reduce anxiety.
• Spending a lot of time washing or cleaning.
• Ordering, evening out, or arranging things “just so.”
• Praying excessively or engaging in rituals triggered by religious fear.
• Accumulating “junk” such as old newspapers, magazines, and empty food containers, or other things you
don’t have a use for.
Instructional Strategies
Allow more time for completing tasks and tests. Other testing accommodations may include testing in an alternate location,
providing breaks during testing, and allowing the student to write directly on the test booklet (see below). In some cases,
you may need to allow the student to take tests orally.

For students with compulsive writing rituals, consider limiting handwritten work. Common compulsive writing rituals
include having to dot i's in a particular way or retrace particular letters ritualistically, having to count certain letters or
words, having to completely blacken response circles on test forms, and erasing and rewriting work until it looks perfect.
Scantron forms may be particularly problematic for a student who feels that s/he has to perfectly darken in each circle -- in
such cases, a reasonable test accommodation would be to have the student circle their answers or record their answers
directly in the test booklet. If writing lecture notes is problematic, the student may need to tape record lectures or the teacher
may need to arrange for providing the student with a hard copy outline of the lecture notes. Alternatively, if the student's
compulsions are not triggered by keyboarding, have the student use a notebook computer or word processor to record
lecture notes.

Be alert to peer problems or teasing or harassment associated with compulsive rituals. If the student is being ridiculed for
their rituals or obsessive fears, consider conducting a peer education program on OCD. The OC Foundation has a 45-minute
film called "The Touching Tree" that may be appropriate for younger students.

For students with compulsive reading rituals, consider limiting the amount to be read or breaking it up into chunks. If
reading rituals and intrusive thoughts are severe, consider going to books on tape or recording the material for your student
to listen to. In some cases, having someone else read aloud to the student may work, but older students may feel frustrated
and demoralized by that.

If the student has perfectionistic traits, they may stay up all night working and reworking an essay or paper. Talk to the
parent to find out if this is happening so that you don't inadvertently reinforce the problem by complimenting the student
on the 'perfect' work. If the problem is severe, you may need to contract with the student as to how much reworking is
allowed or you may need to establish a system whereby they turn their work in at the end of the school day and not take it
home as 'homework.'

During a quiet discussion, consult with the student and inquire as to what support he or she needs from you. Ask whether
gentle refocusing and redirection would be welcomed. By working collaboratively with your student, you will find out what
techniques help your student and what may trigger emotional responses. Keep in mind that it will be extremely difficult, if
not impossible, for the child to interrupt or stop a ritual once it has begun.

Try to reduce triggers to compulsive rituals, if possible. If you know that a student will "have to" engage in a ritual if they
see the pencil sharpener, can you put the sharpener out of sight? If they "have to" touch people, can you take one step back
so that the intensity of the trigger is reduced for them?

Assistive Technology
Allow the student an alternative method for producing test answers if writing is problematic: record answers on tape
recorder; write answers on computer or other assistive technology device; produce answers orally; produce answers on an
alternate test format (e.g., multiple choice, short answer, fill-in-the-blanks).

Community Resources
“Mental Health and High School: A Guide for Students” from the Canadian mental health association. This link provides
students in Canada with appropriate community resources for various mental illnesses including OCD.
http://www.cmha.ca/highschool/

OCDONTARIO is an all volunteer non-profit charity focused on providing help and information to children and adults with
OCD and their families in Ontario.
http://www.ocdontario.org/

Media

This is a clip from the popular news show Inside Edition that reports the story of a 20 year old University student
named Elizabeth with OCD. I believe that it is relevant to adolescent high school learners because it shows what
young people with OCD face on a daily basis. Elizabeth is the national spokesperson for OCD awareness and I feel
that this video would be beneficial for any student who has or believes that he/she has OCD.

OCD report on Inside Edition

This clip is the brief intro to the movie “As good as it gets.” It shows some typical obsessive compulsive behavior
from the main character played by Jack Nicholson.

Intro to "As good as it gets"

 PERVASIVE DEVELOPMENTAL DISORDER-NOS (NOT OTHERWISE SPECIFIED)
Official Definition
This disability is classified as an autism spectrum disorder also known as pervasive development disorder. It is usually
referred to as pervasive developmental disorder-not otherwise specified because the child does not meet the criteria for a
specific pervasive developmental disorder like autism. This kind of diagnosis is usually give to a child who exhibits: severe
and pervasive impairment in some areas such as reciprocal social interaction, verbal and non-verbal communication or
when stereotyped behaviour or activities are present.

Etiology (Causes)
The direct causes of PDD-NOS are unknown, however, the medical community believes that the disability’s origin is genetic
or biological and it affects the brain function. There is a possibility that more than one variable could be responsible for the
different symptoms that are present in individuals with PDD-NOS. It has been proven that there is no direct relation
between the child’s upbringing and PDD-NOS.
:
Characteristics
No two individuals with PDD-NOS are exactly alike however, many have some characteristics in common, such as:

Deficits in social behaviour

Uneven skill development (strengths in some areas and significant delays in others)

Poorly developed speech and language skills and comprehension

Difficulty with changes in environment

Deficits in non-verbal communication

Uncommon responses to taste, sound, smell and touch

Repetitive or ritualistic behaviours (i.e. opening and closing doors or turning a light on and off.)

Unusual likes and dislikes

Instructional Strategies
The following are strategies teachers can use in the classroom to help students with PDD-NOS:

Use visual aids outlining class schedules and expectations.

Use consistent classroom routines. (i.e. asking for help, frequent breaks, putting away homework, getting assignments,
bathroom breaks). Consistent routines lower all students' anxiety and increase their ability to function independently in the
classroom.

Understand the need for transition time and plan for it. Set up and practice transition activities for students to do when
finished with their assigned tasks. Visual reminders of transition times and activities can help guide the child through the
process easier.

Structure the Layout of the Room: mark areas where students hand in work, where they get extra activities and where
extra resources and supplies are kept.

Structure presentation of handouts: highlight instructions, number steps to complete tasks, and give examples.

Explain clearly the purpose of all work assignments: presentations, multimedia materials, or other learning tasks.

Use student's special interests to teach new material

Assign peer buddies: give peer buddies information regarding PDD-NOS and ideas that they can use with the student.
Modeling strategies could be useful for both students.
 Assign individual roles for group work: lowers possibilities of misunderstandings and makes working with groups
easier. Give students specific instructions regarding their role with key phrases they could use like: Could you say that
again please? This allows for them to be less frustrated when trying communicating with group members.

Assistive Technology
The following are different kinds of technology a teacher could implement in their classroom depending on how much
money is available in the budget: (The focus is in creating visual representations for students to be able to connect with)

"Low -Cost" Technology: When there is not enough money for battery operated technology teachers could make
use of the following: dry erase boards, clipboards, 3-ring binders, manila file folders, photo albums, laminated
photographs, highlight tape, etc.

"Mid-Cost" Technology: This includes battery operated devices or "simple" electronic devices like: a tape recorder,
overhead projector, timers, calculators, and simple voice output devices.

"High-Cost" Technology: Complex technological support strategies like: video cameras, computers and adaptive
hardware, complex voice output devices.

The use of any kind of technology will help both young children and adolescents make a connection between
instructions and visuals, giving them a higher chance of success.

Community Resources
The Autism Spectrum Disorder Foundation
Their goal is to support children with an autism spectrum disorder by providing education, information and financial
assistance to their families and relevant community service organizations.

C.A.R.D. Center for Autism and Related Disorders

This center focuses on treating children with autism, Asperger's Syndrome, PDD-NOS, and related disorders. They develop
individualized plans for each child and provide services around the globe.

Media
http://www.youtube.com/watch?v=NbVG8lYEsNs&feature=related

This video is very important in that it demonstrates the use of visuals and ABA therapy to help children with all pervasive
developmental disorders. Since there are no videos specific for adolescents with PDD-NOS I decided to use this video to
demonstrate how effective the use of visuals really is. This is true with all students at all levels because even in middle/high
school children with PDD-NOS need to have visuals to accompany their instruction.
 PHENYLKETONURIA
Official Definition
Phenylketonuria: A single-gene defect that can produce severe retardation because of the body’s inability to break down
phenylalanine, which when accumulated at high levels in the brain results in severe damage; can be controlled by a diet
restricting phenylalanine (Coleman, Gallagher and Kirk, 2009, p. G-6).

