Learning Disabilities And Special Needs Populations Flashcards
Parks 3 step purpose
Isolate the single muscle responsible for a vertical deviation
Parks 3 step and multiple muscles
Not helpful if there are multiple muscles involved
Parks 3 step questions
- Which eye is highest in primary position
- Is the hyper worse when looking to the L or R
- Is the hyper worse with left or right head tilt (Bielchoswkys head tilt test)
Assessment of ocular alignemtn
Hirschberg/Krimsky, amblyoscope, bruckner, 4 BO test
EF assessment
Visuoscopy, haidinger brushs, maxwell spot
ARC assessment
After image test, bagolini lenses
Sensory status assessment
W4D, stereopsis
Allows for gross determination of ocular alignemtn
Hirschberg
Administration of hirschberg
Hold light 50cm-observes corneal reflex of each eye compared to pupillary axis
Nasal displacement in hirschberg
Exotropia; temporal displacement-esotropia
Upward displacement on hirschberg
Hypotropia; downward displacement-hypertropia
Angle lambda
Angle between the pupillary axis (center of pupil) and line of sight (through fovea)
What os the abiltiy to recall visually presented materials and to manipulate these images
Visualization
In what order should you treat visual analysis dysfunction
Visual discrimination FG Visual closure Visual memory Visualization
How would you explain to the parent that the child exhibits difficulty with executive function
Tested with CCT
Difficulty planning out, sequencing, and executing actions
Learning disabilities and objectives of OD treatment
- role of the optometrist is to treat the underlying vision problem-not to treat th reading or learning problems
- remediation these vision problems allows the kid to benefit more fully from educational intervention
- goal: reduce or elimate the signs and symptoms of particular visual deficits
A heterogenous groups of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical abilities
learning disability
learning disability and other problems
Even though a LD may occur concomitant with other handicapping conditions, it is not the direct result of those conditions or influencers
Prevalence of learning disability
- definition is ambiguous
- about 5% of school aged kids in the US are diagnosed with the learning disability
- varies based on definition, age, and population
Learning disability and etiology
Genetics Nutrition Low birth weight Psychological status Maturation of the nervous system
Adaptive behaviors for LD chidlren
Withdrawal reaction
Clowning reaction
Regression reaction
Withdrawal reaction
The child leans to avoid situations that are stressful
Refuses the participate in classroom or life experience that could lead to failure or frustration
Clowning reaction
The child is clowning around in school-child can rationalize that he is not learning because he has chosen not to learn
Regression reaction
The child tries to avoid the potential embarrassment of not being able to perform at an acceptable level by regressing to a less mature level or social and emotional development
Reading dysfunction
Defined as a failure to read
Most common and specific learning disability
Most common and specific learning disability
Reading dysfunction
OD intervention and reading dysfunction
optometric intervention has a maximum impact when the reading problem is related to speed, comprehension, fatigue, and loss of place when reading
With appropriate intervention, these cases have an excellent prognosis
Reading dysfunction info
- average or above average intelligence
- adequate educational opportunities
- normal sensory development (auditory and visual)
- normal acculturation
- no frank brain damage
- no emotional disturbances
Dyslexia
- specific type of reading dysfunction in which there is deficit in the individuals abiltiy to interpret the symbols of written language
- important to differate from other nonspecific or generalizes form of reading dysfunction (less severe)
- poorer prognosis-exhibit aberrations in the brain functions
Letter recognition
Gibson postulates that perceptual learning occurs in two stages
- Learns to look for the individual parts of the letters-enable to identify and name
- Requires attention to directional orientation
Dyseidesia
Poor sight word recognition
Genetic form
Dysphonesia
Impaired phonetic abiltiy (auditory)
- relies on sight word vocabulary
- poor spelling
Dysnemkinesia
Abnormally high frequency of letters reversals
-problems with writing or printing
Dyslexia screening
Rapid screening tool for the three types of dyslexia
Requires about 5 minutes
Dyslexia and eye movements
Increased number of fixations and regressions
Longer duration of fixation
Inefficient eye movements as a result of dyslexia
Legislation of children with LD
Federal and state laws mandate that each exceptional child has the right to a free and appropriate education to meet the child’s unique learning needs from birth to 21 yo
Provisions included:
Assessment
Specially designed classroom instruction
Related services necessary for the classroom program
