Psychodiagnosis for Counselors: The DSM-IV. ERIC Digest

ERIC Identifier: ED366890 
Publication Date: 1994-04-00 
Author: Hinkle, J. Scott 
Source: ERIC Clearinghouse on Counseling and Student Services Greensboro NC. 

Psychodiagnosis for Counselors: The DSM-IV. ERIC Digest.

The profession of counseling is growing rapidly as reflected by the proliferation of professional community mental health counseling graduate programs. Graduates of these programs are providing counseling services in mental health centers, psychiatric hospitals, employee assistance programs, and various other community settings. At the foundation of effective mental health care is problem conceptualization and treatment planning which rely on the establishment of a valid diagnosis. This has caused an increase in the number of graduate community mental health counseling programs requiring course work in abnormal behavior, psychopathology, and psychodiagnosis. As a result, utilization of the "Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition" (DSM-IV) (APA) (1994) also has been dramatically increased in counselor education training. Skill in its use is undoubtedly necessary when assessing counseling clients seeking services in community mental health settings.

Utilization of the DSM-IV within the counseling profession is not, however, without controversy. Assigning a diagnosis to a client is uncomfortable for many counselors. The disadvantages associated with using the DSM have included the promotion of a mechanistic approach to mental disorder assessment, the false impression that the understanding of mental disorders is more advanced than is actually the case, and an excessive focus on the signs and symptoms of mental disorders to the exclusion of a more in-depth understanding of the client's problems including human development. Relatedly, Wakefield (1992) has recently argued that the DSM concept of "mental disorder" would better serve people if it were referred to as a "harmful dysfunction." He has based this on numerous citations that have suggested psychodiagnosis is used to control or stigmatize behavior that is actually more socially undesirable than disordered.

Conversely, advantages to implementing the DSM have included the development of a common language for discussing diagnoses, an increase in attention to behaviors, and facilitation of the overall learning of psychopathology. Seligman (1990) has indicated that knowledge of diagnosis is important for counselors so that they may provide a diagnosis for clients with insurance coverage and inform clients if their counseling will be covered by medical insurance. In addition, a DSM diagnosis assists with accountability and record keeping, treatment plan, communication with other helping professionals, and identification of clients with issues beyond areas of expertise.

MAJOR PSYCHODIAGNOSTIC FEATURES OF THE DSM-IV

According to the DSM-IV, mental disorders are conceptualized as clinically significant behavioral or psychological syndromes or patterns that occur in a "person" and are associated with "distress" (a painful symptom) or "disability" (impairment in one or more important areas of functioning) or with increased risk of suffering death, pain, disability, or an important loss of freedom. In addition, the syndrome or pattern must not be an expectable response to a particular event (APA, 1994).

Although the DSM system can be difficult to interpret for those with limited clinical experience or personal familiarity with mental disorders, it is relatively easy for experienced counselors to learn. Each DSM-IV contains specific diagnostic criteria, the essential features and clinical information associated with the disorder, as well as differential diagnostic considerations. Information concerning diagnostic and associated features, culture, age, and gender characteristics, prevalence, incidence, course and complications of the disorder, familial pattern, and differential diagnosis are included. Many diagnoses require symptom severity ratings (mild, moderate, or severe) and information about the current state of the problem (e.g., partial or full remission).

The DSM-IV contains fifteen categories of mental disorders. "Disorders Usually First Diagnosed in Infancy, Childhood or Adolescence" focuses on developmental disorders and other childhood difficulties. "Delirium, Dementia, Amnestic and Other Cognitive Disorders" include Alzheimer's conditions and Vascular Dementia. "Mental Disorders Due to a General Medical Condition" include anxiety and mood difficulties as well as personality change due to physical complications. "Substance Related Disorders" consist of drug and alcohol abuse and dependence. "Schizophrenia and Other Psychotic Disorders" are a continuum of difficulties that stress lack of contact with reality as well as Delusional Disorders. "Mood Disorders" and "Anxiety Disorders," including Major Depression and Posttraumatic Stress Disorder are featured diagnoses often used by counselors. "Somatoform Disorders, Factitious Disorders, Dissociative Disorders, Sexual and Gender Identity Disorders, Eating Disorders, Sleep Disorders, Impulse Control Disorders, Adjustment Disorders," and "Personality Disorders" are among the other diagnostic categories in the DSM-IV. In addition, several lesser disorders referred to as V Codes are included (e.g., Parent-Child Relational Problem, Partner Relational Problem, Bereavement, and Occupational Problem). Due to the V Codes' "minor status," they are typically not covered by third party payers.

THE MULTIAXIAL SYSTEM

Diagnoses in the DSM-IV are coded by the "multiaxial system" which incorporates five axes. All diagnoses except for Personality Disorders are coded on Axis I. Only Personality Disorders and Mental Retardation are coded on Axis II. Axis III is for physical disorders and conditions. Axes IV and V represent Severity of Psychosocial and Environmental Problems and Global Assessment of Functioning (GAF), respectively, and are used for treatment planning and prognosticating. For example, a full multiaxial diagnosis would be presented as:

AXIS I:

--309.00 Adjustment Disorder with Depressed Mood

--V61.12 Partner Relational Problem

AXIS II:

--799.90 Diagnosis deferred on Axis II

AXIS III: None

AXIS IV:

--Psychosocial stressors: change of jobs

--Severity: 3 - Moderate (acute circumstances)

AXIS V:

--Current GAF: 66

--Highest GAF Past Year: 80

When considering a DSM-IV diagnosis, the frequency, intensity, and duration of symptoms as well as premorbid functioning must be addressed.

SOCIOCULTURAL IMPLICATIONS

Professional counselors utilizing DSM-IV diagnoses yield sizeable power that can be interpreted as oppressive to some groups of people. Third party interests (i.e., insurance carriers) also may bring nonscientific values into the diagnostic process.

In accurate psychodiagnosis depends on ethnocultural and linguistic sensitivity (Malgady, Rogler & Constantino, 1987). Clients of lower socioeconomic class may experience, define, and manifest mental disorders differently from middle- and upper-class clients. Moreover, the DSM's lack of focus on the problematic features of a social context may be perpetuating the oppression of certain groups of people (e.g., women).

Gender and race of clinician also have been found to impact an accurate psychodiagnosis (Loring & Powell, 1988). Counselors using the DSM-IV will need to be keenly aware of the implications associated with its use as well as the impact a diagnosis may have on a client's treatment--within and outside of the counseling process.

In conclusion, the DSM-IV is not the only psychodiagnostic nomenclature in existence, but it is the most popular and is here to stay. Counselors have utilized it in a professional manner in the past, use the DSM-IV today, and will use the DSM-V in the future. An up-to-date understanding of this diagnostic system and its vast implications in counseling will be imperative to the effective and ethical delivery of professional community mental health counseling services.

RESOURCE DOCUMENTS

American Psychiatric Association. (1994). "Diagnostic and statistical manual of mental disorders" (4th ed.). Washington, DC: Author.

Loring, M. & Powell, B. (1988). Gender, race, and DSM-III: A study of the objectivity of psychiatric diagnostic behavior. "Journal of Health and Social Behavior," 29, 1-22.

Hinkle, J. S. (in press). The DSM-IV is coming: Prognosis and implications for mental health counselors. "Journal of Mental Health Counseling."

Malgady, R. G., Rogler, L. H., & Constantino, G. (1987). Ethnocultural and linguistic bias in mental health evaluation of Hispanics. "American Psychologist," 42, 228-234.

Pavkov, T. W., Lewis, D. A., & Lyons, J. S. (1989). Psychiatric diagnoses and racial bias: An empirical investigation. "Professional Psychology: Research and Practice," 20, 364-38.

Perry, S., Frances, A., & Clarkin, J. (1990). "A DSM-III-R casebook of treatment selection." New York: Brunner/Mazel.

Seligman, L. (1990). "Selecting effective treatments: A comprehensive systematic guide to treating adult mental disorders." San Francisco: Jossey-Bass.

Wakefield, J. C. (1992). The concept of mental disorder: On the boundary between biological facts and social values. "American Psychologist," 47, 373-388. 

Auditory Processing Disorders: An Overview

ERIC Identifier: ED474303 
Publication Date: 2002-12-00 
Author: Ciocci, Sandra R. 
Source: ERIC Clearinghouse on Disabilities and Gifted Education Arlington VA. 

Auditory Processing Disorders: An Overview. ERIC Digest.

Children who have difficulty using information they hear in academic and social situations may have central auditory processing disorder (CAPD), more recently termed auditory processing disorder (APD). These children typically can hear information but have difficulty attending to, storing, locating, retrieving, and/or clarifying that information to make it useful for academic and social purposes (Katz & Wilde, 1994). This can have a negative impact on both language acquisition and academic performance.

WHAT IS CENTRAL AUDITORY PROCESSING?

