Transcript Document

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Look at these links
•http://www.tsa-usa.org/
•http://www.tsa-usa.org/news/HBO_Release_apr06_update.htm
Self-reports:
“I was devastated when I found out I had TS. I thought I was going to be a
normal boy. But I’m not. My life is awful. I feel like I’m missing out on a lot of
things because of my tics. I will feel a lot better if my tics go. If they don’t I
will learn to put up with them.” (Neil, 9yrs)
“My teacher treats me like an angel and manages my TS really well. The
other students try to be understanding as my teacher has told them all about
TS.” (Neil, 9yrs)
“I used to get asked why I blinked all the time and everyone used to get angry
at me because I couldn’t help looking at them and I always get harassed.”
Lyle who is 9 years has Aspergerg and TS, and says he feels like he’s in
prison when he is at school.
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Idea Category
• Tourette Syndrome (TS) is now listed as a disability under the
category of Other Health Impaired (OHI).
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Motor Characteristics
MOST develop:
1. eye tic first
2. facial tics or involuntary sounds
3. others within weeks or months
• common examples: head jerks, grimaces, hand-toface movements
Symptoms can:
1. change over time
2. vary (frequency, type, location, or intensity)
3. increase in intensity during early adolescence (12-15
years)
4. improve in less extreme cases during adulthood
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Communication
• Stuttering
• Coprolalia (fewer than 15% have this)
– Occurs in late childhood
– Most disruptive and disturbing (Jay, 2000)
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Social Emotional Characteristics
•The social and emotional difficulties that accompany TS are more
problematic in day-to-day adaptations than are the motor and phonic
tics (Carter et al., 2000). Children are teased and made to feel
stupid, different and unwanted. Peers negative responses to tics can
cause anxiety, which in turn increase tics and generate self-doubt.
Adolescence is a period with strong emphasis on physical
attractiveness. TS results in greater psychopathology during this
period than any other (Chang et al., 2004)
•Children also report uncomfortable, nervous, weird feelings (fear,
disgust, doubt) or like they are going to explode before an onset of
tics (Walter & Carter, 1997).
•Overall there is a higher risk of:
1.poor peer relationships
2.no relationships
3.withdrawn or aggressive social behavior
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Academic Accommodations
General Principals:
1.Tics increase as a function of stress and calling
attention to tics increases them.
2. Tics decrease with relaxation or when focusing
on an absorbing task (Shannon, 2003).
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Accommodations
1.
2.
Model tolerance and do not allow teasing by peers
Try various seating arrangements
(Wilson, Jeni. Shrimpton, Bradely. 2003).
Allow:
1.
2.
3.
4.
5.
short breaks (e.g., break long assignments into smaller
parts)
movement around the room or outside the room (e.g., a
fictitious note to the office)
access to a private room with a bean bag chair--have a
private signal
exams in a private room for tension and tic release and
allow more time
child to tape oral presentations & reports (Lue, 2001)
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INTERVENTIONS
Pharmacological interventions increase success
(Clarke et al., 2001).
1. Anti-tic drugs block the activity of the
neurotransmitter dopamine.
2. Anti-OCD drugs help to restore the brain
chemical serotonin, which reduces unwanted,
thoughts.
(Many people choose tics over the medications
because of side effects, which are sleepy, gain
weight. In addition no medication has been found
that eliminates tics completely.)
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Functional Analysis of a Student with
Tourette Syndrome and a Mild
Intellectual Disability
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1.
2.
16 years old
3.
Diagnosed with Tourette’s in early elementary
school. Showed noticeable tics such as eye
blinking and barking like a dog.
4.
Diagnosed in the 5th grade as a child with a mild
mental disability
5.
In his school work, Chris always completes any
activity or assignment given to him. Almost
compulsive about completing assignments
6.
Chris does not interact with his peers. Seeks adult
interaction
Originally diagnosed with ADHD and still carries
that label
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1. Enjoys helping others
2. Takes initiative in completing
tasks
3. Good memory
4. Good attention to details
5. Has a strong desire to learn and
do what is right
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1. Difficulty with peer relationships
2. Poor fine motor skills including
handwriting
3. Struggles with math and language
arts
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1. Random talking that is
unrelated to subject or task
and includes asking
questions about upcoming
events
2. Pacing
3. Withdrawn and Pouting
4. Yelling
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1. Changes in students daily schedule: 2-hr.
school delays, lack of aide in class, early
dismissals, late bus arrivals.
2. Unstructured activities (breaks and times
when waiting to load buses)
3. Structured but stressful activities: working
on art project, visit to the high school,
academic work in the resource room
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Antecedent that caused the most behavior
Changes in Students Daily Schedule
46%
Behaviors that were seen the most
Random talking/asking questions
58%
Pacing
21%
Payoffs earned the most
Get self-determination (predictability)
85%
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Diagnosis of Tourette’s?
