At madhava, we give a helping hand to those children in our society who are differently abled, we understand and take care of them in all the way we can. Basically we understand;
a) Attention Deficit hyperactivity disorders
b) DEVELOPMENTAL DYSPHASIA
e) PRIMARY SPELLING DISORDER
f) MIXED DISORDERS
g) GIFTED CHILDREN WITH LD
h) LANDAU KLEFFNER SYNDROME
j) ASPERGER’S SYNDROME
k) RETT SYNDROME
l) CEREBRAL PALSY
m) MENTAL RETARDATION
Language disorder – children
Developmental aphasia; Developmental dysphasia; Delayed language; Specific developmental language disorder; SLI; Communication disorder – language disorder
Language disorder in children refers to problems with either:
Getting their meaning or message across to others (expressive language disorder), or
Understanding the message coming from others (receptive language disorder)
Some children only have an expressive language disorder. Others have a mixed receptive-expressive language disorder, meaning that they have symptoms of both conditions.
Children with language disorders are able to produce sounds, and their speech can be understood.
Causes, incidence, and risk factors
For most infants and children, language develops naturally beginning at birth. To develop language, a child must be able to hear, see, understand, and remember. Children must also have the physical ability to form speech.
Up to 1 out of every 20 children has symptoms of a language disorder. When the cause is unknown, it is called a developmental language disorder.
Problems with receptive language skills usually begin before age 4. Some mixed language disorders are caused by a brain injury, and these are sometimes misdiagnosed as developmental disorders.
Language disorders may occur in children with other developmental problems, autistic spectrum disorders, hearing loss, and learning disabilities. A language disorder may also be caused by damage to the central nervous system, which is called aphasia.
Language disorders are rarely caused by a lack of intelligence.
Language disorders are different than delayed language. With delayed language, the child develops speech and language in the same way as other children, but later. In language disorders, speech and language do not develop normally. The child may have some language skills, but not others. Or, the way in which these skills develop will be different than usual.
A child with language disorder may have one or two of the symptoms listed below, or many of the symptoms. Symptoms can range from mild to severe.
Children with a receptive language disorder have difficulty understanding langugae. They may have:
A hard time understanding what other people have said
Problems following directions that are spoken to them
Problems organizing their thoughts
Children with an expressive language disorder have problems using language to express what they are thinking or need. These children may:
Have a hard time putting words together into sentences, or their sentences may be simple and short and the word order may be off
Have difficulty finding the right words when talking, and often use placeholder words such as “um”
Have a vocabulary that is below the level of other children the same age
Leave words out of sentences when talking
Use certain phrases over and over again, and repeat (echo) parts or all of questions
Use tenses (past, present, future) improperly
Because of their language problems, these children may have difficulty in social settings. At times, language disorders may be part of the cause of severe behavioral problems.
Signs and tests
A medical history may reveal that the child has close relatives who have also had speech and language problems.
Any child suspected of having this disorder can have standardized receptive and expressive language tests. A speech and language therapist or neuropsychologist will administer these tests.
An audiogram should also be done to rule out deafness, which is one of the most common causes of language problems.
Speech and language therapy is the best approach to treating this type of language disorder.
Psychological therapy (psychotherapy, counseling, or cognitive behavioral therapy) is also recommended because of the possibility of related emotional or behavioral problems.
The outcome varies based on the cause. Brain injury or other structural problems generally have a poor outcome, in which the child will have long-term problems with language. Other, more reversible causes can be treated effectively.
Many children who have language problems during the preschool years will also have some language problems or learning difficulty later in childhood. They may also have reading disorders.
Children facing dyscalculia have difficulty in learning mathematics. This disorder results out of the harm caused to certain parts of brain. However the IQ level of such children is normal. Dyscalculia is also referred as arithmetic difficulty. Children facing this disorder may also have difficulty with calculating time and measurements. Though such children have problem with calculations they are good at other academic subjects. Children coping with dyscalculia may also have good writing, reading and speaking skills.
Symptoms of dyscalculia
Have a look at some general symptoms shown by the dyscalculic children. Immediate action should be taken after observing these symptoms. Early diagnosis and early treatment will help to save the future of the child.
Types of dyscalculia
Dyscalculia is observed in children in many different types and subtypes. Here are some types of dyscalculia.
Children facing developmental dyscalculia find difficult to count. They are also unable to recognise the mathematical signs. They are unable to calculate the total of numbers in writing as well as mentally. Many a times they confuse with numbers and require lot of effort to recall.
Dyscalculia which occurs during the later stages of life is known as acalculia. It is acquired due to injuries to brain or stroke. Due to this disorder person is unable to carry out normal mathematics like addition, subtraction, division and multiplication. It is different form dyscalculia as it is not acquired during normal stage of learning.
In this type of dyscalculia a child may be able to carry out normal mathematical calculations. However child is not able to verbally name the symbols, signs or counting of the numbers and different items.
