Module 1: What are “special needs”?

1.    What are “special needs”?

Presenter’s note: the time has come, and it has been getting so much better, to destigmatise special needs. If you needed extra math lessons while at school, like me, then you had a special need. No more must special needs only be certain needs, be hidden in the corner and only whispered about. According to the Merriam-Webster dictionary: (https://www.merriam-webster.com/dictionary/special%20needs) Any of various difficulties: such as physical, emotional, behavioural, or learning disability or impairment; that causes an individual to require additional or specialized services or accommodations (such as in education and recreation). The most common special needs that children are diagnosed with are:

• Speech and/ language delays (Presenter’s note: you will see in the special needs discussed that speech/language delays are usually your first indicator that a need might be present)
• Autism Spectrum Disorder
• Cognitive delays
• Social and emotional disorders
• Learning differences/disabilities

2. Normal child developmental milestone

It is important to know normal stages of development so that proper attention can be paid to developmental milestone that might be lagging. Early intervention is always the best and so it is imperative to spot possible problem areas as soon as possible.

2.1 Why is crawling so important?

Creeping is moving along on the stomach. Crawling is raising the body off the ground and moving forward on all fours (hands and knees).

• Postural control – postural control is the maintenance of the alignment of all the body parts when moving or when still. This requires a lot of muscle strength. This is when the baby “splits up” the body in top and bottom: top part is when baby lies with head on the floor, arms bent, and straightens legs. Bottom part is when baby sits on knees and pushes self upright with straight arms.
• Balance – together with postural control this holds the baby upright while still or moving. The brain uses eyes, sensors (proprioceptors) all over the body as well as the system in your inner ear (vestibule and circular canals) to calculate how to stay upright and how to move. This is why a baby rocks on hand and knees before he/she starts crawling. The rocking action synchronises posture, balance, and muscle strength while the eye adjusts to seeing things from a different height. This is when different parts of the body learn to work together through a gradual and progressive integration of the different systems.
• Locomotion – this means to move. Since crawling is the first time a baby starts to move forwards, they start becoming aware of their left and right sides. This is also where they start to do midline crossing, which is vital in a child’s development. Children who cannot cross the body’s vertical midline can have problems with reading (stopping reading in the middle of the page), writing (writes with one hand until the middle and then swaps hands for the other half of the page or writes down the middle of the page). Midline crossing stimulates all four hemispheres of the brain as you need to use both eyes, both ears, both hands, both feet as well as core muscles on both sides of the body. Midline crossing (while crawling) teaches the following:
  • Eye-hand coordination – watching their hands while they crawl is essential for reading and writing skills
  • Tactile stimulation – this helps babies become aware of where their body parts are without having to look at them, this is essential for later coordination
  • Vision – focusing distance is practised while the baby focuses on his/her hands close by, where they want to go that is further, to the left and right, etc.
  • Personal space – since baby expands his/her personal space while crawling, they learn to interact socially. Children with problems in personal space might stand too close to others and sometimes write in a similar way.
• Manipulation – when a baby crawls and takes his/her weight on all fours it develops the following:
  • Joint control of the shoulder, elbow, wrist and within the hand
  • Arches of the hand
  • Strength and tone of the hand
  • Motoric separation of the hand (support on the little fingers side and skills for the thumb)

3. What are the most common special needs?

The following section discusses the most common special needs with their causes and challenges.

3.1. Autism Spectrum Disorder– what does it look like? What causes it?

Presenter’s note: The video is an amazing video to show children as well to help them better understand and have compassion for their friends on the spectrum.

Also called Autism, it is a condition related to brain development. It refers to a range of conditions characterized by the following:

• Challenges with social skills
• Repetitive behaviours
• Speech and nonverbal communication
• Obsessive interests
• Sensory differences/sensitivities

  Symptoms can be broken down into the following:

• Behavioural: inappropriate social interaction, poor eye contact, compulsive behaviour, impulsivity, repetitive movements, self-harm, persistent repetition of words or actions
• Developmental: possible learning disability or speech delay in a child
• Cognitive: intense interest in a limited number of things or problems paying attention
• Psychological: may appear unaware of other’s emotions
• Also common: anxiety, change in voice, sensitivity to sound, etc.

