Learning Disabilities & adjustment reaction to school

Learning disorders (LD) refer to a significant deficit in learning due to a person's inability to interpret what is seen and heard, or to link information from different parts of the brain.

dyslexia
dysgraphia
dyscalculia
dyspraxia

school phobia

1. LEARNING DISABILITY & ADJUSTMENT REACTION TO SCHOOL PRESENTED BY, PUNAM BISWAS M.SC 1 ST YEAR

2. INTRODUCTION

3. DEFINITION Learning disorders (LD) refer to a significant deficit in learning due to a person's inability to interpret what is seen and heard, or to link information from different parts of the brain.

4. INCIDENCE Learning disabilities are present in approximately 5% of school-aged children globally In the Us, lifetime prevalence of 10%. In India, the prevalence of SLD is reported to vary from 3% to 10%

5. HISTORY 1937 1 ST Described dyslexia 1962 10 common features of learning problems 1950 Various approaches for dyslexia 1994 Learning disabilities is most expensive disorder

6. ETIOLOGY GENETIC FACTORS ANTENATAL FACTORS POSTNATAL FACTORS

7. CHARACTERISTICS OF LEARNING DISABILITIES

8. TYPES

9. Dyslexia Dyslexia is generally characterized by difficulties with the alphabets, word recognition, decoding, spelling and comprehension 1

10. fMRI studies have revealed hypoactivity in the left hemisphere of dyslexic patients  PATHOGENESIS:

11. Additional hypotheses include aberrations within the corticostriatal systems responsible for language and communication

12. SYMPTOMS OF DYSLEXIA

13. Word recognition

14. Decoding

15. Spelling

16. –Someone Famous “This is a quote, words full of wisdom that someone important said and can make the reader get inspired.”

17. MANAGEMENT OF DYSLEXIA Special teaching strategy Classroom modification Use of technology

18. Dyscalculia is a learning disorder that affects a person’s ability to understand number-based information and math 2 DYSCALCULIA

19. SYMPTOMS OF DYSCALCULIA

20. Young children Counting upward. Connecting a number to that many of an object. Organizing numbers, such as largest to smallest or first to last. Recognizing and using number lines. Learning using money (such as coins or bills).

21. School-age children Counting on fingers with small numbers Identifying small quantities of items just by looking Doing simple calculations from memory. Memorizing multiplication tables. Recognizing the same math problem when the order of the numbers or symbols Understanding word problems or more advanced symbols Organizing numbers by scale or decimal place.

22. Adolescent Counting backward. Breaking down problems into multiple steps to solve them. Measuring items & quantities Using money to pay for items, exchanging bills for coins (and vice versa) and making change. Understanding and converting fractions.

23. Emotional symptoms Anxiety or even panic. Agitation, anger or aggression School phobia Physical symptoms of any of the above ( nausea and vomiting ,  sweating ,  stomachache )

24. DYSCALCULIA Visual technique Use of memory aid Use of computer

25. DYSGRAPHIA 3 Dysgraphia is a neurological condition in which someone has difficulty turning their thoughts into written language for their age and ability to think, despite exposure to adequate instruction and education.

26. SYMPTOMS OF DYSGRAPHIA

27. Difficulties writing in a straight line. Difficulties with holding and controlling a writing tool. Having trouble recalling how letters are formed. Having trouble knowing when to use lower or upper case letters. Struggling to form written sentences with correct grammar Omitting words from sentences. Using verbs and pronouns incorrectly. SYMPTOMS OF DYSGRAPHIA

28. Writing letters in reverse

29. DYSGRAPHIA Teaching modification Use of technology Occupational therapy

30. DYSPRAXIA 4 Dyspraxia, also known as developmental coordination disorder is a chronic condition that begins in childhood that causes difficulties with motor skills and coordination.

31. Babies and toddlers Delays in reaching expected  developmental milestones  can be an early sign of dyspraxia in babies and toddlers eg. to roll over, sit, crawl or walk. Has difficulty playing with toys that involve good coordination, such as stacking cups. Has some difficulty learning to eat with spoons and forks.

32. Older children Difficulty with walking up and down stairs. Difficulty with balance Difficulty with sports and activities, A void participating in activities because of their lack of coordination. Difficulty with writing, drawing/coloring and using scissors compared to other children their age. Difficulty getting dressed, fastening buttons, brushing their teeth and tying shoelaces.