Attention deficit disorder
ADD: attention deficit disorder
ADHD: attention deficit hyperactivity disorder
Prevalence: 5% of the school aged chidlren
Common characteristics of ADD and ADHA
Inattention
Impulsivity
Hyperactivity
Inattention
Includes disorganization, problems staying on task, constant daydreaming, and not paying attention when spoken to directly
Impulsivity
Includes spur of the moment decisions without thinking about the chance of harm or long term effects. The child acts quickly to get an immediate reward and may regularly interrupt teachers, friends, and family
Hyperactivity
Involves squirming, fidgeting, tapping, talking, and constant movement, especially in situations where its not appropriate
ADD and other problems
64% of them have other mental, emotional or behavior problems
Complaints of ADD and ADHD
- trouble paying attention
- doesnt like or avoids long mental tasks
- trouble staying on task during school, at home, or even at play
- doesnt pay close attention to details
- doesnt appear to listen when spoken to
- disorganized and seems forgetful
- careless mistakes
Diagnosis of ADHD
16 years or younger
- 6 or more hyperactivity/impulse symptoms fro at least 6 months
- chidlren with this form of ADHD have tons of energy and are constantly moving in a way that causes problems
ADD diagnosis
16 years or younger
-6 or more symptoms of inattention for at least 6 months but not signs of hyperactivity/umpulsitivity
ADD is type of ADHD that doesn’t involve constant movement and fidgeting
treatmetns for ADD and ADHD
Stimulants
- most common type
- dopamine and NE
- side effects: increased BP, HR, anxiety, HA, stomach aches
Non stimulants
- take longer to start but can alos improve focus, attention ,and impulsivity in a person with ADHD
- used when a person has bothersome side effects from stimulants, when a stimulant was not effective, or in combination with a stimulant to increase effectiveness
Drugs used for ADD/ADHD
Methylphenidate (Ritalin) Amphetamine (aderall) Dextroamphetamine (Dexedrine) -MOA: increase release of dopamine -ADHD, narcolepsy, and depression -act as adrenegeric agonists thus causing the following ocular side effects: mydriasis, dry eyes, acute angle closure (for this with narrow angles)
Neurodevelopemtnal disorders
Socializing
Language and communications
Problems solving
Physical
Problems with all of these
Autism spectrum disorder
-previously defined as separate subcategories on the autism spectrum (or persuasive developmental disorders-PPD): as-regression, PDD-NOA, childhood distegrative disorder, and automatic disroder
Now defines as “autism spectrum disorder” by the DSM-V
- improved clarity
- defines by a common set of behaviors and should be characterized by a single name according to severity
Prevalence of autism spectrum disorder
- Estimated that 1:59 chidlren have ASD
- 4-5x more likely in boys than girls
- increasing prevalence may be due to: changes in the case definition, increased awareness
Etiology of autumn
Not completely understood
- genetics
- environmental factors
Genetics and autism
May alter brain development
Multiple genes are responsible for ASD with genetic and environmental factors that contribute to variable expression
MRIEs indicate that ASD individuals use diffuse patterns of connectivity, cognitive strategy, and brain areas to process information
Environmental factors and ASD
There is little evidence to conclude that this is a cause
ASD comorbidities
Intellectual disability Seizures Fragile X syndrome Tuberous sclerosis Down syndrome CP NF
20% will also be diagnosed with some type of psychiatric disorder
ASD: deficits in social communication and social interaction
- social reciprocity-how actions of one affect others
- joint attention: abiltiy to share an interest
- nonverbal communication: using or interpreting
- social relationships: developing and maintains friends
ASD: restricted repetitive patterns of behavior, interests, and activities
- lining of toys, flapping hands
- fixed on routine
- restrictive thinking
Early indicators for ASD
- no babbling or pointing by age 1
- no single words by 16 months or 2 words phrases by 2
- no response to name
- loss of language or social skills
- poor eye contact
- excessive lining up of toys or objects
- no smiling or social responsiveness
ASD: later indicators
- impaired ability to make friends
- impaired ability to initiate or sustained a conversation with others
- absence or impairment of imaginative and social play
- restricted patterns of interest that are abnormal in intensity of focus
- preoccupation with certain objects or subjects
- inflexible adherence to epscific routines or rituals
ASD characteristics
Sensory
Social relatedness
Repetitive and restrictive interests
Communication
Sensory issues with ASD
- over and under reaction to common environmental stimuli
- stimuli may relate to sense such as auditory, tactile, visual, etc
- stereotyped body movements (flaps hands, rocks, bounces repetitively)
