Children with special needs

21st Feb 2011

Down syndrome

Types Indications Additional health problems Developing speech and language Social and emotional development Medical difficulties Factors for you to consider Additional developments

Introduction

First described in 1866 Genetic condition – extra chromosome Learning disability and may have some

physical difficulties e.g. heart problems In the UK it occurs in about 1 in 700 births It occurs in all social, economic, cultural,

religious and racial backgrounds It is not a disease and children do not suffer

from Down syndrome

Types

3 different types but the effects on the child are very similar Standard trisomy – 95% of cases; an accident

of nature; 47 chromosomes and not 46; Translocation – 2% of cases; 46 chromosomes

but one of the parents passes on an abnormal chromosome 21

Mosaic Down syndrome – 2-5% of cases; some of child’s cells have 46 chromosomes and some have 47 chromosomes; effects of condition less severe

Indications at birth

Floppy; poor muscle tone Small mouth; highly arched palate and protruding

tongue Flattened nasal bridge Low hairline Eyes slant upwards and outwards; epicanthic folds Ears are small and low set Broad hands with short fingers; one crease across

palm Feet are short and broad with a deep cleft between

the first and second toe extending as a long crease on the side of the foot

Possible additional health difficulties

Hearing – vulnerability to ‘glue ear’ Vision – possibly a squint Physical development – may be smaller Tendency to gain weight Underdeveloped immune system in

early years Heart problems - 40%; half of these will

require surgery

Diagnosis

The risk of having a child with Down syndrome increases with maternal age

Increases if you already have one child with Down syndrome

Genetic counselling often advised Tests during pregnancy

Developing speech and language

Small nasal passages and sinuses; small mouth cavity; thick tongue that tends to protrude – leads to breathing and articulation difficulties

Make sure child can watch your face and mouth

Be patient Sign system can be very helpful Liaise with the speech and language

therapist

Social and emotional development

Children with Down syndrome are all different! Always praise and acknowledge good

behaviour – do not constantly criticise Be realistic in your expectations – the pattern

of development will be the same as a ‘typical’ child but will be slower

Always explain simply and clearly what you expect

Be consistent in your approach Remember that you are an important role

model

Factors to consider for the early years worker

Essential that you motivate and encourage child to regard learning as fun and pleasurable

Watch out for any over protection by other children

Watch out for any bullying or teasing

Factors continued Only ask for one thing at once Break down every task into the smallest unit Check the child understands what you want-

demonstrations accompanied by simple instructions work best

Do not assume that the child understands basic terms such as ‘over’ and ‘under’, ‘top’ and ‘bottom’

Always allow the child enough time If teaching the child something new, make sure there

are no or minimal distractions Gym clubs, ballet classes and swimming can all help

gross motor control and development and community inclusiveness

Use a lot of encouragement and positive feedback

General implications

Tendency for society to stereotype children with Down syndrome

It is important that you care for every child as an individual, balancing all needs and valuing and understanding differences – make sure you do not reinforce stereotypes

Increasingly leading full and independent lives and making positive contributions to society

Additional developments

New techniques of detecting Down syndrome

Cosmetic surgery Support groups – down syndrome Ireland

Case study

Role of the Father in caring for a child with disability

Prader Willi Syndrome

Introduction

Genetic disorder Seven genes on Chromosone 15 are

missing or partially missing Incidence is between 1 in 12,000 and

1 in 15,000 live births Affects both sexes and all races

Causes and diagnosis

Normally contributed to father Diagnosed by genetic testing Rare to reoccur in same family But all families should receive genetic

counselling

Clinical features and signs

In utero Reduced foetal movement Frequent abnormal foetal position

At birth Often breech/caesarian birth Lethargy Hypotonia Feeding difficulties Difficulties establishing respiration Small gonads

Clinical features and signs

Infancy Failure to thrive (continued feeding

difficulties) Delayed milestones/intellectual delay Excessive sleeping Strabismus Scoliosis (often not detected at birth)

Clinical features and signs

Childhood Speech delay Poor physical co-ordination Over eating from age 2-4 years (different from

earlier difficulties) Excessive weight gain

Adolescence Delayed puberty Short stature Obesity

Clinical features and signs

Adulthood Infertility Small gonads Sparse pubic hair Obesity Hypotonia Learning difficulties Proneness to diabetes Delayed motor

development

Prominent nasal bridge

Small hands and feet Soft skin that is easily

bruised Excess fat especially

in central part of body High narrow forehead Picking at skin Almond shaped eyes

Intelligence

May have learning difficulties Show an unusual cognitive profile

Strong in visual organisation and perception (including reading and vocabulary)

Spoken language generally poorer Skill in completing jigsaws Poor with auditory skills Poor at maths and writing

Treatment

No cure Growth hormone replacement therapy Early intervention – team based

approach Highly structured learning environment Controlling of food intake

Dyslexia

Introduction

Affects between 1-4% of children – mainly boys It occurs despite normal teaching and ability In schools may be called ‘specific learning

difficulty’ It mainly affects one or more areas of reading,

spelling and written language In the past children may have been perceived as

being lazy or stupid Should not be used as a handy cover-all label for

children with minor problems of reading and writing

What happens

Condition is not fully understood No genetic pattern of inheritance yet

often found running in families Premature babies and those who have

a difficult period immediately after birth are most at risk

Can cause stress and anxiety for a child leading to low self esteem and a hatred of school

Features Speech difficulties

Jumbled words and phrases Difficulties naming colours Confusion with directional words e.g. up, down, right, left

Movement control Delayed fine motor skills General clumsiness Catching, throwing, riding a bike etc.