33. MANAGEMENT

34. DYSPRAXIA Quick learning therapy Occupational therapy

35. Other treatment Psychological counselling Behaviour management technique Social skill training

36. NURSING RESPONSIBILITY To achieve a comprehensive understanding of the diagnosis and its sequele To be aware of the law and available community services for children who have learning disabilities To promote coping strategies to deal with life stresses that may be by a learning disability To remain free of insults and injuries from the environment Identifying LD and making referral to appropriate services The pediatric nurse meet ambulatory children or those in hospital unit who are ill but also have a learning disability

37. CONT…. School nurses observe them in class room and collect observations for diagnosis and referral Mental health nurse may encounter such children and their families when they seek treatment for behavioral problems The community health nurse may identify them in their homes The child nurse is responsible for referring the family to appropriate community resources so that a diagnosis can be made and treatment planned Provide care during hospitalization Education and genuine support 

38. A Study On Learning Disabilities Among The Secondary School Pupils In North Costal Districts Of Andhra Pradesh Prof. R. Siva Prasadh 1 , Satya Murty. Burle2 1Honorary Professor, I.A.S.E., Department of Education, Andhra University, Visakh 1. Boys and Girls in Secondary Schools differed significantly in their Learning Disabilities (Dyscalculia, Dysgraphia, and Dyslexia). 2. Boys (Mean = 24.27) in secondary schools performed better in Dyscalculia than girls (Mean = 21.92 ) students of secondary schools. The results contradict the findings of the studies conducted by Ms Mrigakshi Sarma and Dr R.D. Padmavathy (2022), Narendra Singh Thagunna Sapana Change (2019), and Deeksha and Navleen Kaur (2016). 3. Secondary school students differed significantly in their learning Disabilities (Dyscalculia, Dysgraphia, and Dyslexia). 4. O.C category students differed significantly from their neighbor groups, i.e., B.C, S.C, and S.T in learning disabilities. 5. Learning Disabilities (Dyscalculia, Dysgraphia, and Dyslexia) found in S.T category students .

39. ADJUSTMENT REACTIONS TO SCHOOL

40. A school adjustment disorder is defined as problems in adapting to the school environment or to the role of being a student. According to Mathur (1999), children's abilities, skills, adjustment characteristics, and interpersonal environment underlie their school adjustment. DEFINITION

41. EPIDEMIOLOGY Male and female equal (APA) Depends upon population study OPD 5-25% IPD 50% Emergency 14%

42. RISK FACTORS Common stressors related to child Bullying Starting a new school Moving to a new home Common stressors related to parents Illness of parents Separation of parents Death of parents

43. ETIOLOGY

44. ETIOLOGY: Stress itself precipitatory factors Other is vulnerability of children (Benton and Lynch)

45. TOXIC STRESS Physical abuse Sexual abuse Domestic violence

46. TOLERABLE STRESS 1) Individual factors 2) Social factors

47. TYPES The DSM-5 recategorizes adjustment disorders as a “heterogeneous array of stress response syndromes that occur after exposure to a distressing (traumatic or nontraumatic) event” (APA, 2013).

48. Adjustment disorder with depressed mood Depressed mood Tearfulness Feelings of hopelessness 01

49. Adjustment disorder with Anxiety Nervousness Worry Jitteriness Fear of separation from major attachment figures 02.

50. Adjustment disorder with mixed anxiety and depressed mood A combination of symptoms from both of these conditions are present. 03.

51. Adjustment disorder with disturbance of conduct Violation of the rights of others Violation of society’s norms and rules (truancy, destruction of property, reckless driving or fighting) 04.

52. Adjustment disorder with mixed disturbance of emotions and conduct A combination of symptoms from all of the above subtypes is present (depressed mood, anxiety and conduct). 05.

53. Unspecified adjustment disorder Social withdrawal Inhibition to normally expected activities like school and work 06.

54. School phobia Fear of going to school was first called “school phobia” Approximately 2% to 5% of all school-aged children I t is more common in children ages 5 to 6 and 10 to 11 years of age

55. Symptoms Autonomic: Muscular, dizziness, abdominal pain, back pain, diaphoresis, joint pain, headaches, shakiness/trembling, palpitations, chest pains Gastrointestinal (GI): Nausea, vomiting, diarrhea Stressful life events: M oving or starting a new school, among others may trigger School Refusal. Other reasons: C hild’s fear a parent being harmed once they are in school or fear that they may not do well in school, or they may be afraid of another student.