Etiology (Causes)
Phenylketonuria is an autosomal recessive disorder (i.e. both parents must be carriers of the defective gene). It is considered
an “inborn error of metabolism” because enzymes that fail be produced or perform their normal function can lead to
unfavourable developmental conditions (Coleman, Gallagher and Kirk, 2009, p. 152). Phenylketonuria results from a single-
gene defect that results in a shortage of the liver produced enzyme phenylalanine hydroxylase (PAH) (Coleman, Gallagher
and Kirk, 2009, p. 152). PAH is necessary to convert phenylalanine (PHE) to tyrosine. A deficiency of PAH results in the
accumulation of phenylalanine in the blood, which is toxic to the central nervous system (Coleman, Gallagher and Kirk,
2009, p. 152).

Characteristics
In Canada and the United States, newborns are screened for PKU through a heel test. A small amount of blood is taken from
the baby's heel and it is sent away for testing (SickKids, 2009). In the case that it is not identified at birth (which is now rare),
the growth plan will be as follows:

Age Normal Development Development of a child with

(Child Development Institute, LLC,
2010)
Birth Sensory Capacities: makes basic
distinctions in vision, hearing,
smelling, tasting, touch, temperature,
and perception of pain
3-6 Months Sensory Capacities: color
perception, visual exploration, oral
exploration."
Motor Ability: control of eye
muscles, lifts head when on stomach.
Control of head and arm
movements, purposive grasping,
rolls over.
1 Year Motor Ability: control of legs and
feet, stands, creeps, apposition of
thumb and fore-finger.
Language: says one or two words,
imitates sounds, responds to simple
commands.
Later development/Other features Motor ability: mature motor control,
skips, broad jumps, dresses himself,
copies a square and a triangle.
Language: talks clearly, uses adult
speech sounds, has mastered basic
grammar, relates a story, knows over
2,000 words
untreated PKU
(National PKU Alliance, 2009)
Newborn appears normal, fairer skin
and hair colour than other family
members
The infant loses interest in their
surroundings; vomiting, irritability,
eczema-like rash, musty odor to
urine
The child experiences developmental
delays; seizures, the skin begins to
lose its pigmentation
Microcephaly (small skull),
prominent cheek and upper jaw
bones with widely spaced teeth, poor
development of tooth enamel,
decreased body growth

Additionally, when PKU is left untreated/undetected and/or PKU patients consume too much phenylalanine, they can be
characterized by/ be at risk of:

• Neurological complications (excessive phenylalanine is toxic to the central nervous system)

• IQ loss
• Memory loss
• Concentration problems
• Mood disorders
• Mental retardation

Any damage done is irreversible so early detection is crucial and maintaining the low-protein diet is very important.

When PKU is detected and treated early with a diet that is rigorously maintained, children with PKU can experience:
• Normal lifespan
• Normal development

Instructional Strategies
As an educator, it is important to understand the impact legislation has in the field of education. From the landmark case of
Brown vs. board of education of Topeka in 1954, it is evident that the field of education is constantly moving towards a more
inclusive setting for all students. While Brown vs. Board of education had everything to do with race and very little to do
with exceptional students, it did open doors for further legislation that allowed students with exceptionalities access to the
same resources as general education students in order to succeed within the public school system. In 1963, following Brown
vs. board of education, President John F. Kennedy rallied for Public law 88-164, which authorized funds for training
professionals to work with children with exceptionalities (Coleman, Gallagher and Kirk, 2009, p. 38). These funds were also
authorized for research and demonstration for students with intellectual and developmental disabilities (IDD) and hearing
impairments (Coleman, Gallagher and Kirk, 2009, p. 38). While Brown vs. Board of education was a landmark in changing
the field of education; Public law 88-164 changed the landscape of special education. Fast-forwarding approximately 30
years, the landscape of special education is still being carved out. Today’s teachers must be attentive to IDEA 2004, Section
504 of the Rehabilitation Act of 1973 and the Americans with Disabilities act of 1992. These three pieces of legislation ensure
that students with exceptionalities receive the same quality public education that students in the general classroom receive
(Coleman, Gallagher and Kirk, 2009, p. 41). IDEA 2004 ensures that students with disabilities are dealing with certified
special educators; they must have an IEP (Individualized Education Plan) that reflects scientifically based instructional
practices, cognitive behavioral intervention and early intervention services as appropriate (Coleman, Gallagher and Kirk,
2009, p. 41). Furthermore, the IEP must include plans for the use of assistive technology to help the student accommodate
themselves in the general classroom, as well as short-term objectives for students who take alternative assessments
(Coleman, Gallagher and Kirk, 2009, p.41). Section 504 states that it is illegal to deny a student any services, participation in
activities or programs based on their disability. All students must have equal access to programs and services (Coleman,
Gallagher and Kirk, 2009, p. 41). Lastly, the Americans with Disabilities Act ensure that students with disabilities are
guaranteed the same civil rights as persons without disabilities. This act ensures that students with disabilities have equal
access to educational resources and cannot be discriminated against based on their disability (Coleman, Gallagher and Kirk,
2009, p. 41).
A student with PKU that is rigorously controlled through diet and is developing in an otherwise normal manner
would not qualify for special education services under IDEA 2004. But if the diet begins to affect their social life and thus
behavior and performance in school, the student could qualify for services under Section 504 (Coleman, Gallagher and Kirk,
2009, p. 41). Section 504 acts as the first step to Response to Intervention as it is designed to help students who fail to turn in
homework, students with failing grades, chronic behavior problems, suspensions and/or failure to complete and return
homework (Coleman, Gallagher and Kirk, 2009, p. 41). By beginning the three-tiered response to intervention model, Section
504 can act as a bridge to IDEA 2004 if the student is in need of additional support (for example, the student has abandoned
their diet and is beginning to feel the effects of the buildup of phenylalanine which would result in cognitive delays and
other characteristics listed above). While not all students with PKU may require a 504 plan, it is still important for the
teacher of a student with PKU to be aware of some instructional strategies. These include but are not limited it:
Attention to the student’s diet - Peer pressure can often pull students off their restrictive diets. This is easy to
understand when one considers that western society is based largely around the culture of food (sharing food, eating
together, going out to eat, etc.). For this reason, it is important for the teacher to include the student in activities that involve
food. For example, contacting parents or student with PKU before class trips, dances, etc. to make sure that the student has
something similar to eat (that is low in phenylalanine) as his or her classmate. This will make them feel more included and
will reduce peer pressure and the likelihood that they will abandon their diet (Texas Department of State Health Services,
2005).
Attention to the emotional well being of the student- Treating the student with PKU as a normal, healthy member
of the class is vital to their emotional development. It is important to remember that when the diet is properly maintained,
students with PKU are no different in their social, emotional, academic growth and development. If a student is becoming
emotional due to the stresses of peer pressure, than it is important to acknowledge this and provide support to the student
(Texas Department of State Health Services, 2009).
Most importantly, keeping an open line of communication with the parents is a key instructional strategy. They can
be the teacher’s primary source of information when it comes to the student’s diet and they can provide the teacher with
support by helping to include the student in the general classroom. Moreover, a line of communication is important to
reinforce the monitoring of food eaten away from home. The teacher should let the parent know if the student has eaten any
food that is not allowed, if the students if refusing to maintain the diet (ex. eat the food sent from home) and if any special
occasions are coming up so that the parent can provide low PHE foods (Texas Department of State Health Services, 2009).
Currently, the American institution of education is grappling with the Public Law 107-110 No Child Left Behind
act. While not targeted at students with disabilities, it does indeed affect them. NCLB stipulates that all schools must bring
every student to a minimal level of competency. For many students, this minimum level of competency is unattainable, even
when performing at their peaks. Modifications are currently being made to NCLB so that the expectations are more realistic
but it will still continue to pose a problem for students with exceptionalities and as general educators, it is important to keep
up with the changes as NCLB affects all students in the general classroom (Coleman, Gallagher and Kirk, 2009, pp. 42-43).