When the ears detect sound, the auditory stimulus travels through the structures of the ears, or the peripheral auditory system, to the central auditory nervous system that extends from the brain stem to the temporal lobes of the cerebral cortex. The auditory stimulus travels along the neural pathways where it is "processed," allowing the listener to determine the direction from which the sound comes, identify the type of sound, separate the sound from background noise, and interpret the sound. The listener builds upon what is heard by storing, retrieving, or clarifying the auditory information to make it functionally useful.

WHAT IS A DISORDER OF AUDITORY PROCESSING?

APD is an impaired ability to attend to, discriminate, remember, recognize, or comprehend information presented auditorily in individuals who typically exhibit normal intelligence and normal hearing (Keith, 1995). This definition has been expanded to include the effects that peripheral hearing loss may contribute to auditory processing deficits (Jerger & Musiek, 2000). Auditory processing difficulties become more pronounced in challenging listening situations, such as noisy backgrounds or poor acoustic environments, great distances from the speaker, speakers with fast speaking rates, or speakers with foreign accents (Sloan, 1998).

WHAT ARE THE BEHAVIORS OF CHILDREN WITH APD?

Children who have auditory processing disorders may behave as if they have a hearing loss. While not all children present all behaviors, Keith (1995) offers the following examples of behaviors that may be displayed by children who have APD:

* Inconsistent response to speech

* Frequent requests for repetition (What? Huh?)

* Difficulty listening or paying attention in noisy environments

* Often misunderstanding what is said

* Difficulty following long directions

* Poor memory for information presented verbally

* Difficulty discerning direction from which sound is coming

* History of middle ear infection.

WHAT ARE ACADEMIC CHARACTERISTICS OF CHILDREN WHO HAVE APD?

In addition to the preceding behaviors, children may also present a variety of academic characteristics that may lead teachers and parents to suspect APD. Baran (1998) offers the following characteristics. Again, all children will not present all characteristics.

* Poor expressive and receptive language abilities

* Poor reading, writing, and spelling

* Poor phonics and speech sound discrimination

* Difficulty taking notes

* Difficulty learning foreign languages

* Weak short-term memory

* Behavioral, psychological, and/or social problems resulting from poor language and academic skills.

HOW IS APD DIAGNOSED?

Given the complexity of auditory processing disorders, it is important to involve a multidisciplinary team including psychologists, physicians, teachers, parents, and of course, audiologists and speech-language pathologists. Audiologists diagnose the presence of APD (hearing and processing problems), and speech-language pathologists evaluate a child's perception of speech and receptive- expressive language use. Other team members conduct additional assessments to determine a child's educational strengths and weaknesses. Checklists that ask teachers and parents to observe the child's auditory behaviors may be used to determine a need for the APD evaluation. The parent's description of the child's auditory behavior at home is an especially important contribution to the diagnosis of APD.

WHAT DOES THE AUDIOLOGIST DO?

The audiologist assesses the peripheral and central auditory systems using a battery of tests, which may include both electrophysiological and behavioral tests. Peripheral hearing tests determine if the child has a hearing loss and, if so, the degree to which the loss is a factor in the child's learning problems. Assessment of the central auditory system evaluates the child's ability to respond under different conditions of auditory signal distortion and competition. It is based on the assumption that a child with an intact auditory system can tolerate mild distortions of speech and still understand it, while a child with APD will encounter difficulty when the auditory system is stressed by signal distortion and competing messages (Keith, 1995). The test results allow the audiologist to identify strengths and weaknesses in the child's auditory system that can be used to develop educational and remedial intervention strategies.

HOW SHOULD TEST RESULTS BE INTERPRETED?

As with any kind of evaluation, test results should be interpreted with caution. The effects of neurological maturation may influence test results for children under the age of 12 years. A true diagnosis of APD cannot be determined until that time (Bellis, 1996). However, there are much younger children whose auditory behaviors, language, and academic characteristics indicate that APD is a strong possibility, and even without a formal diagnosis, these children would benefit from intervention. Remediation should address their strengths and areas of need based on available speech-language and psychoeducational testing.

IS THERE A RELATIONSHIP BETWEEN APD AND ADHD?

The behaviors of children with APD and ADHD may be very similar, especially with regard to distractibility. Given what is presently known, APD and ADHD do not appear to be a single developmental disorder. Each can occur independently, or they can coexist. This is a prime example of where the team approach to evaluation is critical, as the team can rule out the presence of ADHD or determine its contribution to the potential educational impact on the child.

WHAT CAN BE DONE TO HELP CHILDREN WITH APD IN THE CLASSROOM?

Traditional educational and therapeutic approaches can be employed to remediate areas of need in language, reading, and writing. Many techniques that have shown to be effective with children with APD would be beneficial to all children, with and without APD, if the strategies employed are specific to the child's areas of need (Bellis, 1996; Chermak & Musiek, 1997; Sloan, 1998). Some of these are described below:

* Modify the environment by reducing background noise and enhancing the speech signal to improve access to auditory information:

- Eliminate or reduce sources of noise in the classroom (air vent, street traffic, playground, hallway, furniture noises, etc.).

- Use assistive listening devices (ALDs) such as a sound field amplification system or an FM auditory trainer.

- Allow preferential or roving seating to ensure that the child is seated as close to the speaker possible.

- Allow the child to use a tape recorder and/or a peer note taker.

- Ensure that the speaker gets the child's attention before speaking, and considers using a slower speaking rate, repeating directions, allowing time for the child to respond to questions, pausing to allow the child to catch up, and presenting information in a visual format through overheads, illustrations, and print.

* Teach the child to use compensatory strategies, "meta" strategies, or executive functions to teach how to listen actively. The child should:

- Learn to identify and resolve difficult listening situations.

- Develop skills to understand the demands of listening: attending, memory, identifying important parts of the message, self-monitoring, clarifying, and problem solving.

- Develop memory techniques: verbal rehearsal (reauditorization), mnemonics (chunking, cueing, chaining).

- Encourage use of external organizational aids: checklist, notebook, calendar, etc.

- Develop vocabulary, syntax, and pragmatic skills to facilitate language comprehension.

* Provide auditory training to remediate specific auditory deficits:

- Children who have poor reading, writing, and spelling skills may benefit from phonological awareness activities.

- Auditory closure activities may assist children in filling in or predicting the information they are listening to in the classroom and conversations.

- Instruction in interpreting intonation, speaking rate, or vocal intensity, and in the relationship between syllable and word may assist children in determining important parts of the message.

- When the child has demonstrated success on the above tasks in a quiet environment, give the child practice engaging in the same tasks in an environment that includes background noise.

- Explore the use of commercially available computer programs designed to develop the child's attention to the phonological aspects of speech. These should be recommended by a professional who can determine their applicability to the child's needs.

RESOURCES

American Speech-Language-Hearing Association. Task Force on Central Auditory Processing Disorders. (1995). Central auditory processing: Current status of research and implications for clinical practice. Rockville, MD: Author.

Baran, J. A. (1998). Management of adolescents and adults with central auditory processing disorders. In Masters, M. G., Stecker, N. A., & Katz, J. (Eds.). Central auditory processing disorders: Mostly management. Needham Heights, MA: Allyn and Bacon, 195-214.

Bellis, T. J. (1996). Assessment and management of central auditory processing disorders in the educational setting: From science to practice. San Diego, CA: Singular Publishing Group, Inc.

Chermak, G. D. & Musiek, F. E. (1997). Central auditory processing disorders: New perspectives. San Diego, CA: Singular Publishing Group, Inc.

Jerger, J. & Musiek, F. E. (2000). Report on the consensus conference on the diagnosis of auditory processing disorders in school-aged children. Journal of the American Academy of Audiology, 11, 467-474.

Katz, J. & Wilde, L. (1994). Auditory processing disorders. In Katz, J. (Ed).Handbook of clinical audiology. (4th edition.). Baltimore, MD: Williams and Wilkins, (4th ed.). 490-502.

Keith, R. W. (1995). Tests of central auditory processing. In Roeser, R. J. & Downs, M. P. (Eds.). Auditory disorders in school children. New York, NY: Thieme Medical Publishers, Inc., 101-116.

Sloan, C. (1998). Management of auditory processing difficulties: A perspective from speech-language pathology. Seminars in Hearing, 19, 367-398.

Diagnosing Communication Disorders in Culturally and Linguistically Diverse Students

ERIC Identifier:  ED482343
Publication Date: 2003-10-00
Author: Crowley, Catherine J.
Source: ERIC Clearinghouse on Disabilities and Gifted Education

Diagnosing Communication Disorders in Culturally and Linguistically Diverse Students. ERIC Digest.

The disproportionate referral of bilingual and culturally diverse students to special education and related services is a pressing challenge in public school systems. Not only are unnecessary services a drain on resources, but they are harmful to children, taking them away from the classroom and inevitably stigmatizing them. In addition, an incorrect diagnosis may mean that a child does not receive the services he or she does need.

