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Chapter 8
Learning and Behavior Disorders
Learning and Behavior Disorders
The terms:
behavior disorder,
ADHD, or
learning disability
should be used with
extreme caution when
describing young
children.
Attention Deficit Hyperactivity Disorder
ADHD
• Attention Deficit Hyperactivity Disorder (ADHD)
is a condition that becomes apparent in some
children in the preschool and early school years.
• It is hard for these children to control their
behavior and/or pay attention.
• It is estimated that between 3 and 5 percent of
children have ADHD, or approximately 2 million
children in the United States.
– This means that in a classroom of 25 to 30 children,
it is likely that at least one will have ADHD.
History of ADHD
• ADHD was first described by Dr. Heinrich
Hoffman in 1845.
• Book of poems, complete with illustrations,
about children and their characteristics.
• "The Story of Fidgety Philip" was an
accurate description of a little boy who had
attention deficit hyperactivity disorder.
Attention Deficit Hyperactivity Disorder
• History of ADHD
– It has been studied for the last 50 years.
– It was originally thought to be brain damage.
– The APA finally decided there were two
categories:
• ADD
• ADHD
– There are three patterns of behavior.
Attention Deficit Hyperactivity Disorder
(continued)
• Predominantly hyperactive-impulsive
– No inattention
• Predominantly inattentive
– Often called ADD
– No hyperactive-impulsive behavior
• Combined
– Inattentive and hyperactive-impulsive
Attention Deficit Hyperactivity Disorder
(continued)
• Current attempts at defining ADHD
– It must be a clinical diagnosis that involves parent and
teacher input.
– It must manifest before age seven.
– Characteristics must occur in multiple settings.
– Characteristics must be maladaptive for the child’s
age.
– It must effect the child’s academic performance.
– It cannot be a temporary response to a situation.
Attention Deficit Hyperactivity Disorder
(continued)
• Causes and prevalence of ADHD
– There is no known absolute cause.
– Possible causes are genetics; one or more
parents is also hyperactive.
– Maternal smoking or drug use during
pregnancy may be a factor.
Causes of ADHD
• Alcohol and drug abuse (including
nicotine) during pregnancy can cause poor
motor and muscular development and
sensory impairment; problems with
learning, memory, attention, and problem
solving; and problems with mental health
and social interactions.
• Smoking during pregnancy
• Certain theories regarding other potential
causes of ADHD--for example, dietary
factors (e.g., food allergies, sensitivities to
food additives, sugar consumption),
environmental allergies or sensitivities-have garnered much attention in the
popular media.
• However, they have received little or no
research support to date.
Symptoms of ADHD
• The year 2000 Diagnostic & Statistical
Manual for Mental Disorders (DSM-IV-TR)
provides criteria for diagnosing ADHD.
The criteria are presented here in modified
form in order to make them more
accessible to the general public. They are
listed here for information purposes and
should be used only by trained health care
providers to diagnose or treat ADHD.
Symptoms of ADHD
DSM-IV Criteria for ADHD Either A or B:
A. Six or more of the following symptoms of inattention have been present for at least 6
months to a point that is disruptive and inappropriate for developmental level:
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Inattention
Often does not give close attention to details or makes careless
mistakes in schoolwork, work, or other activities.
Often has trouble keeping attention on tasks or play activities.
Often does not seem to listen when spoken to directly.
Often does not follow instructions and fails to finish schoolwork,
chores, or duties in the workplace (not due to oppositional behavior or
failure to understand instructions).
Often has trouble organizing activities.
Often avoids, dislikes, or doesn't want to do things that take a lot of
mental effort for a long period of time (such as schoolwork or
homework).
Often loses things needed for tasks and activities (e.g. toys, school
assignments, pencils, books, or tools).
Is often easily distracted.
Is often forgetful in daily activities.
B. Six or more of the following symptoms of hyperactivity-impulsivity have been
present for at least 6 months to an extent that is disruptive and inappropriate for
developmental level:
Hyperactivity
•
Often fidgets with hands or feet or squirms in seat.
•
Often gets up from seat when remaining in seat is expected.
•
Often runs about or climbs when and where it is not appropriate (adolescents or adults
may feel very restless).
