DISORDERS OF MOTOR PLANNING AND RESPONDING 1 Motor Disorders Gross Motor Developmental Coordination Disorder (DCD) Fine Motor Dyspraxia Dysgraphia

Fred 8/18/2015zentall 2 Fred was a quiet baby and babbled very little. He makes more babbling noises now (4 ½ yr.). He has never used words or jargon, but has developed a great deal of gesture for use in communication. He understands everything we say to him and enjoys stories and other verbal activities. He has begun to print words but only a few of these are used for purposeful communication. When Fred was 3 yr. and 9 mo. old he began to imitate animal noises. Most of these were produced with vowel sounds and an occasional ‘b’ or ‘k’. I remember a few weeks before his third birthday he repeated “bah, bah, bah” all one day. Thinking it might mean “bye-bye”, I took him out in an attempt to satisfy his whish and encourage him to continue, but he never repeated the sound after that day, so I may have been mistaken.

Fred cont. At about the same time on three separate but identical occasions he made the sounds “wah dow”. I interpreted it to mean “want down” and helped him down. Then he learned to get down for himself and the sounds to my knowledge have never been repeated. Whether these were simply coincidences or not, I don’t know.expression, hand and body movements, etc. He will frequently “act out” verbs like fall, jump, etc. and sounds like escalator, revolving door, airplane, etc. When he was three years and 10 months old, I suddenly realized that Fred was reading words: dog, cat, etc. because he’d make the sounds for the animal when he saw only the word. At three years and eleven months he started making words all by himself with his alphabet blocks. Later he started printing the words; he was unable to make lower case letters well, but could translate lower case letters on toy blocks into capital letters. 8/18/2015zentall 3

8/18/2015Zentall 4 Developmental Coordination Disorder

8/18/2015zentall 5 Dyspraxia

8/18/2015 zentall 6 Dyspraxia and Mislabeling 2 girls with Apraxia, a motor disorder, mistakenly labeled: hearing impaired behavior disordered Another woman (undergrad in this course) was referred for testing at the age of 2 for not speaking—now also w/ bad handwriting and poor gross motor control, could run, however, because less motor skill involved.

Zentall 7 8/18/2015 Communication Specific characteristics of Apraxic speech include un-sequenced sounds or syllables inconsistent speech the loss of sounds or words during articulation

8/18/2015Zentall 8 Look at this link Apraxia Video:Apraxia Video: listen to Brandon as an example of dyspraxia

Zentall 9 8/18/2015 Communication cont. Examples include  "shif" instead of "fish" or  "miskate" instead of "mistake"  pronouncing "gate" as it should be one day, but replacing the "g" sound the next day with "k" or "d" and saying "kate" or "date" (Hall, Part I, 2000).

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8/18/2015 zentall 11 Dysgraphia. History and handedness

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13 8 yr old Dysgraphic

14 Vocabulary: 3 types of dysgraphia 1. memory dysgraphia 1. motor dysgraphia 1. perceptual-spatial dysgraphia 1. cannot recall the written form of letters but can copy 2. cannot form letters but know that their writing is poor 3. cannot form their letters and do not know that their writing or drawing is poor

15 Learning Characteristics 1. Perception 2. Memory RESPONSE CHARACTERISTICS 1. Fine motor

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8/18/2015 zentall 18 ADHD and Dysgraphic

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8/18/2015 zentall 20 Perceptual or Motor

8/18/2015 zentall 21 Perceptual or Motor

22 Emotional Characteristics Students with dysgraphia are punished by… 1. staying in for recess to complete assignments 2. taking home excessive amounts of homework People may assume that they are… 1. Lazy 2. Careless 3. Not intelligent = Low self-efficacy & Low self-esteem

23 In contrast, writing forwards, backwards, upsidedown, upsidedown & backwards with either hand may look like giftedness:

Interventions Zentall 24 8/18/2015

25 Deficit or Compensation Training?

26 Read this linklink

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MOTOR TICS MOST develop: 1. eye tic first 2. facial tics or involuntary sounds 3. others within weeks or months common examples: head jerks, grimaces, hand-to-face movements 28

VERBAL TICS Stuttering Sounds (burping, gagging, barking) Words (‘oh boy’) Coprolalia (fewer than 15% have this)  Occurs in late childhood  Most disruptive and disturbing (Jay, 2000) 29

TOURETTE SYNDROME (VERBAL + MOTOR TICS): IDEA Category within Other Health Impaired (OHI) Tourette’s (versus tic disorder) Symptoms can: 1. change over time 2. vary (frequency, type, location, or intensity) 3. improve in less extreme cases during adulthood 30

SOCIAL EMOTIONAL Most problematic: in day-to-day & during adolescence Overall there is a higher risk of: 1. poor peer relationships 2. no relationships 3. withdrawn or aggressive social behavior 31

Academic Accommodations General Principle: 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 ß 32

Model tolerance and do not allow teasing by peers Allow: 1. Short breaks 2. Placement options: movement around or outside the room access to a private room with a bean bag chair—with a private signal exams in a private room for tic release and allow more time 3. Tape student’s oral presentations 33

INTERVENTIONS Pharmacological interventions increase success 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.) 34

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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 36

37 Diagnosis of OCD or Perfectionism? Chris’ compulsions have to do with checking, ordering, repeating, and getting things ‘just right’ (perfectionism) rather than trivial concerns with contamination, something bad happening, or being neat and clean (OCD). Behaviors are connected to an event in a realistic way and help him to neutralize the unpredictability of the event.

38 Diagnosis of ADHD? First determine 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

39 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 Accommodations for the teacher:

40 Interventions for Chris to learn: To address the Chris’ need for self-determination, Chris must learn: 1. That when he cannot regain control, to 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.)