56. CLINICAL DIAGNOSIS(DSM 5) A. The development of emotional or behavioral symptoms within 3 months of the onset of the stressor B. These symptoms or behaviors are clinically significant, 1. Marked distress 2. Significant impairment in social, occupational , or other important areas of functioning C. The stress related disturbance dose not meet the criteria for another mental D. The symptoms do no represent normal bereavement E. The symptoms do not persist for more than an additional 6 month

57. Treatment

58. Psychological approaches The treatment of choice for AD is interpersonal psychotherapy (IPT) It seeks to reduce or remove the stressor or improve coping ability

59. COMPONENT DESCRIPTION Psychoeducation Provide information about symptom treatment and management Behavioural activation Scheduling pleasant activities, such as exercise, time with friends Cognitive restructuring Identifying unrealistic thoughts and beliefs, examining evidence for and agains Problem solving Identifying problems; breaking down into component parts, developing solutions, evaluating effects Motivational interviewing Assessing readiness for change; facilitating movement to next stage of change behavior. Addressing ambivalence Cognitive behavioral therapy

60. Stress management Stress management is particularly beneficial in cases of high stress and helps the youth learn how to manage stress in a healthy way.

61. Group therapy Group therapy among of likeminded/afflicted individuals can help group members cope with various features of adjustment disorders.

62. Family therapy Family therapy is helpful for identifying needed changes within the family system. These changes may include improving communication skills and family interactions and increasing support among family members.

63. Medication Benzodiazepines (lorazepam or clorazepate) Selective serotonin reuptake inhibitors (SSRIs) or serotonin–norepinephrine reuptake inhibitors (SNRIs) Plant extracts (kava kava or valerian)

64. Kava and valerian are herbal remedies, claimed to have anxiolytic and sedative properties respectively, without dependence potential or any appreciable side-effects. In this pilot study, 24 patients suffering from stress-induced insomnia were treated for 6 weeks with kava 120 mg daily . This was followed by 2 weeks off treatment and then, 5 having dropped out , 19 received valerian 600mg daily for another 6 weeks. Stress was measured in three areas : social, personal and life-events ; insomnia in three areas also: time to fall asleep, hours slept and waking mood . Total stress severity was significantly relieved by both compounds (p 0.01) with no significant differences between them ; as was also insomnia (p 0.01). The proportion of patients with no side-effects was 58% with each drug respectively and the ‘ commonest’ effect was vivid dreams with valerian (16%), followed by dizziness with kava (12% ) .

65. Other services Service delivery through telehealth has emerged as an effective means of delivering both psychotherapy and psychiatric services, particularly in remote regions with significant provider shortages. The collaborative care model has been shown to be particularly well suited to this type of remote practice, simultaneously expanding the potential reach as well as the efficiency of these interventions

66. Guidelines for parents Parents must not be fobbed when the child express concern over schooling or not willing to attend classes anymore. Never threaten or forcibly drag the child to school Rewarding and praising might work for some time but parents must be cautious as the child tend to habituate to praising. There is no overnight wonder that treat the school phobia. Patience and the active participation is the key to manage anxiety Don't be afraid to go over the persons head you are currently dealing with. Never show your anger over petty issues, familial conflicts or because of workplace problems.

67. Guidelines for parents cont … Allow your child to talk about the stress in a supportive environment Eat a healthy diet Have a regular sleep routine Get regular physical activity Engage in a hobby, either alone or with family Offer support and understanding Reassure your child that his or her reactions are common Work with teachers to track progress at school Let your child make simple decisions, including dinner and movie choices

68. Pharmacotherapy of adjustment disorder: A review Pages S46-S52 | Received 22 May 2018, Accepted 20 Jun 2018, Published online: 11 Sep 2018 https://doi.org/10.1080/15622975.2018.1492736 Abstract Background:   Adjustment disorder has been reconceptualized as a trauma- and stressor-related condition, and there is a growing understanding of the psychobiology of stress responses. Against this context it is timely to review of the pharmacotherapy of adjustment disorder.

69. Methods:   A comprehensive electronic database ( Pubmed ) was searched for randomised controlled trials of the pharmacotherapy of adjustment disorder. Data from each trial were extracted and collated. Results:   To date there have been relatively few controlled trials in this area. Comparator trials provide limited support for a number of antidepressant agents, and a series of studies indicate that etifoxine is superior to buspirone and benzodiazepines for adjustment disorder with anxiety. Conclusions:   The work done has been useful insofar as it provides clinicians with some insights into the advantages and disadvantages of a number of pharmacotherapy options. Additional rigorously designed trials are needed to further advance the field.

70. Conclusion

71. Do you have any questions?

72. Thanks!