•
Often has trouble playing or enjoying leisure activities quietly.
•
Is often "on the go" or often acts as if "driven by a motor".
•
Often talks excessively.
Impulsivity
•
Often blurts out answers before questions have been finished.
•
Often has trouble waiting one's turn.
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Often interrupts or intrudes on others (e.g., butts into conversations or games).
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Some symptoms that cause impairment were present before age 7 years.
•
Some impairment from the symptoms is present in two or more settings (e.g. at
school/work and at home).
•
There must be clear evidence of significant impairment in social, school, or work
functioning.
•
The symptoms do not happen only during the course of a Pervasive Developmental
Disorder, Schizophrenia, or other Psychotic Disorder. The symptoms are not better
accounted for by another mental disorder (e.g. Mood Disorder, Anxiety Disorder,
Dissociative Disorder, or a Personality Disorder).
Treatment
• A child with ADHD faces a difficult but not
insurmountable task ahead. In order to
achieve his or her full potential, he or she
should receive help, guidance, and
understanding from parents, guidance
counselors, and the public education
system.
ADHD Treatment
• Although there is no cure for ADHD, treatment can help control
symptoms.
• Stimulant medications:
– amphetamines (examples include Dexedrine or Adderall)
– methylphenidate (examples include Ritalin, Concerta, or
Metadate CD),
are effective in controlling symptoms in children.
• Studies show that some children who receive behavioral
therapy along with medication improve more than those who
receive medication alone.
ADHD Treatment
• Often, extra support at home and at school and
counseling help children find success at school
and feel better about themselves.
• Doctors recommend that children be closely
followed after they begin to take medications for
ADHD.
• Side effects—including loss of appetite,
headaches or stomachaches, tics or twitches,
and problems sleeping—usually decrease after
a few weeks on the medication, or the dosage
can be lowered to offset them.
Attention Deficit Hyperactivity Disorder
(continued)
• Causes and prevalence of ADHD
– There is no known absolute cause.
– Possible causes are genetics; one or more
parents is also hyperactive.
– Maternal smoking or drug use during
pregnancy may be a factor.
Attention Deficit Hyperactivity Disorder
(continued)
• Intervention strategies
– Medication and behavior management
combined seems to be the best approach.
– Medication
• Ritalin is the most common.
• It helps a child control impulsivity and pay attention
in class.
• It can cause sleep disorders, weight loss, and
increased blood pressure.
• Parents and teacher rely on the medicine to fix the
behaviors.
Attention Deficit Hyperactivity Disorder
(continued)
• Special diets such as the Feingold Diet,
which linked artificial food coloring and
food additives with hyperactivity, have
proven ineffective.
• Parents feed the child additive- and dye-free foods
to lessen hyperactive behaviors.
• Nutrition is key, but eliminating foods does not
solve the problem.
Attention Deficit Hyperactivity Disorder
(continued)
– Behavior management
• Reward positive behaviors.
• Evaluate the environment for behaviorcausing areas and correct.
• Plan developmentally appropriate activities
for all children.
Attention Deficit Hyperactivity Disorder
(continued)
• Disorders that sometimes accompany
ADHD
– Learning disabilities
– Oppositional Defiant Disorder
– Conduct Disorder
– Bipolar Disorder
Learning Disabilities
• What is a learning disability?
– A disorder in one or more of the basic
psychological processes involved in
understanding or in using language, spoken
or written, which may manifest itself in the
imperfect ability to listen, think, speak, write,
spell, or do mathematical calculations
Learning Disabilities
• Learning Disabilities (LD) are
neurologically-based processing problems.
• These processing problems can interfere
with learning basic skills such as reading,
writing, or math.
• They can also interfere with higher level
skills such as organization, time planning,
and abstract reasoning.
Learning Disabilities
• The types of LD are identified by the specific
processing problem.
• They might relate to getting information into the
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brain (Input),
making sense of this information (Organization),
storing and later retrieving this information (Memory),
or getting this information back out (Output).
Learning Disabilities (continued)
• It states clearly that a learning disability is
not the result of:
– visual, hearing, or motor handicaps.
– mental retardation.
– emotional disturbance.
– environmental, cultural, or economic
disadvantage.
