Learners with Additional Needs (Part 2) PDF

Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education LEARNERS WITH DIFFICULTY MOVING/WALKING A. Definition When the child has difficulty moving and/or walking, the physical domain of...

Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education LEARNERS WITH DIFFICULTY MOVING/WALKING A. Definition When the child has difficulty moving and/or walking, the physical domain of development is affected. Examples of physical disability are developmental coordination disorder or dyspraxia, stereotypic movement disorders, tics, and cerebral palsy. Developmental coordination disorder (DCD) As described in the DSM-5 (American Psychiatric Association 2013), it refers to significant and persistent deficits in coordinated motor skills that are significantly below expected typical development. Difficulties are manifested as clumsiness (e.g., dropping or bumping into objects), slowness, and inaccuracy of motor skills (e.g., catching an object, using scissors or cutlery, handwriting, riding a bike, or participating in sports). These observed deficits impact academic performance and other activities of daily living, which do not result from intellectual disability, visual impairment, or any neurological condition affecting movement (e.g., cerebral palsy). Dyspraxia, used synonymously with developmental coordination disorder, is a term often used by occupational therapists. Stereotypic movement disorder (SMD) It is characterized by repetitive, seemingly driven, and nonfunctional motor behavior (e.g., hand shaking or waving, body rocking, head banging, self-biting, hitting own body). These behaviors interfere with social, academic, or other activities and may result in self-harm or injury (American Psychiatric Association, 2013). Such motor behaviors do not result from any other neurodevelopment or mental disorder. Cerebral Palsy (CP) Refers to a disorder of movement and posture that results from damage to the areas of the brain that control motor movement (Kirk et al. 2015). This damage to the brain can occur before, during, or after birth due to an accident or injury. Muscle tone (tension in the muscles) affects voluntary movement and full control of the muscles which results in delays in the child’s gross and fine motor development. There are different classifications of cerebral palsy, depending on which parts of the body are affected and the nature of the effects on muscle tone and movement. The term plegia, from the Greek word meaning “to strike”, is used with a prefix that indicate the location of limb movement. 1  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education B. Identification In conducting an assessment, a specialist determines the child’s developmental history, intellectual ability, and gross and fine motor skills. To differentiate between the two, gross motor skills involve the use of large muscles in the body to coordinate body movement, which includes throwing, jumping, walking, running, and maintaining balance. On the other hand, fine motor skills involve the use of smaller muscles that are needed in activities like writing, cutting paper, tying shoelaces, and buttoning. 2  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education Assessment is conducted to check the child’s balance, sensitivity to touch, and performance in other gross and fine motor activities (Nordqvist 2017). Oral motor coordination in doing activities like blowing kisses or blowing out birthday candles may also be reported. An evaluator will check the following: (1) strength and flexibility by palpating muscle bulk and texture, assessing flexibility of joints, and the quality and intensity of grasp, and (2) motor planning, which includes observing functional fine and gross motor skills and determining hand dominance or lack thereof (Harris et al. 2013). Similar steps are followed in the identification of the presence of Stereotypic Movement Disorder (SMD) among children. Typically developing children may display stereotypic movements, or behaviors, often referred to as stereotypes, between ages two and five, as well as children with other neurological conditions such as Autism Spectrum Disorder (ASD) and other developmental disabilities. Because of this, specialists classify SMD as “primary” when it occurs in an otherwise typically developing child, or “secondary” if it exists alongside other neurological disorders (Valente et al. 2019). C. Learning Characteristics Motor difficulties and disabilities are known to significantly affect a child’s ability to perform daily activities, which include memory, perception and processing, planning, carrying out coordinated movements. Speech may also be affected as motor control is needed in articulation and production. Developmental coordination disorder (DCD) also affects psychosocial functioning as children report to have lower levels of self-efficacy and competence in physical and social domains, experience more symptoms of being depressed and anxious, as well as display externalizing behaviors (Harris et al. 2015). Children with stereotypic movement disorder (SMD) also tend to have low self-esteem and have been reported to be withdrawn (Valente et al. 2019) Students with motor movement disorders may excel in other areas of intelligences that are not controlled by motor functions. They may have adequate intelligence, creativity, and language skills depending on the severity of the disorder and the presence of a supportive adult. 