Accurate assessment of culturally and linguistically diverse students is difficult in any area. Assessing the speech and language skills of these students is even more challenging. The evaluator must make the crucial differential diagnosis between a communication disorder and something else. This "something else" could have a cultural basis, such as a mismatch between demands of school and home, or a linguistic basis, such as evidence of the normal process of second language acquisition or speaking a non-standard dialect of English. This digest describes the current preferred practice in the assessment of communication disorders in culturally and linguistically diverse students.

What qualifies as a communication disorder?

For any student, communication skills are disordered if they deviate sufficiently from the norms and expectations of the student's speech community.

The challenge with culturally and linguistically diverse students is that many of the traditional assessment tools and benchmarks are not based upon their speech communities. Instead, they generally are based upon the "mainstream" or "standard" dialect of American English, known as "Standard American English" (SAE). (This dialect is often identified as the one spoken by newscasters or in educational settings.) While it is critical that students acquire this dialect, evaluators cannot identify students with a communication disorder because they speak a different dialect.

Why not use test scores to identify a communication disorder?

The limitations of speech and language tests in accurately discriminating typical and impaired language speakers of SAE are widely known (McCauley & Swisher, 1984). So, before reporting any test scores, the evaluator analyzes the test's quality and applicability. To do this, the evaluator considers:

• Construct validity. How accurate is the test in distinguishing typically developing students from students with communication disorders?
• Content validity. Do the test items make sense?
• Normative sample. Did significant numbers of the subjects used to norm the test have similar linguistic and cultural backgrounds as the student being evaluated?
• Reliability. Are the test results consistent for a student even if the test is given again or given by a different evaluator?

An analysis of the quality and applicability of currently available tests reveals that none meets acceptable standards (McCauley & Swisher, 1984). The use of scores derived from such tests causes inaccurate identification of students with communication disorders, which has "serious" "social consequences" (Plante & Vance, 1994, p. 21).

With English language learners, the use of translated versions of speech and language tests pose even greater problems. For example, many translations provide word-for-word translations which do not account for a lack of equivalent linguistic forms in the second language. Additionally, translated tests do not consider the effects of second language acquisition on a student's performance. As a result, scores from these translated versions should not be used to diagnose a communication disorder.

How does the evaluator determine whether a student has a communication disorder?

Before deciding whether a communication disorder exists, the evaluator first accumulates a good deal of information about the student's communication skills. The evaluator approaches this phase as both an anthropologist and a detective. Critical information includes:

• Comprehensive data concerning the student's significant current and past exposure to particular languages and dialects, and consideration of the student's proficiencies in those languages and dialects.
• Data about the student's speech and language skills in a number of settings and covering different types of language, such as social language and more demanding uses such as for comparison, synthesis, and problem solving. This can be gathered by direct observation and elicitation, by interviewing people who can provide that information, and by reviewing historical information on the student's speech and language skills.
• Parent/long-time caregiver reports (this may be the most valuable information) including:
  • Developmental history and significant medical history;
  • Information on the parent's education and;
  • The parent's judgment as to:
    1. how the student's speech and language development compares to his/her siblings at the same age, or to the student's peers in his/her speech community;
    2. whether there is a history of speech-language problems in the student's family and/or;
    3. whether there is a history of academic problems in the student's family (Dale, 1996; Restrepo, 1998).
• Teacher interviews and portfolio reviews on overall school performance, both currently and historically.
• Tasks designed to probe particular areas of speech and language, whether using standardized or nonstandardized tools, including:
  • Grammatical development compared to the norms of the student's speech community;
  • Ability to comprehend and integrate information the student hears and reads in his/her school and community;
  • Ability to organize and integrate ideas and information so the student can express himself/herself when participating in classroom discussions and in written work;
  • Development of curriculum-based language skills such as phonological awareness, language-based memory skills, vocabulary development, and language-based literacy and math skills.
• Information on the student's ability to learn, generally elicited through dynamic assessment methods, to aid in determining whether the student's incorrect response was due to a lack of prior exposure to the test's task requirement or content, or a true communication disorder.

How does the evaluator analyze the information?

After all the critical information is gathered, the evaluator analyzes a number of factors to determine whether any apparent difficulties are due to a true communication disorder or to something else-such as a communication difference or a lack of prior exposure. To make this differential diagnosis, the evaluator applies available research on the norms of a student's speech community. Often the research is limited. The evaluator applies his/her own knowledge base, and may enlist the help of someone who knows the student's linguistic and cultural background and who can, with proper training, provide valuable information on these critical factors:

• Sociolinguistics. The evaluator considers how social and cultural factors might have influenced the quality and quantity of information gathered. For example, a student might be reticent to talk 1) with an adult she/he does not know, 2) about something the student is not interested in, or 3) in an unfamiliar setting. The evaluator also considers how the particular information-gathering tasks might be culturally unfamiliar to the student. Depending on the student's speech community, examples of unfamiliar tasks might include tasks requiring that the student 1) answer questions that the evaluator already knows the answers for; 2) tell stories if the student did not have experience telling or hearing stories; or 3) label objects when that is not commonly done at home (Heath, 1982).
• Prior educational experiences. The evaluator distinguishes between the effect of poor educational experiences and a true communication disorder. Substandard school instruction may impact many aspects including the fund of general knowledge, vocabulary skills, problem solving skills, literacy skills, and, of course, success in meeting curriculum standards.
• Linguistics. The evaluator adjusts his/her linguistic criteria based upon characteristics of second language learning; amount and quality of exposure to various dialects the student produces; and variations as to when certain developmental benchmarks are met in different languages and dialects. This linguistic knowledge also enables the evaluator to distinguish an accent from an articulation or phonological delay.

In the end, the evaluator analyzes the data to determine

• whether the student has a communication disorder, and
• if so, the level of severity of that disorder.

The written report contains sufficient information, including quoting and describing actual speech and language performance data, to enable a reader to understand how the evaluator forms his/her clinical judgment, based upon an analysis of all the accumulated information.

Terminology

Culturally diverse: Describes an individual or group that is exposed to, and/or immersed in, more than one set of cultural beliefs, values, and attitudes.

Dialect: Describes a variety of a language. Dialects are seen as applicable to all languages and all speakers. All languages are analyzed into a range of dialects, which reflect the regional and social background of their speakers.

Linguistically diverse: Describes an individual or group that is exposed to, and/or immersed in, more than one language or dialect.

Speech community: A group of people who share at least one speech variety in common. Members of bilingual/bidialectal communities often have access to more than one speech variety. The selection of the specific variety depends upon such variables as the participants, the topic, the function, and the location of the speech event.

References

Dale, P. (1996). Parent report assessment of language and communication. In K. Cole, P. Dale and D. Thal (Eds.), Assessment of Communication and Language. Baltimore: Paul H. Brooks.

ERIC Clearinghouse on Disabilities and Gifted Education. (2000). Assessment of Culturally and Linguistically Diverse Students for Special Education Eligibility (ERIC EC Digest #E604). Arlington, VA: Author.

Heath, S.B. (1982). What no bedtime story means: Narrative skills at home and school. Language in Society (Vol. II). New York: Cambridge, pp. 49-6.

McCauley, R.J. & Swisher, L. (1984). Psychometric review of language and articulation tests for preschool children. Journal of Speech and Hearing Disorders, 49, 34-42.

Plante, E. & Vance, R. (1994). Selection of preschool language tests: A data-based approach. Language, Speech, and Hearing Services in Schools, 25, 15-24.

Restrepo, M.A. (1998). Identifiers of Predominantly Spanish-Speaking Children with Language Impairment, Journal of Speech, Language and Hearing Research , 1398-1411.

Children with Communication Disorders

ERIC Identifier: ED321504 
Publication Date: 1990-00-00 
Author: 
Source: ERIC Clearinghouse on Handicapped and Gifted Children Reston VA. Children with Communication Disorders. ERIC Digest #E470 (Revised #419). 

The term COMMUNICATION DISORDERS encompasses a wide variety of problems in language, speech, and hearing. Speech and language impairments include articulation problems, voice disorders, fluency problems (such as stuttering), aphasia (difficulty in using words, usually as a result of a brain injury), and delays in speech and/or language. Speech and language delays may be due to many factors, including environmental factors or hearing loss. 

Hearing impairments include partial hearing and deafness. Deafness may be defined as a loss sufficient to make auditory communication difficult or impossible without amplification. There are four types of hearing loss. Conductive hearing losses are caused by diseases or obstructions in the outer or middle ear and can usually be helped with a hearing aid. Sensorineural losses result from damage to the sensory hair cells of the inner ear or the nerves that supply it and may not respond to the use of a hearing aid. Mixed hearing losses are those in which the problem occurs both in the outer or middle ear and in the inner ear. A central hearing loss results from damage to the nerves or brain. 