  Causes: Many causes of autism have been proposed but understanding of the theory of causation of autism and the other autism spectrum disorders is incomplete. In the U.S. 1 in 45 children, between the ages of 3 to 17, are diagnosed with autism. Studies have also shown that autism is four to five times more common in boys than girls. An estimated 1 in 45 boys and 1 in 189 girls are diagnosed with autism in the U.S. (https://www.cdc.gov/ncbddd/autism/data.html)  

3.1.1 Possible signs that a child may have autism

At 6 months:

1. not making eye contact with parents during interaction
2. not cooing or babbling
3. not smiling when parents smile
4. not participating in vocal turn-taking (baby makes sound, parents makes sound, and so forth)
5. not responding to peek-a-boo games

At 12 months:

1. no attempts to speak
2. not pointing, waving or grasping
3. no response when name is called
4. indifferent to others
5. repetitive body motions such as rocking or hand flapping
6. fixation on a single object
7. oversensitivity to textures, smells, sounds
8. strong resistance to change in routine
9. any loss of language

At 24 months:

1. does not initiate two-word phrases (that is; doesn’t just echo words)
2. any loss of words or developmental skill

Most therapies for autism are behaviour based. 

3.2 Cerebral Palsy – what does it look like? What causes it?

Video here

Cerebral Palsy (CP) is caused by brain damage. The brain damage is caused by brain injury or abnormal development of the brain that occurs whilst the brain in still developing – before birth, during birth, or immediately after birth. Some more facts about CP:

• Every case of CP is unique to the individual.
• CP is non-life threatening. (Except with children born with severe cases)
• CP is incurable.
• CP is non-progressive – this means that it is the result of a one-time brain injury, and that there will not be further degeneration of the brain (as with, for example, disease).
• CP is permanent
• CP isn’t contagious, it is not communicable.
• CP is manageable.

CP is the most common motor disability in childhood. Population based studies from around the world report prevalence estimates of CP ranging from 1.5 to more than 4 per 1000 live births or children of a defined age. Symptoms include exaggerated reflexes, floppy or rigid limbs and involuntary motions. They appear by early childhood. In the U.S. about 8000 babies and infants are diagnosed with the condition per year. In addition, some 1200-1500 preschool children are recognized each year to have CP. Of all children with CP, 40% were born prematurely and 60% were born at term. 11% of children were from a multiple birth. Other symptoms may include:

1. • Muscular: difficulty walking, difficulty with bodily movements, muscle rigidity, permanent shortening of muscle, problems with coordination, stiff muscles, overactive reflexes, involuntary movements, muscle weakness, muscle spasms, or paralysis of one side of the body
   • Developmental: failure to thrive, learning disability, slow growth, speech delay in a child
   • Speech: delays in speech development or difficulty speaking
   • Also common: constipation, difficulty raising the foot, difficulty swallowing, drooling, hearing loss, leaking of urine, paralysis, physical deformity, scissor gait, seizures, spastic gait, teeth grinding or tremor

Causes: It is caused by brain injury or brain malformation that occurs before, during or immediately after birth while the infant’s brain is under development. How the brain injury affects a child’s motor functioning and intellectual abilities is highly dependent on the nature of the brain injury, where the damage occurs and how severe it is. However, a person can intentionally or unintentionally increase the likelihood a child will develop CP through abuse, accidents, medical malpractice, negligence or the spread of a bacterial or viral infection.

Most therapies for cerebral palsy are physical therapies as well as surgical and medical. 