3  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education LEARNERS WITH DIFFICULTY REMEMBERING AND FOCUSING A. Definition The International Classification of Functioning, Disability, and Health of the World Health Organization (2001) provides definitions of specific mental functions and focusing. Memory functions include short-term memory, long-term memory, and retrieval, while attention functions include sustaining, shifting, dividing, and sharing attention. Students with Learning Disability (LD) and/or Attention Deficit Hyperactivity Disorder (ADHD) are characterized by having difficulties with memory and attention functions. Learning Disability (LD) It was Samuel Kirk who coined the term, “learning disability” in 1962 when he met with parents and families as they discussed about students who encountered pronounced difficulties in school despite having average to above-average intelligence. He further described student with LD as a heterogeneous mix of learners who all had neurologically- based problems that affected their learning in different ways (Kirk et al., 2015). To better understand learning disabilities, Gargiulo (2012) provided common components on the definitions of a LD: Intellectual functioning within normal range Significant gap or discrepancy between a student’s assumed potential and actual achievement Inference that LD is not primarily caused by other disabilities or extrinsic factors Difficulty in learning in one or more academic areas 4  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education National Joint Commission on Learning Disabilities (1990) defined LD as “Learning disabilities is a general term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self- regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. Although learning disabilities may occur concomitantly with other disabilities (for example, sensory impairment, intellectual disabilities, emotional disturbance), or with extrinsic influences (such as cultural or linguistic differences, insufficient or inappropriate instruction), they are not the result of those conditions or influences”. The term Learning Disability is differentiated from Specific Learning Disability (SLD) which focuses on difficulties in “one or more basic psychological processes involved in understanding or in using language, spoken, or written, which may manifest as difficulties in the ability to listen, think, speak, read, write, spell, or do mathematical calculations” (Individuals with Disabilities Education Act, 1997). Thus Learning Disability is a general term under which other difficulties are included. Attention Deficit Hyperactivity Disorder (ADHD) DSM-5 (American Psychiatric Association 2013) provides the diagnostic criteria for ADHD, which include inattention, hyperactivity and impulsivity, and a combination of the two. For a child to be diagnosed with ADHD, the observed behaviors should meet the following criteria: Display a persistent pattern for at least 6 months that significantly interferes with functioning or development Observed in two or more settings (e.g., at home, school, work; with friends or relatives; and in other activities) Several of the symptoms were present before the age of 12 years. 5  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education The behaviors are not resulting from other disorders (e.g., schizophrenia, anxiety disorder, personality disorder, etc.) B. Identification 1. LD In identifying students with LD, a discrepancy between academic achievement and intelligence needs to be established using tests that measure intelligence and standardized achievement tests. Children with LD oftentimes display average to above average intelligence but perform below their grade placement in achievement tests of reading, spelling, maths, and written expression. In addition to the use of clinical testing, teachers can provide essential information about a student’s patterns of abilities and difficulties. Conducting student observations, interviews, and error analysis of schoolwork will provide the supplementary information needed to determine ways to help a child who may be at-risk and/or have signs of a learning disability. A clinical educational psychologist and/or a special education diagnostician use all available data from norm-referenced tests, teachers’ observations, analysis of achievement tests, and parent interview to determine if the learning difficulties may be attributed to the presence of a learning disability. On the other hand, identifying children with specific learning disabilities, do not adhere to the achievement-potential discrepancy. In its place, what is measured is the discrepancy between the current level of skills (i.e., reading, spelling, math, written expression) and the expected grade level performance in achievement tests in reading, spelling, oral reading fluency, and math. To create a holistic picture for the learner, observations, and interviews with parents and teachers are essential. 2. ADHD There are three components that are needed in identifying students with ADHD: Medical examinations are needed to rule out the presence of sensory impairment or middle ear infections that can cause hearing problems. Other medical conditions such as seizure 6  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education disorders, brain tumors, and thyroid problems that may be the underlying cause of the inattentive and and/or hyperactive behaviors also need to be ruled out (Barkley & Edwards 2006). Clinical interview with the parent/s provides the specialists with a holistic perspective of the child and essential information about the student’s physical and psychological characteristics, family and cultural background, and peer relationships. An ecological approach to assessment is necessary to rule out other contributing factors, like drastic changes in family dynamics such as separation of parents, unexpected deaths, and others that may be causing the observed behaviors of inattention and/or hyperactivity. Teacher and parent rating scales are used as additional tools to provide evidence if the