2 _ to _% of children/youth have a LD ___% of children who have an LD also have a social, emotional or behavioural problem_ to _ % of kids with ADHD also have a LD___% of children with ADHD who also have anxiety1 in __ children and youth in Canada have a mental health disorder (which includes anxiety and depression)Co-morbid – explain term “roommates”ADHD has a lot of room mates (Behaviour and LDs most common)ADHD most likely suggested by teachers as an issue – because it is BEHAVIOURAL and can be observed.Not always the full story – teacher/school staff are in the best position to observe and watch for changes in behaviour, mood, trauma especially if there is a relationship however teachers need more info and training.You don’t need to solve/fix/diagnose. Need to observe, suggest and support.
3 “Walk A Mile In My Shoes” Learning Objectives:To introduce the concepts of Learning Disabilities (LDs)To experience what it might feel like to have LDsTo talk about resources around anxiety and depressionBrief introductions (recognition of their expertise in residential treatment); we have done this workshop for … but new to residential. Help us to understand what the kids day looks like, recognize that security is keyEliciting problem behaviors: What are the behaviors that are problematic / that wears you out/down?Want to elicit typical problems rather than horror storiesLooking for top 10Examples – telling a kid 10 times to their chores; not finishing the stuff they start;
4 What are learning disabilities? Neurologically based disordersAffect the ability to take in,understand, remember or express information.Specific, not global impairmentsFound in individuals who possess average to above average thinking and reasoning skillsLifelong disorders
5 What are learning disabilities? LDs reflect neurobiological factors, including genetics, congenital or acquired conditionsLDs are not due to differences in culture, language, SES, motivation
6 What are learning disabilities? Impairments in one or more of the following psychological processes:Language processingPhonological processingVisual-spatial processingProcessing SpeedMemory & attentionExecutive functioningSelf disclosureLingo is fluid – words – but meanings change, people use terms differently,Process – what is that word?Talk about phonol processing – what does this mean?Our experience like LD – read and may not get meaning – level of language is so dense – tackle it togetherAnd giving you a cheat sheet – use with clients, will go back to itDemonstrate this is our knowledge – not belonging to psychologists only in a reportTalk about first 3 today – and next three in context of lD/ADHDFor each one – activity first, discussion, info: terms, why NB in general, why for your kids? (what are implications/strategies)
7 What are learning disabilities? Impairments may affect learning in the areas of:ReadingOral languageWritten languageMathDx of LD made when have average intelligence but problem with one of those processes we just listed. And the problem affects school skills – can be in one or more than one of these areas.As we go through the processes, we’ll try to show why the processes get in the way of reading or writing or math, for example.
8 What Do LDs Affect?LDs come in many forms & affect everyone differentlyPossible problems in social situations:Understanding sarcasmFiguring out how someone is feeling from their body language or facial expressionsUnderstanding the unwritten social rulesParticipating in groupsMarjory to lead
9 If a large solid-hoofed mammal becomes available to you without compensation, refrain from casting your faculty for seeing into the oral cavity of such a creature.Melissa to lead
10 Demystifying Processes TermDescriptionApplicationVerbal ReasoningVerbal ComprehensionGeneral Verbal AbilityAbility to think through problems using wordsAbility to understand words and connected languageUnderstanding instructions, lessons, storiesLogical thinking and problem-solvingUnderstanding word meaningsExpressing ideas in wordsMPLink to exercise to underscore the following concepts:Need integration of processes to work out the answer – including:vocabulary (long-term memory),Logical Reasoning / strategies – how did you figure out how to start the problem? E.g., look for words you know, like mammal = animalAbstract reasoning – understanding metaphors & words with multiple meanings, eg even if figure out each word separately, may not have meaningCulture – age, context – how many don’t recognize the proverb? Anyone know of a similar saying in another language or culture?