Assistive Technology
Measuring cup and/or scale: Many students with PKU can eat certain types of foods as long as it is limited. This is done by
weighing the food (especially if it is substitute, such as low-protein pasta) and limiting their intake by carefully measuring
how much they consume. Also check out these iPhone apps!
Community Resources
Canada:
Canadian PKU and Allied Disorders Inc.
email: info@canpku.org
Canadian PKU and Allied Disorders Inc. (CANPKU) is a non-profit association of volunteers, first organized in the
Spring of 2008 based in Toronto, Ontario. CANPKU is dedicated to providing accurate news, information and
support to families and professionals dealing with phenylketonuria and similar, rare, inherited metabolic disorders.
The mission of CPKUAD is to improve the lives of people with PKU and allied disorders and the lives of their
families.

The PKU Program at The Hospital for Sick Kids (Toronto)

The Hospital for Sick Children! 555 University Avenue!Toronto, Ontario!, Canada !M5G 1X8
The PKU program at The Hospital for Sick Children provides a comprehensive, family-centered interdisciplinary
service including: diagnosis, nutrition counseling, specialized health assessment and education, psychological and
school-related assessment, support for parents and kids in coping with the challenges of a specialized diet, genetic
counseling, and preparation for the child/youth's transition to independent self-management. In addition, we
provide training opportunities for medical residents and fellows, and genetic counselors enrolled in graduate
education in the Division of Clinical and Metabolic Genetics/University of Toronto.

PKU Listserv
Listserv@Listserve.Emory.Edu
The PKU Listserv is a great place for families of a child with PKU, persons with PKU, and professionals involved in
PKU treatment to share their ideas and concerns with others. This list provides an easy way for people all over the
world to come together and communicate with one another about PKU. If you are interested in joining the listserv,
send an email request including your name and email address to: macpku@verizon.net.
Note: Also available from the U.S

United States of America:

National PKU Alliance

www.npkua.org; 1-877-NPKUA-22
The National PKU Alliance works to improve the lives of individuals and families associated with PKU through
research, support, education and advocacy, while ultimately seeking a cure. The NPKUA is the first national non-
profit organization to unite adults, families, statewide organizations, the medical community and PKU-friendly
businesses under one umbrella organization.

PKU.com
www.pku.com
PKU.com provides comprehensive information about PKU and a place to meet others with PKU. Log on today to
join the discussion and to make new PKU friends. Join at www.pku.com

Taste Connections
www.tasteconnections.com; (310)371-8861
Taste Connections was formed in 2003 by a mother to a child with Homocystinuria, a metabolic disease that requires
a special diet similar to PKU. Taste Connection specializes in low-protein products and formulating quick and easy
recipes, inspiring metabolic patients to stay on their life-saving diet.

Media
This video entitled: Your Body, Your Problems: PKU & You, was created by high school AP Biology students. This
video is a good introduction for those who are unfamiliar and those who have some understanding of PKU. This video is
purposeful in that it touches on the genetic causes of the disability and it also highlights the social aspects of controlling the
disability. This video can be found at:

http://www.youtube.com/watch?v=k87hUZZxyaI
 PRADER-WILLI SYNDROME (PWS)
Official Definition
Prader-Willi Syndrome is an inherited disorder genetic disorder which is generally caused by a deletion in Chromosome 15.
(DSM-IV)

Etiology (Causes)
It has been hypothesized that the onset of Prader-Willi Syndrome may be associated with environmental factors. However,
current research indicates that PWS arises mainly from one of four genetic abnormalities: A delition on chromosome 15,
chromosome 15 maternal disomy (one or more chromosomes are present twice, without having the entire genome doubled),
a translocation of chromosomes involving chromosome 15, an error in the imprinting of chromosome 15.

As a summary, some have observed that Prader-Willi Syndrome may be environmentally linked, though current evidence
indicates that it is a genetic disorder. People with PWS have a flaw in their hypothalamus with normally transmits feelings
of hunger and satiety. Though not entirely understood, this flaw results in the characteristics hyperphagia present in later
years.

Characteristics
There is a prenatal onset of hypotonia, characterized by decreased fetal movement and abnormal fetal position. In infancy,
there is decreased movement and lethargy, as well as a poor or weak suck reflex. Cognitive disability becomes noticeable at
a young age. Most people with Prader-Willi Syndrome exhibit learning disabilities and poor academic performance. In later
childhood hyperphagia, an insatiable appetite begins to become apparent. Hyperphagia is hypothalamic and results in
people with PWS never feeling as though they are full or satisfied after eating. As a result of food-seeking behaviour,
combined with low metabolism and decreased physical activity, central obesity can develop. Complications from obesity are
the main sources of morbidity and mortality in people who have PWS.

Other characteristics include stubbornness, temper tantrums and compulsive behaviours. Some people with PWS may
experience sleep abnormalities, such as sleep apnea, which may result in excessive daytime sleepiness. Finally, people with
PWS may exhibit skin picking, easy bruising and small hands and feet.

Some developmental characteristics of individuals with PWS (PWSN, 2010):

Age 0 to 6
o Hypotonia
o Weak sucking reflex
o Developmental delay
Age 6 to Adolescence
o Persistent Hunger and Hyperphagia (Lack of Satiation)
 Can lead to obesity if not managed
o Short stature and small hands/feet
o Mild intellectual impairment and learning disabilities
Adolescence to Adulthood
o Behavioural challenges (such as Obsessive-Compulsive Disorder)
o Obsession with Food
o Sleep disorders

Instructional Strategies
Repetition and positive reinforcement are important for instruction. In addition, establishing routines that curb food-seeking
behavior while recognizing the student’s right to eat are important.

Nutritional counseling and guidance should begin at an early age to manage the effects of food-seeking behavior. Parents
and educators should also enforce limit-setting to curb the effects of compulsive behaviors and food-seeking behavior. If
weight is controlled, then people with PWS can have high life expectancy. Routines and expectations need to be made clear
and enforced. Advance warning must be given before changes to plans are made.

Counseling families with regards to controlling food-seeking behavior is necessary. In addition, educators can work
alongside families to learn what routines have been established in an effort to maintain them in the classroom (or, to ease the
transition from home to school).

Specific support can be helpful for people with PWS depending on their needs. Below is a brief list outlining potential areas
of support (BCPWSA, 2009):
• Speech and Language Consultant: Development of speech and language can be slow in people with PWS.
• Physiotherapy: Physiotherapy can help people with PWS become better aware of their bodies.
• Dietitian: Planning for meals while balancing nutrition and calorie intake.
• Behavior Consultant: People with PWS may exhibit an inability to regulate their emotions and behavior. A
Behavior Consultant may provide strategies for home and school life.
 • Educational Assistant: Some people with PWS require extra support in school, beyond a caring and inclusive
classroom environment. An Educational Assistant could provide this support.

Assistive Technology
There may be eye abnormalities associated with PWS stemming from low muscle tone. Although some people with PWS
may wear corrective lenses to accommodate for this impairment, additional audio instruction should be given. Systems of
microphones and speakers may help to ensure that teachers are audible from any location in a classroom.

Furthermore, people with PWS may exhibit characteristics of obsessive-compulsive disorder or they may be resistant or feel
stress when unexpected change occurs. As such, scheduling in the classroom is imperative. In addition, changes to
scheduling must be communicated far in advance.

People with PWS may become tired and fall asleep during instruction if their attention and interest is not maintained.
Stimulating visual organizers and information can help to maintain the interest of a person with PWS. Specifically, Smart
Boards and computers can help to keep people with PWS interested. Encouraging movement and active participation can
also go a long way towards keeping people with PWS engaged.

Community Resources
Prader-Willi Associaion (USA) – http://www.pwsausa.org/ - “PWSA (USA) is an organization of families and professionals
working together to promote and fund research, provide education, and offer support to enhance the quality of life of those affected by
Prader-Willi syndrome.”

