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Attention Deficit Hyperactivity Disorder
Any child may show inattention, distractibility, impulsivity, or hyperactivity at times. The child with ADHD shows these symptoms and behaviors more frequently and severely than other children of the same age or developmental level to the point where their symptoms significantly interfere with functioning.
ADHD occurs in 3-8% of school age children. ADHD can continue into adulthood. ADHD runs in families with about 25% of biological parents also having this medical condition.
A child with ADHD often shows some of the following:
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Trouble paying attention
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Inattention to details and makes careless mistakes
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Easily distracted
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Loses school supplies, forgets to turn in homework
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Trouble finishing class work and homework
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Trouble listening
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Trouble following multiple adult commands
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Blurts out answers
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Impatience
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Fidgets or squirms
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Leaves seat and runs about or climbs excessively
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Seems "on the go"
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Talks too much and has difficulty playing quietly
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Interrupts or intrudes on others
A child presenting with ADHD symptoms should have a comprehensive evaluation. A child with ADHD may also have other problems such as learning disabilities, motor coordination problems, anxiety disorder, depressive disorder, or bipolar disorder. Without proper treatment, the child may fall behind in schoolwork, and friendships may suffer.
A comprehensive approach to treatment is needed including education about the disorder, behavior management strategies, educational modifications and medication. Treatment approaches may include behavioral therapy, social skills training, parent education, and modifications to the child’s education program. Medication also can help improve attention, focus, goal directed behavior, and organizational skills.
Autism/Pervasive Developmental Disorder
Autism Spectrum Disorders are a group of neurologically based developmental disorders characterized by varying degrees of impairment in communication skills, social interactions, play behaviors, restricted interests and repetitive or stereotyped patterns of behavior. Autism spectrum disorders include Autistic Disorder, Asperger Syndrome and Pervasive Developmental Disorder, not otherwise specified (PPD, NOS).
Children with Autistic Disorders typically present before age three with delays in language, social interaction and atypical behaviors. Children with Asperger Syndrome or milder forms of PDD NOS may not present for evaluation until they are older.
Children on the Autism spectrum often have other problems that complicate the diagnosis and management such as cognitive delays, language disorders, motor coordination problems, sensory processing issues, attention deficits, behavioral and emotional difficulties.
Comprehensive evaluation is needed to assess all the issues and to devise an appropriate treatment plan that often includes special education services, behavior therapy, language therapy, occupational therapy and/or social skills training.
Chronic Medical Conditions with Associated Learning Problems
Children with a chronic physical health condition may also develop cognitive delays and difficulty with school work, as well as emotional difficulties. At the CCSN we evaluate these children’s developmental and behavioral difficulties in collaboration with the physicians monitoring their physical health condition(s).
Behavior Disorders
Behavioral Disorders interfere with a child or adolescent’s acquiring academic, vocational, and social skills and negatively affect adult adjustment. Therefore, early identification and intervention for students with behavioral problems is essential.
Children may exhibit behavioral problems for a variety of reasons, including developmental or environmental stressors and/or the presence of a longer term disorder.
A behavior disorder can be caused by or co-exist with other disorders. This category may include children or youth with mental illness, mood disorders, autistic spectrum disorders, anxiety disorders, or who have other sustained disturbances of conduct, attention, or adjustment. Some children have on-going behavior problems because they are unsuccessfully coping with a disability such as a learning disability.
Functional behavior assessment procedures are recommended to gather information about the child’s behavior in relationship to the instructional and social environment.
Cognitive, learning and emotional functioning should be assessed. Other assessments, (i.e. Speech/Language, Occupational Therapy, Neurodevelopmental, Neurological) should be conducted if indicated.
A trained Behavioral Specialist can then conduct a Behavioral Analysis to develop short and long term goals and strategies for intervention.
Learning Disabilities
The regulations for Public Law (P.L.) 101-476, the Individuals with Disabilities Education Act (IDEA), formerly P.L. 94-142, the Education of the Handicapped Act (EHA), define a learning disability as a "disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or to do mathematical calculations."
Many conflicting theories exist about what causes learning disabilities and how many there are. The definition assists in classifying children, not teaching them. It is therefore important to observe both how and how well the child performs, to assess strengths and weaknesses, and develop ways to help each child learn. It is important to remember that there is a high degree of interrelationship and overlapping among the areas of learning. Therefore, children with learning disabilities may exhibit a combination of characteristics.
