Exceptional Child Final 10-12

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hearing loss

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defined by the degree of loss, type of loss, and age at which loss occurred:

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Deafness

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a hearing impairment that is severe enough that the child cannot process linguistic information through hearing, even when using amplification or hearing aids
• Profound or complete inability to hear

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Hard of Hearing

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impairment in hearing that may be permanent or fluctuating and that adversely affects a child’s educational performance but that is not included under the definition of deafness
• All other categories of hearing loss

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Prelinguistic hearing loss

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hearing loss that occurs before the child’s language has developed

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Postlinguistic hearing loss

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hearing loss that occurs after the child has acquired some speech and language

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Types of hearing loss (4)

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1. Conductive losses – occurs when something blocks the sound passing through the outer or middle ear (wax, infections, etc); usually temporary

2. Sensorineural losses – caused by damage to the inner ear (cochlea) or to auditory nerve, particularly in the delicate sensory hairs of inner ear or nerves that supply them; affects both ability to hear faint sounds and the ability to hear clearly; hearing aids/cochlear implants may be considered

3. Mixed hearing losses – results from problems in outer ear as well as in the middle/inner ear, combining both conductive and sensorineural difficulties; person may hear distorted sounds; cochlear implant may be considered

4. Central auditory processing losses – limits the individual’s ability to use auditory information; CAPDisorder may cause trouble with sound localization, auditory discrimination, understanding speech sounds against noisy background, auditory sequencing, memory, etc.

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Prevalence:

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2004, 31.5 million persons in US (10%) were reported to have some degree of hearing loss
- 3 in 10 people over age 60
- 1 in 6 people ages 41 to 59
- 1 in 14 people ages 29 to 40
- ~1.4 million children under age of 18

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Causes of Hearing Loss - Genetic Causes

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- Likely involved in more than half of all congenital hearing loss incidents
- Nearly 600 syndromes and 125 genes associated with hearing
- Genetic hearing loss can be inherited from one or both parents (either hearing or nonhearing)
- Children with Down Syndrome/Cleft Palate are associated with hearing problems

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Causes of Hearing Loss - Environmental Causes

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- Exposure to bacteria, viruses, toxins, trauma, and infection during pregnancy/birth process
- Uncontrolled diabetes in mother may causing hearing loss in child
- Group of infections, TORCHS:
 Toxoplasmosis – parasitic disease
 Rubella – german measles
 Cytomegalovirus (CMV) – infection in mother’s uterus
 Herpes simplex virus
- Otitis media, middle ear infection, is most common cause of hearing loss for young children

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Characteristics - Cognitive Development

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- Children have capacity for normal/gifted intelligence, but may experience developmental delays (due to not having access to sounds)
- 33% children with hearing loss have other disabilities
- Difficult to test intelligence of children with hearing loss because the tests aren’t designed for them
o Child whose language is ASL should be tested with that language
- The Universal Nonverbal Intelligence Test (UNIT) is highly recommended for students who are deaf

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Characteristics - Language Development

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- During prelinguistic period, children with hearing losses exhibit the same behaviors as hearing children (crying, babbling, etc.)
o However, babbling does not develop into words
- Children with hearing losses gesture at about the same time at which hearing children babble
o If parents don’t help the child form signs into language, child with develop their own system “home sign”
- When hearing parents don’t recognize their hard of hearing child’s attempts at manual communication, and attempts aren’t reinforced, language development is delayed
- Pattern of language development for deaf/hard of hearing children and for children who can hear is essentially the same

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Deaf Community/Culture

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exists as a separate cultural group within our society, and has exhibited considerable cohesiveness for more than a century
 Very diverse backgrounds, common language (ASL), membership is part of deaf individuals’ identity, strong and active community

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Audiologist’s Role/ Assessing Hearing Loss

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 Audiologist - can assess the degree, type, and extent of hearing loss, and can help monitor the child’s use of hearing aids/cochlear implant supports
- Methods for assessing infants
o Otoacoustic auditory emissions (OAE) – placing small microphone in child’s ear, when click sound is played in hearing child’s ear, echo is generated
o Auditory brainstem response (ABR) – measurements taken from surface electrodes that record brains activity in response to sounds
o Auditory steady state response (ASSR) – uses continuous stimuli to elicit a reponse
- Bone-conductor test – measures movement of sound through the bone/hearing system of the brain, bypassing the ear
- Play audiometry – used with young children; toys move and make sounds, and toys used to elicit responses
- Pure-tone audiometry – for children 3 years and older; audiometer presentes pure tones, individual responds to sounds by raising their hand