- unusual behaviors (looks form angles, sniff/licks objects, toe walks, etc)
Social difficulties for ASD
- difficulty relating to or expressing emotions
- limited eye contact
- limited use or understanding of non verbal gestures
- flat or limited facial expressions
- minimal initiation or response to joint attention
- lack or social/emotional repirciocity (difficulty taking perspective of another person)
- difficulty making friends
- trouble understanding abstract words or concepts (analogies, sarcasm, love)
- inappropriate behaviors may occur due to anxiety and discomfort
Repetitive interests and activities in ASD
- limited range of interests
- finds comfort in predictability of structure and repetition
- often rigid and excessive interest in usual objects/activities
- exhibits atypical play behaviors
- these actions may cause the individual to appear distracted/inattentive and viewed as inflexible and disobedient
Communication and ASD
- very limited verbal communication
- communications primarily to have needs met and not for social reasons
- language often develops late
- prior to language development: poor understanding of language, gestural deficits (Lack of understanding), jargon/unusual nosies
ASD diagnosis
- observe behaviors
- listening to caretakers observations
- given a severity score
Level 1 autism
High functioning autism
- needs support
- patients social and communication skills and repetitive behaviors are only noticeable without support
Autism level 2
Needs substantial support
Patients social and commutation skills and repetitive behaviors are still obvious to the causal observer, even with support in place
Severe autism level 3
Needs very substantial support
Patients social and communication skills and repetitive behavior severely impair daily life
ASD treatment
There is no cure
Educational problems and behavioral therapy may be recommended
Examine kids with ASD
A successful visual often begins before you ever see the patients
- it may be beneficial to have the caregiver complete the forms prior to the exam
- staff training for awareness of ASD and appropriate interactions during office visit
Pre-examination questions for ASD
- pateitns mode of communication
- sensory needs or triggers
- motivations
- proactive behavioral strategies used before
- negative behaviors
- is the patient echolalic
- follow directions
- able to answer questions
Things to make exam better for ASD
Limit wait time Offer quiet alternative if needed Visual aids may assist in understanding Reinforce items throughout Consider shortened visual or taking a break End on a positive note
Effective commutation and exam for ASD
- clear and concise
- clear expectations
- respectful, neutral tone
- use visuals (gestures, pointing)
- praise often
Important keys for ASD
- ASD should automatically limit your exam
- remain positive
- allow the caregiver/parent to respond
- be flexible
- some test may need to be modified if fixation is an issue
- know when to throw in the towel but always end on a positive note
- know when to refer to another doctor
OD treatment for ASD
- do not avoid giving glasses because you do not think the patient will respond
- talk about adaptation to the frames and lenses
- consider the type of fram-sensory isues, frame adjustment, period of adjustment to glasses
Addressing ASD
- dont say “for an autistic child..”
- instead “everything is normal for your child”
- do NOT identify the child by the condition
Intellectual disability
Disability characterized by the following
- limitations in intellectual functioning (learning, problem solving, judgement)
- limitations in adaptive behavior (activities of daily life including social and practical skills)
- onset prior to the age of 18
- previously referred to as mental retardation
Intellectual disability epidemiology
- affects about 1% of the population. Of those, 85% have mild intellectual disability
- Malle more likely than females to be diagnosed with intellectual disability
Intellectual disability-intellectual functioning
- IQ test is a major tool in the measuring of INTELLECTUAL FUNCTIONING (mental capacity for learning, reasoning, problem solving, etc)
- a test score below for around 70 indicates a limitation in intellectual functioning
Conceptual skills and intellectual disabilities
Language and literacy
Money, time, and number concepts
Self direction
Social skills and intellectual disabilities
Interpersonal skills Social repsosnsibility Self esteeem Social problem solving Ability to follow rules, obey laws, and avoid being victimized
Practical skills and intellectual disability
Activities of daily living
Problems living by themselves
Down syndrome
- remains the most common chromosomal condition in the US
- 1:700 babies born with down
Genetics of Down syndrome
Trisomy 21
Translocation Down syndrome
Mosaic Down syndrome
Trisomy 21
95% with Down syndrome
3 copies of chromosome 21
Translocation Down syndrome
- 3% with Down syndrome
- extra part or a whole chromosome 21 is present ,but it is attached or translocation to a different chromosome
