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Diagnosing and Treating Learning Disabilities


It may not be easy to detect learning disabilities in children. This type of problem does not reveal itself in a day or a week. There are warning signs, however, that can help parents know if their children have a learning disability. Parents should note if any of the situations listed below are present in their preschool children:

Delays in language development. By 2 1/2 years old, children should be able to put sentences together.

Trouble with speech. By 3 years old, parents and others should understand what children say more than half of the time.

Trouble with coordination. Just before kindergarten, children should be able to tie shoes, button, hop and cut.

Short attention span. Between 3 and 5 years old, children should be able to sit still while being read a short story. (Attention span should increase with age during this period.)

Regard these signs as risk factors only. Remember that no child develops in the same manner or at the same pace. These signs may not always reveal a learning disability. If you have any questions about the proper activities for your child’s age, talk to your pediatrician.

The people who have the most contact with the children are parents, teachers or pediatricians. Doctors or teachers can give screening tests to see if a problem exists. The pediatrician can help the parents decide if further evaluation is needed. This may include an eye exam by an eye doctor (ophthalmologist), a psychological exam by a psychologist, an ear exam by an ear/nose/throat doctor, or a language assessment by a speech and language clinician. Federal laws require that schools test and help all children with language and/or learning disabilities. These tests are at no cost to parents. New laws ensure diagnostic and remedial services to all children from birth to 21 years of age.

Despite the many frustrations, proper help from a number of professionals can make a difference. While there is no cure for a learning disability, children may learn to achieve and lead a fruitful life in spite of their disability.

There are people and groups who offer simple answers or solutions for learning disabilities. Be cautious of these claims. Some allege that visual treatments can help although no data support this theory. Others believe in special diets and exercise. Still others claim certain vitamins will provide children’s bodies with a needed balance and cure the problem. Keep in mind there is no guidance to support any of these treatments. There are no quick fixes for a learning disability. Dealing with this problem is tough. It’s often a lifelong battle.

Early identification and treatment cannot be stressed enough. With the proper help, children with learning disabilities can become quite successful later in life. Famous Americans with learning disabilities include inventor Thomas Edison, Vice President Nelson Rockefeller, scientist Albert Einstein and athlete Bruce Jenner. These people rose above their disability and went on to achieve great personal and national goals.

People who learn to overcome their disabilities can do great things in life. For children with a learning disability, nothing can replace a good educational program and proper medical management. As important are loving and supportive parents, family and friends.

 

SCREENING TOOLS FOR ADHD:

Vanderbilt Scale Parents

ADHD Vanderbilt Teacher Scale

 

SCREENING FOR Autism Spectrum Disorders:

Autism A.L.A.R.M.

M-CHAT Modified Checklist for Autism in Toddlers

 


What is developmental screening?


Developmental screening is a procedure designed to identify children who should receive more intensive assessment or diagnosis, for potential developmental delays. It can allow for earlier detection of delays and improve child health and well-being for identified children.


Why is developmental screening important?
Many children with behavioral or developmental disabilities are missing vital opportunities for early detection and intervention. Many children with developmental delays are not being identified early.


In the United States, 17% of children have a developmental or behavioral disability such as Autism, mental retardation, and Attention Deficit Hyperactivity Disorder. In addition, many children have delays in language or other areas, which also impact school readiness. However, less than 50% of these children are identified as having a problem before starting school, by which time significant delays may have already occurred and opportunities for treatment have been missed.


Early identification and intervention for children with developmental delays is mandated in
The Individuals with Disabilities Education Act (IDEA) Amendments of 1990 to 1997 requiring states to provide early identification and provision of services to infants and toddlers with 1) developmental delays, 2) established conditions that are associated with developmental delays, and, 3) at the state’s option, children at risk for developmental delays. States that do not serve the at-risk population are encouraged to track and monitor these children’s development, so that they may be referred in the future if needed. IDEA also mandates that states refer children, free of charge, for a comprehensive, multidisciplinary evaluation by a team who, with the family, decides on which services are needed for the child (via the Individualized Family Service Plan). Furthermore, it mandates states to implement coordinated, family-centered, and culturally competent community-based systems of care, to provide early intervention services for children identified with developmental problems. The National Early Childhood Technical Assistance Center, lists early intervention programs by state and provides their contact information for interested parents and professionals.


Parents are interested in knowing more about their child’s development and pediatric practitioners need to be better prepared for this. Recent surveys indicate that parents want information and guidance from their health care provider about their child’s development. However, studies sponsored by the American Academy of Pediatrics (AAP) show that about 65% of pediatricians feel inadequately trained in assessing children’s developmental status.