student’s inattention, hyperactivity, and/or combination of the two. Standardized rating scales, such as the Conners Rating Scales (Conners 2007), are used by clinical psychologists and special scale measures the following behaviors: hyperactivity, aggressive behavior, violent tendencies, compulsive behaviors, perfectionism, difficulty in class, extra trouble with math, difficulty with language, social issues, emotional distress, and separation anxiety (Johnson 2018). The teachers’ and parents’ responded to the rating scales are based on their daily observations of the student for the past six months in their respective settings (home, school, or workplace). C. Learning Characteristics Students with LD are known to have challenges in language, literacy, and memory (Kirk et al. 2015) as well as in math, writing, and focusing/attending skills. Nonetheless, it is important to note that these are merely general characteristics as there are individual differences in terms of abilities and difficulties among children with LD and ADHD. In language development, they often display delays in learning how to speak, have difficulties in naming objects and retrieving words from memory, and have limited vocabulary in comparison to typically developing peers. Students with LD oftentimes struggle with having to organize their thoughts that they are unable to use precise words to express their ideas. On the other hand, there are students with LD who are better at oral expression in relation to their reading and writing skills. Such students are better at expressing themselves, at times rather fluently, but are unable to transfer their thoughts to writing. In terms of reading skills, students with dyslexia display delays and difficulties in phonological processing, word reading/decoding, spelling, and oral reading fluency. Fundamental to reading is phonological awareness, or the knowledge that all words can be segmented into phonemes (sounds) and that the letters in a written word correspond to these sounds. Individuals with dyslexia have poor phonological awareness, that subsequently impedes word reading ability, fluency, and accuracy. This basic weakness, then, blocks access to higher-order language process and to gaining meaning from text. Thus, problems with comprehension may be adributed to inaccurate decoding and lack of oral reading fluency, but they can use higher-level skills of vocabulary, reasoning, problem-solving, concept formation, and general intelligence (Shaywitz 2003). 7  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education In terms of written language, students with LD have tendencies to reverse letters or words, have poor spelling skills and display difficulties in the quality, organization, sentence fluency, and application of writing conventions, including handwriting, spelling, and grammar, as well as motivation to write (Graham 2017). As for math skills, the difficulties manifest in relation to students’ age and grade (Shalev 2004). For instance, students in the first-grade level have problems in the retrieval of basic math facts in computing exercises, while older children display severe difficulties in learning the multiplication table and understanding algorithms of the four basic operations (addition, subtraction, multiplication, and division). As a result, students with LD, struggle with more complex math equations and problems as they lack the foundational arithmetic skills. Students with LD also display problems with short-term and working memory (I.e., mental resources used to retain information while simultaneously engaged in another activity), deficits in metacognition, display attention problems, and hyperactivity. As a result, they often have trouble focusing on tasks, exhibit excess movement, restlessness, and fidgety behaviors that are characteristics of students with ADHD. Because of difficulties in executive functioning, students with LD and ADHD are known to be forgetful of daily activities and routines, can be disorganized with their personal belongings and even schedules, and have problems monitoring comprehension. Moreover, students with ADHD exhibit academic underachievement as well as disruptive behavior that impact on family and peer relationships (DuPaul and Stoner 2003). Anchoring on neurodiversity, children with LD and ADHD also have their strengths and abilities amidst such difficulties and limitations. Students with LD are known to have strong artistic abilities and visual-spatial skills. Moreover, they are known to be creative, divergent thinkers, imaginative, and highly curious. 8  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education D. General Educational Adaptations Planning the classroom environment and how routines are implemented is equally important in an inclusive classroom. Because students with LD and ADHD show a tendency to be restless, become hyperactive, and have short attention spans, providing a classroom that is highly structured and with clear expectations is essential. Class rules and norms, agreements, routines as well as schedules need to be written and accompanied by clear and simple images. These need to be explained, displayed, and implemented consistently to make the classroom environment structured and safe for all children. 