Many communication disorders result from other conditions such as learning disabilities, cerebral palsy, mental retardation, or cleft lip or cleft palate. 

HOW MANY CHILDREN HAVE COMMUNICATION DISORDERS?

The overall estimate for speech and language disorders is widely agreed to be 5% of school-aged children. This figure includes voice disorders (3%) and stuttering (1%). The incidence of elementary school children who exhibit delayed phonological (articulation) development is 2% to 3%, although the percentage decreases steadily with age. 

Estimates of hearing impairments vary considerably, with one widely accepted figure of 5% representing the portion of school-aged children with hearing levels outside the normal range. Of this number, 10% to 20% require some type of special education. Approximately one-third of students who are deaf attend residential schools. Two-thirds attend day programs in schools for students who are deaf or day classes located in regular schools. The remainder are mainstreamed into regular school programs. 

WHAT ARE SOME CHARACTERISTICS OF CHILDREN WITH COMMUNICATION DISORDERS?

A child with speech or language delays may present a variety of characteristics including the inability to follow directions, slow and incomprehensible speech, and pronounced difficulties in syntax and articulation. SYNTAX refers to the order of words in a sentence, and ARTICULATION refers to the manner in which sounds are formed. Articulation disorders are characterized by the substitution of one sound for another or the omission or distortion of certain sounds. 

Stuttering or dysfluency is a disorder of speech flow that most often appears between the ages of 3 and 4 years and may progress from a sporadic to a chronic problem. Stuttering may spontaneously disappear by early adolescence, but speech and language therapy should be considered. 

Typical voice disorders include hoarseness, breathiness, or sudden breaks in loudness or pitch. Voice disorders are frequently combined with other speech problems to form a complex communication disorder. 

A child with a possible hearing problem may appear to strain to hear, ask to have questions repeated before giving the right answer, demonstrate speech inaccuracies (especially dropping the beginnings and endings of words), or exhibit confusion during discussion. Detection and diagnosis of hearing impairment have become very sophisticated. It is possible to detect the presence of hearing loss and evaluate its severity in a newborn child. 

Students who speak dialects different from standard English may have communication problems that represent either language differences or, in more severe instances, language disorders. 

WHAT ARE THE EDUCATIONAL IMPLICATIONS OF COMMUNICATION DISORDERS?

Many speech problems are developmental rather than physiological, and as such they respond to remedial instruction. Language experiences are central to a young child's development. In the past, children with communication disorders were routinely removed from the regular class for individual speech and language therapy. This is still the case in severe instances, but the trend is toward keeping the child in the mainstream as much as possible. In order to accomplish this goal, teamwork among the teacher, speech and language therapist, audiologist, and parents is essential. Speech improvement and correction are blended into the regular classroom curriculum and the child's natural environment. 

Amplification may be extremely valuable for the child with a hearing impairment. Students whose hearing is not completely restored by hearing aids or other means of amplification have unique communication needs. Children who are deaf are not automatically exposed to the enormous amounts of language stimulation experienced by hearing children in their early years. For deaf children, early, consistent, and conscious use of visible communication modes such as sign language, finger spelling, and cued speech and/or amplification and aural/oral training can help reduce this language delay. Some educators advocate a strict oral approach in which the child is required to use as much speech as possible, while others favor the use of sign language and finger spelling combined with speech, an approach known as TOTAL COMMUNICATION. There is increasing consensus that whatever system works best for the individual should be used. 

Many children with hearing impairments can be served in the regular classroom with support services. In addition to amplification, instructional aids such as captioned films and high interest/low vocabulary reading materials are helpful. For most children with hearing impairments, language acquisition and development are significantly delayed, sometimes leading to an erroneously low estimate of intelligence. 

Students whose physical problems are so severe that they interfere with or completely inhibit communication can frequently take advantage of technological advances that allow the individual to make his or her needs and wants known, perhaps for the first time. 

ADDITIONAL READING

Adams, J. W. (1988). You and Your Hearing-Impaired Child: A Self-Instructional Guide for Parents. Washington, DC: Gallaudet University Press. 

Freeman, R. D., Carbin, C. F., & Boese, R. J. (1981). Can't Your Child Hear? A Guide for Those Who Care about Deaf Children. Baltimore: University Park Press. 

Grant, J. (1987). The Hearing Impaired: Birth to Six. Boston: Little, Brown. 

Hixon, T. J., Shribers, L. D., & Saxman, J. H. (Eds.). (1980). Introduction to Communication Disorders. Englewood Cliffs, NJ: Prentice-Hall. 

King, R. R. & Sommers, R. K. (1986). Talking Tots: Normal and Impaired Communication Development of Preschool Children. Danville, IL: Interstate Printers and Publishers. 

Luterman, D. (1987). Deafness in the Family. Boston: Little, Brown. 

Miller, A. L. (1980). Hearing Loss, Hearing Aids, and Your Child. Springfield, IL: Charles C Thomas. 

Moores, D. F. (1987). Educating the Deaf: Psychology, Principles, and Practices (3rd ed.). Boston: Houghton Mifflin. 

National Information Center on Deafness, & National Association of the Deaf. (1987). Deafness: A Fact Sheet. Washington, DC: Author. 

Ogden, P., & Lipsett, A. (1982). The Silent Garden: Understanding the Hearing Impaired Child. New York: St. Martin's. 

Oyer, H. J., Crowe, B., & Haas, W. H. (1987). Speech, Language, and Hearing Disorders: A Guide for the Teacher. Boston: Little, Brown. 

Schwartz, S. (Ed.). (1987). Choices in Deafness: A Parent;s Guide. Rockville, MD: Woodbine House. 

Van Hattum, R. J. (Ed.). (1980). Communication Disorders. AN Introduction. New York: Macmillan. 

Children and Post Traumatic Stress Disorder: What Classroom Teachers Should Know

ERIC Identifier: ED460122 
Publication Date: 2001-09-00 
Author: Grosse, Susan J. 
Source: ERIC Clearinghouse on Teaching and Teacher Education Washington DC., ERIC Clearinghouse on Counseling and Student Services Greensboro NC. 

Children and Post Traumatic Stress Disorder: What Classroom Teachers Should Know. ERIC Digest.

Post traumatic stress disorder: development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (APA, 1996).

School children may be exposed to trauma in their personal lives or, increasingly, at school. Classroom teachers can help prepare children to cope with trauma by understanding the nature of trauma, teaching children skills for responding to an emergency, and learning how to mitigate the after-effects of trauma.

PTSD RELATED TRAUMA

By the very unexpected nature of trauma, one can never totally prepare for it. And because each individual responds differently to emotional upset, it is impossible to predict trauma after-effects. Under certain circumstances, trauma can induce Post Traumatic Stress Disorder (PTSD). Unrecognized/untreated PTSD can have a lifelong negative impact on the affected individual. Teachers, who spend up to eight hours each day with the children in their charge, can influence the outcome of a child's response to trauma stress by creating an environment in which PTSD is less likely to develop to the point of life impact.

Not all emotionally upsetting experiences will cause PTSD. Trauma sufficient to induce PTSD has specific characteristics and circumstances, including situations

* perceived as life-threatening,

* outside the scope of a child's life experiences,

* not daily, ordinary, normal events,

* during which the child experiences a complete loss of control of the outcome, and

* when death is observed.

Disasters, violence, and accidents are just some of the experiences that can lead to PTSD. Preparing children for trauma involves giving them skills and knowledge to survive the experience and emerge with as little potential as possible for developing PTSD.

SKILLS TO SURVIVE TRAUMATIC EXPERIENCES

Survival skills for traumatic experiences are essentially emergency action plans.Carrying out emergency action plans not only helps a child retain some personal control, but increases the potential for a healthy outcome. Children must know how to:

* Follow directions in any emergency (i.e., stay in their classroom during a lock down)

* Get help in any type of emergency (i.e., dial 911 or call a neighbor)

* Mitigate specific emergencies (i.e., take shelter during a tornado)

* Report the circumstances (i.e., tell an adult if a stranger approaches them or touches them)

* Say "no" and mean it (i.e., firmly shouting "no, don't touch me").

Implementing survival skills requires knowing right and wrong. Children must know or be able to recognize:

* Appropriate vs. inappropriate touching (i.e., shoulder vs. genitals).

* Appropriate vs. inappropriate information sharing (i.e., who is at home at what times).

* Presence of appropriate vs. inappropriate people (i.e., the teacher on playground duty vs. a prowling stranger).

SKILLS TO MITIGATE PTSD

While there is no predictability in who will develop PTSD, it is possible to take steps to prepare children ahead of time and by doing so, lessen the PTSD potential. Children need to be taught lessons about trauma. Learning about people who have experienced trauma and gone on to live healthy lives gives children role models and hope for their own future.

