“BEHAVIOURS”
IN THE CLASSROOM
BRIDGING THE GAP
BETWEEN
TEACHER AND PAEDIATRICIAN
Dr. Aven Poynter
Financial Disclosures
None with respect to mental
health
OBJECTIVES
1. Recognize symptoms that warrant
referral/investigation
2. Learn what you can do to assist in
diagnosis
3. Review suggestions from medical
and mental health professionals to
support the child in the classroom
Diagnosis vs Label
Naming a Condition
• Helps understand
the feelings &
behaviours
• Helps find
treatment and
support
Labeling a Person
• You are an “ADHD”
person
• You will carry this
label forever
2 Traditional Approaches
to Mental Health
Problems in School
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Fix the school
Fix the kid
Dr. S. Kutcher
PARENT
TEACHER
CHILD
COMMUNITY
RECOURCES
DOCTOR
Do You Have a Pupil Who?
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Easily distracted
Developmental dysmaturity
Feels different
Doesn’t consider consequences
Doesn’t listen
Doesn’t follow through
Do You Have a Pupil Who?
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Difficulty organizing
Difficulty with transitions
Poor impulse control
Acts hyperactive
Sleep disturbance
Indiscriminately affectionate
Do You Have a Pupil Who?
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Lack of eye contact
Lies about the obvious
Won’t/can’t learn
Abnormal speech/incessant chatter
Wide mood swings
Problems with social interactions
Do You Have a Pupil Who?
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Over/under responsive to stimuli
Perseverates, inflexible
Escalates in response to stress
Poor problem solving
Difficulty seeing cause and effect
Difficulty initiating/following
through
Do You Have a Pupil Who?
• Manages time poorly, lack of
comprehension of time
• Speech/language processing
difficulties
• Loses temper
• Argues with adults, actively defies
• Blames others, resentful
15% of children and adolescents have a
mental health (psychiatric) disorder
Age at Diagnosis
14
12
10
8
6
4
2
0
Autism
ADHD
Anxiety
Depression
ADHD
Attention Deficit
Hyperactivity
Disorder
ADHD
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5 – 10% of children
Boys > Girls
Described 200 years ago!
A Neurobiological disorder
NOT
A Behavioural disorder
ADHD
Impairments in
• Executive function
• Working memory
• Processing speed
ADHD
• Combined Type
• Inattentive Type
• Hyperactive-Impulsive Type
ADHD
Inattentiveness
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Easily distracted
Difficulty concentrating for reasonable length of time
Fails to pay close attention to details, makes careless mistakes
Loses belongings
Difficulty organizing activities
Does not seem to be listening
Problems following instructions
Difficulty completing activities
Difficulty getting started, especially if a challenging activity
Often forgetful- forgets to write things down, forgets
routines
ADHD
Hyperactivity-Impulsivity
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Often squirmy, fidgety
Constantly moving and on the go
Makes a lot of noise
Interrupts
Blurts out answers to questions before hearing
the whole question
• Talks when supposed to be quiet
• Runs about and climbs when not appropriate
• Can’t wait in line, can’t await turn
ADHD
• Started before age 7 years
• Duration more than 6 months
• Difficulties in more than one place,
like both at school and at home
• Significantly impair the child
• Are not related to another disorder
• Video – brain chemistry
ADHD
POSITIVES
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Spontaneous
Creative
Social butterfly
Can multitask
Can think outside the box
Enthusiastic
Daring
ODD
Oppositional Defiant
Disorder
ODD
• Learned behaviour
• Interaction between child, parent,
environment
ODD
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Loses temper
Argues with adults
Defies/refuses adult requests
Defies rules
Deliberately annoys others
ODD
• Blames others for his mistakes or
misbehaviour
• Touchy or easily annoyed
• Angry and resentful
• Spiteful or vindictive
DCD
Developmental
Co-ordination
Disorder
DCD
• 5% of children
• Boys > Girls
• DCD is a prevalent yet underrecognized movement skill disorder
that significantly affects everyday
functioning
DCD
• Coordination difficulties affect child's
ability to perform everyday tasks
• A discrepancy is found between