Who provides developmental screening services?
Developmental screening can be done by various professionals in healthcare, community, or school settings. The role of health professionals has become particularly important, because of the greater emphasis placed on early identification of children with delays. Through well-child visits, health professionals have regular contact with children 0 to 3 years-of-age, allowing them an opportunity to monitor development through periodic developmental screening. This has led healthcare professional organizations, such as the American Academy of Pediatrics and the American Academy of Neurology, to recommend that all infants and young children be screened for developmental delays periodically in the context of office-based primary care.


Special topics:

Today, a number of good screening tools are available designed for a variety of settings, ages, and purposes.

  • Milestones which may be used as part of developmental screening
    • 0 to 1 years— infants (link already on our website)
    • 1 to 2 years—toddlers (link already on our website)
    • 2 to 3 years—toddlers (link already on our website)
    • 3 to 5 years—preschoolers (link already on our website)
  • Barriers to integrating developmental screening into pediatric practice

(When reviewing the results of these surveys it is important to note that the response rate of most of them is about 60%)
 

  • State and national efforts

Significant efforts (for example, by the American Academy of Pediatrics Committee on Children with Disabilities, the Commonwealth Fund, or the Department of Education) have been made, over an extended period of time, to address the issue of developmental screening. This has allowed for the implementation of several national and multistate programs.  However, there are currently no national data sets that track this practice and how it is integrated into primary care. There are a few data sets that are particularly relevant to developmental screening and there are several that cover related topics.

  • Notes from Working Group on Developmental Screening

The National Center on Birth Defects and Developmental Disabilities (CDC) invited experts in the field of developmental screening and some key stakeholders, to determine how the CDC can best contribute to the goal of promoting optimal child development within public and private health systems. The focus of the meeting was on creating a change in the way general pediatricians address and manage the developmental needs of children. Meeting Notes

 


WHAT CAUSES Autism Spectrum Disorders (ASD)?

It is suspected that there may be multiple causes for ASD due to a complex interaction of genetic and environmental factors. Family studies have shed the most light on the genetic contribution to Autism. Studies of twins have shown that in identical twins there is about a 75% rate of both twins having autism, while in non-identical twins this occurs about 3% of the time. The inheritance pattern is complex and suggests that a number of genes are involved.


For the majority of people with ASDs, the cause is not known; however, ASD tends to occur more frequently than expected among individuals who have certain other medical conditions, including Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome, and untreated phenylketonuria (PKU). Some harmful substances ingested during pregnancy also have been associated with an increased risk of Autism, specifically, the prescription drug thalidomide.


There is no known cure for ASDs. However, early and intensive education can help children grow and learn new skills. The goal of these efforts is to help with the difficult symptoms of an ASD in a child and to improve the child’s skills that help him or her talk, interact, play, learn, and care for his or her needs. Medicines can relieve symptoms and be helpful for some people, but structured teaching of skills (often called behavioral intervention) is currently the most effective treatment.

Autism in Children 4-17 - Fact Sheet (pdf)

 



AutismandVaccineSafetyInformationforParents

 

Is There a Connection Between Vaccines and ASD?
Vaccines and Autism Theory


At a glance: The weight of currently available scientific evidence does not support the hypothesis that vaccines cause Autism. We recognize there is considerable public interest in this issue, and therefore support additional research regarding this hypothesis. CDC is committed to maintaining the safest, most effective vaccine supply in history.


MMR vaccine and Autism Fact Sheet

Key messages, facts, and additional sources of information on MMR vaccine and Autism.


FAQs on theory of MMR vaccine and Autism
Frequently Asked Questions on the hypothesis of MMR and Autism answering the following questions:

  • What is Autism?

  • Does MMR vaccine cause Autism?

  • What have studies found?

  • Are there studies that suggesting a connection?

  • What about claim that autism numbers have been increasing ever since MMR vaccine in use?

  • Would it be safer to separate the MMR vaccine into its individual components?

  • Should a younger sibling of an autistic child, or a child of someone who has Autism be vaccinated with MMR or other vaccines?

  • Should we delay vaccination until we know more about the negative effects of vaccines?

CDC research on vaccines and Autism

CDC Research on the Safety of Thimerosal Containing Vaccines

Key Messages and answers to questions about CDC research into possible links between thimerosal in childhood vaccines and neurodevelopmental disorders such as Autism.


IOM reports
Review the most recent and past IOM reports on the theory of the possible link between the use of the Measles, Mumps, and Rubella (MMR) vaccine and Autism including:

  • Primary conclusions of IOM reports

  • Recommendations of IOM reports

  • Links to actual IOM reports

References
References on Autism, Inflammatory Bowel Disease (IBD), and the study of Autism and vaccines.