During a traumatic experience, children will survive better if they have a structure to follow and can maintain some sense of control. Learning the survival skills will aid in maintaining this control. Children need accurate and specific information about their immediate safety, about what has happened and about what will happen to them next (James, 1989). Knowledge helps them control their thoughts and feelings.

Following a trauma, debriefing is critical. Children will vary concerning their willingness and readiness to talk about their experiences. Some will play out the event, while others may be more comfortable writing or drawing about the event. What is important is the opportunity to communicate. There are different avenues for the child to communicate, including online discussion forums for children (Sleek, 1998).

A child's initial debriefing should be child-centered and nonjudgmental. The adult should recognize that each child did his or her best, no matter what the outcome, and refrain from offering advice. Adults should recognize that no two children will have the same thoughts, feelings, or opinions. All expressions about the trauma are acceptable.

Following a trauma, it is also important to help a child reestablish control. Reviewing survival skills and drills and planning for "next time" reestablishes strength. Allowing a child to make choices reestablishes their governance over their own lives.

IDENTIFYING PTSD

Everyone reacts to trauma. What differentiates normal reaction from PTSD is the timing of the reaction, its intensity, and the duration of the reaction. Trauma includes emotional as well as physical experiences and injury. Even second-hand exposure to violence can be traumatic. For this reason, all children and adolescents exposed to violence or disaster, even if only through graphic media reports, should be watched for signs of emotional distress (National Institute of Mental Health, 2000).

Symptoms lasting more than one month post trauma may indicate a problem. Specific symptoms to look for include:

* Re-experiencing the event (flashbacks),

* Avoidance of reminders of the event,

* Increased sleep disturbances, and

* Continual thought pattern interruptions focusing on the event.

In children, symptoms may vary with age. Separation anxiety, clinging behavior, or reluctance to return to school may be evident, as may behavior disturbances or problems with concentration. Children may have self doubts, evidenced by comments about body confusion, self-worth, and a desire for withdrawal. As there is no clear demarcation between adolescence and adulthood, adult PTSD symptoms may also evidence themselves in adolescents. These may include recurrent distressing thoughts, sleep disturbances, flashbacks, restricted range of affect, detachment, psychogenic amnesia, increased arousal and hypersensitivity, and increased irritability and outbursts or rage.

HELPING THE CHILD

Making the diagnosis of PTSD requires evaluation by a trained mental health professional. However, regular classroom teachers have a major role in the identification and referral process. Children often express themselves through play. Because the teacher sees the child for many hours of the day including play time, the teacher may be the first to suspect all is not well. Where the traumatic event is known, caregivers can watch for PTSD symptoms. However, traumatic events can involve secrets. Sexual abuse, for example, may take place privately. Sensitive teachers should monitor all children for changes in behavior that may signal a traumatic experience or a flashback to a prior traumatic experience.

Teachers can help a child suspected of post traumatic stress disorder by: * Gently discouraging reliance on avoidance; letting the child know it is all right to discuss the incident;

* Talking understandingly with the child about their feelings;

* Understanding that children react differently according to age - young children tend to cling, adolescents withdraw;

* Encouraging a return to normal activities;

* Helping restore the child's sense of control of his or her life; and

* Seeking professional help.

Professional assistance is most important since PTSD can have a lifelong impact on a child. Symptoms can lie dormant for decades and resurface many years later during exposure to a similar circumstance. It is only by recognition and treatment of PTSD that trauma victims can hope to move past the impact of the trauma and lead healthy lives. Thus, referral to trained mental health professionals is critical. The school psychologist is a vital resource, and guidance counselors can be an important link in the mental health resource chain.

Although professional assistance is ultimately essential in cases of PTSD, classroom teachers must deal with the immediate daily impact. Becoming an informed teacher isthe first step in helping traumatized children avoid the life long consequences of PTSD.

REFERENCES

American Psychiatric Association. (1996). Diagnostic and statistical manual of mental disorders IV. Washington, DC. American Psychiatric Association.

James, B. (1989). Treating traumatized children: new insights and creative interventions. Lexington, MA: D.C. Heath.

National Institute of Mental Health (2000). Helping children and adolescents cope with violence and disasters. Washington, DC: NIMH. Available online at http://www.nimh.nih.gov/publicat/violence.cfm

Sleek, S. (1998). After the storm, children play out fears. APA Monitor, 29(6). Available online at http://www.apa.org/monitor/jun98/child.html.

RESOURCES AVAILABLE FROM ERIC

These resources have been abstracted and are in the ERIC database. Journal articles (EJ) should be available at most research libraries; most documents (ED) are available in microfiche collections at more than 900 locations. Documents can also be ordered through the ERIC Document Reproduction Service (800-443-ERIC).

Demaree, M.A. (1995). Creating safe environments for children with post-traumatic stress disorder. Dimensions of Early Childhood, 23(3), 31-33, 40. EJ 501 997.

Demaree, M.A. (1994). Responding to violence in their lives: Creating nurturing environments for children with post-traumatic stress disorder (conference paper). ED 378 708.

Dennis, B.L. (1994). Chronic violence: A silent actor in the classroom. ED 376 386.

Karcher, D.R. (1994). Post-traumatic stress disorder in children as a result of violence: A review of current literature (doctoral research paper). ED 379 822.

Motta, R.W. (1994). Identification of characteristics and causes of childhood posttraumatic stress disorder. Psychology in the Schools, 31(1), 49-56. EJ 480 780.

Richards, T., & Bates, C. (1997). Recognizing posttraumatic stress in children. Journal of School Health, 67(10), 441-443. EJ 561 961.

OTHER RESOURCES

American Academy of Child and Adolescent Psychiatry, 3615 Wisconsin Avenue, NW, Washington, DC, 20016-3007, 202-966-7300, http://www.aacap.org

American Psychiatric Association, 1400 K Street, NW, Washington, DC 20005, 202-682-6000; http://www.psych.org

American Psychological Association, 750 First Street, NE, Washington, DC 20002, 202-336-5500, http://www.apa.org

Anxiety Disorders Association of America (ADAA), 11900 Parklawn Drive, Suite 100, Rockville, MD 20852, 301-231-9350; http://www.adaa.org

Disaster Stuff for Kids, http://www.jmu.edu/psychologydept/4kids.htm

Federal Emergency Management Agency http://www.fema.gov/kids

International Society for Traumatic Stress Studies (ISTSS), 60 Revere Drive, Suite 500, Northbrook, IL 60062, http://www.istss.org

National Center for Kids Overcoming Crisis, (includes Healing Magazine online) 1-800-8KID-123, http://www.kidspeace.org/facts

National Center for PTSD, 215 N. Main Street, White River Junction, VT 05009; 802-296-5132; http://www.ncptsd.or

National Center for Post-Traumatic Stress Disorder of the Department of Veterans Affairs http://www.ncptsd.org/

National Institute for Mental Health (NIMH) 6001 Executive Boulevard, Rm 8184, MSC 9663, Bethesda, MD 20892-9663; 301-4513, Hotline 1-88-88-ANXIETY, http://www.nimh.nih.gov

Adults with Attention Deficit Hyperactivity Disorder (ADHD)

