Category Archives: Chidren/Teens

Teaching Students with Feeding Tubes: What You Need To Know

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If you work in a special education class or a day habilitation setting, more than likely you are teaching a student or an individual with complex needs including the use of a feeding tube.

According to the Tube Feeding Awareness Foundation, there are over 300 conditions that require students and individuals to receive nutritional support through tube feeding.

What is a feeding tube?

A feeding tube is a device that is inserted in the stomach wall and goes directly into the stomach. It bypasses chewing and swallowing in a student or individual who no longer has the ability to safely eat or drink. This allows for students and individuals to receive adequate nutritional support.

A feeding tube is also used for students and adults who cannot take in enough food by mouth. Feeding tubes can be temporary or permanent .

Reasons to use a feeding tube
The student or individual may have a swallowing disorder or dysphasia. This means there is an increase risk for the student or individual to aspirate their foods or liquids into their lungs. Causes of swallowing problems include low-muscle tone, brain injury, genetic conditions, sensory issues, neurological conditions, cleft lip/palate and birth defects of the esophagus or stomach.
Types of Feeding Tubes

Gatro Feeding Tube

The gastrostomy tube (G tube) is placed through the skin into the stomach. The stomach and the skin usually heal in 5-7 days. This type of tube is generally used in people with developmental disabilities for long term feeding.

Nasogastric Feeding Tube

The nasogastric (NG tube)  is inserted through the nose, into the swallowing tube and into the stomach. The NG tube is typically used in the hospital to drain fluid from the stomach for short term tube feeding.

Neurological and Genetic Conditions Requiring Tube Feeding

Some students and individuals with neurological and genetic conditions often require tube feeding due to gastrointestinal issues including constipation, reflux, and abnormal food-related behaviors. It For example, it is estimate that 11% of children with cerebral palsy use a feeding tube due to difficulty with eating, swallowing, and drinking.

The following are different types of neurological or genetic conditions that may require the use of a feeding tube.

22q11.2 Deletion Syndrome

Angelman Syndrome

Aspiration

Cerebral Palsy

CDKL5 Disorder

Cornelia de Lange

Cri Du Chat Syndrome

Down Syndrome

Dravet Syndrome

Dysphasia

Edwards Syndrome

Fetal Alcohol Syndrome

Fragile X Syndrome

Hydrocephalus

Lennox-Gestaut Syndrome

Microcephaly

Ohtahara Syndrome

PPD- Not Otherwise Specified

Turner Syndrome

Trisomy 18

Spastic Diplegia

Traumatic Brain Injury

West Syndrome

Williams Syndrome

 

Signs and Symptoms of Issues related to a g-tube

Complications due to tube feeding may include:

  • constipation
  • dehydration
  • diarrhea
  • infections
  • nausea/vomiting

Aspiration

Aspiration can be caused by:

  • reflux of stomach contents up into the throat
  • weak cough, or gag reflux
  • the feeding tube is not in place
  • delayed stomach emptying
  • The head is not raised properly.

Students should be observed for aspiration during feeding. The following are signs and symptoms of aspiration:

  1. Choking or coughing while feeding
  2. Stopping breathing while feeding
  3. Faster breathing while feeding
  4. Increased blood pressure, heart rate and decreased oxygen saturation.

 

What is Tourette Syndrome?

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According to the Tourette Association of America, tics are involuntary, repetitive movement and vocalizations. They are the defining feature of a group of childhood-onset, neurodevelopmental conditions known collectively as Tic disorders and individually as Tourette Syndrome.

Tics are common in childhood. The estimated prevalence of Tourette Syndrome disorder ranges from 3 to 8 per, 1,000 in school-aged children. Males are more commonly affected than females. Some people may have tic-free periods of weeks to months.

There are three types:

  1. Motor tics cause a movement including eye blinking, facial grimacing, jaw movements, and head bobbing
  2. Vocal/phonic tics produce a sound including throat clearing, grunting, hooting, and shouting
  3. Provisional tic disorders involve a person who experiences involuntary motor and/or verbal tics for one year.