3.3 Down Syndrome – what does it look like? What causes it?

Video here

Down Syndrome (DS) is typically associated with physical growth delays, characteristic facial features and mild to moderate intellectual ability. Characteristics can be broken up into the following:

• Developmental: delayed development, learning disability, short stature, speech delay in a child
• Eyes: amblyopia (crossed eye(s)) or spots (Brushfield Spots)
• Also common: mild to moderate intellectual ability, brachycephaly (when the shape of the skull is shorter than average), upslanting palpebral fissures (palpebral fissures refer to the opening between the eyelids), atlantoaxial instability (excessive movement at the junction between C1 and C2 vertebrae), bent little finger, congenital heart disease, displacement of the tongue, excess skin on the back of the neck, flaccid muscles, hearing loss, immune deficiency, low-set ears, mouth breathing, obesity, obstructive sleep apnoea (intermittent airflow blockage during sleep – snoring), polycythaemia (increased red cell production in bone marrow), seborrheic dermatitis (scaly and red skin patches – mainly on scalp), single line in palm, thickening of the skin on the palms and soles, thyroid disease and vision disorder.

There are three types of Down Syndrome:

1. Trisomy 21 – this is the most common type of DS and occurs when there are three, rather than two, number 21 chromosomes present in every cell of the body. Instead of the usual 46 chromosomes, a person with DS has 47. This additional genetic material alters the course of development and causes the characteristics associated with the syndrome. Trisomy 21 accounts for 95% of all DS cases.
2. Translocation – this is when part of chromosome 21 breaks off during cell division and attaches to another chromosome, typically 14. While the total number of chromosomes in the cells remains 46, the presence of an extra part of chromosome 21 causes the characteristics of DS. This accounts for 4% of all cases of DS.
3. Mosaicism – this occurs when nondisjunction of chromosome 21 takes place in one – but not all – of the initial cell divisions after fertilization. When this occurs, there is a mixture of two types of cells, some containing the usual 46 chromosomes and others 47. This accounts for 1% of DS cases.

They may need a mixture of behavioural and physical therapy, and sometimes medical intervention.

Presenter’s note:An interesting factoid is that when you have an amniocentesis done, it only checks for Trisonomy 21. I know of three couples who had the check done but still had a child with Down Syndrome.

3.4 Attention Deficit/Hyperactivity Disorder – what does it look like? What causes it?

Video here

Characteristics of AD/HD:

• Behavioural: possible aggression, excitability, fidgeting, hyperactivity, impulsivity, irritability, lack of restraint, persistent repetition of words and actions.
• Cognitive: absent-mindedness, difficulty focussing, forgetfulness, problem paying attention, short attention span
• Mood: anger, anxiety, boredom, excitement, mood swings
• Also Common: depression and learning disability

Causes: Children that are born with a low birth weight, prematurely or whose mothers had difficult pregnancies have a higher risk of having ADHD. The same is true for children with head injuries to the frontal lobe of the brain, the area that controls impulses and emotions. These are the reasons AD/HD can be present with many other syndromes like Cerebral Palsy as the brain damage might be in the frontal lobe.

Most therapies will be behavioural in the case of ADHD. 

3.5 Dyslexia

Video 1 here

Video 2 here

Dyslexia is a learning disorder that involves difficulty reading due to problems identifying speech sounds and learning how they relate to letters and words (decoding). Also called reading disability, dyslexia effect areas of the brain that process language. People with dyslexia have normal intelligence and usually have normal vision. Most children with dyslexia can succeed in school with tutoring or a specialized education program. Emotional support also plays an important role. Though there’s no cure for dyslexia, early assessment and intervention result in the best outcome. Sometimes dyslexia is undiagnosed for years and isn’t recognised until adulthood, but it’s never too late to seek help. Characteristics may include:

• Cognitive: difficulty memorising, difficulty spelling, difficulty thinking, difficulty understanding
• Developmental: learning disability or speech delay in a child
• Also common: delayed reading ability, headache, speech impairment

Causes: It is neurologically based and often hereditary. It is associated with difficulties in reading, writing, spelling and organization. Functional Magnetic Resonance Imaging shows that the brains of people with dyslexia develop and function in a different way. It is not due to cognitive disability, brain damage or lack of intelligence.

The causes of dyslexia vary by type. In primary dyslexia, much research focuses on hereditary factors. Researchers have recently identified specific genes as possibly contributing to the signs and symptoms of dyslexia.

Dyslexia is the most common language-based learning difficulty. It occurs in at least one in every 10 people, putting more than 700 million children and adults in the world at risk of life-long illiteracy and social exclusion.

Main therapy types will include behaviour and supplementary academic therapy.