Adults with Attention Deficit Hyperactivity Disorder (ADHD). ERIC Digest. by Wasserstein, Jeanette - Wasserstein, Adella - Wolf, Lorraine E. Attention deficit hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder affecting 3-10% of children that often remains unrecognized or "hidden" in adulthood. Although ADHD was once thought to disappear as children grew up, data suggest that one to two thirds of children with ADHD continue to have significant symptoms throughout life (Wender, Wasserstein, & Wolf, 2001). Adult prevalence estimates vary widely. Conservatively, 1-6% of adults are believed to meet formal diagnostic criteria. The core symptoms of ADHD-hyperactivity, inattention, and impulsivity-change as the child grows older. Research suggests that hyperactivity declines with age, attentional problems remain fairly constant, and executive function problems increase in adulthood. Coexisting psychiatric conditions, learning disabilities, and social difficulties are common. The persistence of ADHD into adulthood first became apparent in the 1970's, but is only recently becoming more generally known in the adult mental health field (Wender, Wolf, and Wasserstein, 2001). MBD, HYPERACTIVITY, ADD, ADHD, AND LD: HOW DO THEY RELATE? While there is agreement that ADHD occurs in adults, the terminology and our understanding of its underlying pathology are still emerging. The names and criteria for this syndrome have changed frequently over time, reflecting shifts in prevailing thinking about key symptoms or underlying mechanisms (see Wender et al., 2001, for review). Originally designated as "minimal brain dysfunction" (MBD), the terms "hyperactivity" and/or "hyperkinesis" were used in the 1960's, "attention deficit disorder (or ADD), with or without hyperactivity" in the 1980's, and finally "attention deficit hyperactivity disorder" (or ADHD) currently. These changes in terms reflect changes in thinking away from a focus on structural brain damage (e.g., MBD) toward a focus on symptoms or behavior, such as excessive activity and inattention. The terminology is likely to continue to change as we further develop our understanding of what we have come to call "ADHD." The shift away from the original MBD label also signaled an emerging recognition of the difference between disorders of behavior (i.e., in activity level or attention) and specific disorders of learning (i.e., learning disabilities such as dyslexia, dyscalculia or dysgraphia). These cognitive and behavioral problems often coexist, but are now believed to be based on different genetic clusters and mechanisms (Farone et al., 1993). SYMPTOMS OF ADHD The American Psychiatric Association (1994) recognizes three types of ADHD: ADHD Predominantly Hyperactive Impulsive Type, characterized by motor and impulse control problems; ADHD Predominantly Inattentive Type, problems in attention or arousal; and ADHD Combined Type, significant problems in both areas. It is still unclear whether these subtypes reflect a common neuropathology or whether they represent distinct disorders (Faraone, Biederman & Friedman, 2000). It has also been argued that these categories, which were created primarily for children, may not apply equally for adults (Wolf & Wasserstein, 2001). Children with ADHD are often overactive, impulsive, and inattentive. In order to be diagnosed in adulthood, it is essential that some level of these core symptoms were present during childhood. Over activity generally decreases by adolescence and is often replaced by fidgetiness and/or cognitive restlessness. More recently, researchers are focusing on self-regulation (i.e., problems with executive functions), rather than attention or activity level as the main deficit in ADHD (e.g., Barkley, 1997). Associated features in both children and adults may include moodiness, poor social relationships with peers, and a variety of different learning problems. Other psychiatric conditions are often also present, clouding the picture (e.g., see Marks, Newcorn & Halpern, 2001 for review). WHAT ARE THE PERTINENT ADULT PROBLEMS? * Substance abuse, antisocial behavior, and even criminality are among the better-known problems of some adults with ADHD (Hechtman, Weiss, & Perlman, 1984). However, these issues are hardly universal, and may be more likely in some groups of patients. Poor social skills or deficits in self-awareness are also frequent. * When unrecognized, and therefore untreated, ADHD occurs along with other psychiatric conditions, it can contribute to the failure of medication and psychotherapy. This is because the "comorbid," or coexisting, conditions are then the only focus of treatment (Ratey, Greenberg, Bemporad, & Lindem, 1992). * Problems with independent adaptive functioning are among the most common complaints of adults who have ADHD and seek therapy (Silver, 2000). For example, they may have difficulty finding and keeping jobs, trouble maintaining routine and organization, and problems with self-discipline. In contrast, behavior control issues are the more usual complaints in children with ADHD. The difference between children and adults may reflect the fact that parents, teachers, and society can provide external forms of regulation for children, but cannot fulfill that role for adults. Additionally, the tasks of adulthood generally require more self-regulation, thereby making deficits in this area more apparent. Problems with social skills and adaptive functions can be very stressful to relationships. Adults with ADHD may thus have a greater likelihood of family violence, divorce, and multiple marriages. RECOGNIZING ADHD IN ADULTS There are two main groups of adults with ADHD: (1) those who were diagnosed as children and still have symptoms, and (2) those who were never diagnosed. The second group may be more likely to include females. When looking at childhood symptoms, it is important to consider that a highly organized home life can mitigate the expression of ADHD symptoms. Pronounced difficulties may only emerge during higher education, or even later in the work world, when environmental demands become more complex. Often there is also a strong family history of ADHD, learning disabilities, or both. There is no definitive diagnostic test for ADHD, although standardized ADHD scales are extremely helpful in understanding current (and past) symptoms. Examining for comorbid psychiatric conditions and ruling out alternative psychiatric problems that can resemble ADHD (such as depression or anxiety disorders) is essential. The goal of assessment is to understand the individual's unique pattern of strengths and weaknesses in order to design appropriate interventions (whether medical, psychosocial, or remedial). Fear of stigma, shame, and denial can interfere with seeking help. TREATMENT As is the case for children, the best treatment involves both drug and psychosocial interventions. Among drugs, stimulant medications, such as Ritalin, are usually tried first. Individuals who do not respond to stimulants, or who have comorbid substance abuse problems or depression, may be treated with antidepressants. Generally, medications are better at addressing inattention and hyperactivity than impulsivity. Comorbid illness, if present, affects the choice of drugs. Psychosocial treatment is also key. These interventions typically involve (1) psychotherapy addressing how the ADHD affects the person's life (relationships and functioning), and (2) education about the disorder. Technologies helpful for ADHD include structured external supports like day planners, computers, and coaching, as well as some specialized forms of cognitive remediation (see Wasserstein, Wolf & Lefever, 2001, Part V; Nadeau, 1997). ADHD IN ADULT EDUCATION AND EMPLOYMENT Adults with ADHD often face their biggest challenges in higher education and later in the work world. Executive and planning abilities are extremely challenged in the young person with ADHD who is making the transition from the structured environments of high school and home to an unstructured life at college. Similarly, working adults need to create multiple layers of structure at work, and they must manage to integrate work demands with competing personal responsibilities. In other words, adults need to plan and execute their own internal structure, which is especially difficult for those with ADHD. Poor time management, chronic lateness, and difficulties completing paperwork and meeting deadlines are exceedingly common work-related problems of adults with ADHD. Some students and/or employees with ADHD may be eligible for supports and/or accommodations. Students and employees who are disabled by ADHD may be covered under Section 504 of the Rehabilitation Act and the Americans with Disabilities Act in school and work settings. These laws prohibit discrimination on the basis of disability and guarantee equal access to programs and facilities. All adults with ADHD and clinicians evaluating them should become familiar with these statutes in order to evaluate their need, and eligibility, for services (Wolf, 2001). REFERENCES American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.) Washington, DC: American Psychiatric Association.  Barkley, R.A. (1997). ADHD and the nature of self-control. New York: Guilford. Faraone, S.V., Biederman, J., & Friedman, D. (2000). Validity of DSM-IV subtypes of attention-deficit/hyperactivity disorder: A family study perspective. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 300-307. Faraone, S.V., Biederman, J., Lehman, B.K., Keenan, K., Norman, D., Seidman, L.J., Kolodny, R., Kraus, I., Perrin, J., & Chen, W.J. (1993). Evidence for independent familial transmission of attention deficit hyperactivity disorder and learning disabilities: Result from a family genetic study. American Journal of Psychiatry, 150, 891-895. Hechtman, L, Weiss, G., & Perlman, T. (1984). Hyperactives as young adults: Past and current substance abuse and antisocial behavior. American Journal of Orthopsychiatry, 54, 415-425. Marks, D.J., Newcorn, J.H., & Halpern, J.M. (2001). Comorbidity in adults with attention deficit/hyperactivity disorder. Annals of the New York Academy of Sciences, 931, 216-238. Nadeau, K. (1997). Adventures in Fast Forward. New York: Brunner/Mazel. Ratey, J., Greenberg, S., Bemporad., J.R., & Lindem, K. (1992). Unrecognized attention-deficit hyperactivity disorder in adults presenting for outpatient psychotherapy. Journal of Child and Adolescent Psychopharmacology, 4, 267-275. Silver, L. (2000). Attention deficit/hyperactivity in adult lives. Child & Adolescent Psychiatric Clinics of North America, 9, 511-523. Wasserstein, J., Wolf, L.E., & LeFever, F. (Eds.) (2001). Attention deficit disorder: Brain mechanisms and life outcomes. New York: The New York Academy of Sciences. Wender, P.H., Wolf, L.E., & Wasserstein, J. (2001). Adults with ADHD. An overview. Annals of the New York Academy of Sciences, 931, 1-16. Wolf, L.E. (2001). College students with ADHD and other hidden disabilities. Annals of the New York Academy of Sciences, 931, 385-395. Wolf, L.E. & Wasserstein, J. (2001). Adult ADHD: concluding thoughts. Annals of the New York Academy of Sciences, 931, 396-408.

Autism and Autism Spectrum Disorder (ASD)

ERIC Identifier: ED436068 
Publication Date: 1999-10-00 
Author: Dunlap, Glen - Bunton-Pierce, Mary-Kay 
Source: ERIC Clearinghouse on Disabilities and Gifted Education Reston VA. 

Autism and Autism Spectrum Disorder (ASD). ERIC Digest #E583.

Autism is a developmental disability that affects a person's ability to communicate, understand language, play, and interact with others. Autism is a behavioral syndrome, which means that its definition is based on patterns of behaviors that a person exhibits. Autism is not an illness or a disease. It is not contagious and, as far as we know, it is not acquired through contact with the environment. Autism is a neurological disability that is presumed to be present from birth and is always apparent before the age of three. Although autism affects the functioning of the brain, the specific cause of autism is unknown. In fact, it is widely assumed that there are most likely multiple causes, each of which may be manifested in different forms, or subtypes, of autism. Future research will help us understand the etiologies of autism.