Prader-Willi Syndrome Network (PWSN) – http://www.pwsnetwork.ca/pws/index.shtml - “The Prader-Willi Syndrome

Network provides information and resources for service providers who work with individuals with Prader-Willi Syndrome (PWS) and
their families.” A handbook about PWS is available from the Network for a small price:
http://www.pwsnetwork.ca/pws/Handbook.html

The British Columbia Prader-Willi Syndrome Association (BCPWSA) – “We are a non profit charity that provides an
understanding and awareness of Prader-Willi Syndrome by supporting those who have the syndrome, their families and all who come in
contact with PWS.”

Media
“Only Human: Can’t Stop Eating” - http://www.youtube.com/watch?v=zdA7amVMrBc&feature=related
A documentary about two children with Prader-Willi Syndrome. A wonderful resource for teachers who have a desire to
learn more about PWS and its characteristics.
 POST TRAUMATIC STRESS DISORDER (PTSD)
Official Definition
According to the DSM-IV, post traumatic stress disorder is, “the development of characteristic symptoms following
exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened
death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a
threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of
death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event
must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated
behavior) (Criterion A2).”

Etiology (Causes)
Although this condition has likely existed since human beings have endured trauma, PTSD has only been recognized as a
formal diagnosis since 1980. Virtually any trauma, defined as an event that is life-threatening or that severely compromises
the emotional well-being of an individual or causes intense fear, may cause PTSD. Such events often include either
experiencing or witnessing a severe accident or physical injury, receiving a life-threatening medical diagnosis, being the
victim of kidnapping or torture, exposure to war combat or to a natural disaster, exposure to other disaster (for example,
plane crash) or terrorist attack, being the victim of rape, mugging, robbery, or assault, enduring physical, sexual, emotional,
or other forms of abuse, as well as involvement in civil conflict. Although the diagnosis of PTSD currently requires that the
sufferer has a history of experiencing a traumatic event as defined here, people may develop PTSD in reaction to events that
may not qualify as traumatic but can be devastating life events like divorce or unemployment.

The Typical Child vs. A Child with Post Traumatic Stress Disorder

Typical children have the ability to cope in most situations. They do not experience “trigger” experiences. A child with
PTSD may experience the characteristics below.

Characteristics
The three groups of symptoms that are required to assign the diagnosis of PTSD are
• recurrent re-experiencing of the trauma (for example, troublesome memories, flashbacks that are usually caused by
reminders of the traumatic events, recurring nightmares about the trauma and/or dissociative reliving of the
trauma),
• avoidance to the point of having a phobia of places, people, and experiences that remind the sufferer of the trauma
and a general numbing of emotional responsiveness, and
• chronic physical signs of hyper-arousal, including sleep problems, trouble concentrating, irritability, anger, poor
concentration, blackouts or difficulty remembering things, increased tendency and reaction to being startled, and
hyper-vigilance to threat.

Signs and Symptoms of PTSD

• lack of interest in activities that used to be enjoyed (anhedonia),

• emotional deadness,
• distancing oneself from people,
• and/or a sense of a foreshortened future (for example, not being able to think about the future or make future
plans, not believing one will live much longer).
• problems regulating feelings,
• which can result in suicidal thoughts,
• explosive anger,
• or passive aggressive behaviors;
• a tendency to forget the trauma or feel detached from one's life (dissociation) or body (depersonalization);
• persistent feelings of helplessness, shame, guilt, or being completely different from others;
• feeling the perpetrator of trauma is all-powerful and preoccupation with either revenge against or allegiance with
the perpetrator;
• and severe change in those things that give the sufferer meaning, like a loss of spiritual faith or an ongoing sense of
helplessness, hopelessness, or despair.

At least one re-experiencing symptom, three avoidance/numbing symptoms, and two hyper-arousal symptoms must be
present for at least one month and must cause significant distress or functional impairment in order for the diagnosis of
PTSD to be assigned.

Acute Stress Disorder

Like PTSD but less severe. Typically symptoms generally last from two days to four weeks. Also, fewer symptoms
are required for diagnosis.

Complex Post Traumatic Stress Disorder (C-PTSD)

 C-PTSD is a variant of PTSD and is more common in victims of long-term abuse, torture, and/or control.

Instructional Strategies

• Establish a feeling of safety and acceptance within the classroom.

• Greet the child warmly each day, without physical touch, and make eye contact. Let the child know that
he/she is valued and that you care.
• Interrupt activities and avoid circumstances that are upsetting or re-traumatizing for the child.
• Offer deep breathing and other grounding exercises for the class as a way to transition from one activity to
another
• Provide a consistent, predictable routine through each day as much as possible to help maintain a sense of
normalcy and security in the child’s life. Communicate changes to routine beforehand.
• Try to eliminate stressful situations from your classroom and routines.
• Plan your day or class period so that it alternates between active and quiet activities. Being forced to maintain
the same level of activity for too long may cause the child to become restless and anxious.
• Make yourself available and open to listening. Remember to always respect the child’s need for confidentiality.
• Do not tell a child to forget about the incident. PTSD symptoms may be a result of trying to do just that. This
request also minimizes the importance of the trauma, and children may feel a sense of failure if they can’t
forget.
• Reassure children that their symptoms are common and that they are not “crazy” or bad.
• Incorporate large muscle activities into the day. Short breaks involving skipping; jumping, stretching, or other
simple exercises can help relieve anxiety and restlessness.

Assistive Technology

• Multimedia/Movies- Students with PTSD need to learn about their survival skills and also need to be exposed
to others with like “stress” related conditions. Providing students with opportunities to learn about others that
live with their conditions and their triumphs allows them to begin healing.
• “Knowledge helps control thoughts and feelings”- Students with PTSD need ample opportunity to learn either
through viewing related multimedia or through research. All the student time with guidance to research their
own condition.
• Communication-Students that have been through a traumatizing event eventually need to “talk.” NEVER
push a student to tell you what happened, but provide them with various methods to express themselves.
Allow them to draw, write, take pictures, write songs, create short films, PowerPoints, journals etc.
• “Planning for the Next time”- Through each of the above you can guide the student to begin thinking about
what they would do if it happened again. (Make sure to seek professional guidance about how to do this.)
• Choices- students with PTSD thrive when they have some control over their learning experience. Allowing
them to make decisions, or choices, whenever possible helps them to navigate the classroom experience in a
“safer” manner. This is also known as differentiated instruction.
• Professional Help-Ultimately the most important factor in recovery from PTSD is professional help. Refer a
student (and parents) with this condition to seek professional assistance. Allow and/or suggest that the
student bring their work to their sessions, and be prepared to share anything disturbing with the professional
and/or parents. It is said that classroom teachers are often the first to notice severe PTSD.

Community Resources

• National Center for PTSD, www.ncptsd.org, 802-296-5132

Links to interdisciplinary index database, publications, books, research quarterly, clinical quarterly, and
assessment instruments
• National Institute of Mental Health (NIMH), www.nimh.nih.gov, 866-615-6464, Free educational materials
for professionals & the public
• Parent Education and Assistance for Kids (PEAK), www.peakparent.org
• PTSD Alliance, www.ptsdalliance.org

Media
Post Traumatic Stress Disorder
http://www.youtube.com/watch?v=WFYeoPqjV28&feature=related
I chose this video because it incorporates music with lyrics that make youthink about children as victims of our "mad
world." Also the video hasseveral facts stated that show PTSD as a result of various things. I think that all too often we
associate PTSD with war and thus assign thestipulation that one must have seen war to suffer from this. We rarely
think of PTSD as the result of anything outside of 9/11 or war, and we surely do not think of traumatic events through the
eyes of children.
 RETT SYNDROME
Official Definition
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), students with Rett syndrome have a
neurodevelopmenal disorder that is classified as an autism spectrum disorder which affects girls almost exclusively. An
autism spectrum disorder is a spectrum of psychological conditions characterized by widespread abnormalities of social
interactions and communication, as well as severely restricted interests and highly repetitive behavior. Development is
normal until 1 year of age, when language and motor milestones regress and acquired microcephaly is seen. There is a loss
of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking,
seizures, and intellectual disability. The signs of this disorder are most easily confused with those of Angelman syndrome,
cerebral palsy and autism.

