Chapter 11 Attention-Deficit/Hyperactivity Disorder, Health Impairments, and Physical Disabilities Developed by: Blanche Jackson Glimps Tennessee State University

Chapter Objectives Define attention-deficit/hyperactivity disorder (ADHD) and describe the most common treatment options for ADHD. Define physical disabilities and health impairments. State two reasons why the number of children served under the other health impairments or orthopedic impairments categories of the IDEA is much smaller than the actual number of children who have health impairments or physical disabilities.

Chapter Objectives List and describe the types and causes of health conditions and physical impairments seen most frequently in school-age children. Briefly explain how severity, age of onset, and visibility of a health impairment or physical disability can affect a child’s educational performance. Discuss the importance of a “parallel curriculum” for students with health impairments or physical disabilities.

Chapter Objectives Explain why the continuum of educational services and placement options is especially critical for students with health impairments or physical disabilities.

ADHD Definition and Diagnosis The essential feature is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed Three ADHD subtypes: combined, predominantly inattention, and predominantly hyperactive/ impulsive Must exhibit six or more symptoms for at least six months in two or more environments 55% have the combined type, 27% have the predominantly inattentive subtype, and 18% have the hyperactive-impulsive subtype

Eligibility for Special Education and Prevalence Children with ADHD can be served under the “other health impairments” category or under Section 504 APA estimates the prevalence of ADHD at 5% of school-age children Boys are 3 times more likely to be diagnosed with ADHD than girls The ratio is higher at younger ages A large proportion of the 779,000 children who received special education services in 2012 to 2013 under the OHI category were diagnosed with ADHD.

ADHD: Academic Achievement and Comorbidity Most children with ADHD struggle in the classroom. They score lower on tests of academic achievement tests; earn lower grades in school; and have more difficulty with skills that support academic achievement. There is comorbidity with other disabilities (e.g., EBD, ID, LD, autism, tic disorder, obsessive compulsive disorder)

ADHD: Causes The causes of ADHD are not well understood. There is no clear and consistent evidence that links brain damage/dysfunction to behavioral symptoms of ADHD. Evidence indicates that genetic factors may place individuals at a greater than normal risk of an ADHD diagnosis. Research using neuroimaging technologies has shown that some individuals with ADHD have structural or biochemical differences in their brains.

ADHD: Treatment Medication Prescription stimulant medication is the most common intervention. No clear evidence indicates that stimulant medications lead to improved academic achievement. Behaviorally Based Intervention Applied Behavior Analysis Teaching Self-Regulation and Self-Monitoring Skills

Definitions: Physical Disabilities Severe Orthopedic Impairment (OI) Congenital abnormality - club foot, absence of a limb, etc. Impairments caused by disease - poliomyelitis, bone tuberculosis Impairments from other causes - cerebral palsy, fractures, burns, etc. Adversely affects educational performance

Definitions: Other Health Impairments (OHI) Limited strength, vitality, or alertness due to chronic or acute health problems Such as asthma, attention deficit/hyperactivity disorder, diabetes, epilepsy, a heart condition, hemophilia, leukemia, sickle cell anemia, lead poisoning, nephritis, rheumatic fever, or Tourette syndrome Adversely affects academic performance

Definitions Orthopedic Impairment Neuromotor Impairment Involves the skeletal system Neuromotor Impairment Involves the central nervous system Chronic Conditions Long lasting and most often permanent Acute Conditions Of limited duration

Prevalence During the 2012 to 2013 school year, around 59,000 children between the ages of 3 and 21 years received services under the orthopedic impairment disability category About 779,000 were served under OHI These two disability represent approximately 1% and 12% of all children receiving special education, respectively.

Prevalence The actual number of children served is much higher than the number receiving special education services under IDEA because Many children with OI and OHI receive services under other categories. Some do not require specialized educational services.