Operational dyscalculia is a problem associated with memorising the rules of mathematics. It is also associated with difficulty in applying rules during mathematical operations. It also relating to the confusion in mathematical symbols
As the name suggest this disorder refers to disability to count numbers according to sequence. The child also has problem with calculating time, checking schedule, tracking direction and taking measurement.
Dysgraphia is a neurological disorder. Dysgraphia is also popularly known as motoragraphia. It can be hereditary or it may be caused due to brain injuries or strokes. A dysgraphic is unable to write proper shaped and sized letters with proper spellings. They have very bad hand writing. Person facing this disorder lacks fine motor skills. However, they do not face any other academic problems. In fact children facing dysgraphia may have better abilities in mathematics or in other related fields.
Symptoms of dysgraphia
Here are some commonly observed symptoms of dysgraphia. These symptoms can be seen even after children have adequate knowledge and normal training.
Types of dysgraphia
Researchers have identified three basic types of dysgraphia which are as follows. However study is in progress to find its root causes and more specific types.
As the name suggests the children facing this disorder lacks fine motor skills. Children suffering with motor dysgraphia are unable to avoid mistakes while writing even if copied from other source. They also lack proper muscle tone. The pattern of writing is slanting in most of the cases but their spelling skills are good.
In this type of dysgraphia the children lack spelling skills but are able to write looking at the copy. It is not necessary that each person coping with dysgraphia will have dyslexia.
It is the condition where children are unable to understand the spacing characteristics while writing. Sometimes too much space or sometimes no space can be seen between the words and letters.
Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood disorders and can continue through adolescence and adulthood. Symptoms include difficulty staying focused and paying attention, difficulty controlling behavior, and hyperactivity (over-activity).
ADHD has three subtypes:
Combined hyperactive-impulsive and inattentive
Treatments can relieve many of the disorder’s symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it.
Symptoms of ADHD in children
Inattention, hyperactivity, and impulsivity are the key behaviors of ADHD. It is normal for all children to be inattentive, hyperactive, or impulsive sometimes, but for children with ADHD, these behaviors are more severe and occur more often. To be diagnosed with the disorder, a child must have symptoms for 6 or more months and to a degree that is greater than other children of the same age.
Children who have symptoms of inattention may:
• Be easily distracted, miss details, forget things, and frequently switch from one activity to another
• Have difficulty focusing on one thing
• Become bored with a task after only a few minutes, unless they are doing something enjoyable
• Have difficulty focusing attention on organizing and completing a task or learning something new
• Have trouble completing or turning in homework assignments, often losing things (e.g., pencils, toys, assignments) needed to complete tasks or activities
• Not seem to listen when spoken to
• Daydream, become easily confused, and move slowly
• Have difficulty processing information as quickly and accurately as others
• Struggle to follow instructions.
Children who have symptoms of hyperactivity may:
• Fidget and squirm in their seats
• Talk nonstop
• Dash around, touching or playing with anything and everything in sight
• Have trouble sitting still during dinner, school, and story time
• Be constantly in motion
• Have difficulty doing quiet tasks or activities.
Mixed bipolar disorder is a form of mental illness. In most forms of bipolar disorder, moods alternate between elevated and depressed over time. A person with mixed bipolar disorder experiences both mood “poles” — mania and depression — simultaneously or in rapid sequence.
Who Gets Mixed Bipolar Disorder?
Virtually anyone can develop bipolar disorder. About 2.5% of the U.S. population suffers from some form of bipolar disorder — almost six million people.
Mixed bipolar disorder is a common pattern in people with bipolar disorder. Estimates vary widely, but between 20% and 70% of people with bipolar disorder experience mixed episodes.
Those who develop bipolar disorder at a younger age, particularly in adolescence, may be more likely to have mixed bipolar disorder.
Most people are in their teens or early 20s when symptoms from bipolar disorder first start. Nearly everyone with mixed bipolar disorder develops it before age 50. People with an immediate family member with bipolar are at higher risk.
Symptoms of Mixed Bipolar Disorder
Mixed bipolar disorder is defined by periods of mania and depression that occur at the same time, or in rapid sequence. These combined manic-depressive periods are called mixed mania or mixed manic episodes:
This may seem impossible — how can someone be manic and depressed at the same time? Because mixed manic episodes are a form of mental illness, they defy any predictable pattern of feelings or behavior.
For example, a person in a mixed manic episode could be crying uncontrollably while announcing they have never felt better in their life. Or they could be exuberantly happy, only to suddenly collapse in misery. A short while later they might suddenly return to an ecstatic state.
Mixed manic episodes can last from days to years, if untreated. Mixed bipolar disorder episodes tend to last longer than other forms of bipolar disorder.
People with “regular” bipolar disorder may appear to have mixed bipolar disorder while under the influence of alcohol, cocaine, or other drugs.