Etiology (Causes)
Although Rett syndrome is a genetic disorder, less than 1 percent of recorded cases are inherited or passed from one
generation to the next. Most cases are spontaneous, which means the mutation occurs randomly. However, in some
families of individuals affected by Rett syndrome, there are other female family members who have a mutation of their
MECP2 gene but do not show clinical symptoms. These females are known as “asymptomatic female carriers.” Rett
syndrome can also be caused by a mutation to the gene encoding cyclin-dependent kinase-like 5 (CDKL5). Rett syndrome
affects 1 in every 12,500 female live births.

Characteristics
Psychomotor and cognitive abilities rapidly decline within 1-2 years of age. Symptoms that develop are autistic-like, with
mental retardation and poor growth. It is, hence, easy for the misdiagnosis of Rett for autism, or cerebral palsy. There are
various characteristics that teachers and parents can see. Signs of Rett syndrome that are similar to autism:

• screaming fits
• panic attack
• inconsolable crying
• avoidance of eye contact
• lack of social/emotional reciprocity
• general lack of interest
• markedly impaired use of nonverbal behaviors to regulate social interaction
• loss of speech
• Balance and coordination problems, including losing the ability to walk in many cases
• gastrointestinal problems
• sensory problems

Signs of Rett syndrome that are also present in cerebral palsy (regression of the type seen in Rett syndrome would be
unusual in cerebral palsy; this confusion could rarely be made):

• possible short stature, and/or might be unusually proportioned because of difficulty walking or malnutrition due
to difficulty swallowing.
• hypotonia
• delayed or absent ability to walk
• gait/movement difficulties
• ataxia
• microcephaly in some - abnormally small head, poor head growth
• some forms of spasticity
• chorea - spasmodic movements of hand or facial muscles
• dystonia

Instructional Strategies
Some instructional strategies are waiting for a response with patient anticipation. This is critical to success. The child learns
when people will likely take the time to wait for her, so she can decide if it is worth her effort. Sometimes talking the girl
through the motor movements and /or modeling them can be helpful. Coordinating all components of a task on an
automatic level is extremely challenging for children with Rett Syndrome.
Therefore use functional and natural contexts to give the child opportunities to develop skills, where only one
component is cognitively challenging her at a time. For ex: motor, cognitive, language, etc. The child needs to experience
success with at least one component at a time, therefore engineer activities so this is possible. The task should not be so
difficult that the child doesn’t experience some sense of success, nor too boring as to not be worth the effort. Provide a
variety of these types of activities throughout the day – to challenge the child in all areas of development, but mainly just
one at a time.
Reduce Motor Demands is another instructional strategy. Utilize multiple modalities such as eye-gaze, reaching,
direct switch access, step scanning, touch points, subtle non-verbal communication, head stick/pointer, voice and
intonation. Teacher should be flexible to use whatever system seems to work best in that situation at that time. Also allow
the child to withdraw and center and then continue at her own pace. Kids learn in short spurts and then need time to
process information. Children sometimes need to re-center themselves neurologically by taking a break, staring, rock, etc.
The use of active learning is much effective that passive learning. Student’s interest and ability to learn will be increased
with active participation.

Assistive Technology
Communication Devices

Mobility devices. Another device that can be used is a standing frame. This provides alternative positioning to sitting in a
wheelchair by supporting the person in the standing position. Standing frames are used for the medical benefits, but also to
increase independence, mobility, and self-esteem.

Community Resources
http://www.rett.ca/
The Ontario Rett Syndrome Association (O.R.S.A.) exists to ensure that girls and women with RS are enabled to achieve their
full potential and enjoy the highest quality of life within their community

http://www.rettsyndrome.org/
The core mission of the IRSF is to fund research for treatments and a cure for Rett syndrome while enhancing the overall
quality of life for those living with Rett syndrome by providing information, programs, and services.

Media
The video called “Rett Syndrome” and was created by a student at The University of Kentucky. I chose this clip because it
is a very informative clip on what it is, characteristics and causes of this disease. It is a quick recap that summarizes the
important information of this disorder.
http://www.youtube.com/watch?v=5NdwBUvF5-w&feature=related
 SCHIZOPHRENIA
Official Definition
Although definitions can vary across different cases, the most commonly used definition of Schizophrenia is as follows.
Schizophrenia is a mental disorder characterized by abnormalities in the perception or expression of reality. It most
commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with
significant social or occupational dysfunction. Onset of symptoms typically occurs in young adulthood, with around 0.4–
0.6% of the population affected. Diagnosis is based on the patient's self-reported experiences and observed behavior. No
laboratory test for schizophrenia currently exists.

Etiology (Causes)
Schizophrenia is found all over the world. The severity of the symptoms and long-lasting, chronic pattern of schizophrenia
often cause a high degree of disability. Medications and other treatments for schizophrenia, when used regularly and as
prescribed, can help reduce and control the distressing symptoms of the illness. However, some people are not greatly
helped by available treatments or may prematurely discontinue treatment because of unpleasant side effects or other
reasons. Even when treatment is effective, persisting consequences of the illness – lost opportunities, stigma, residual
symptoms, and medication side effects – may be very troubling.
The first signs of schizophrenia often appear as confusing, or even shocking, changes in behavior. Coping with the
symptoms of schizophrenia can be especially difficult for family members who remember how involved or vivacious a
person was before they became ill. The sudden onset of severe psychotic symptoms is referred to as an “acute” phase of
schizophrenia. “Psychosis,” a common condition in schizophrenia, is a state of mental impairment marked by hallucinations,
which are disturbances of sensory perception, and/or delusions, which are false yet strongly held personal beliefs that result
from an inability to separate real from unreal experiences. Less obvious symptoms, such as social isolation or withdrawal, or
unusual speech, thinking, or behavior, may precede, be seen along with, or follow the psychotic symptoms.
Some people have only one such psychotic episode; others have many episodes during a lifetime, but lead
relatively normal lives during the interim periods. However, the individual with “chronic” schizophrenia, or a continuous
or recurring pattern of illness, often does not fully recover normal functioning and typically requires long-term treatment,
generally including medication, to control the symptoms.

Schizophrenia cannot be understood without understanding despair.

R. D. Laing

Characteristics
The causes of schizophrenia are not fully known. However, it appears that
schizophrenia usually results from a complex interaction between genetic and
environmental factors. There are certain genetic causes of this disease.
Schizophrenia has a strong hereditary component. Individuals with a first-
degree relative (parent or sibling) who has schizophrenia have a 10 percent
chance of developing the disorder, as opposed to the 1 percent chance of the
general population. But schizophrenia is only influenced by genetics, not
determined by it. While schizophrenia runs in families, about 60% of
schizophrenics have no family members with the disorder. Furthermore,
individuals who are genetically predisposed to schizophrenia don’t always
develop the disease, which shows that biology is not destiny.

Along with genetic components, Schizophrenia includes

environmental characteristics. Twin and adoption studies suggest that
inherited genes make a person vulnerable to schizophrenia and then
environmental factors act on this vulnerability to trigger the disorder. As for
the environmental factors involved, more and more research is pointing to
stress, either during pregnancy or at a later stage of development. High levels of
stress are believed to trigger schizophrenia by increasing the body’s
production of the hormone cortisol.

Research points to several stress-inducing environmental factors that may be

involved in schizophrenia, including:

• Prenatal exposure to a viral infection

• Low oxygen levels during birth (from prolonged labor or premature birth)
• Exposure to a virus during infancy
• Early parental loss or separation
• Physical or sexual abuse in childhood

Furthermore, there is evidence that chemical imbalances in certain neurotransmitters, proteins, and amino acids play a
role in causing schizophrenia.
 • Dopamine — Dopamine is the primary brain chemical implicated in schizophrenia. The dopamine hypothesis
suggests that an excess of dopamine in the brain contributes to schizophrenia.
• Glutamate — Glutamate is another important neurotransmitter implicated in schizophrenia. Studies show an
underactivity of glutamate in schizophrenic patients. This supports the dopamine hypothesis, since dopamine
receptors inhibit the release of glutamate.