Language Delay and Disorders
A child's communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Sometimes a child will have greater receptive (understanding) than expressive (speaking) language skills, but this is not always the case.
Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, mental retardation, drug abuse, physical impairments such as cleft lip or palate, and vocal abuse or misuse. Frequently, however, the cause is unknown.
Speech disorders refer to difficulties producing speech sounds or problems with voice quality. They might be characterized by an interruption in the flow or rhythm of speech, such as stuttering, which is called dysfluency. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems.
A language disorder is an impairment in the ability to understand and/or use words in context, both verbally and nonverbally. Some characteristics of language disorders include improper use of words and their meanings, inability to express ideas, inappropriate grammatical patterns, reduced vocabulary and inability to follow directions. One or a combination of these characteristics may occur in children who are affected by language learning disabilities or developmental language delay. Children may hear or see a word but not be able to understand its meaning. They may have trouble getting others to understand what they are trying to communicate.
Mental Retardation
The American Association of Mental Retardation defines mental retardation as a disability characterized by significant limitations both in intellectual functioning and in adaptive behavior as expressed in conceptual, social, and practical adaptive skills. This disability originates before age 18. A complete and accurate understanding of mental retardation involves realizing that mental retardation refers to a particular state of functioning that begins in childhood, has many dimensions, and is affected positively by individualized supports.
An IQ (Intelligence Quotient) test is administered as a standardized test to confirm the diagnosis. Mental retardation ranges from mild to profound as determined by the IQ test score. The amount and type of support a child needs depends on the degree of mental retardation.
Supports for individuals with mental retardation are very important as they improve the overall well-being of the individual, increase their integration in the society and their personal function.
Motor Coordination Disorders
Developmental Coordination Disorder (DCD) is also known as developmental dyspraxia. Children with DCD have struggles with motor coordination compared to other children of the same age and are sometime thought of as "clumsy" or "awkward."
Motor Coordination difficulties are caused by disorganization of the messages sent from the brain to the muscles. If there is not a clear message sent to the muscles, they cannot perform in a smooth and expected manner. This can lead to difficulties in attaining motor skills such as crawling, walking, jumping, standing on one foot and catching a ball. It can also affect fine motor skills, for example: handwriting.
Developmental Problems of Premature Infants
The NICU Follow Up Clinic is a multidisciplinary clinic emphasizing the unique medical and neurodevelopmental needs of medically complex infants as they grow and develop.
Infants that are eligible for the NICU Follow-Up Clinic include:
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Those born less than 28 weeks gestation or weighing less than 2 pounds 3 ounces
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Infants with severe complications in the newborn period
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Infants with complex medical issues
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Any infant with a diagnosis associated with developmental delay
Evaluation in the NICU Follow-Up Clinic consists of:
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Neurodevelopmental evaluation that consists of assessment of motor development, receptive and expressive language, and cognitive development
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Review of medical issues and management, tailored to the needs of the complex infant
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Guidelines and recommendations provided in a multidisciplinary conference with the parents/caregivers
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Reports documenting the guidelines and recommendations provided to the primary care giver, others involved in the infant’s care, and family
Tourette Syndrome
Tourette disorder refers to a neurological problem which causes tics. Tics are sudden rapid sounds or movements made by a person that are beyond their control. The tics usually occur in bouts, several times a day. They may stop for a period of days or weeks before the same or different tics start up again. Movement tics can include eye blinking, head jerking, shoulder shrugging, jumping, touching people or things, smelling or licking things, twirling about. Vocal tics can include throat clearing, sniffing, barking noises, repeating words or phrases, shouting, swearing. Tourette disorder is believed to be genetic in origin and develops before the age of 18. A child or adolescent who is suspected of having Tourette should have a medical evaluation and some may benefit from medication.
Emotional Issues Associated with Disabilities
Children who have disabilities often experience anxiety, depression, low self-esteem or other emotional difficulties. This may be due to the fact that children with developmental disabilities are more likely than those without to have emotional disorders due to their neurological makeup. It may also be due to the fact that these children are often treated differently and experience social rejection.
Children with developmental differences, and their parents, are typically under more stress than those without, which can cause mental health problems.
Concerns Related to Gender Identity and Sexual Orientation
Children whose play, playmate, and activity preferences are not typical of their gender may have associated emotional or behavioral difficulties. Their parents may have questions or concerns about their development and/or school success. Adolescents who are or are wondering if they are gay or lesbian and their families, may also have questions or concerns.
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