Cognitive Function and Learning Disorder in Children with Spina Bifida and Hydrocephalus
Runa Schøyen Izmir, Turkey June 2013
• General cognitive development • What are cognitive problems? • Major categories of disabilities • Intervention strategies
• General cognitive development • What are cognitive problems? • Major categories of disabilities • Intervention strategies
• General cognitive development • What are cognitive problems? • Major categories of disabilities • Intervention strategies
Cognition is the mental process which controls perception knowing understanding
This affects learning use of knowledge experience
Cognition is the way we experience the world around us.
We meet the world through our senses by organising and remembering our experiences. Then we adapt our experiences by solving problems making plans acting upon them
Definition
Cognitive problems difficulties in adapting and working with impressions and information problems with carrying out and accomplishing actions difficulties in socialising and problems with controlling one’s own behaviour
Cognitive problems can affect how we use our senses how we think and talk how attentive we are how effective we are how we learn and remember how we control our behaviour how motivated we are how we feel
The cause of cognitive problems Damage to the central neurological system (the spine and brain) Can also be seen in persons with temporary or permanent psychological problems, weariness, fatigue and other conditions
Examination of cognitive function Several different professionals Psychologist Speech-therapist Physiotherapist Occupational therapist Teacher / special needs teacher Medical personnel
Neuro-psychological assessment Examination of the various functions of the brain Individual and standardised tests A multifaceted process involving the collection and interpretation of data obtained by: observation interviews informal assessment administration of norm-referenced tests curriculum-based assessments for children in school
Identify the resources, then the difficulties!
What functions will be tested? General psychological assessment (IQ) Abstract thinking and problem solving Use of language and how to solve practical problems Memory Attention and concentration Motor-sensory skills The ability to organise oneself
• General cognitive development • What are cognitive problems? • Major categories of disabilities • Intervention strategies
Disabilities affecting the psychological assessment process Motor Disabilities: Loss of motor control in arms and hands (fine motor skills) Poor eye-hand co-ordination Ambidextrous Difficulties with motor planning skills
Disabilities affecting the psychological assessment process Visual Disabilities: Abnormal eye gaze Nystagmus (trembling) Strabismus (squinting) Poor visual acuity Visual perception (orientation in space)
Disabilities affecting the psychological assessment process Speech and Language Disabilities: Delayed language development Dysarthria (paralysis)
The Cocktail Party Syndrome
Disabilities affecting the psychological assessment process Attention, Concentration and Memory Disabilities: Sustained attention Focusing on relevant information Long-term and short-term memory Attention Deficit Hyperactivity Disorder (ADHD)
Disabilities affecting the psychological assessment process Emotional Problems:
Coping with the disability Family problems Problems in adjusting to surgical and medical procedures
“Diagnostic overshadowing”
“An invisible disability” • Difficulty in concentration • Difficulty in remembering • Reduction in “staying power” • Reduced endurance and stress tolerance • Difficulty in carrying out several tasks at the same time • Slow learning and slow tempo
This is what some young persons with SB have told me about their cognitive problems “some sight problems / I see double” “ugly writing - takes a long time” “arithmetic is difficult” “problems with finding my way both indoors and outside” “often tired” “lose the thread in conversation” “slow learner” “problems with doing several tasks at the same time” “to plan ahead is difficult”
• General cognitive development • What are cognitive problems? • Major categories of disabilities • Intervention strategies
What can we do to help?
The first years of a child’s life
• Play with the child using both motor functions and the senses. Use songs and ryhmes touching fingers, toes and all other parts of the body. • Make the child aware of all the parts of his or her body by turning around, tossing the child in the air, rolling around on the floor. • Put on music and dance with the child. • Help the child to get around by rolling, creeping and crawling and by pushing itself around using its hands. • Help the child to sit, to stand on the knees and to get up into a standing position.
• Take the child with you out into the world and let it feel, taste, listen, see and discover with all the senses, utilising the whole body. • Use short sentences with a clear message, one at a time, and let them sink in. • Talk about and explain everyday words and concepts. • Encourage social interaction with other children both inside and outdoors as much as possible.
• Explain to the child things the other children learn by intuition or observation. • Explain visual signals to help the child understand social settings and situations. • Ensure that the child is tested for cognitive problems before starting school. • Volunteer information to the child’s teachers and classmates.
And above all: Let the child do things by itself. Do not help too much. Avoid "learned helplessness�.
What can we do to help?
Intervention strategies in the classroom
• Seat in front of classroom • The desk and chair should provide good stability – a chair with armrests is preferred. • The desk should be free of clutter and other visual stimuli. • To improve fine motor co-ordination: practice gluing macaroni on paper, play with clay, cut with scissors. • Use thick grip pencil to train writing skills. Type on computer keyboard. • Learning aids for quick references taped to the desk – alphabet in upper and lower case letters and the multiplication tables.
• Highlight and extract relevant details in the literature, directing the child’s attention to what’s important. • Allow additional time needed to complete written work. • Quantity of written work must be decreased • Each task broken down into small steps. • Develop methods organising tasks and activities. • Obtain notes from the teacher or a peer.
What can we do to help?
Youth and adult life
• Help to organise studies and work situation. Consider carefully the amount of homework. • Co-operation between the student, school and the parents. Provide information on cognitive problems. Prevent moralising and unjust demands. • Education – clear goals, aims and objects. A good consultant or adviser is important. • Time is an important factor in higher education. More time on tests etc should be allowed.
• Vocational rehabilitation. Consider a combination of employment and disablement benefit if such exist. • Time for socialising, being with friends – prevent social withdrawing. • Ensure thriving and enjoyment by encouragement. • Be a creative problem solver!
Challenges in living with cognitive problems • Focus on the possibilities, not the problems • Do not under-estimate the child, “self-fulfilling prophecies” • Do not over-estimate the child / demanding too much • Remember “invisible disability”, do not listen to “She can do it if she just tries harder” • Do not listen to “Wait and see” or “he will grow out of it”. Find appropriate help – start early • Compensate / find other solutions in stead of excessive training
Have realistic expectations and plan accordingly.