Autism Spectrum Disorder (ASD) is an increasingly popular term that refers to a broad definition of autism including the classical form of the disorder as well as closely related disabilities that share many of the core characteristics. ASD includes the following diagnoses and classifications: (1) Pervasive Developmental Disorder-Not Otherwise Specified (PDD-NOS), which refers to a collection of features that resemble autism but may not be as severe or extensive; (2) Rett's syndrome, which affects girls and is a genetic disorder with hard neurological signs, including seizures, that become more apparent with age; (3) Asperger syndrome, which refers to individuals with autistic characteristics but relatively intact language abilities, and; (4) Childhood Disintegrative Disorder, which refers to children whose development appears normal for the first few years, but then regresses with the loss of speech and other skills until the characteristics of autism are conspicuous. Although the classical form of autism can be readily distinguished from other forms of ASD, the terms autism and ASD are often used interchangeably.

Individuals with autism and ASD vary widely in ability and personality. Individuals can exhibit severe mental retardation or be extremely gifted in their intellectual and academic accomplishments. While many individuals prefer isolation and tend to withdraw from social contact, others show high levels of affection and enjoyment in social situations. Some people with autism appear lethargic and slow to respond, but others are very active and seem to interact constantly with preferred aspects of their environment.

BEHAVIORAL DESCRIPTION

Individuals with autism are characterized primarily by developmental difficulties in verbal and nonverbal communication, social relatedness, and leisure and play activities. All individuals with autism experience substantial problems with social interactions. In addition, people with autism often exhibit unusual, repetitive, and perseverative movements (including stereotyped and self-stimulatory behaviors), resistance to changes in routines and in other features of their environments, apparent oversensitivity or undersensitivity to specific kinds of stimulation, and extreme tantrums, aggression or other forms of acting out behavior. It is also observed that individuals with autism have uneven patterns of skill development. Some people display superior abilities in particular areas (such as music, mechanics, and arithmetic calculations), while other areas show significant delay.

DIAGNOSIS AND EVALUATION

The principal source for diagnosing autism is the Diagnostic and Statistical Manual of the American Psychiatric Association, Fourth Edition (DSM-IV,1994). Although children affected by autism are being identified at earlier ages than was the case previously, the diagnosis usually does not occur until sometime between two and three years of age. Diagnosticians are often reluctant to issue a formal diagnosis before the age at which complex language is expected to emerge. However, early intervention services can still be provided on the basis of developmental delay, even without a formal diagnosis of autism.

A diagnosis of autism is often provided by developmental pediatricians, psychologists, child psychiatrists, or neurologists. At the time of (or prior to) diagnosis, a comprehensive evaluation is typically arranged. Such an evaluation usually includes a neurological examination, tests for biochemical abnormalities, and other assessments designed to rule out physical and diagnostic conditions. A battery of developmental and educational evaluations is also conducted to help develop an appropriate early intervention plan. Family involvement is integral to this entire process.

PREVALENCE

In 1997, the Centers for Disease Control and Prevention (1999) estimated that a broad definition of autism may be present in as many as one person out of every 500. This estimate suggests that there are roughly 500,000 people in the United States who could be described as having autism or autism spectrum disorder.

It is well established that autism occurs in four times as many boys as girls (NICHCY, 1999) and that there are no known racial, social, economic, or cultural distinctions. Although it is possible that there are some genetic linkages with some forms of autism, there are no associations with particular familial or cultural histories or practices. Earlier theories that implicated parents' behavior in the occurrence of autism have been thoroughly discredited.

There have been occasional speculations about clusters of autism in some areas of the country, and it has been suggested that such clusters may be associated with environmental contaminants or regional medical practices. To date, however, there have been no clear data that support these speculations.

APPROACHES TO INTERVENTION AND EDUCATIONAL SUPPORT

Since autism was first identified as a syndrome more than 50 years ago, a variety of intervention strategies have been suggested. These interventions and treatments have risen from a range of theoretical positions, but most have not proven to be effective with large numbers of children. This pattern continues today, with a large number of diverse treatment approaches being touted as uniquely effective in resolving patterns of autistic behavior. For the most part, such claims have not been substantiated in controlled research. The message for families, teachers, and other consumers is to be cautious when considering new, grandiose testimonials, and to be very thoughtful and selective when constructing plans for intervention and support.

Even though autism has attracted an array of spurious treatments, a good deal of real progress has occurred, and some very credible approaches have been demonstrated repeatedly to be effective in improving the behaviors and adaptability of people with autism. Interventions that are derived from an educational and behavioral orientation have been shown to help children and adults affected by autism, primarily by teaching new skills that enable the person to function more successfully in the daily world of home, school, work, and community interactions. Years of research and experience have produced some relevant guidelines for providing instruction and intervention for individuals with autism. For example, it is important that interventions be developed on an individualized basis. The label of autism by itself is not prescriptive. It does not indicate what intervention should be provided or how intervention should be provided.

As a set of general rules, it is widely agreed that people with autism respond better in a context where there is structure and clear guidelines regarding expectations for appropriate and inappropriate behavior. It is also recommended that the environment include systems or materials, such as written or picture schedules, that can help the person to comprehend and predict the flow and sequence of activities. The focus of intervention and instructional efforts should be to develop functional skills that will be of immediate and ongoing value in the context of daily living. This typically includes strategies for enhancing a person's ability to communicate, to understand language, and to get along socially in complex home, school, work, and community settings.

Another important guideline for intervention pertains to family involvement. To the greatest extent possible, family members should be encouraged to participate in all aspects of assessment, curriculum planning, instruction, and monitoring. Parents and other family members very often have the most useful information about an individual's history and learning characteristics, so effective intervention and instruction should take advantage of this vital resource. Furthermore, because families are so essential in the lives of people with autism, family support that helps strengthen the family system is regarded as a vital element in providing effective intervention for people with autism.

REFERENCES

American Psychiatric Association. (1994).(4th ed.). Diagnostic and statistical manual of mental disorders. Washington, DC: Author.

Centers for Disease Control. (1999). Autism among children. (On-line). Available: fact sheet at http:www.cdc.gov/nceh/programs/cddh/dautism.htm.

National Information Center for Children and Youth with Disabilities.( 1999). Autism and pervasive developmental disorder. (Fact Sheet Number 1). Available from NICHCY, PO Box 1492, Washington, DC 20013. 1-800-695-0285. Also available online at http://www.nichcy.org/pubs/factshe/fs1txt.htm.

Readings and Resources on Autism, ERIC Minibibliography No. E13.

delapan hal penyebab susah tidur

REPUBLIKA.CO.ID, Ketika gangguan tidur terjadi lebih dari satu bulan, ada baiknya Anda mulai memerhatikan sejumlah faktor pemicu. Berikut adalah beberapa hal yang mungkin saja menyebabkan Anda menjadi 'manusia kelelawar' belakangan ini.

Sakit
Dalam satu studi terungkap bahwa dari sekitar 15 persen orang yang menderita penyakit kronis, setidaknya dua per tiga dari mereka dilaporkan mengalami kesulitan tidur. Sakit punggung, sakit kepala, dan masalah pada persendian menjadi penyebab utama sulit tidur.

Stres dan masalah mental
Insomnia adalah paduan dari gejala dan akibat dari depresi dan kegelisahan. Karena otak menggunakan 'sinyal' serupa untuk mengatur jadwal tidur dan emosi, sangat sulit untuk menentukan mana yang harus dimunculkan lebih dulu. Situasi atau kejadian yang membuat stres, seperti masalah uang atau perkawinan, sangat ampuh untuk memicu insomnia. Bahkan, bisa jadi masalah ini akan berkepanjangan.

Mengorok
Dalam sejumlah kasus, mengorok merupakan gejala dari sleep apnea, kelainan yang dikaitkan dengan penyakit jantung, tekanan darah tinggi, dan stroke.

Jet lag
Melintasi zona waktu bisa mengacaukan jam biologis ini. Jam inilah yang memerintahkan otak Anda tidur ketika gelap dan terbangun saat terang. Tubuh Anda baru dapat menyesuaikan dengan satu perubahan dalam tiga hari. Bila Anda kerap melintasi berbagai zona waktu, jet lag dapat menyebabkan masalah tidur.

Perubahan jam kerja
Jam kerja yang berlawanan dengan jam tidur normal. Orang yang kerap berpindah jam kerja mengalami penurunan level serotonin, hormon dan saraf pengirim yang terdapat dalam sistem saraf pusat yang membantu mengatur tidur.

Perubahan hormon
Menstruasi, menopause, dan kehamilan merupakan sumber utama masalah tidur pada perempuan. Ruam panas, masalah payudara, atau sering buang air kecil juga mengganggu pola tidur teratur. Menurut sebuah lembaga yang menangani masalah tidur, sekitar 40 persen yang mengalami masa transisi menjelang menopause kerap mengalami masalah tidur.