Signs and Symptoms:

Tic Disorders:

  • eye blinking
  • coughing
  • throat clearing
  • sniffing
  • facial movement
  • shoulder shrugging

Vocal Tics:

  • barking or yelping
  • grunting
  • repeating what someone else says
  • shouting
  • sniffing
  • swearing

Co-Occurring Disorders Include:

  • Attention Deficit/Hyperactivity Disorder (ADHD)
  • Obsessive -Compulsive Disorder
  • Learning difficulties
  • Behavior problems
  • Anxiety
  • Mood problems
  • Sleeping issues
  • Social skills and deficits

Risk Factors

  • Temperamental- it is worsened by anxiety, excitement and exhaustion.
  • Environmental- observing a gesture or sound in another person my result in an individual with a tic disorder making a similar sound.
  • Genetic- genetics and environmental factor influences tic symptoms.

Updated on 7/6/24

ADHD and Dyscalculia (Math)

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Studies suggests that between 4-7% of students have experience difficulty in math compared to 26% of children with ADHD.

This may be the result of the working memory, problem solving skills and inattentive skills all characteristics of a student with ADHD.

What is Dyscalculia?

Dyscalculia is defined as a learning disability specifically in math and numbers including the inability to understand the concept of numbers and applying math principles to solve problems. The following are signs and symptoms of dyscalculia:

  • Difficulty in counting backwards.
  • Difficulty in recalling facts.
  • Slow in performing calculations.
  • Difficulty with subtractions
  • Difficulty using finger counting.
  • Difficulty with the multiplication table
  • Poor mental math skills
  • Difficulty with understanding the concept of time.
  • May show signs of anxiety when conducting math activities.
  • May have a poor sense of direction (i.e. north, south, east, west)
Early signs of dyscalculia include:
  • Delays in learning how to count.
  • Delays in recalling facts.
  • Difficulty with time
  • Displays a poor memory.
  • May lose track when counting.
  • Difficulty sorting items by groups include color, shape, texture, and size.

Accommodations

Students diagnosed with ADHD qualify for accommodation in the classroom. Here are a few suggestions:

The ADHD magazine, ADDitude suggests the following accommodations to help students with ADHD and Dyscalculia:

  • Allow extra time on test
  • Provide frequent checks for accuracy during classroom activities.
  • List clearly numbered steps/procedures for multi-step problems
  • Use individual dry-erase boards.
  • Reduce the number of problems you assign.

VeryWell suggests the following accommodations for students expressing difficulties in math:

  • Allow the student to use desk copies of math facts such as multiplication table factsheet.
  • Allow the use of calculations in the classroom.
  • Provide models of sample problems and allow the students to use these models as a reference.
  • Decrease the number of math problems.
  • Allow the students to use graph paper rather than notebook paper.
  • Provide the student with review summaries to help prepare for tests.

Updated 2/20/24

Accommodations for Students with Dysgraphia

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Dysgraphia is describes as a learning disability that affects writing, spelling and fine motor skills. Dysgraphia is a neurodevelopmental disorder that can occur as a stand alone disorder or part of a co-occurring disorder with other disabilities such as ADHD, Autism, and Dyslexia. Typically it is diagnosed or discovered in the early years when children are beginning to learn how to write. Most adults often remain undiagnosed.

Early Signs of Dysgraphia

Signs and symptoms of dysgraphia generally begin to show up when children began to lean how to write. Early signs of Dysgraphia include:

  • Inconsistent spacing between letters
  • Poor spatial planning
  • Poor spelling
  • Unable to read own handwriting
  • Poor fine motor skills
  • Omitted words
  • Writes slow
  • Pain in hand from writing
  • Messy unorganized papers
  • Difficulty organizing thoughts on paper
  • Illegible printing and cursive letter formation
  • Slopping handwriting
  • Tight, cramped pencil grip
  • Tires quickly when writing
  • mixes upper and lower case or irregular sizes and shapes of letters.

The following articles provide resources on accommodations:

6 tips for creating a dysgraphia-friendly classroom

A guide to classroom and at-home accommodations for dysgraphia

Classroom accommodations for students with dysgraphia

Dysgraphia Accommodations

Dysgraphia accommodations and modifications

Dysgraphia accommodations in the classroom

Dysgraphia accommodations that improve learning

Dysgraphia symptoms, accommodations, and IEP goals

How to assist a student with dysgraphia in the classroom

Possible accommodations to consider for children with dysgraphia

Accommodations for Students with Dyscalculia

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What is Dyscalculia?