– second language learning.
Learning Disabilities (continued)
• Non disadvantaged ruling
– This excludes children who live in
environmental or economic disadvantage
from being labeled learning disabled.
• Academic ruling
– The definition states that there should be
difficulty in reading, writing, spelling, and
mathematical calculations. At what age?
Learning Disabilities (continued)
– Areas that children may show signs of
future learning disabilities:
• Perinatal stress
• Genetic or environmental conditions
• Developmental milestones
• Attention and behavior
Learning Disabilities (continued)
• Predicting learning disabilities
– Observation of child
– Matching observation to performance
measures
– Caution: Children can develop skills in a
range; looking for deviations from the range is
a sign of possible learning disability.
Learning Disabilities (continued)
• Prerequisite skills
– These are skills needed to enter school.
– Often children with learning disabilities lack
these necessary skills to be successful in
school.
Learning Disabilities (continued)
– Examples
• Sensorimotor difficulties (gross motor)
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Imperfect body control
Poor balance
Uncertain bilateral and cross-lateral movements
Inability to cross body midline
Faulty spatial orientation
• Sensorimotor difficulties (fine motor)
– Problems in buttoning, lacing, snapping, cutting, pasting,
and stringing beads
– Perseveration
Sensory-motor Difficulties
• Motor Disability: A student with motor problems might have
difficulty with
• fine motor planning (coloring, cutting, writing, buttoning,
zipping, tying) and/or with
• gross motor planning (running, jumping).
• Some may have difficulty with visual-motor (eye-hand)
activities required when doing certain visual spatial tasks or
when catching or hitting a ball.
• In addition, this child might have difficulty with vestibular
function, manifested by weak upper trunk muscles and
possibly by difficulty learning to ride a bike.
• Finally, some may show tactile sensitivity, not liking to be held
or cuddled or not liking cloths that are felt to be too rough.
• This total clinical picture of motor problems is called Sensory
Integration Dysfunction.
Learning Disabilities (continued)
– Cognitive disorders
• Trouble organizing
• Abstract thought is difficult
• Poor memory
• Problems with generalizing information
Learning Disabilities (continued)
– Visual and auditory perception problems
– Information is primarily brought into the brain through
the eyes (visual perception) and ears (auditory
perception). An individual might have difficulty in one
or both areas.
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Visual discrimination
Visual orientation
Visual memory
Visual tracking
Visual-motor integration
Auditory perception problems
Visual Perception
• One might have difficulty distinguishing subtle differences in shapes
(called graphemes).
• They might rotate or reverse letters or numbers (d, b, p, q, 6, 9); thus
misreading the symbol.
• Some might have a figure-ground problem, confusing what figure(s)
to focus on from the page covered with many words and lines.
• They might skip words, skip lines, or read the same line twice.
• Others might have difficulty blending information from both eyes to
have depth perception.
– They might misjudge depth or distance, bumping into things or having difficulty
with tasks where this information is needed to tell the hands or body what to do.
• If there is difficulty with visual perception, there could be problems
with tasks that require eye-hand coordination (visual motor skills)
such as catching a ball, doing a puzzle, or picking up a glass.
Auditory Perception
Also called Receptive Language
• The individual might have difficulty distinguishing
subtle differences in sound (called phonemes)
• Might have difficulty distinguishing individual
phonemes as quickly as normal.
• Either problem can result in difficulty processing
and understanding what is said.
• Individuals might have difficulty with what is
called auditory figure-ground.
– They have difficulty identifying what sound(s) to listen to when
there is more than one sound.
Learning Disabilities (continued)
– Language deviations
• Receptive language
• Expressive language
– Social skills deficits
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Bullying
Withdrawn
Aggressive
Overdependent
Learning Disabilities (continued)
• Response to intervention
– This allows a teacher to intervene with a child
without there being a required discrepancy
between ability and achievement.
– Tiered approach
• Screening and group interventions
• Target and short-term interventions
• Intensive instruction
Learning Disabilities (continued)
• Program considerations
– All children will show signs of learning
disabilities at one time or another.
– Children need environments that are positive
and developmentally appropriate.
– Schedules need to be consistent.
– Tasks need to be broken down into smaller
chunks of information.