When the signs and symptoms of schizophrenia are ignored or improperly treated, the effects can be devastating both to the
individual with the disorder and those around him or her. Some of the possible effects of schizophrenia are:

• Relationship problems – Relationships suffer significantly because people with schizophrenia often withdraw and
isolate themselves. Paranoia can also cause a person with schizophrenia to be suspicious of friends and family.
• Disruption to normal daily activities – Schizophrenia causes significant disruptions to daily functioning, both
because of social difficulties and because everyday tasks become hard, if not impossible to do. A person’s
delusions, hallucinations, and disorganized thoughts typically prevent him or her from doing normal things like
bathing, eating, or running errands.
• Alcohol and drug abuse – Schizophrenics frequently develop problems with alcohol or drugs, which are often used
in an attempt to self-medicate, or relieve symptoms. In addition, they may also be heavy smokers, a complicating
situation as cigarette smoke can interfere with the effectiveness of medications prescribed for the disorder.
• Increased suicide risk – People with schizophrenia have a high risk of attempting suicide. Any suicidal talk, threats,
or gestures should be taken very seriously. People with schizophrenia are especially likely to commit suicide
during psychotic episodes, during periods of depression, and in the first six months after they’ve started treatment.

An example of a Schizophrenia patient in therapy. This is the product when asked to draw what they are thinking.

Teacher Role
Students with schizophrenia can have educational problems such as difficulty concentrating or paying attention.
Their behaviour and performance may fluctuate from day to day. These students are likely to exhibit thought problems or
physical complaints; or they may act out or become withdrawn. Sometimes they may show little or no emotional reaction; at
other times, their emotional responses may be inappropriate for the situation. They may also have possible frequent or
extended absences from school for medical intervention and difficulties with relationships.

Instructional Strategies
Educational adjustments are designed to meet student needs on a case-by-case basis. Possible adjustments could include:

• Help the student set reasonable goals

• Be flexible, as symptoms may come and go – it may happen on a daily basis
• Be accepting, caring and supportive – provide a safe environment for the student
• Break tasks down into smaller pieces, minimize distractions, have a plan to redirect the student to help him/her
return to the task at hand
• Assist the student with planning and organizational skills
• Have additional materials, books, supplies available for the student to use if he/she doesn’t bring them
• Work with the student to relieve anxiety and have a plan if the student does become overly anxious.
• Socialising may be exhausting for this student – she/he may have difficulty with groups or when everyone is
excited, so plan accordingly
• Give short, concise directions
• Try to avoid sensory overload
• Negotiated attendance (part day attendance) followed by a plan to gradually re-integrate the student into a
mainstream class/program when deemed appropriate
• Identified potential triggers and cues for distress and/or violence by conducting a Functional Behavioural
Assessment (FBA)
• Virtual schooling
• Reduction of subject load
• Alternative assessment
• Extended time for assessment - assignments, exams
• Exemption or alternative arrangements (refer to QSA Policy for Special Consideration)
• Immediately addressing any negative behaviour by peers towards the student
• Providing copies of class teacher’s or other students’ notes to cover emergency absences where possible
• Exit plan
• Allowance of break periods as needed for rest and taking of medication
• Access to external agency support (Child and Youth Mental Health Services)
• Regular access to a guidance officer or school based youth health nurse.
Community Resources
Schizophrenia is a life-changing disease for you and your family. Accepting that you have schizophrenia is hard. You and
those close to you may feel angry, sad, or frightened. Talk to your caregivers, family, or friends about your feelings. You
may also want to join a support group with other people who have schizophrenia. Ask your caregiver for contact
information for support groups. Contact the following for more information:

• National Alliance for the Mentally Ill

Colonial Place Three, 2107 Wilson Blvd, Suite 300
Arlington, VA 22201
Phone: 1-703-524-7600
Phone: 1-800-950-6264
Web Address: http://www.nami.org

• National Alliance for Research on Schizophrenia and Depression

60 Cutter Mill Road, Suite 404
Great Neck, NY 11021
Phone: 1-800-829-8289
Web Address: www.narsad.org

• National Institute of Mental Health (NIMH), Public Information & Communication Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 1-301-443-4513
Phone: 1-866-615-6464
Web Address: http://www.nimh.nih.gov/

Media

http://www.youtube.com/watch?v=UTUMt05_nCIà
Young Schizophrenic at Her Minds Mercy

http://www.youtube.com/watch?v=ZLhmD2UYEdc
Older Patient
 SENSORY PROCESSING DYSFUNCTION
Official Definition
The Sensory Processing Disorder Foundation defines this condition as "a condition that exists when sensory signals don't get
organized into appropriate responses." Sensory Processing Disorder (SPD) is not currently considered a disorder, but is
being considered for the 2013 DSM-V. SPD can vary from mild challenges that do not affect daily functioning to a nearly
crippling disorder and often appears as a symptom of a larger disorder, such as autism, schizophrenia, multiple sclerosis, or
manic depression. Like Autism, SPD is a spectrum disorder encompassing three main diagnostic groups:

1. Sensory Modulation Disorder (SMD) - an inability to appropriately respond to sensory stimulation

2. Sensory Based Motor Disorder (SBMD) - difficulty processing sensory information resulting in motor control
challenges
3. Sensory Discrimination Disorder (SDD) - inability to properly process visual or auditory input

Etiology (Causes)
Little is known about SPD, but research suggests this condition results from a combination of environmental and genetic
factors. Prenatal and birth complications have also been pegged as possible causes. SPD is a complex brain disorder in which
the nervous system receives and processes sensory stimuli in a disorganized manner and therefore the brain (and
individual) responds inappropriately. Therefore, individuals with SPD experience difficulties in the communication paths
between the brain and the senses.

Characteristics

The most common symptom among sufferers of SPD is the presence of hyper- or hypo-sensitivities, which are usually
treated by cognitive behavior therapy (i.e. Sensory Integration Therapy) intended to increase or decrease an individual's
tolerance to sensory stimulation. Individuals with SPD will exhibit either an unusually high or low tolerance for specific
sensory stimuli. This can include an excessive aversion to or ignorance of certain sounds, tastes, smells, sights, or physical
sensations. Some individuals may have a heightened awareness to external stimuli, while others may fail to recognize
sensory stimuli. In the classroom, SPD may express itself in a variety of behaviors including inattentiveness, hyperactivity,
lack of gross motor skills, aversion to specific sensory stimuli, irritability, anxiety, stubbornness, self-absorbed behaviors,
disengagement or hyper-engagement, disorganization, and poor school performance.

Instructional Strategies

A variety of accommodations may improve the learning environment for individuals with Sensory Processing Disorder.
These methods will vary from individual to individual, depending upon the manifestations of SPD that person experiences.
The most important first step in accommodating a student with SPD is to stay informed with that individual’s treatment.
Many individuals with SPD will undergo Occupational Therapy (OT), a sensory-rich experience in which the child
undergoes a variety of sensory experiences in a meaningful, interactive, and purpose-driven environment. This therapy
often permeates all aspects of an individual's life, and family-centered treatment is recommended. Therapy can include
tactile experimentation with a variety of textured toys, heavy work activities intended to settle down overactive children,
sleep programs that include soothing sounds (individuals with SPD often have difficulty sleeping), sound and water play,
aromatherapy, massagers or other vibrating toys, play tunnels and tents, food therapy, or proprioceptive (related to muscle,
ligament, and joint motion) activities. Before altering your classroom routine, it may be very beneficial to inform yourself by
speaking with the student’s parents. We must work with the parents to develop a plan to implement in the school that is
consistent with the treatment being done outside the classroom.

Even if you are unable to gather further information from parents, the following strategies may help create a friendly, safe,
and supporting environment for a student with Sensory Processing Disorder.