11 Demystifying Processes TermDescriptionApplicationPerceptual processingVisual-spatialAbility to make sense of what one seesPutting together visual informationNoticing & understanding facial expressionsUnderstanding a chart or graphReading a map
14 Demystifying Processes TermDescriptionApplicationNon-Verbal ReasoningPerceptual reasoningVisual-spatialPerceptual-organizationalPerformanceVisual problem-solvingAbility to organize, put together or orient visual informationAbility to form and mentally manipulate imagesUnderstanding concept words related to time, spaceBuilding according to a plan or modelJudging space and distanceMath (geometry, shapes, measurement)Following sewing patterns, IKEA instructions
15 What symbol has to come next in the sequence of the five symbols on the left? Can you sketch this sixth figure?Answer is back-to-back 6Cover up one side of each mirrored figure – elicit discussion about problem solving strategies.15
16 What symbol has to come next in the sequence of the five symbols on the left? Can you sketch this sixth figure?MP to lead if time
17 Kids with LDs and other disabilities are at risk – why? Frustration at not being able to do what child knows he/she should be able to doFeelings about having a “disability”Sense that others’ expectations are not being met (parents, teachers)Peers’ responsesLack of others’ understanding/responsesResponses to others’ feelings & anxieties
18 Invisible Disabilities Neurobiological impairments are invisible.Mental Health Issues are invisibleBehaviour may be are only clue.Where else can we look?OSR, past reports, grades, parents, teachers and kidsOSR Ontario School Record – what is your equivalent?
19 What is Anxiety/worry?Diffuse uncomfortable sense of apprehension, often accompanied by autonomic symptoms” (Barlow, 2002)Basic human emotionPart of normal developmentCan be adaptiveLots of definitions of anxiety, depending on who you read. I like Barlow’s because it captures the uncomfortable nature of anxietyOne of the basic human emotions – we all experience anxiety at some times, or at some stages of our lives. e.g., public speaking – one of the most common anxiety-producing experiences,Part of normal development – dependency to autonomy – exposed to new situations and learn to master your fear e.g. sleeping with light off as kid, starting new school, first day of high school, job interviewAlso has an important function – we need anxiety:Safety mechanism – hard-wired response to perceived danger – when we perceive threat, there is an increase in autonomic nervous system reactions – palms sweat, breath faster or more shallowly, feel butterflies in stomach – that works as an early warning mechanism – tells us something is upCave man times – fight or flight
20 What is an Anxiety Disorder? Symptoms interfere with the youth’s ability to function in everyday lifePersistentIntensity of reactions is severeAnxiety disorders are relatively common in childhood: Prevalence rate of >10%Can look like skipping, lack of motivation, withdrawal, externalizing behaviour, “aggressive avoidance”So if anxiety is normal and we all have it, how do you know when it is a problem, especially a problem for your child or teen?Short answer:When it seriously interferes with the child’s ability to do the tasks of everyday life – e.g., restricts their ability to go to school or hang out with friends at the mall, or interferes with their concentration – can’t think about school work, can’t sleepWhen it is persistent – not just a period of time when a big change is happening – like child not sleeping well & distracted in grade eight, worrying about starting high schoolWhen the intensity of the child’s responses are outside the norm – when doing an assessment and making a diagnosis, we usually try to get information about the child from a variety of sources – the parents, school, sometimes extended family, watching the child in the assessment – often, people will notice somethingResearch into anxiety disorders suggests that some of the anxiety disorders start fairly early , put a child vulnerable to developing other psychiatric problems, and if untreated, can persist into adulthood.
21 Types of Anxiety Disorders in Childhood Generalized Anxiety Disorder (GAD)Social PhobiaSpecific PhobiaPost-traumatic Stress Disorder (PTSD)Panic DisorderObsessive-Compulsive Disorder (OCD)Separation Anxiety Disorder (SAD)TGeneralized Anxiety Disorder (GAS) %Obsessive-Compulsive Disorder (OCD) 1-3%Panic AttacksRare in children, unless part of another anxiety disorder but more common in adolescents with specific phobias, Social phobia, SAD or GADPosttraumatic Stress Disorder 1% of adults, unknown in childrenSeparation Anxiety % of children under 7These are the Anxiety Disorders in the Diagnostic and Statistical Manual (DSM) system – psychologists, psychiatrists use criteria to make a diagnosis.Diagnosis can be helpful for a couple of reasons:Short hand way of communicating information –Research – group kids with particular cluster of symptoms together – can do careful studies and learn what symptoms are part of the disorder and what are unique to the child – predict what to watch out for; and most importantly, to learn how to help these kids – what works and what doesn’t workAlso – diagnosis is not the end point, though. Usually, understanding a child from a broader perspective – issues /stresses, how does a child feel; how do they cope?Bio-psycho-social model usefulhese are the Anxiety Disorders in the Diagnostic and Statistical Manual (DSM) system – psychologists, psychiatrists use criteria to make a diagnosis.