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Parent involvement and early intervention-strategies for parents

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 Family provides essential support; family oriented approaches lead to better communication skills for children who are deaf/hard of hearing
 Early and intense intervention using communication system that the child can master is essential
 Parents are faced with decisions
o Use of amplification (hearing aids)
o Communication systems (oral/manual)
o Possibility of cochlear implant

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Communication Methods

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- Auditory/oral method – using oral/speech language for individuals who are hard of hearing
- Auditory/verbal method – manual communication
- Sign language
o ASL – American sign language
o PSE
o SEE II
o Finger Adaptive Technology
o Total communication method – some type of manual communication used simultaneously with speech

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Adaptive technology

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 Alerting devices/alarm systems that flash lights or use vibration
 Hearing aids for sound amplification, assistive listening devices (ALD), frequency modulated systems (FM), cochlear implants, etc.’
 Visual voice tools – provide visual displays (balloon getting bigger to illustrate loudness)
 Speech-to-print systems – reproduce dialogue on a computer screen

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History of education for the visually impaired

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- Formal efforts in US began in Boston, 1829, with establishment of Perkins School for the Blind (residential school)
- First public school class for blind, Chicago 1900 (Braille perfected 1834)
- Education for All Handicapped Children Act (pl 94-142, IDEA 2004) stimulated growth in public school services
- Before IDEA, children with multiple handicaps (including visual disabilities) were often refused education in schools for the blind

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Legal blindness

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corrected sight of 20/200, one cannot see after correction at 20 feet what typical person sees at 200 feet

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Low vision

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after correction, 20/70 – 20/200 vision

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Legal definition

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need/eligibility for special education services

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Prevalence

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4 in every 10,000 students are visually impaired; low incident disability

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Braille

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literary raised dots code of reading (Louis Braille)

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Residual Vision

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ability to sense light/dark, some imagery

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Learning Aids

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 Human readers
 Tape and digital recorders/players
 Digital talking book players
 Talking calculators
 Talking computers/GPS/dictionaries, etc.

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Snellen Chart

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– has rows of letters in gradually smaller sizes that children read at a distance of 20 feet; standard school screening instrument

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Field of vision

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extent of observable world seen at any given moment”

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Visual efficiency

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depth perception, color perception, and oculomotor skills such as eye teaming, eye movement, and eye focusing speed and accuracy

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Myopia

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refraction error, creates blurred vision (assoc. with albinism)

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Hyperopia

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refraction error, creates blurred vision (assoc. with albinism)

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Astigmatism Strabismus

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refraction error, creates blurred vision

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Amblyopia

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decrease in acuity due to poor transmission of information to the brain (assoc. albinism)

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Nystagmus

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rapid irregular movemnts of the eye (albinism)

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Amblyopia

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decrease in acuity due to poor transmission of information to the brain (assoc. albinism)

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Cataract

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clouding of lens of eye

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Nystagmus

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rapid irregular movemnts of the eye (albinism)

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glaucoma

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group of eye conditions. leads to damage of optic nerve

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Cataract

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clouding of lens of eye

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diabetic retinopathy

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damage to eye's retina due to long term diabetes

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glaucoma

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group of eye conditions. leads to damage of optic nerve

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retinopathy of prematurity

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retrolental fibrioplasia (formerly)

was once thought to be caused by overadministration of oxygen to premature infants; more complicated, associated with low birth weight, and neurodevelopmental impairment in motor/cognitive areas

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diabetic retinopathy

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damage to eye's retina due to long term diabetes

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Lifespan issues

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- Mastering the environment is extremely important for independence
- Current transitional emphasis is on placement in real job settings whenever possible
- Social adjustment, rather than specific vocational training, is central to successful adult adaptation

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retinopathy of prematurity

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retrolental fibrioplasia (formerly)

was once thought to be caused by overadministration of oxygen to premature infants; more complicated, associated with low birth weight, and neurodevelopmental impairment in motor/cognitive areas

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Children with Multiple/ Severe disabilities - TASH definition