Masalah kesehatan
Kesulitan tidur juga dapat terkait dengan kondisi medis. Dengan penyakit paru-paru atau asma, misalnya, sesak napas dan bersin tentu saja bisa mengganggu tidur. Apalagi, bila ini terjadi saat dini hari. Bila Anda mengalami penyakit jantung, bisa saja Anda punya pola bernapas yang tidak normal. Parkinson dan penyakit saraf lain juga mencuatkan insomnia sebagai efek samping.

Obat-obatan
Obat, yang bebas atau dengan resep dokter, bisa mengganggu pola tidur. Terlebih bila Anda mengonsumsinya menjelang waktu tidur atau dosisnya berlebihan.

sumber redaksi : http://id.she.yahoo.com/susah-tidur-delapan-hal-inilah-penyebabnya-2-071419032.html

Berapa kali Anda bertekad bangun lebih pagi tapi tak pernah bisa menghindari dari godaan tombol "Snooze" di jam alarm? Niat saja tak cukup untuk membuat angan-angan bangun pagi jadi kenyataan. Kita juga perlu menyertainya dengan sejumlah usaha yang bisa membuat kita mau tak mau harus bangun juga. Berikut beberapa cara yang mungkin bisa membantu. 1. Tidur efektif Semua juga tahu kalau ingin bangun lebih pagi kita sebaiknya tidur lebih awal. Tapi percuma saja tidur selama delapan jam jika tidur kita tidak efektif. Jika posisi tidur tak nyaman, bantal terlalu tinggi, atau suhu kamar terlalu dingin, kita akan terbangun berkali-kali di tengah malam, dan tubuh pun merasa kita belum mendapat cukup istirahat. 2. Hindari kopi, red wine, dan cokelat sebelum tidur Penelitian menunjukkan tiga jenis makanan dan minuman ini adalah yang paling berpotensi mengganggu tidur. Mengonsumsinya di malam hari bisa membuat perut Anda bergejolak di malam hari dan tidur pun tak nyaman. 3. Buka tirai jendela kamar Begitu matahari terbit, sinarnya akan masuk ke kamar dan membantu Anda terbangun. 4. Geser rutinitas Anda jadi lebih pagi Jika biasanya Anda memulai aktivitas sehari-hari jam 8 pagi, tambahkan beberapa aktivitas tambahan yang dilakukan di jam 7 pagi. Misalnya jogging, berenang di kolam belakang kompleks, memasak sarapan sendiri, menulis untuk blog, atau apa pun aktivitas yang Anda senangi. Lakukan secara rutin setiap hari hingga jadi bagian gaya hidup Anda. 5. Gunakan 2 alarm Anda biasa menyimpan jam alarm (atau menggunakan alarm ponsel) di samping tempat tidur? Silakan. Tapi pasang juga satu alarm lain, kalau bisa yang bunyinya lebih kencang, di tempat yang berjarak minimal 5 langkah dari tempat tidur. Mau tak mau Anda harus bangun untuk mematikannya. Tapi setelah itu jangan tidur lagi, ya. 6. Simpan segelas air di samping tempat tidur Begitu alarm berbunyi, duduklah di tempat tidur dan minum segelas air yang sudah disediakan. Sampai habis. Ini berguna untuk membuat tubuh Anda siap beraktivitas dan tak ingin kembali tidur. 7. "Jump out of bed" Istilah dalam bahasa Inggris ini bisa diartikan secara harfiah. Setelah mematikan alarm, langsung bangkit dan "melompat" turun, lalu jauhi tempat tidur. 8. Pikirkan hal menarik yang akan terjadi hari ini Sebelum memutuskan untuk tidur lagi, pikirkan rencana kegiatan yang akan Anda jalani hari ini. Jika Anda bangun lebih pagi, tentunya akan ada lebih banyak waktu untuk bersiap-siap, memilih busana terbaik, menata rambut, dan berdandan dengan lebih maksimal. Menyenangkan, bukan? 9. Jadikan kebiasaan Oke, Anda sudah berhasil bangun lebih pagi dari Senin hingga Jumat. Weekend bisa bangun jam 10 lagi, dong? Jangan salah. Tubuh bekerja menyesuaikan dengan jadwal yang sudah jadi kebiasaan. Jika Anda sudah membiasakan diri selama seminggu untuk bangun pagi, seterusnya tubuh Anda akan terbangun sendiri di jam yang sama. Namun jika rutinitas itu dirusak (tiba-tiba Anda kembali bangun siang selama 3 hari), tubuh pun akan mengikuti jadwal yang baru. 10. Pikirkan risikonya Setiap Anda berpikir, "Tidur lagi deh, 15 menit lagi," ingatlah bahwa rata-rata manusia menghabiskan sepertiga hidupnya untuk tidur. Jadi jika Anda diberi usia hingga 70 tahun, Anda akan menghabiskan lebih dari 20 tahunnya untuk tidur. Jadi, lupakan tidur 15 menit lagi. Anda masih punya banyak waktu untuk tidur besok-besok. Sumber redaksi : http://id.she.yahoo.com/10-cara-agar-berhasil-bangun-lebih-pagi.html

Delapan Tanda Pria Playboy

TRIBUNNEWS.COM - Tidak ada wanita yang ingin memiliki kekasih playboy. Tapi masih banyak yang tidak menyadari kalau dia sedang memacari pria playboy. Sebelum terlanjur cinta, kenali dulu karakternya. Bisa jadi, pria yang dekat dengan Anda sekarang juga termasuk tipe player. Dilansir dari Girl Ask Guy dan dikutip Terselubung blogspot.com, berikut delapan tandanya. 1. Menghubungi Setelah Pukul 11 dan 12 Malam Ada 24 jam setiap harinya, jika pria menyukai Anda, dia akan memilih waktu yang tepat untuk menanyakan kabar Anda. Setelah pukul 11 dan 12 malam merupakan jam 'iseng' pria. Jika ia menelepon di jam-jam tersebut berarti dia tidak ingin serius dengan Anda, dia hanya sedang mencoba menggoda Anda di waktu luangnya. 2. Memiliki Banyak Teman Wanita Waspadalah ketika pria memiliki banyak teman wanita dibanding pria. Tipikal pria playboy dapat dekat dengan beberapa wanita dalam satu waktu. Jadi jika si dia sering menerima telepon dari wanita, Anda harus lebih waspada padanya. 3. Pintar Merangkai Kata Mengapa wanita sulit untuk menolak jeratan si playboy? Karena dia pandai berbicara dan merayu. Dia tahu apa yang harus dibicarakan ketika Anda sedang marah, kesal atau sedih. Dia pun akan membuat Anda merasa istimewa dan setiap kata-katanya mencerminkan dia pria yang baik. Pada saat ini, sesungguhnya dia sedang menipu Anda dan mengontrol emosi Anda. 4. Berbicara Banyak Tentang Fisik Anda Wanita mana yang tidak senang akan pujian. Namun ketika dia lebih banyak memuji bagian tubuh Anda, maka berhati-hatilah. Dia menginginkan hubungan yang lebih dan sedang mencoba mempermainkan Anda. 5. Bersikap Berbeda di Depan Teman-teman Prianya Ketika berada di depan teman-temannya, pria tipe player akan lebih banyak memberi pelukan dan sentuhan fisik kepada wanitanya. Jangan bangga dulu, ini bukan lah ungkapan sayangnya, tapi sekedar ingin menunjukkan kepada teman-teman prianya 'ini mangsa baruku'. 6. Sangat Percaya Diri Si player memiliki tingkat kepercayaan diri yang tinggi. Bagaimana tidak, dia merasa dapat menaklukan gadis-gadis yang diinginkan.Lebih dari itu, mereka dapat menjerat dua hingga tiga gadis sekaligus dalam satu waktu. Itulah yang membuat playboy semakin percaya diri. 7. Tidak Tertarik dengan Hidup Anda Ketika dia bertanya tentang hari-hari Anda, belum tentu dia benar-benar mempedulikannya. Mereka membuat seolah peduli, pada kenyataannya tidak. Mereka melakukan ini semua untuk mendapatkan sesuatu. Ketika seorang wanita telah mempercayainya, maka dengan mudah dia akan mendapatkan keinginannya. 8. Menghindari Pergi Bersama Anda Tentu si player ingin bermain mulus dengan para wanitanya. Sehingga ia memilih menghindari pergi keluar bersama Anda. Tapi ada juga tipe player yang sangat lihai. Bisa jadi, sebelum pergi bersama Anda, dia akan meminta izin ke wanita lainnya kalau ia akan pergi bersama sepupu atau adik perempuannya. Taktik ini dilakukannya untuk membuatnya lebih aman jika bertemu dengan seseorang.