• Be sensitive to the sensitivities of your students. Never force a student to do something that upsets them.
• Allow children to play with toys while they learn.
• Avoid impulsive reactions to student behavior.
• Color code content to assist in visually stimulating students.
• Seat individuals away from potential distracters or upsetting sensory experiences.
• Reinforce positive behavior.
• Provide structured activities and thoroughly explain tasks and the steps involved in them
• Use group work and collaborative activities that emphasize social interaction to develop social skills in a safe
context.
• Allow students to present their learning in a variety of manners - visual, oral, kinesthetic
• Provide a copy of the teacher's notes or another student's notes
• Good teaching practices translate into good accommodations for your students with exceptionalities!

Assistive Technology
There are a variety of resources that can be integrated into the classroom to assist students with Sensory Processing
Disorder. It is very important that before you try anything, you speak with the student’s parents to ensure that your
classroom methods are consistent with the treatment the child experiences outside school. The assistive technology should
be appropriate for the individual’s sensory perceptions. Students may benefit from noise-cancelling headphones during
silent work times to eliminate auditory distractions. Others can be helped by color-coded notes, in which certain types of
information are always presented and recorded in specific colors. Vibrating and strongly textured toys may assist some
students, while others may enjoy mood music during work time.

Community Resources
• The Sensory Processing Disorder Foundation, available online at http://www.spdfoundation.net/index.html
• The Sensory Processing Disorder Resource Center, available online at http://www.sensory-processing-
disorder.com/

Media
The following video, a news story aired to increase awareness about Sensory Processing Disorder, provides a brief overview
of the condition including some of its characteristics and the behavioral treatments available. I selected this video because
although this can be a difficult condition for those unfamiliar with it to understand, this video does an excellent job of
initiating people into the lives of individuals with SPD.
The video can be viewed at: http://www.youtube.com/watch?v=QDaj4daRWJc

Occupational Therapy, more commonly associated with assisting the elderly or equipment prescription after an
accident or injury, is a little known gold mine of help for children and adolescents with SPD. The video below
provides parents and professionals with an understanding of the skills that occupational therapy can assist children
with, focusing particularly upon play, social, attention and academic skill development in the home, child care,
kindergarten and school setting.
 SPINA BIFIDA
Official Definition
Spina Bifida means cleft spine, which is an incomplete closure in the spinal column. In general the three types of spina
bifida (from mild to severe) are:

1. Spina Bifida Occulta: There is an opening in one or more of the vertebrae (bones) of the spinal column without
apparent damage to the spinal cord.
2. Meningocele: The meninges, or protective covering around the spinal cord, has pushed out through the opening in
the vertebra in a sac called the “meningocele”. However, the spinal cord remains intact. This form can be repaired
with little or no damage to the nerve pathways.
3. Myelomeningocele: This is the most severe form of spina bifida, in which a portion of the spinal cord itself protrudes
through the back. In some cases, sacs are covered with skin; in others, tissue and nerves are exposed. Generally,
people use the terms “spina bifida” and “myelomeningocele” interchangeably.

Etiology (Causes)
The exact cause of spina bifida remains a mystery. No one knows what disrupts complete closure of the neural tube,
causing a malformation to develop. Scientists suspect genetic, nutritional, and environmental factors play a role. Research
studies indicate that insufficient intake of folic acid—a common B vitamin—in the mother’s diet is a key factor in causing
spina bifida and other neural tube defects. Prenatal vitamins that are prescribed for the pregnant mother typically contain
folic acid as well as other vitamins.

Characteristics
The characteristics depend on the severity, but may include:
• no noticeable defect
• a lump or cyst on the back
• curvature of the spine
• club or deformed feet
• muscle weakness or paralysis
• lack of bladder and bowel control
• hydrocephalus (an accumulation of fluid in the brain)

Instructional Strategies
The main concerns of most students with spina bifida are mobility and access. Accommodations that may assist a student
with spina bifida include:
• Accessible classroom - access to the room by a walkway, ramp, or elevator.
• Location - near toilet facilities, the cafeteria, and exits might be an important consideration for some students.
• Appropriate furniture - there is a range of considerations for students, including special desks, tables, standing
tables, and others.
In some cases, students with spina bifida who also have a history of hydrocephalus experience learning problems. In these
cases, instructional strategies may include:
• Advance notice of assignments
• Alternative ways of completing assignments (oral presentation versus written)
• Course or program modifications
• Document conversion (alternative formats: large print, tape, electronic, raised lettering)
• Test modifications
• Study skills and strategies training
• Time extensions
• Taped lectures

Assistive Technology
If verbal or visual impairment exist, then other considerations may include: Eye-controlled input systems, Speech-controlled
input systems, Touch screens or Power pads

Community Resources
An agency that provides assistance to individuals with spina bifida and their families is the Spina Bifida Association
(www.spinabifida.org). This organization offers education, advocacy, research and service to individuals and families
affected by spina bifida.

Media: This link shows a child with spina bifida participating in common, everyday activities. She and her family have
not allowed spina bifida to limit their choices and actions.
http://www.youtube.com/watch?v=PqUDdxm-qSA
 TOURETTE’S SYNDROME
Official Definition
DSM-IV definition of TS: – Four criterion must be met:
1. A person must have involuntary motor AND vocal tics for more than one year
2. The frequency and severity of the tics vary
3. The person never has a tic-free period longer than three months
4. The onset of this condition shows signs well in advance of 18 years of age
5. The tics are not caused by any foreign factors (drug/ alcohol usage, general medical conditions, etc)

Characteristics
How to Recognize TS From a Motor or Vocal Dysfunction
As defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), a person with TS must have both a
motor AND vocal tic hose with a motor tic without a verbal tic (and vice versa) do not have TS: they have some other type of
chronic or transient tic disorder

Individuals with TS will often have comorbid medical or cognitive disorders

An individual with comorbidity will experience two different medical/cognitive disorders simultaneously but the
conditions will act independently. An example of an individual with comorbidity would be the presence of Autism and
Dyslexia. Most often, individuals with TS will have a comorbid case of Attention Deficit Hyperactive Disorder and
Obsessive Compulsive Disorder

Other Characteristics
Social-emotional problems may occur caused by teasing from classmates. These problems can include, but are not limited to
Depression
Anxiety
Schoolphobia
Impulsivity
Aggression combined with explosive outbursts

Etiology (Causes)
Genetics
While the specific gene or allele have yet to distinguished, most research points to genetics as a large contributing factor
This finding has been established with familial aggregation studies, but the gene responsible for the disorder is still a
mystery. Some research involved comparing the chromosomes of a person diagnosed with TS against a control group: one
of the results involved a “translocation error between chromosome 6 and 9”

Neurological
The Basal Ganglia is a section of the brain whose functions include:
The control of cognition
Movement coordination
Voluntary movement

In cases of TS, the neurons within the Basal Ganglia will act abnormally, causing
inhibitions of the Basal Ganglia’s functions. This inhibiting of functions would then
cause unwanted movements or sounds: a tic

Instructional Strategies
It is estimated that 70% of all students with TS are outfitted in special education
classrooms – Other studies show that 12% of ALL children in special education
classes have TS . Recalling the comorbidity issues apparent in most students with
TS, how could being placed in a special education setting be any more helpful than
a general education class? It is also worth noting that individuals with TS typically
do not have below-average intelligence

Other Instructional Strategies

• There is no one-size-fits-all medication for TS: what works for patient may
have no effect on or worsen the conditions of another but medication can
promote self-regulation. This can be useful in combating the tic symptoms as well as any comorbid issues present
within an individual but there are other things to consider: Combining medications can be dangerous: Using Ritalin
for the ADHD, Orap for the tics, and Prozac or any other anti- depressant for mood swings and this individual is
swimming in a “chemical cocktail”

• New Possible Strategies “Habit Reversal Training”

This is a new theoretical training program to reshape and relearn habitual patterns and motor sequences
Students with TS are trained to identify times when they experience uncontrollable urges to tic
This training would teach students to substitute their tic with a minor routine
Ideally, this behavioral training would wipe out the usual tic and allow teachers to handle some of the comorbid
issues with greater ease
Community Resources
One of the foremost organizations is the Tourette’s Syndrome Association (TSA)
This is one of the only non-profit organizations dedicated identifying the cause and cure for the effects of TS
TSA helps individuals and families with TS by offering “resources and referrals” Like this very project, TSA is determined to
counter over-stereotyped portrayals of TS in the media