Date: October 29, 2004
Content source: National Immunization Program


Neuroimaging Research & ADHD

 

Researchers had long suspected that ADHD was associated in some way with abnormalities or developmental delays in brain functioning. Supporting such an interpretation in the 1990s were numerous neuropsychological studies showing deficits in performance by children with ADHD on tests that were presumed to assess frontal lobe or executive functions (for reviews, see Barkley, 1997b; Barkley et al., 1992; Goodyear & Hynd, 1992). Moreover, psychophysiological research in earlier decades had suggested brain underactivity, particularly in functioning related to the frontal lobes (Hastings & Barkley, 1978; Klorman, 1992). And thus there was good reason to suspect that delayed or disturbed functioning in the brain, and particularly the frontal lobes, might be involved in this disorder.

In 1990, Alan Zametkin and his colleagues at the National Institute of Mental Health (NIMH) published a landmark study (Zametkin et al., 1990). The authors evaluated brain metabolic activity in 25 adults with ADHD who had a childhood history of the disorder and who also had children with the disorder. The authors used positron emission tomography (PET), an exceptionally sensitive technique for detecting states of brain activity and its localization within the cerebral hemispheres. The results of this study indicated significantly reduced brain metabolic activity in adults with ADHD relative to a control group, primarily in frontal and striatal regions. Such results were certainly consistent in many, though not all, respects with the earlier demonstrations of reduced cerebral blood flow in the frontal and striatal regions in children with ADHD (Lou et al., 1984, 1989).

Significant in the Zametkin et al. (1990) study, however, was its use of a much better-defined sample of patients with ADHD and its focus on adults with ADHD. Although later attempts by this research team to replicate their original results with teenagers were consistent with these initial results for girls with ADHD, no differences were found in boys with ADHD (see Ernst, 1996, for a review). Sample sizes in these studies were quite small, however, almost ensuring some difficulties with the reliable demonstration of the original findings. Despite these difficulties, the original report stands out as one of the clearest demonstrations to date of reduced brain activity, particularly in the frontal regions, in ADHD.

At the same time as the NIMH research using PET scans was appearing, other researchers were employing magnetic resonance imaging (MRI) to evaluate brain structures in children with ADHD. Hynd and his colleagues were the first to use this method, and they focused on the total brain volume as well as specific regions in the anterior and posterior brain sections. Children with ADHD were found to have abnormally smaller anterior cortical regions, especially on the right side, and they lacked the normal right-left frontal asymmetry (Hynd, Semrud-Clikeman, Lorys, Novey, & Eliopulos, 1990). Subsequent research by this team focused on the size of the corpus callosum, finding that both the anterior and posterior portions were smaller in children with ADHD (Hynd et al., 1991); however, in a later study, only the posterior region was found to be significantly smaller (Semrud-Clikeman et al., 1994). Additional studies were reported by Hynd et al. (1993), who found a smaller left caudate region in children with ADHD, and Giedd et al., (1994), who found smaller anterior regions of the corpus callosum (rostrum and rostral body).

More recently, two research teams published studies using MRI with considerably larger samples of children with ADHD (Castellanos et al., 1994, 1996; Filipek et al., 1997). These studies documented significantly smaller right prefrontal lobe and striatal regions in these children. Castellanos et al. (1996) also found smaller right-sided regions of structures in the basal ganglia, such as the striatum, as well as the right cerebellum. Filipek et al. (1997) observed the left striatal region to be smaller than the right.

Despite some inconsistencies across these studies, most have implicated the prefrontal-striatal network as being smaller in children with ADHD, with the right prefrontal region being smaller than the left. Such studies have placed on a considerably firmer foundation the view that ADHD does indeed involve impairments in the development of the brain, particularly in the prefrontal-striatal regions, and that these impairments are likely to have originated in embryological development (Castellanos et al., 1996). Advances in neuroimaging technology continue to provide exciting and revealing new developments in the search for the structural differences in the brain that underlie this disorder (see Chapter 6). For instance, the advent of functional MRI (fMRI), with its greater sensitivity for localization of activity, has already resulted in a number of newly initiated investigations into possible impairments in these brain regions in children and adults with ADHD.


Brain Changes Mirror Symptoms in ADHD (NIMH Article)

 

 



Early Identification and Treatment of
ADHD * Autism Spectrum Disorders * Speech/Language Disorders

Working together as a team to improve the lives of children in Mississippi

Sponsored in full by The Phil Hardin Foundation