Behavior Disorders
• Behavior is extreme, chronic, and
unacceptable.
• Experts who work with these children
prefer the term behaviorally disordered
because it places the focus on the
observable aspect of the children’s
problems: the behavior that is causing
problems in school and at home.
Behavior Disorders (continued)
• The term emotional or behavioral disorder
means a disability characterized by
behavioral or emotional responses in
school so different from appropriate age,
cultural, or ethnic norms that they
adversely affect educational performance.
Behavior Disorders (continued)
• Emotional and behavioral disorders can
co-exist with other disabilities.
Behavior Disorders (continued)
• This category may include children or
youths with schizophrenic disorders,
affective disorders, anxiety disorder, or
other sustained disorders of conduct or
adjustment when they adversely affect
educational performance in accordance
with section (I) (Forness & Knitzer, 1992,
p. 13).
Behavior Disorders (continued)
• Severe depression
– This is categorized by low self-esteem, poor
school performance, lack of friends, inability
to cope with daily routines.
– Some children with depression have parents
who suffer from depression.
Behavior Disorders (continued)
• Anxiety
– People who experience excessive fear, worry,
or uneasiness.
– Some fears may even become phobias.
– Fears are normal, but when taken to the
extreme, they can cause multiple maladaptive
behaviors.
Behavior Disorders (continued)
• Anxiety
– People who experience excessive fear, worry,
or uneasiness.
– Some fears may even become phobias.
– Fears are normal, but when taken to the
extreme, they can cause multiple maladaptive
behaviors.
Anxiety Disorders
• Panic Disorder—Repeated episodes of
intense fear that strike often and without
warning.
– Physical symptoms include
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chest pain,
heart palpitations,
shortness of breath,
dizziness,
abdominal distress,
feelings of unreality, and
fear of dying.
• Obsessive-Compulsive Disorder—Repeated,
unwanted thoughts or compulsive behaviors that
seem impossible to stop or control.
• Post-Traumatic Stress Disorder—Persistent
symptoms that occur after experiencing or
witnessing a traumatic event such as rape or
other criminal assault, war, child abuse, natural
or human-caused disasters, or crashes.
– Nightmares, flashbacks, numbing of emotions,
depression, and feeling angry, irritable or distracted and
being easily startled are common.
– Family members of victims can also develop this
disorder.
Phobias
Two major types:
• social phobia
– People with social phobia have an overwhelming and disabling
fear of scrutiny, embarrassment, or humiliation in social
situations, which leads to avoidance of many potentially
pleasurable and meaningful activities.
• specific phobia
– People with specific phobia experience extreme, disabling, and
irrational fear of something that poses little or no actual danger;
the fear leads to avoidance of objects or situations and can
cause people to limit their lives unnecessarily.
Generalized Anxiety Disorder
• Constant, exaggerated worrisome
thoughts and tension about everyday
routine life events and activities, lasting at
least six months.
• Almost always anticipating the worst even
though there is little reason to expect it;
accompanied by physical symptoms, such
as fatigue, trembling, muscle tension,
headache, or nausea.
Autism Spectrum Disorders
• Autism Spectrum Disorders (ASD), also known as
Pervasive Developmental Disorders (PDDs), cause
severe and pervasive impairment in thinking, feeling,
language, and the ability to relate to others.
• These disorders are usually first diagnosed in early
childhood and range from a severe form, called autistic
disorder, through pervasive development disorder not
otherwise specified (PDD-NOS), to a much milder form,
Asperger syndrome.
• They also include two rare disorders, Rett syndrome and
childhood disintegrative disorder.
Autism
• a brain disorder that •
affects 3 of every 1000
children 3-10 years
old,
• often results in a
lifetime of impaired
thinking, feeling and
social functioning—our •
most uniquely human
attributes.
typically affects a
person's ability to
communicate, form
relationships with others,
and respond
appropriately to the
external world.
becomes apparent in
children generally by the
age of 3.
Autism Characteristics
Some or all of the following characteristics may be
observed in mild to severe forms:
• Communication problems (e.g., using and understanding
language);
• Difficulty in relating to people, objects, and events;
• Unusual play with toys and other objects;
• Difficulty with changes in routine or familiar surroundings;
and
• Repetitive body movements or behavior patterns.