Dyscalculia is defined as a learning disability specifically in math and numbers including the inability to understand the concept of numbers and applying math principles to solve problems. The following are signs and symptoms of dyscalculia:

  • Difficulty in counting backwards
  • Difficulty in recalling facts
  • Slow in performing calculations
  • Difficulty with subtractions
  • Difficulty using finger counting
  • Difficulty with the multiplication table
  • Poor mental math skills
  • Difficulty with understanding the concept of time
  • May show signs of anxiety when conducting math activities
  • May have a poor sense of direction (i.e. north, south, east, west)
Early signs of dyscalculia include:
  • Delays in learning how to count
  • Delays in recalling facts
  • Difficulty with time
  • Displays a poor memory
  • May lose track when counting
  • Difficulty sorting items by groups include color, shape, texture and size.

A guide to the classroom and at-home accommodations for dyscalculia

Students with diagnosed with ADHD qualify for accommodations in the classroom. Here are a few resources:

Accommodations for students with dyscalculia– Adventures in Inclusion

Classroom accommodations for dyscalculia– Understood

How to help kids with dyscalculia- Child Mind Institute

How to treat the symptoms of dyscalculia– ADDitude

Accommodations for Students with Physical Disabilities

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Accommodations for physical disabilities 

Inclusive teaching; physical disability

Instructional strategies for students with physical disabilities 

Strategies in helping students with physical disabilities in the classroom using IDEA

Supporting students with physical disabilities

Teaching students with physical disabilities 

Tips for working with students with medical or physical disabilities

What is Augmentative and Alternative Communication (AAC)?

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According to the American Speech Language Hearing Association, there are over 2 million people with significant expressive language impairment who use AAC. AAC users including people with the following disorders; autism, cerebral palsy, dual sensory impairments, genetic syndromes, intellectual disability, multiple disabilities, hearing impairment, disease, stroke, and head injury.

According to the International Society for Augmentative and Alternative Communication Organization. AAC is a set of tools and strategies that an individual uses to solve everyday communicative challenges. Communication can take many forms such as: speech, a shared glance, text, gestures, facial expressions, touch, sign language, symbols, pictures, speech-generating devices, etc. Everyone uses multiple forms of communication, based upon the context and our communication partner. Effective communication occurs when the intent and meaning of one individual is understood by another person. The form is less important than the successful understanding of the message.

The types of AAC includes both low-tech and high tech. Low tech AAC includes symbol charts, PECS,  and communication boards, while high tech AAC include electronic devices such computers, tablets and devices.

The following information provides resources, articles and tips on using AAC:

3 sets of AAC goals for interactive books

5 quick and easy games that build AAC skills

50 simple switch or low tech activities

AAC and Echolalia

AAC for caregivers manual

AAC Quiz

Augmentative and alternative communication (AAC) systems for students with CVI and multiple disabilities 

How to make an AAC symbol library

Language opportunities to use AAC at home

Low-Tech AAC Ideas

Promoting inclusion and participation for people who use AAC

Reducing prompt dependence in AAC learners: 5 things to try

The periodic table of AAC

Using AAC more in the classroom

Using LIST in PODD communication books

What does it take to implement AAC

 

Supporting a Special Needs Child with Sickle Cell Anemia in the Classroom

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What is Sickle Cell Anemia?

According to the Centers for Disease Control and Prevention (CDC), SCD is a group of inherited red blood cell disorders. Healthy red blood cells are round, and they move through small blood vessels to carry oxygen to all parts of the body. In someone who has SCD, the red blood cells become hard and sticky and look like a C-shaped farm tool called a “sickle”. The sickle cells die early, which causes a constant shortage of red blood cells. Also, when they travel through small blood vessels, they get stuck and clog the blood flow. This can cause pain and other serious problems such infection, acute chest syndrome and stroke.

What is an Intellectual Disability?

DSM-V defines intellectual disability as a disorder with onset during the developmental period that includes both intellectual functioning including abstract thinking, judgment, academic learning, problem solving.  Adaptive functioning including limitations in activities of daily living, communication, social participation, and independent living across multiple environments such as home, school, work and community. Deficits are on the onset during the developmental period.

According the American Association on Intellectual Disabilities (AAIDD), Intellectual Functioning refers to general mental capacity such as, learning, reasoning and problem-solving.

Types

Although historically, the levels of severity was based on I.Q. scores, this has changed to adaptive functioning which determines the levels of support required.