intellectual capabilities and motor abilities
• DCD persists into adolescence and
adulthood
DCD
• DCD is commonly seen with other
developmental conditions including ADHD, LD,
speech/language disorders, and behavioural
disorders
• DCD may contribute to secondary emotional,
social and mental health problems
DCD
Has troubles with daily activities
• Putting on and taking off clothing
• Tying shoelaces
• Managing zippers, buttons and snaps
• Using eating utensils
• Cutting with scissors
• Catching a ball
DCD
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moves awkwardly
seems clumsy or poorly coordinated
frequently trips, or drops things
prints or writes poorly, and with
much effort
DCD
• avoids participation in physical or
motor-based activities
• has difficulty learning and
transferring new motor skills
DCD
• The motor-based activities of school are
challenging for children with DCD
• Teachers are in a unique position to
identify children with motor problems
• Boys tend to be identified more often than
girls, perhaps related to behavioural issues
• DCD remains an under-recognized disorder
DCD
Activity
• Ball skills
• Fine motor skills with workgloves on
LD
Learning Disabilities
Learning Disabilities
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“Learning Difference”
10% of population
15% of Canadians illiterate
42% of Canadians illiterate or
semi-literate
Learning Differences
• Dys – lexia
– Processing Language
• Affects reading, writing, spelling
Learning Differences
• Dys – calculia
– Math skills
• Computation
• Remembering math facts
• Concepts of time and money
Learning differences
• Dys – graphia
– Written expression
• Messy handwriting
• Poor spelling
• Can’t get thoughts onto paper
Learning Differences
• Auditory Processing Disorders
• Visual Processing Disorders
Learning Disabilities
• Discrepancy between intellect and
achievement
• Can often result in emotional,
behavioural and attentional problems
CAPD
Central Auditory
Processing Disorder
CAPD
• Normal hearing
• Can’t filter out irrelevant noise
• Difficulty understanding what s/he is
hearing
• Doesn’t seem to pay attention in the
classroom
ODD
ADHD
DCD
LD
How can you help sort
these out?
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Discuss concerns with student’s parent
Describe concerns and observations
Don’t mention a diagnosis
Recommend vision exam
Recommend hearing test
Recommend general medical exam
How can you help to sort
these out?
• Review school file
• Consider consulting
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Counsellor
Learning Assistance (Resource) Teacher
Speech & Language Therapist
Behaviour Resource Teacher
School Psychologist
Useful Information
for me
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Reports of above assessments
Brief narrative of your observations
All previous report cards for student
SNAP rating scale
Conners’ rating scale
Weiss rating scale
What I will ask of You
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**Psychoeducational Assessment**
Occupational Therapy Assessment
Speech & Language Assessment
IEP
Resource room block
FASD
Fetal Alcohol
Spectrum Disorder
ARND
Alcohol-Related
Neurodevelopmental Disorder
FASD
• First described 1968
• Prenatal alcohol exposure
• Constellation of physical and
neurodevelopmental abnormalities
• Diagnosis by multi-disciplinary team
• 1:100 but under-diagnosed
FASD
• A permanent brain injury
• We see the intellectual effects and
the BEHAVIOURAL effects
• http://www.fasdoutreach.ca/
FASD
• People with FASD can
“talk the talk but not walk the walk”
• We need to recognize that it is not
that the child with FASD won’t do it,
but can’t do it
FASD
Primary Disabilities
• Lower developmental age
• Speech and language problems
• Fine and gross motor difficulties
• Slow processing
• Memory problems -> confabulation
and ownership
FASD
Primary Disabilities
• Impulsivity
• Distractibility
• Poor abstract thinking
– Generalization
– Time, money, space
• Cause and effect
FASD
Secondary disabilities
• Mental health
• School problems -> drop out
• Inappropriate sexual behaviour
• Trouble with law
• Employment
FASD
Secondary Disabilities
• Substance abuse
• Housing
• More apparent with age
FASD
Many people with FASD have strengths
which mask their cognitive challenges.