Memory and sequencing Rhymes, days of the week, months, alphabet etc.

Other areas Boredom, shy, withdrawn, unco-operative, but may enjoy chatting to

others Creative

Who makes the diagnosis?

Parents School Educational psychologist GP Speech and language therapist Hearing and sight tests should be carried

out to exclude any other possible difficulties

Care

Good practice for a child with dyslexia is also good practice for any child, but child will need more one to one attention

Will need time and patience and to be able to talk about problems as they happen

Use appropriate language and repetition Boost self confidence by praising

achievements Listen carefully to the child

Suggested activities

Rhyming songs Clapping out rhythms Encourage games to develop sequencing Picture lotto Sorting games Encourage co-ordination with large ball games

and balancing games Top, bottom, right and left Painting Dressing games

Ongoing management

Carefully organised and structured Multi-sensory Systematic with lots of reinforcement Provide a framework of acceptable codes

of behaviour Individualised learning programme May get very tired due to the need to

concentrate more than most children

General implications and additional developments

Needs lots of encouragement to practise skills

Will take longer to reach goals Intelligence is the same so may shine in

other areas Many child care workers feel that they

needed more knowledge and confidence in working with these children

Alternative therapies

Main approach is the use of teaching strategies e.g. multi-sensory

Movement based therapies Eye related therapies Auditory therapies Nutritional supplements/diet

Epilepsy

Introduction

Most common serious neurological condition In epilepsy there is an interruption in the

chemical activity in the nerve cells in the brain and a ‘fit’ or seizure can result

Seizures can occur that are not epilepsy i.e. febrile convulsions

About 6 in 1000 children have epilepsy and 80% attend mainstream school

Slightly more girls than boys have epilepsy

What happens?

Electrical changes in the brain caused by something in the brain itself -

Antenatal infections Family history Jaundice Some drugs taken in pregnancy

What happens?

Electrical changes caused by factors external to the brain –

Temporary lack of oxygen Photosensitivity Severe infections – brain infections Certain severe diseases

Types of seizuresOver 40 different types – classified as

generalized or partial seizures. They need to be managed in different ways.

Generalized seizures Tonic/clonic – ‘grand mal’ Absences

Partial seizures Simple partial seizures Complex partial seizures

Diagnosis

Pattern of repeated fits Electroencephalogram (EEG) is used

to confirm. Electrodes are placed on various points of the head and the brain activity is monitored – painless and harmless

Care

See first aid leaflet Be careful of your reaction for the sake

of the child and other children The child may not remember the

seizure only sensing what has happened from others around them

Ongoing management

Medication – but the success of this depends on several factors: Type of epilepsy Accuracy of the diagnosis Accuracy of the treatment The child’s response to the medication Additional problems

Ongoing management

Seizures can be controlled in 80% of cases Occasionally seizures lessen as the child

grows older A child needs to be involved in the

management of their own treatment and see medication as a positive part of remaining healthy and not part of an ‘illness’

Beware of negative images born out of fear and ignorance

Management in school/pre-schoolThe disabling effects of epilepsy can be lessened if there is good communication between professionals, parents, the child and their friends. A teacher or pre-school worker must have full information on:

Type of epilepsy Frequency of seizures Speed of recovery following a seizure The most appropriate management for the child How the child feels about their epilepsy Information about triggering factors Details about medication including any possible side

effects

General implications

Over protection will affect a child’s self esteem

Answer the child any other children’s questions honestly

Activities such as swimming and climbing? Identification bracelet Medication – careful storage; dosage

checked; possible side effects known

General implications

Additional help must be sought in the following situations; Child has injured themselves during a

seizure Child has trouble breathing after a seizure One seizure immediately follows another,

or the seizure lasts longer than 5 minutes The seizure lasts longer than usual

General implications Do not have low expectations Epilepsy should not be used as an excuse

for attention seeking or any other unacceptable behaviour

Possible causes of underachievement Frequent major seizures Frequent ‘absence’ seizures Severe epilepsy – disorganised brain activity Incorrect or excessive drug use – sleepiness Rapid growth can affect amount of drug

needed

Additional developments

Epilepsy and surgery Useful if scarring has occurred e.g. from

meningitis or head injury Only undertaken after extensive

investigation Specific stimulation, via a nerve in the

neck, is offered to some older children Most children manage their epilepsy well

through medication

Case study