Mild
  • Social Domain- There may be difficulties in regulating emotions and behaviors in an age-appropriate manner. There tends to be a limited understanding of calculated risk, and social judgment.
  • Practical Domain- May need assistance in independent living skills such as grocery shopping, transportation, banking and food preparation.
Moderate
  • Social Domain: Capacity for relationships is evident in ties to family and friends and may have successful friendships across life and sometimes relationships in adulthood.
  • Practical Domain: Can care for personal needs involving eating, dressing and hygiene and as an adult participate in all household task.
Severe
  • Social Doman: Spoken language is limited. Speech may be ingle words or phrases. The individual understands simple speech.
  • Practical Domain: Requires support for all activities of daily living, including meals, dressing and bathing. The person will require supervision at all times. Unable to make responsible decisions regarding self-care.
Profound
  • Social Domain: Has limited understanding of symbolic communication in speech and gestures. The person expresses his or her own desires and emotions through non-verbal communication.
  • Practical Domain: The child or adult is dependent on other people for basic needs including self-care and independent living including health and safety.

A sickle cell “crisis” occurs when the red blood cells decrease and the irregular sickle cells block the blood vessels leading to organ damage and pain. A person with an intellectual disability may not be able to communicate they are experiencing a crisis. signs and symptoms to look for include:

  • Pain
  • Tiredness
  • Fatigue
  • Leg Ulcers

Ways to support a student with sickle cell includes the following:

  1. Offer water throughout the day including frequent small amounts of water
  2. allow for accommodations during extreme weather conditions
  3. Watch for signs of a stroke
  4. Allow the student opportunities to make up homework if missed days from school are due to an illness or crisis.

Resources

Kids Health
Mayo Clinic
Medicine Net
NHLBI (National Heart, Lung, and Blood Institute)
WebMD
Organizations

Children’s Sickle Cell Foundation, Inc.

Foundation for Sickle Cell Research

Sickle Cell Disease Association of America

Teaching Strategies for Students with Orthopedic Impairments

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The definition of orthopedic impairment under IDEA means a severe orthopedic impairment that adversely affects a child’s education performance. Causes include:

  • genetic
  • disease
  • injury
  • birth trauma
  • burns
  • fractures
  • cerebral palsy amputation

There are 3 classifications that an orthopedic impairment can fall under:

  1. Neuromotor impairment, this would include cerebral palsy, spinal cord injuries, spina bifida, and seizure disorders
  2. Degenerative Disease such as muscular dystrophy and Ehlers-Danlos Syndrome
  3. Musculoskeletal Disorders including scoliosis and deformed limbs.

Students with orthopedic impairments often qualify for therapy including physical and occupational therapy. assistive technology should be included for accommodating the students needs.

The following links provide resources on teaching assessment, modifications, and teaching information.

Orthopedic impairment: A guide for parents and teachers

Orthopedic impairment characteristics: Classroom modification and assistive technology

Orthopedic impairment and special needs students

Orthopedic impairment disability

Teaching strategies for mobility impaired students

Teaching strategies for orthopedic impairment

Teaching students with disabilities: Orthopedic impairment

Teaching students with orthopedic impairment

Understanding individuals with physical, health, and multiple disabilities

What is a Multiple Disability?

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According to the Individuals with Disabilities Act (IDEA), multiple disabilities refers to simultaneous impairments such as intellectual-blindness, intellectual disability-orthopedic impairment. The combination of which causes such severe educational needs that cannot be accommodated in a special education program solely for one of the impairments, meaning a student has more than one or multiple impairments. According to the U.S. Department of Education, 2.0 percent of students currently are diagnosed with multiple disabilities.

The term multiple disability is a broad term and can include a number of disabilities. For example, a person diagnosed with cerebral palsy may also have a diagnosed of epilepsy, intellectual disability  and ADHD. The Center for Parent Information and Resources explains that from the term, your cannot tell how many disabilities a child has, which disabilities are involved or how severe each disabilities are involved or how severe each disability is. It is important to know the following in orde to support the child:

  • which individual disabilities are involved;
  • how severe (or moderate or mild) each disability is; and
  • how each disability can affect learning and daily living.

Support should include the following areas:

  • caring for oneself;
  • performing manual tasks;
  • seeing, hearing, eating, and sleeping;
  • walking, standing, lifting, and bending;
  • speaking and communicating;
  • breathing;
  • learning;
  • reading;
  • concentrating and thinking; and
  • working.
Resources

Parent Center Hub