9 Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education 10  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education LEARNERS WITH DIFFICULTY WITH SELF-CARE A. Definition Self-care often refers to a person’s capacity to perform daily living activities or specific to body care such as the following skills: washing oneself, brushing teeth, combing, trimming nails, toileting, dressing, eating, drinking, and looking after one’s health. Self-care skills are gradually learned by very young typically developing children through adult modeling and direct instruction within developmental expectations. On the other hand, children with additional needs may struggle with the basic activities of daily living. Oftentimes, such students are those with moderate to severe cognitive deficits, including individuals with Intellectual Disability or Intellectual Developmental Disorder (ID or IDD). Intellectual Disability (ID) is a developmental disorder that includes deficits in intellectual and adaptive functioning across domains of conceptual, social, and practical that occur during the developmental period. To be diagnosed with ID, a student must have deficits in both the cognitive and adaptive domains (Kirk 2015). Children with Down syndrome with moderate to severe disability may also have problems with self-care. B. Identification The traditional approach to measuring levels of severity of ID was determined through the use of intellectual tests: Mild level: IQ 50-70 Moderate level: IQ 35-50 Severe level: IQ 20-35 Profound level: IQ below 20 However, based on the definition provided by the American Psychiatric Association (2013), using measures of intelligence is only one aspect as adaptive functioning also needs to be assessed to identify if a child has an intellectual disability. In place of IQ levels, the support needed by a person with ID is used to determine the level or degree of severity of the disability. The presence of ID/IDD is measured by direct observation, structured interviews, and standardized scales such as the AAMR Adaptive Behavior Scale (Lambert et al. 1993) and Vineland Adaptive Behavior Scales (Sparrow et al. 2016). Some of the domains measured by the AAMR Adaptive Behavior Scale include personal self-sufficiency, community self-sufficiency, and social adjustment. On the other hand, Vineland Adaptive Behavior Scale cover communication, daily living skills, socialization, and motor skills. C. Learning Characteristics Students who have difficulty with self-care oftentimes reach developmental milestones at a later age compared to typically developing peers. They learn to sit up, crawl, walk, and talk later than other children and may have trouble remembering and understanding consequences of actions. Due to cognitive difficulties, children with ID may also have deficits in the areas fo reasoning, planning, judgment, and abstract thinking. Depending on the level of support needed, a student with ID learns adaptive skills at a slower pace, resulting in delay, compared to same aged typically developing students. They benefit from modeling and can imitate well. Adults with mild ID eventually learn to be functional and independent in society. Youths with ID are known to be friendly, sociable, and are reported to have positive coping skills. D. General Educational Adaptations Specific approaches have been found to be effec/ve in teaching students with difficulty with self-care, namely, the use of direct/explicit instruction, task analysis, forward and backward chaining, as well as the use of videos modeling. 11  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education Task analysis is a behavioral approach that breaks down a complex behavior or task into step-by- step procedures, thereby providing modeling and ample practice for the student with difficulties. Gargiulo (2012) provided working guidelines on how to do task analysis: Define the target behavior or task. Identify the required skills needed to successfully complete the task. Identify the necessary materials to perform the task. Observe an able and competent person perform the task. List the needed steps in sequential order to complete the task. In an inclusive classroom, self-care skills such as washing hands and brushing teeth can be task analyzed into the simplest steps and presented in a poster accompanied by pictures. Using the direct instructions, the teacher models how each step is done then allows the student to try the steps with guidance and prompts until he/she is able to do the task independently. Sample of Task Analysis of Brushing Teeth Forward and backward chaining is used alongside task analysis. In forward chaining, the program begins with the first step in the sequence, such as getting the toothbrush and toothpaste, then providing the needed hand-over-hand assistance, and then gradually fading verbal and then gestural prompts. The goals is to allow the student to master the first step first and then followed by the next step in the sequence until the entire task has been performed. In backward chaining, the teacher models all the steps from the beginning and then allows the child to do the last step of the behavior chain with assistance and prompts. The use of video-based intervention including video modeling and video prompting for teaching daily living skills, such as brushing teeth, setting a table washing dishes, etc. has been found effective for learners with intellectual and learning difficulties (Rayner 2011). With video modeling, the student watches a brief video of an able person performing a target skill or task and then imitates the behavior. 12  Module 6: Learners with Additional Needs (Part 2) EDCN109 Foundations of Special & Inclusive Education You have learned the different disability labels that are associated with the difficulties, their challenges in learning, their strengths, and educational adaptations in the form of accommodation. While awareness and understanding of their disability and needs are essential, as educators supportive of inclusive education, it is utmost importance that we see learners with additional needs beyond their difficulties, to enable them to explore and use their range of strengths and abilities as well as provide opportunities for them to succeed and flourish in their own positive niches. 13