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Highly verbal
Bright in some areas
Artistic, musical, mechanical, athletic
Friendly, outgoing, affectionate
Determined, persistent
Helpful
Generous
Good with younger children
ASD
Autism Spectrum
Disorder
ASD
Pervasive Developmental Disorders
• Autism Spectrum Disorder
• Asperger’s Disorder
• PDD Not Otherwise Specified
Prevalence changing – 1:150 to 1:100
ASD
• Leo Kanner – Autism – 1943
• Hans Asperger –Asperger’s – 1944
• “Disorders of Empathy”
ASD
1. Disturbance in social interaction
2. Impairments in communication
3. Restricted, repetitive and
stereotyped patterns of behaviour,
interests, and imaginative activities
AUTISM
Qualitative impairment in social interaction
• No use of noverbal behaviours such as eye
contact, facial expressions, gestures
• Failure to develop peer relationships
• Does not share enjoyment/interests,
• Lack of social/emotional reciprocity
AUTISM
Impairment in Communication
• Lack of spoken language, not
compensated by gesturing
• If has speech, inability to initiate or
sustain conversation
• Stereotyped, repetitive, or
idiosyncratic language
• Lack of spontaneous make-believe play
AUTISM
Restricted, repetitive, stereotyped
behaviour and interests
• Encompassing preoccupation
• Inflexible adherence to
nonfunctional routines or rituals
• Repetitive motor mannerisms
• Preoccupation with parts of objects
AUTISM
• Usually also mental retardation
• Sometimes special talents
• Cannot understand that other people
think and feel
• Results in extreme deficits in
empathy
• Sensory regulation disorders
ASPERGER’S DISORDER
• Qualitative impairment in social
interaction
• Restricted, repetitive, stereotyped
patterns of behaviour, interests and
activities
• Normal intellect
• No delay in early language acquisition
Asperger’s Disorder
• Seem highly intelligent
• Like a “little professor”
• Detailed knowledge about specific
topic of interest
• Relate better to adults
• Want friends, can’t make/be friends
Asperger’s disorder
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Concrete
Unusual use of language
Difficulty understanding metaphors
Difficulty understanding jokes
Difficulty reading facial expressions
Develop Anxiety
Tourette’s
Syndrome
Tourette’s Syndrome
• 1825 – described by Dr. Itard
• 1883 – described by Dr. George Gilles
de la Tourette
Tourette’s Syndrome
• Chronic motor and vocal tics
– Onset usually age 6 – 8 years
– Simple tics and complex tics
– Coprolalia is rare
Tourette’s Syndrome
• Often also have
– Obsessive-Compulsive Disorder
– ADHD
RDSP
Regulation Disorder of
Sensory Processing
RDSP
• Difficulties in areas of
– Sensory response
– Motor responses
– Behavioural responses
• Often see difficulties in
– sleep, eating, elimination
– Language
– Cognitive function
RDSP
• Hypersensitive subtype
– Over-reactive to touch, sound, smell,
taste, visual stimuli
– Fearful & cautious or negative/defiant
– May reject movement -> difficulty with
motor planning and play
RDSP
• Hyposensitive/Under-responsive
Subtype
– Under-reactive to sound, taste, smell,
touch, proprioception, visual stimuli
– Withdrawn
– Seek repetitive sensory patterns
– Decreased imaginative play
RDSP
• Sensory Stimulation seeking/impulsive
subtype
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Impulsive
Disorganized behaviour
Poor motor planning -> accident prone
Looks like ADHD, but earlier onset
Anxiety
Disorders
Anxiety Disorders
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Separation Anxiety Disorder
Obsessive Compulsive Disorder
Post-Traumatic Stress Disorder
Panic Disorder
Anxiety Disorders
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School avoidance
Tummy-aches & headaches
Inattentiveness
Hyperactive behaviour
Defiance
Crying
Anxiety
• May be primary
• Often co-exists with
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ADHD
DCD
LD’S
FASD
ASD
RDSP
Anxiety
Prevention
• FRIENDS program
Screening if you suspect
• SCARED
In the
Classroom
Classroom Environment
• Same for everyone
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Uncluttered
Not too noisy
Post schedule
Organize supplies
Study carrell
• Seat distractible students near you
Classroom Strategies
• Allow movement
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Errands
wiggle cushion
Squeeze ball
Arrange a cue with hyperactive child
Allow wandering
Classroom Strategies
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Quiet class before giving instructions
Visual and verbal together
Establish eye contact
One instruction at a time, allow time
to process before next instruction
Classroom Strategies
• Create predictable schedules and
routines for:
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transitions
turning in homework
asking for help
getting supplies or materials
Classroom Strategies
• Break assignments into small chunks
• Reduce number of questions –
sufficient to demonstrate knowledge
• Close support with agenda book and
organizing homework
• Provide pre-printed notes
Classroom Strategies
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Clear rules
Consider token system
Lots of short-term, achievable goals
Immediate feedback
Positive feedback for good behaviour
Positive feedback for successes
Warn ahead for transitions
Classroom Strategies
• Technology
– FM system
– Computer - keyboarding
- spellcheck
- voice software
Audiotapes
• Old-fashioned scribe
Classroom Strategies
• Consult OT when sensory issues
involved as therapy needs to be
individualized
• ABA is not for everyone with autism
Classroom Strategies
• PE – same team position for child
with problems with motor skills
• Capitalize on individual talents eg
music/dance
Modify the task
Alter your expectations
Teaching strategies
Change the environment
Help by understanding