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those who require extensive ongoing support in more than one life activity in order to participate in integrated community settings and to enjoy a quality of life that’s available to citizens with fewer/no disabilities. Support may be required for life activities (mobility, communication, self care, learning for independence, employment, self sufficiency

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Lifespan issues

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- Mastering the environment is extremely important for independence
- Current transitional emphasis is on placement in real job settings whenever possible
- Social adjustment, rather than specific vocational training, is central to successful adult adaptation

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Amblyopia

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decrease in acuity due to poor transmission of information to the brain (assoc. albinism)

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Relationship of severe to multiples disabilities

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any definition of either must be broad because it includes a very heterogeneous population

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Nystagmus

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rapid irregular movemnts of the eye (albinism)

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Children with Multiple/ Severe disabilities - TASH definition

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those who require extensive ongoing support in more than one life activity in order to participate in integrated community settings and to enjoy a quality of life that’s available to citizens with fewer/no disabilities. Support may be required for life activities (mobility, communication, self care, learning for independence, employment, self sufficiency

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Pervasive Developmental disorders (PDD)

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 Rhett Disorder (Rett Syndrome) – mainly affects females; repetitive hand movements, seizures, no verbal skills (google)
 Childhood Disintegrative Disorder – “a condition in which children develop normally through age 3 or 4. Then, over a few months, children lose language, motor, social, and other skills that they already learned” google
- PDDNOS – PDD, not otherwise specified

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Relationship of severe to multiples disabilities

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any definition of either must be broad because it includes a very heterogeneous population

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Cataract

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clouding of lens of eye

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glaucoma

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group of eye conditions. leads to damage of optic nerve

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Pervasive Developmental disorders (PDD)

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 Rhett Disorder (Rett Syndrome) – mainly affects females; repetitive hand movements, seizures, no verbal skills (google)
 Childhood Disintegrative Disorder – “a condition in which children develop normally through age 3 or 4. Then, over a few months, children lose language, motor, social, and other skills that they already learned” google
- PDDNOS – PDD, not otherwise specified

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diabetic retinopathy

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damage to eye's retina due to long term diabetes

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retinopathy of prematurity

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retrolental fibrioplasia (formerly)

was once thought to be caused by overadministration of oxygen to premature infants; more complicated, associated with low birth weight, and neurodevelopmental impairment in motor/cognitive areas

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Lifespan issues

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- Mastering the environment is extremely important for independence
- Current transitional emphasis is on placement in real job settings whenever possible
- Social adjustment, rather than specific vocational training, is central to successful adult adaptation

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Children with Multiple/ Severe disabilities - TASH definition

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those who require extensive ongoing support in more than one life activity in order to participate in integrated community settings and to enjoy a quality of life that’s available to citizens with fewer/no disabilities. Support may be required for life activities (mobility, communication, self care, learning for independence, employment, self sufficiency

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Relationship of severe to multiples disabilities

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any definition of either must be broad because it includes a very heterogeneous population

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Pervasive Developmental disorders (PDD)

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 Rhett Disorder (Rett Syndrome) – mainly affects females; repetitive hand movements, seizures, no verbal skills (google)
 Childhood Disintegrative Disorder – “a condition in which children develop normally through age 3 or 4. Then, over a few months, children lose language, motor, social, and other skills that they already learned” google
- PDDNOS – PDD, not otherwise specified

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Orthopedic impairments

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severe orthopedic impairment that adversely affects a child’s educational performance (cerebral palsy, amputations, fracture/burns, etc)

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Cerebral Palsy

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refers to disorder of movement/posture caused by damage to the motor control centers of the brain; affects muscle tone, interferes with voluntary movement and full control of muscles, delays gross/fine motor development

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Neural Tube Defects

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occurs when neural tube (surround spine) does not close properly and the developing brain/spine is exposed to amniotic fluid during gestation; can be prevented by taking folic acid during pregnancy

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Neural Tube Defects - Spina Bifida, Encephalocele, anencephaly

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- Spina bifida – surgery can often close spinal opening, though damage to the nerves will cause difficulties
- Encephalocele – “characterized by sac-like protrusions of the brain and the membranes that cover it through openings in the skull” google
- Anencephaly – “occurs when cephalic(head) end of neural tube fails to close, resulting in absence of major portion of brain, skull, and scalp” google