22 What is Distress/sadness Always associated with a trigger, event or situationWill improve with environmental accommodation or removal of stressorFunctional impairment usually mildProfessional psychiatric treatment not usually necessaryCounselling and therapy will often helpSocial supports (friendships and family) will often helpMedications would not be normally used
23 What is Depression? Referred to as Major Depressive Disorder -MDD Characterized by:Feelings of hopelessness, sadnessLoss of interest in activitiesVegetative signs: change in eating or sleeping, low energy or fatiguePoor concentration, difficulty making decisionsPersistentInterferes with daily livingRare in children under 12 years old-
24 Depression in Childhood Diagnosis of Depression is often overlooked in childhood:Some symptoms are more typical of children than of adults (e.g., irritability)High co-occurence with other disorders (such as ADHD & behavioual issues) may mask the symptomsCertain features of Depression are more typical at different agesPerception that kids don’t get depressed.Also – really hard to diagnose accurately.What it looks like changes over time. - e.g., depressed mood – feeling sad or hopeless & looking tearful for younger kids, often is manifest as irritable mood.Loss of interest in activities – may not be in all activities with kids. Can have a kid who still plays his DS every day but does not want to play with other kids or may not take pride in his ability to get to the next level, eg.
25 When to ask for more help When you are concerned about safety or well being of studentWatch for obvious indicators of mood issues:Crying, shaking, avoidanceFreezing in classroom situationsAngry Outbursts & Increased IrritationPhysical Evidence of Self-Harm or DeclineWatch for changes:In behaviourIn HygieneIn peer interactionsIn interactions with teachers and school staffWhen
26 What would help worry/distress at school? Involve student in problem-solving process (they have great ideas!)Acknowledge effort even if output is weakEncourage & support accountabilityAddress barriers caused by LD, ADHD, OT,Note takingSchedulingPlanning & Organizing (Support Self-Reliance)
27 What would help worry/distress at school? Make sure learning style is understoodAre accommodations appropriate and sufficient?Watch for bullying or peer difficultiesTeach pro-social skills to entire class and be clear about classroom expectationsDiscuss Fair versus Equal
28 What would help worry/distress at school? Find out what is overwhelming them in the school setting & accommodateSet up student for success and mastery to build self-esteemWatch for activities/subjects/projects that are “too hard”Empower them by encouraging and being receptive to attempts at self-advocacy
29 Support & Listen Reach Out - Ask student if they’re alright Ask about any changes in their lifeCheck in with other teachers, peers, their familyBe Real about limits of confidentialityAlways encourage parental involvementMay chose to state policy outrightNever promise you won’t tell anyone
30 Suggest Help In school support School Team (rule out learning issues, bullying, or situation within class)Social WorkersGuidanceSpecial EducationAdministrators
31 Suggest a Referral Inform family and student of your concern Enlist the help of your teamEncourage a thorough assessmentBe open to school involvement in treatmentOutside Referral for Assessment & Treatment:Hospital Clinic or ProgramChildren’s Mental Health ClinicGP
32 Resources GP’s will know local referral sources: Hospital Clinics Children’s Mental Health ClinicsSpecialty Clinics (Integra, Sick Kids Anxiety Groups, CAMH First Episode Clinic)Pediatricians and specializing psychiatrists and psychologistsPrivate practitioners (play therapists, social workers, therapists) – only after a thorough assessment
33 Resources – Websites & Books Sick Kids – Information and Resources – “Trusted Answers”Information on Referral SourcesResources for TeachersTeachADHDThe ABCs of Mental Health – A Teacher ResourceOrientation to Children’s Mental Heath – Teachers GuideLearning Disability Association of ON