Epilepsy Definition: when seizures occur chronically and repeatedly Seizures are caused by abnormal electrical discharges in the brain Types of seizures: generalized tonic-clonic, absence, complex partial, simple partial Aura-a warning sensation that takes various forms and appears a short time before a seizure Seizures can be controlled with medicine in 70% of cases

Diabetes Definition: A chronic disorder of metabolism that occurs when the body is unable to obtain and retain adequate energy from food. Type 1 diabetes have insufficient insulin Type 2 diabetes, the most common form, results from insulin resistance Hypoglycemia Hyperglycemia

Asthma Chronic lung disease resulting in a narrowing of airways Most common lung disease of children Prevalence range from 7% to 10% of school-age children Leading cause of absenteeism in school Causes are unknown but considered an interaction of heredity and environment Emotional stress can be a causative factor Treatment involves an asthma teaching program

Autosomal Recessive Disorders Inherited when two copies of an abnormal gene are present Most common types Cystic Fibrosis Sickle Cell Disease Tay-Sachs Disease

HIV and AIDS HIV can lead to AIDS A person with AIDS cannot resist and fight off infections because of a breakdown in the immune system No vaccines or cures exist Advances in antiretroviral drug treatment reduced mortality rates Parents are not required to inform the school that their child has HIV School personnel should be trained in universal precautions

Cerebral Palsy A disorder of movement and posture A permanent condition that results from lesion to the brain or an abnormal brain growth Most prevalent physical disability in school-age children No clear relationship between the degree of motor impairment and degree of intellectual impairment (if any) Classified according to muscle tone (hypertonia) and motor movement Spastic, Athetosis, Ataxia

Spina Bifida Congenital malformations of the brain, spinal cord, or vertebrae Most common neural tube defect Can result in paralysis below affected vertebra Three types: spina bifida occulta (mildest form), meningocele, myclomeningocele (most common and most severe form) Hydrocephalic condition common in many children with myclomeningocele- treated with a shunt Requires clean intermittent catherization

Types and Causes Muscular Dystrophy Progressive atrophy of the body’s muscles Duchenne muscular dystrophy-most common Spinal Cord Injuries Caused by penetrating injury, fracture, stretching, or compression of spinal cord Can result in paralysis-the higher the injury on the spine and the more the injury cuts the spinal cord Quadriplegia Paraplegia

Characteristics Students with physical disabilities or health impairments function well below grade level academically Daily health care routines and medications have negative side effects Educational progress is often hampered by frequent and sometimes prolonged absences As a group, these students perform below average on measures of social-behavioral skills. Concerns about physical appearance are reasons for emotional difficulties and feelings of depression

Variables Affecting Educational Performance A physical disability or health impairment can limit a child’s ability to engage in age-appropriate activities, mobility, cognitive functioning, social and emotional development, sensory functioning, and communication across a continuum ranging from normal functioning to extremely impaired. Age of onset - children with congenital or acquired impairments have different needs Visibility - the visibility of impairment may cause some to underestimate the child’s abilities and limit opportunities

Teaming and Related Services Physical Therapists Occupational Therapists Speech-Language Pathologists Adapted Physical Educators Recreational Therapist School Nurses Others (e.g., prosthetists, orthotists, orientation and mobility specialists, biomedical engineers, health aides, counselors and medical social workers)

Educational Approaches Environmental Modifications Barrier-free Architecture Functional Adaptations Assistive Technology Assistive Technology Devices Assistive Technology Services Animal Assistance Helper or Service Dogs Monkeys as Personal Care Attendants

Special Health Care Routines Proper positioning and movement encourage the development of muscles and bones and help maintain healthy skin. Proper seating helps combat poor circulation, muscle tightness, and pressure sores and contributes to proper digestion, respiration, and physical development. Lifting and transferring requires making contact with the child, communicating what is going to happen in a manner the child can understand, preparing the child physically for the transfer, and requiring the child to participate in the routine as much as possible.

Independence and Self-Esteem Children need encouragement to develop A positive, realistic view of themselves and their physical conditions As much independence as possible The ability to cope with their disabilities, set realistic expectations, and accept help gracefully when needed The ability to explain their physical disability or health condition and to respond to questions Collaboration with self-help groups for people with similar disabilities

Placement Options During the 2012 to 2013 school year: 55% of students who received special education services under the category of orthopedic impairment and 60% of those with OHI were educated in general education classrooms 22% and 16%, respectively were served in resource rooms 10% of those with OHI and 22% of those with orthopedic impairments were educated in separate classroom Technology-Dependent Students

Related Services in the Classroom and Inclusive Attitudes Controversial issues concern including students with physical impairments and special health care needs in general education classrooms. The extent teachers and schools are responsible for a child’s physical health care needs Irving Independent School District v. Tatro Catheterization is a related service Cedar Rapids Community School District v. Garret F Nursing services are related services Acceptance is the most basic need of children with physical disabilities and health impairments.