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Seizures/epilepsy

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caused by abnormal electrical discharge within the brain that disrupts the brain’s normal functioning
 May include muscle contractions, purposeless movement, vocalization, frothing at the mouth, etc.
 Most seizure disorders respond well with medication and or surgery

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Traumatic Brain Injury

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most common cause of accidental death/disabilities; injuries may be either closed/open and trauma caused can be mile or severe; can result in LD, ADD, personality changes, CP, etc; severe head injury is most common acquired disorder in category of TBI

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Muscular dystrophy

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inherited, progressive disorders of the muscles that affect movement and function
- Duchenne muscular dystrophy – most common form, primarily found in boys; disease appears between 2-5 years, may not be able to walk by age 12; eventually weakens respiratory system
- Treatment protocols of low resistance muscle training, nutrition, medication, CPT for respiration, using noninvasive interventions to avoid tracheotomy

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Juvenile rheumatoid arthritis

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causes swelling, stiffness, effusion, pain, and tenderness in the joins with persistent fever; complete remission possible, and others treated with drugs

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Scoliosis

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spinal curvature forming a “c” or “s”

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Osteogenesis imperfecta

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inherited congenital fragility of the bones caused by genetic mutation; leads to fractures, causing short statures, scoiliosis, etc.

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Juvenile diabetes

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Metabolic Disorder

disorder in which blood sugar of an individual is abnormally high because body doesn’t produce enough insulin (type 1) or because body is insensitive to the insulin produced (type 2)
 Type 1 can develop any time, type 2 becoming more common in children due to obesity
 Nothing can prevent type 1; diet, exercise, weight loss can prevent onset of type 2

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Cardiac conditions

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Cardiac conditions– children born with heart defects, severity ranging from immediately life threatening to so slight the problem doesn’t appear for years

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Cooley’s Anemia

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blood disorder passed down through families (inherited) in which the body makes an abnormal form of hemoglobin, the protein in red blood cells that carries oxygen. The disorder results in excessive destruction of red blood cells, which leads to anemia” google

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Sickle Cell Anemia

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form of anemia caused by mutation in gene that tell body to make hemoglobin (that allows oxygen to be carried throughout body); can be treated with pain relievers, antibiotics, blood transfusions, therapeutic oxygen; most common among African Americans/middle eastern/indian

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Cystic Fibrosis

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inherited disease that affects a child’s breathing and digestion; affects the movement of salt in/out of cells that line the lungs and pancreas, causing secretion of mucus and other thick fluids that clog lungs, etc.; medical treatments of breathing assistance (respiratory therapy, vibrating vests), drugs

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Tourette syndrome

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“is a condition that causes people to make repeated, quick movements or sounds that they cannot control. These movements or sounds are called tics” google

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AIDS

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acquired immune deficiency syndrome, breakdown of body’s immune system caused by HIV; people with AIDS more susceptible to certain diseases/cancers because their immune systems are compromised
 90% cases in children are due to transmission from infected mother during pregnancy
 infection through transfusion of contaminated blood

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Educational adaptations - For students who cannot acquire speech/writing

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 communication boards, electronic devices with speech output

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Educational adaptations - For students with limited use of hands

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 switch – when correct row is lit on device, child presses switch
For difficulty writing

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Educational adaptations - for difficulty writing

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 hand splints to aid pencil grasping, special pencil holders, slant boards, wide lined paper, etc.

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Lifespan issues

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- early childhood: obtaining accurate diagnosis, locating services, addressing issues of stigma, setting expectations, etc.
- elementary school: establishing family routines, emotional adjustment, mainstream vs. special class placement, etc.
- adolescence: emotional adjustment, emerging issues of sexuality, career/vocational planning, etc.
- adulthood: possible need for guardianship, initiation career choice/vocation, etc.

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Substance abuse

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abusive drug use

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Child abuse

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physical/psychological mistreatment of children, mainly by parents

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Social adjustment

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children with physical disabilities sometimes feel powerless, feelings of isolation, fears about life, rejections from peers, etc; people are more likely to accepts their physical disability when the environment is supportive

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Controversial issues of mainstreaming

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- many positive outcomes
o disabled children with greater academic gains, more positive attitudes of nondisabled children toward disabled peers, improvements in social/comm. skills of disabled children, improved interaction, etc.
- creating the environment to nurture true inclusion can be very challenging for children with multiple/severe disabilities, and it can be difficult to create the environment