Assistive Technology
A mix of high and low tech materials can be used to help students with TS
Calculators, spreadsheets, and other similar devices can be used to help students complete calculations in
mathematical environment

PDA’s or PC’s can be used to take notes or even write assignments

Computers would be especially helpful because work can easily be corrected if individuals experience a motor tic
while doing homework

Computers can also help students with group work: using Internet to share work
IMS Instant Message Systems written interactions between groups gives students with TS the chance to improve
their writing skills. Computer reads the story aloud and has other modes to promote learning such as:
Highlighting words as they are read
Changing font and color as necessary to reduce distraction
Pronunciation of syllables and definitions of words given

Multimedia tools such as graphics, pictures, audio and visuals can help cultivate students’ learning experiences
based on Gardner’s Multiple Intelligences

E-Books (not iPads or Kindles) can provide a multimedia aspect that will help promote reading among students
These include stories that take student interests into account

Media
 TURNER SYNDROME
Official Definition
Turner syndrome is a chromosomal disorder that occurs in 1 in 2,500 females and is caused by the complete or partial
absence of an X chromosome (Genetic and Rare Diseases Information Centre, n.d.) Mosaic Turner Syndrome is when the X
chromosome is missing in some cells but not all.

Other names for TS are:

• monosomy X
• TS
• Turner's Syndrome
• Ullrich-Turner syndrome
• 45,X
• Bonnevie-Ulrich syndrome
• Gonadal Dysgenesis (45,X)
• Schereshevkii Turner Syndrome
• Turner Varny Syndrome

Etiology (Causes)
The etiology of Turner Syndrome is still a bit of a mystery however, there has been much advancement in research about
this disease. It has been determined that Turner Syndrome is caused by a random dysfunction during gamete formation.
Normal developed females have 2 X chromosomes while females with TS will only have 1 fully functional X chromosome (1
could be nonfunctional or missing all together). It is not known what genes on the X chromosome are responsible for TS.
One gene, SHOX is important for growth development and therefore missing it may be responsible for the short stature that
is found in TS. (Genetics Home Reference, 2008). According to The National Human Genome Research the syndrome is not
usually inherited from generation to generation.

Characteristics
**It is important to remember that TS presents itself differently in people therefore will vary greatly from student to
student**
• Short stature (avg. height 4’7”)
• Low hairline
• Short neck
• Low-set ears
• Swollen or puffy hands and feet
• Soft nails that bend upwards
• Some have heart defects
• High blood pressure
• Structurally abnormal kidney (fully functional)
• Lack of estrogen (increase risk of osteoporosis)
• High risk of diabetes
• Risk of hypothyroidism (causes weight issues)
• Increased chance of hearing problems
• Difficulty with visual-spatial problems

Instructional Strategies
McCauley and Sybert (2006) argue that some strategies for
educators are:
• Individual cognitive testing with ongoing attention
• Tutoring to keep up with expectations
• Coaching to assure active social involvement
• Preparation for real world by assigning chores,
social activities, and jobs outside the home (done
with families)
• Start strategies early in high school so that they can
be guided through school and can succeed at
college level

Media
My Life as a Turner Syndrome Girl
I chose this clip because it is told by a young adult, with TS,
who found it beneficial to share her story with the world.
 WILLIAMS SYNDROME
Official Definition
Williams syndrome (WS) also know as Williams-Beuren Syndrome is a rare neurodevelopment disorder, estimated to occur
in one in ten thousand births, which causes medical and developmental problems.

Etiology (Causes)
Until recently the cause of Williams Syndrome was unknown. It was thought to be a hereditary condition, caused by an
autosomal dominant mutation. In 1993, it was determined that Williams Syndrome is caused by a deletion of twenty six
genes (approximately) from the long arm of chromosome seven. It is this microdeletion of genes that cause the clinical
features and characteristics of Williams Syndrome.

Characteristics
The following are characteristics that are common among individuals with Williams Syndrome.

• Characteristic facial appearance

• Heart and blood vessel problems
• Hypocalcaemia (elevated blood calcium levels)
• Low birth-weight / low weight gain
• Feeding problems
• Irritability (colic during infancy)
• Dental abnormalities
• Kidney abnormalities
• Hernias
• Hyperacusis (sensitive hearing)
• Musculoskeletal problems
• Overly friendly (excessively social) personality
• Developmental delay, learning disabilities and attention deficit
o Distractibility
o Difficulty modulating emotions
o Heightened sensitivity to sound
o Anxious to change
o Difficulty building friendships

Instructional Strategies
The following are classroom strategies that can be used for students with Williams Syndrome that are prone to short
attention span and distractibility:
• flexibility in requirements for time spent working
• frequent 'breaks' in work time
• a "high success," high motivation curriculum
• minimal distractions; auditory as well as visual
• rewards for attending behaviours and, when possible, redirection around 'off task' behaviours or ignoring same
• allowing some degree of choice for the child in terms of activity
• small groups
• consultation with a behaviourist familiar with positive behaviour management approaches

The following are classroom strategies that can be used for students with Williams Syndrome that have difficulty
modulating emotions:
• Decide when this is a problem. For example, expressing enthusiastic excitement, albeit impulsively or without
raising a hand, may be beneficial to the motivation of the class as a whole, whereas frequent tears and a high degree
of anxiety is problematic for the child with Williams syndrome as well as the other children.
• Help the child to develop increasingly effective internal controls to modulate emotions while adapting the
environment to minimize situations of extreme anxiety and frustration.

The following are classroom strategies that can be used for students with Williams Syndrome that have heightened
sensitivity to sound:
• Provide warning just before predictable noises when possible (fire drills, hourly bells etc.)
• Allow the child to view and possibly initiate the source of bothersome noises (e.g. turn the fan on and off, see
where the fire alarm is turned on)
• Make tape recordings of the sounds and encourage the child to experiment with the recording (playing it
louder/softer etc.)

The following are classroom strategies that can be used for students with Williams Syndrome that are anxious to change:
• Provide a predictable schedule and routine with specific warnings (e.g. a specific song a few minutes before
cleanup time) marking daily transitions
• Minimize unexpected changes
• For preschool aged children: use of picture schedules for daily routines, and wall calendars with big squares on
which special events can be sketched are helpful
• For older children: use digital watches and date books
 • Evaluation of other issues which might be making a child susceptible to feeling anxiety or a loss of control around
changes
• Capitalize on the child's orientation to a predictable schedule to work in less desirable but necessary activities at
predictable times

The following are classroom strategies that can be used for students with Williams Syndrome that experience difficulty
building friendships:
• Ignoring the behaviors when possible while trying to lower environmental stress is usually sufficient to reduce
them
• If the behavior bothers the child or other children, sometimes occasional reminders in conjunction with behavioral
techniques can be helpful (e.g. a sticker for each hour without nail biting)

Community Resources
Canadian Association for Williams Syndrome
The Canadian Association of Williams Syndrome (CAWS) was founded by a group of parents in 1984. They are a
national federation of the provinces of Canada that provide support to individuals with Williams Syndrome and their
families. Their registered non-profit society consists of three hundred families and continues to grow as awareness is
increased and information is shared. CAWS offer support for other Williams Syndrome Associations and their families
around the world and vice versa.

The Williams Syndrome Foundation

The Williams Syndrome Foundation (WSF) seeks to create or enhance opportunities in education, housing,
employment and recreation for people who have Williams Syndrome and other related or similar conditions. The WSF
identifies, initiates, funds and provides strategic guidance for major, long-range development projects, either by itself, or by
cooperating with other organizations.

The Williams Syndrome Association

The (Williams Syndrome Association (WSA) is the only group in the US devoted exclusively to improving the lives
of individuals with Williams Syndrome and their families. The WSA supports research into all facets of the syndrome, and
the development of the most up to date educational materials regarding Williams Syndrome.

Media
Williams Syndrome Media Clip
Jeremy Vest is a reporter for "How's your News", a comedy/ news program that aired for one season on MTV featuring
reporters with mental and physical disabilities. This clip depicts Jeremy, who has Williams Syndrome, conducting an
interview.