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Lecture 3

lecture 3.doc

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Stuart Kamenetsky

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Lecture 3 Class Notes The early childhood years • Focus on individualized attention is important throughout the lifespan • What happens before age 6 and after age 21 (before school takes over)? o School takes over typically around age 6 (gr. 1) o Sometimes school offers support @ age 4,5  In JK/SK – fully included in general ED classes (not a lot of special ED services) o dependent on individual school system • school takes responsibility from gr. 1 (6)  gr.12 (18) … can stay in until 21 First years of life are crucial to the overall development of children • Brain is very plastic • Critical period of development – important skills (walk, talk) & functions • Unless developed in critical periods, hard to develop later on in life • For each child, we don’t know what optimal capabilities are Early stimulation : affects dev’t of language, intelligence, personality, self-worth • Understanding of neurological system: brain is not completely hardwired (it is plastic; synaptic transmission under learning = physical brain changes) o The brain is most susceptible to changes when the child is very young • Long lasting effects on development from early stimulation o Early intervention can reduce overall impact of the disabilities (reach child before brain becomes more hardwired) • Early intervention can help children with disabilities to reach their potential regardless what their potential are Early intervention: ↓ overall impact of disabilities & counteract negative effects of delayed intervention • Financial advantages w. early intervention o Intervene earlier, reduce impact earlier – prevent large costs later on in life • LONG run: less costly & more effective than providing services later in life eg. Behavioral intervention in autistic children o Debate: who should pay? COSTLY o Children do a lot better with this – chances of learning skills (eg. Language) greater with intervention 1 Lecture 3 Class Notes o More costly up front = but helps develop skills (eg. Communication) o Growing up without skills = need more services, become more frustrated = behavioral problems, crime, handled by mental health system • However, they are not cure What services are available? Network of “infant development programs” up to age 6 • Each region (municipality) own network • Well funded Services: don’t deal w. disabilities o OHIP for health, school system for education o Neither – completely cover services that infants need if disabled  Medicine: Disability isn’t illness (eg. Hearing impairment)  School: no role until 4,5 or 6 o Need something beyond school & OHIP • Two agencies: NETWORK + CHILDREN’S AID o Children’s aids = deals w. abuse & neglect not disability  Don’t have laws that mandate operation o IDPs only ones designed to deal w. disabilities  BUT not mandated (no laws) like laws IDA, Bill 82 that mandate educational process  Have ANNUAL funding, but constantly apply for grants • Types of disabilities: intellectual disabilities (developmental delays) o PDD, autism, aspergers; genetic disorders (down syndrome) • Other disabilities: OTHER networks support them o Hearing/visual impairment – other agencies that serve them o Speech & language pathologists, audiologists, optometrists • Even still: others not recognized until kids go to school (eg. Learning/ADHD) Purpose : to serve infants who are at risk for development delay & their families Goals: 1. Optimize the child’s functioning level to their potential – • not to cure or reach certain milestone but to optimize o developmental delays cannot be cured • tries to enable child to reach own potential based on genetic inheritance 2 Lecture 3 Class Notes o normal kids – know what the “potential” is (on average; know bell curve) o disabled kids – don’t know the “potential”  In some, know what to expect (DS), others you don’t know (PDD) • THEREFORE: always be above child’s level to encourage optimal development of child 2. Help parents with information and support – • disability sets lifelong disappointments of dreams and hope for their children • doctors can’t offer support (medication/surgery won’t help) = refer to agency like this 3. Help family solve problems w. special issues/gain access to available services • Waitlists of agencies; people don’t have “rights” to immediately be served by agency • Let them know available services (a lot of variability in the services that are provided!) & help them get access Target population: Who do agencies serve (top priority)? Established risk (diagnosed medical disorder) – first • Know for certain child has disability (diagnosed at birth/in pregnancy) o Example: down syndrome – diagnosed through amniocentesis • Know developmental trajectory o how dev’t will take place & o what support needed to maximize change they reach their potential • Always leads to disability • Help received in individual setting (more optimal) Biological risk (early negative events) – second • Early negative events = high likelihood for causing disability {don’t know for sure} o Example: Birth complication  umbilical cord around the neck of the baby  lack of oxygen during childbirth (anoxia);  breached kid  FAS, drug abuse o Example 2: high fever & hospitalization o Example 3: Prematurity  more preterm = more likely they will have problems (vision, hearing, respiratory, minor neurological disorders - ADHD/learning) 3 Lecture 3 Class Notes • not chromosomal (genetic) – early events = high likelihood of disability (may/may not) • help received in group setting first, then when waiting list is done = individual help Psychological risk (vulnerabilities magnified by environment) – third • Examples: o Poverty o Poor neighborhood o Child abuse: alcohol, poor nutrition o Depressed mother • May or may not increase chances of disability (least likely) • help received in group setting first, then when waiting list is done = individual help ** not mutually exclusive – can overlap (likelihood child will have 1+ risk) eg. preterm child born with DS (biological and established risk) + born to single poor mother whose father was a drug addict and took off (psychological risk) ** ** stimulate child – so that skills that develop naturally in normal children develop to the maximum potential in these children? ** Intervention Approaches Client centered (help client) • only client is involved (ie. Dentist, any type of surgery) • example: medical profession Family centered (help family help client) – mediator model • early period during child’s life • medicine won’t help; primary focus: educational • development strategies implemented by parents – feed, diaper, play, assist o any attempt to intervene w. dev’t delay = family centered o teach family how to stimulate child as best as they can to optimize learning Example: child with language development • NEEDS optimal (& maximal) environment (exposed to language – mom & dad always talking, in a specific way = higher chance for 4 Lecture 3 Class Notes language to develop)  mediator teaches parents how to interact with the child (eg. exaggerate stimulation) • NORMAL children: develop language naturally (TV, friends, etc) even w.o extra stimulation from parents • Inexpensive (no psychologists) and naturally implemented by parents Clear in infants BUT – seen in adults too • Problems in family – seek psychologist (client centered {family is ok, you’re the problem} vs. family centered {difficult family} ** one is NOT better than other (suitability) = best fit to the “problem” we are trying to fix - infants: in general (dev’t delays) family centered BUT if surgery can help = may start with client centered (eg. ear pathology) and THEN implement family centered combo between 2 approaches ** Services Assessment • Typical age: 36 months for Autism – broad assessment o Takes time, has to be done by registered psychologist//psychiatrist • Early screening tools developed: see if the child is AT RISK for delay o Implement intervention at YOUNGER age Planning with parents (IFSP; individualized family service plans) • help family – what are they doing to do to deal w. the disability of child • Who works? Who will they hire? Wellbeing of other siblings? 5 Lecture 3 Class Notes • Purpose: wellbeing for child & for family (will in turn help family) In-home Programs • programs inside the child’s home o child feels most comfortable there o more convenient for parents (don’t have to carry child around; cold weather) – prevent parents from not going to programs o see rearing environment of child (food in fridge) – go back to IFSP to develop plan accordingly to ensure early intervention will work (eg. ways to get money) • parents and agencies have the same goal for the child BUT – o family can shut services out (not legally required to get help from agency) o have to report to children’s AID if see abuse/neglect – take child away • Fine line – best thing for child is for agency staff to develop good relationship with the parents to keep them on board Office visits: programs done in office Counseling • Family grieves all @ once for all the lost opportunities of their children • families need a lot of counseling; children need strong parents to succeed Case management • social worker, speech & language pathologist, etc – related rehab professionals o work together to help the child • someone is responsible to make sure everyone else is on board o make sure program/strategy is implemented in a similar way o parents often become case managers, but not ideal (not professionals) • selecting case manager: o services needed most by child based on the disorder; everyone else 2ndary role  eg. speech pathologist if child is speech impairment o relationship w. family (similarity of culture & language)  understands family most (w.o judgment)  understands cultural rules – dynamics of family roles = appropriately select how to implement changes Parents support groups • provide info and consultation VERY important • can relate on a level they might not be able to other professionals Information 6 Lecture 3 Class Notes Consultation w. staff of other agencies (know what others can offer) • Case manager can facilitate this Research and training (not enough of it; important) • Research to understand how it progresses, etc. • Train pediatrics: recognize signs of early developmental delays & what to do about it Toy and book library Public information talks Who works there? • Nurses • Occupational Therapists – modify env’t & help child w. skills (eg. Motor) • Physiotherapists • Psychologist – not always full time • Speech and language pathologists • Social workers • Graduates – semi-professionals (a lot of work = family visits) Transition to high school and adult life • Transferring to high school  child services continues to be mandated by school board (according to provincial legislation) o Disability recognized sometime before 7 Lecture 3 Class Notes • Middle school get together w. high school + visits by parents to diff. high schools o For the most part, look to the same system Young children with disabilities receive more attention • They are cute like other children o Alike other normal children o They are helpless • People feel sorry or guilty o Bad in the long term – will think they can’t achieve much (no job) o Short term it’s good – they get attention and funding • Correct sense that something can still be done o motivate people to do something about it – brain isn’t hardwired yet o increase likelihood that if child has high potential they will reach it • Parents have hope and they care o Still optimistic; very early on still Therefore compared to other age groups there is more funding & support for younger children (OHIP, early intervention programs) Older children (+ Adults) with disabilities receive less attention • They are not cute anymore • People feel sorry for them, BUT their behavioral problems turn people away o Organic (part of the condition) OR o Learnt (frustration, exclusion, misunderstood) o Protect yourself from them (public safety) • Many feel it’s too late to do anything o If didn’t receive intervention, not much can be done  Example: at 16, the system spews them out of group homes  Feel they’ve been through so many group homes & through so much that nothing can be done o If nothing worked until then, nothing will • Youth and adults with disabilities may become unmanageable to their parents due the their physical size, extend of difficulties and age of their parents o Child is older & so are parents – hard to care for individuals  parents are less able to care for them o Stunt growth of children (hormonal treatments; controversial)  keep them small as adult to be more manageable in terms of care • Parents/educators may have lost hope after many years 8 Lecture 3 Class Notes o Try to teach them something for many years & they can’t do it, give up o Parent becomes frustrated Adolescence Special challenges Normal adolescence issues • Getting larger, are messy • Independent; question authority o Wants to hang out with friends o More challenging (rebellious) • May be excluded
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