Autism Characteristics
• Children with autism or PDD
vary widely in abilities,
intelligence, and behaviors.
• Some children do not speak;
others have limited language
that often includes repeated
phrases or conversations.
• People with more advanced
language skills tend to use a
small range of topics and have
difficulty with abstract
concepts.
• Repetitive play skills, a limited
range of interests, and
impaired social skills are
generally evident as well.
• Unusual responses to sensory
information -- for example, loud
noises, lights, certain textures
of food or fabrics -- are also
common.
Pervasive Developmental Disorders/
Autism Spectrum Disorders
– Usually present by age three
– Abnormal social interaction
– Impaired communication
– Peculiar interests and behaviors
Pervasive Developmental Disorders/
Autism Spectrum Disorders (continued)
• Autism
– Early sign is not wanting to be cuddled or
held.
– Rarely making eye contact.
– Treating people like inanimate objects.
– Rigid requirements of sameness are typical.
– Self-stimulating behaviors like spinning,
rocking, and head banging are common.
Pervasive Developmental Disorders/
Autism Spectrum Disorders (continued)
• Problems that may accompany ASD
– Fragile X syndrome, sensory problems,
mental retardation, and tuberous sclerosis
sensory problems
– Acute sense of touch with regards to clothing
– Oblivious to pain
Childhood Onset Schizophrenia
• Major characteristics are tantrums and
bizarre behaviors or postures.
• Rejection and withdrawal from social
contacts.
• Mood swings are unpredictable.
• They use language to talk to self, and it is
rather difficult to decode.
Other Forms of ASD
• Rett’s disorder
– Present in females
– Results in the loss of motor skills,
predominantly the hands
– Speech also halts
Other Forms of ASD (continued)
• Asperger’s disorder
– Lack of social skills
– Difficulty in social relationships
– Poor concentration
– Restricted interests
– Normal IQ
– Normal language development
Intervention
• Applied behavior analysis
– Intensive one-on-one interactions for over 40
hours a week
– Predictable routines
– Effective instructional strategies
– Appropriate curricular content
Intervention (continued)
• Dietary intervention
– Removal of dyes and glutens
• Chelation
– Removal of metals from the child’s blood
Eating and Elimination Disorders
• Pica
– The craving of nonfood items
• Soiling and wetting
– Persistent wetting may be a sign of an
infection.
– Child may have an intestinal virus.
– Diabetics have trouble with bladder control.
– Strange bathrooms may cause an undue
stress on a child.
Eating and Elimination Disorders
• Pica
– The craving of nonfood items
– The persistent eating of nonnutritive
substances for a period of at least one month.
Eating and Elimination Disorders
• Soiling and wetting
– Persistent wetting may be a sign of an
infection.
– Child may have an intestinal virus.
– Diabetics have trouble with bladder control.
– Strange bathrooms may cause an undue
stress on a child
Prader-Willi Syndrome
• (PWS) is an inherited
disorder genetic disorder
which is generally caused
by a deletion in
Chromosome 15.
• The features of this
disorder includes short
stature, mental
retardation or learning
disabilities, incomplete
sexual development,
characteristic behavior
problems, and an
insatiable appetite.
Elimination Disorders
• Elimination disorders occur in children who
have problems going to the bathroom -both defecating and urinating.
• Although it is not uncommon for young
children to have occasional "accidents,"
there may be a problem if this behavior
occurs repeatedly for longer than 3
months, particularly in children older than
5 years.
Elimination Disorders
Two types of elimination disorders:
• Encopresis is the repeated passing of feces
into places other than the toilet, such as in
underwear or on the floor.
– This behavior may or may not be done on
purpose.
• Enuresis is the repeated passing of urine in
places other than the toilet.
– Enuresis that occurs at night, or bed-wetting, is the
most common type of elimination disorder.
– As with encopresis, this behavior may or may not be
done on purpose.
A Final but Important Note
• Every child can exhibit behavior problems
at one time or another.
• It is cautioned to not prematurely label a
child.
• It is not how a child is classified but how a
child is cared for that is the most important
issue when addressing behavior and
learning problems.