•Chris’ diagnosis of Tourette’s syndrome is correct.
•He meets all of the criteria for a diagnosis
a. Although his tics have dissipated, he still shows motor tics including
eye blinking and head jerking.
b. Research shows that it is common for children to see a reduction in
the tics as they get older. Chris’ onset was in his early elementary
years.
c. Chris shows TS, which includes social and academic impairments
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Diagnosis of ADHD?
Although ADHD can be a comorbid condition of TS, we must first
determine whether his co-occurring learning disabilities and mild
mental retardation might not better explain his inattentive
behavior.
Follow-up:
a. Now that he is given schoolwork based on his level of
reading, language, and math, Chris is able to listen and sustain
attention during his academics periods.
b. He remains in his seat during class, never runs about the
room, does not blurt out answers, and is able to wait his turn.
Conclusion: Chris is not ADHD; he has a mild intellectual
disability
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Diagnosis of OCD?
Chris’s OCD is a comorbid condition of the TS
•Chris’ obsessions and compulsions have to do with checking,
ordering, repeating, and getting things ‘just right’ rather than
trivial concerns with contamination, something bad happening, or
being neat and clean.
•Chris’s obsessive/compulsive behaviors are connected to an
event in a realistic way and help him to neutralize the
unpredictability of the event.
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Accommodations
To address the child’s need for predictability and
self-determination, teachers must provide:
1. A stable daily routine/schedule
2. Advance warning of any changes
3. Opportunities to ask questions as this is his way
to reassure himself about a situation that is
making him feel stressed and anxious
4. An escape, if needed, to regain control
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Interventions
To address the Chris’ need for self-determination, Chris
must learn:
1. That when he cannot regain control, to be patient
and ask for short breaks
2. To use scripts to interact with his peers. (For
example, Chris does not know how to initiate a
conversation; he only uses statements and needs to
learn to ask questions.)
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Autism Spectrum Disorders
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Autism Spectrum
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Asperger Syndrome
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Emotional Characteristics
Look at this link
http://www.cbc.ca/thelens/theboyinside/index.html
1. Lack of empathy
2. Low emotional maturity & do not
mature socially as they age (Myles)
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Summary: Verbal vs.
Nonverbal
•
•
•
•
•
•
•
Non-Verbal
Verbal
Lack of empathy
• Monotone,
Little or no ability to form friendships;
repetitive
naïve, inappropriate one-sided
speech
interactions
Low emotional maturity & do not mature • Good structural
language skills
socially as they age
Poor non-verbal communication
• Poor pragmatic
everyday
Intense absorption w/ certain subjects
Clumsy and ill coordinated movements communication.
Odd postures (Tony Attwood)
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Academic Characteristics
Often, academic progress in the early grades is area
of relative strength; for example, rote reading and
calculation skills are usually quite good, and many
children can obtain “high levels of factual information”
Difficulties:
1. shifting attention
2. multitasking
3. planning/organizing
4. applying information and skills across settings
5. drawing inferences and applying knowledge
6. pencil skills
7. reading comprehension
8. written language and drawing tasks can cause anxiety
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Accommodations
Provide a safe place so the child can retreat when s/he becomes over
stimulated or has difficulty adjusting to a new activity.
1. Establish a schedule early on, and be consistent with it. Provide
a visual representation of the daily schedule.
2. Write notes in advance for the child if the schedule is going to
change for a special event.
1. Provide visual cue cards to use during instruction and
teaching.
2.Set clear expectations and boundaries, and post them on the
wall.
3.Provide verbal and written instructions for the child.
3. Ask questions to check the child’s understanding of the
instructions.
4. Use a timer to limit perseveration/ echolalia/ singing.
5. Allow the child to earn “free time” in the child’s chosen area of
interest, such as art or computers
6. Teach other children how to interact appropriately with the
child with Asperger Syndrome in both academic and social 30
settings.
Savant Abilities
Savants are rare and have spectacular islands
of brilliance, which stand in marked contrast
to their disability
1. 10% prevalence in autism
2. 1% prevalence in those who are not autistic but
had intellectual disabilities or major mental
illness)
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Cognitive Characteristics
Generally they excel in one of
the following areas:
1. Mathematical
calculations
2. Memory feats
3. Artistic abilities
4. Musical abilities
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Kim Peek
The real
Rain Man
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Alonzo Clemons
• Alonzo is a savant.
He is known for his
sculptures.
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Alonzo can see a fleeting
image on a television screen
of any animal, and in less than
20 minutes sculpt a perfect
replica of that animal in threedimensional accuracy. The
wax animal is correct in each
and every detail -- every fiber
and muscle.
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Richard Wawro
Known world-wide, for
his detailed drawings
using wax oil crayons
as his only medium.
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