- 1/3 cases of Down syndrome resulting from translocation has a hereditary component
Mosaic Down syndrome
2% of Down syndrome
-they have a mix of normal characteristics and down charactieriscs
Downs sybdrome and mother age
Probability of having kids with Down syndrome increases droaamtically after the age 35 and up
Screeenign test for Down syndrome
- estimate the chance of the fetus having Down syndrome (provides probability)
- involve bloodwork and ultrasound
Diagnostic test for down sydnrome
- chorionic villus sampling and amneocentesis
- 1% risk of miscarriage but nearly 100% accurate in diagnosisning Down syndrome
Diagnosis at birth of down sybdrome
Presence of certain physical traits
- low muscle tone
- single deep crease across the palm of hand
- slightly flattened facial profile
- upward slant of the eyes
Karyotype is done to confirm the diagnosis
Physical features of Down syndrome
- hypotonia
- small, broad head
- large, protruding tongue
- small nose with low, flat bridge
- upward slanting tmperoal palpebral fissure
- small, poorly defined ears
- short, thick neck
- study hands with a single palmar crease
- short, stubby fret
Clinical findgins with Down syndrome
Cognitive impairment
Developmental delays (static)
Impaired social skills
Associations of down sybdrome
- hearing loss
- otitis media
- obstructive sleep apnea
- congenital heart defects
- delayed dental eruption and hypodontia
Down syndrome and vision problems
60% of kids with Down syndrome have vision problems
Down sybdrome ocular findgins
- significant refractive error
- cataracts
- strab
- nystagmus
- NLD
- brushfiled spots
- commonly see amblyopia and keratoconnus
High refractive error and Down syndrome
- most often high astigmatism and hyperopia
- prescribe to prevent amblyopia
- may notice more behavior challenges with attempting glasses wear
Down syndrome and glasses
Often need frames to fit flat nasal bridge
- regular most pads often font fit well
- specs 4 us: frames have lower set bridge and nose pads
Acccommodative insufficiency and Down syndrome
Could be an additional barrier to literacy and early learning
May benefit from bifocal or reading glasses
Reduced amplitudes and lags on MEM
Brushfield spots
- multiple round focal areas on anterior surface of the iris that appear beige or light brown/gray
- areas of iris stromal hyperplasia surrounded by relative hypoplasia
- more commonly seen in chidlren with down sybdrome and with lightly pigmented irises and of European decent
- not pathognomonic
Reduced VA and Down syndrome
- studies have shown reduced contrast and vernier acuities
- important: may no be abnormally for your patient to have 20/30 to 20/60 BCVA
Normal is 20/45
Cataract ans and Down syndrome
Congential
Cerulean
-blue dot opacities in the anterior and posterior capsule
-typically bilateral
-often do not affect visual acuity
-often stable and do not progress over time
Nystagmus and Down syndrome
Up to 1/3 mah have it
Horizontal
May see latent nystagmus
Strab and down sydnrome
- esotropia is the most common
- congential or infantile ET
- accommodative ET
- do not confuse with spasm of over accomodation
Amblyopia and Down syndrome
Isometropia and anisometropia
Strabismus
IMPORTANT: avoid atropine penalization due to common cardiac abnormalities
Keratoconnus and Down syndrome
Onset in early adulthood Possibile etiolgoes -increased eye rubbing -steeper cornea with higher rates of astigmatism -genetic linke to chromosome 21
Exam recommendations for Down syndrome
- best technique depends on the cognitive/developmental leve, cooperation, and associated conditions
- pediatric test may be ideal for some patients with Down syndrome regardless of age
Cerebral palsy
- disorder of movement, muscle tone, or posture that is caused by damage that occurs to the immature, developing brain (most often before birth)
- every case of cerebral palsy is unique to the individual
Etiology of cerebral palsy
Abnormalriy or disruption in brain development, usually before a child is born, factors that may lead to problems with brain develpepemtn include
- mutations
- maternal infections
- fetal stroke
- infant infections
- traumatic head injury
- lack of oxygen
Signs of CP
- impaired movement associated with abnormal reflexes
- rigidity of limbs and trunk
- abnormal posture
- involuntary movements
- unsteady walking
Functional abilities and CP
Effect greatly varies
-physical and intellectual
Associations with CP
Epilepsy, blindness, and deafness
Commonly have eye muscle imbalance
Mild CP
A child can move without assistance, his or her daily activities are not limited
Moderate CP
A child will need braces, medications, and adaptive technology to accomplish daily activities
Severe CP
A child will rewuire a wheelchair and will have significant challenges in accomplishing daily activities
CP location
How it affects the body, one arm, two arms, upper half, lower half, whole body
Spastic CP
Increased muscle tone
Non spatis CP
Exhibit decreased or fluctuating muscle tone