Treatments for Mixed Bipolar Disorder
Mixed manic episodes generally require treatment with medication. Unfortunately, mixed bipolar disorder is more difficult to control than other forms of bipolar disorder. The main drugs used to treat mixed manic episodes are mood stabilizers and antipsychotics.
Lithium is highly effective at controlling mania. Lithium has been used for more than a century to treat bipolar disorder. It can take weeks to work fully, making it better for maintenance treatment than for sudden manic episodes. Blood levels of lithium must be monitored to avoid side effects.
Depakote is an antiseizure medication that also levels out moods. It has a more rapid onset of action, often making it more effective for sudden mania than lithium. Depakote can also be used for prevention of mixed manic episodes.
Some other antiseizure drugs, such as Tegretol, are also effective mood stabilizers.
For some mixed manic episodes, antipsychotic drugs may be necessary. Zyprexa is often used, and many other drugs are available. Antipsychotic drugs are also used for preventive treatment.
Electroconvulsive Therapy (ECT)
Despite its frightening reputation, ECT is an effective treatment for mixed manic episodes. Electroconvulsive therapy can be helpful if medication fails or can’t be used.
Treatment for Depression in Mixed Bipolar Disorder
Common antidepressants like Prozac, Zoloft, and Paxil can set off manic episodes in a people with bipolar disorder. For this reason, the first treatment for depression in bipolar disorder should be lithium, Depakote, or an antipsychotic. If these fail, after a few weeks an antidepressant can be safely started. Psychotherapy, such as cognitive-behavioral therapy, may also help.
Mixed bipolar disorder usually recurs and many people have frequent symptoms. Most people with mixed bipolar disorder should take medication on a continuous basis, for prevention.
Science has made great strides in understanding the inner workings of the brain, and one important discovery that brings new hope for learning disabilities and disorders is called neuroplasticity. Neuroplasticity refers to the brain’s natural, lifelong ability to change¾to form new connections and generate new brain cells in response to experience and learning. This knowledge has led to groundbreaking new treatments for learning disabilities that harness the power of neuroplasticity to retrain the brain.
Understanding the brain help with a learning disability or disorder
Using a telephone analogy, faulty wiring in the brain disrupts normal lines of communication and makes it difficult to process information easily. If service was down in a certain area of the city the phone company might fix the problem by re–wiring the connections. Similarly, under the right learning conditions, the brain has the ability to reorganize itself by forming new neural connections. Those new connections facilitate skills like reading and writing that had been difficult using the old connections.
Parenting a child with a learning disability or learning disorder
As a parent, discovering that something may stand in the way of your child’s success can be unsettling and difficult. Whether or not your child has a learning disability, remember that the way you behave and what you do has the most impact on your child’s chances of success. Everyone faces obstacles and the most important thing you can show your child, apart from your consistent love and support, is how to deal with obstacles. A good attitude won’t solve the problem, but it can give your child hope and confidence that things can improve.
Your first task as the parent of a child with a learning disability is to recognize that there are many things you can do to help your child:
In this age of endless budget cuts and inadequately funded schools, your role in your child’s education is more important than ever. Don’t sit back and let someone else be responsible for providing your child with the tools they need to learn. You can and should take an active role in your child’s education.
Symptoms and types of learning disabilities and disorders
If you’re aware of some of the common signs of learning disabilities and learning disorders in children, you’ll be able to catch the problem early and take steps to get your child help. Paying attention to normal developmental milestones for toddlers and preschoolers is very important. Early detection of developmental differences may be an early signal of a learning disability and problems that are spotted early can be easier to correct.
A developmental lag might not be considered a symptom of a learning disability until your child is older, but if you recognize it when your child is young, you can intervene early. You know your child better than anyone else does, so if you think there is a problem, it doesn’t hurt to get an evaluation. You can also ask your pediatrician for a developmental milestones chart.
The activity of diagnosing the type of learning disability can be overwhelming and time consuming. Try not to get caught up in trying to determine the label or type of disorder and focus instead on figuring out how best to support your child.
Types of learning disabilities are often grouped by school–area skill set or cognitive weakness. If your child is in school, it will probably be apparent if he or she is struggling with reading, writing, or math, and narrowing down the type will be easier.
Math difficulties and learning disabilities
Learning disabilities in math vary greatly depending on the child’s other strengths and weaknesses. A child’s ability to do math will be affected differently by a language learning disability, or a visual disorder or a difficulty with sequencing, memory or organization.
A child with a math–based learning disorder may struggle with memorization and organization of numbers, operation signs, and number “facts” (like 5+5=10 or 5×5=25). Children with math learning disorders might also have trouble with counting principles (such as counting by 2s or counting by 5s) or have difficulty telling time.
Language difficulties and learning disabilities
Language and communication learning disabilities involve the ability to understand or produce spoken language. Language is also considered an output activity because it requires organizing thoughts in the brain and calling upon the right words to verbally explain something or communicate with someone else.
Signs of a language–based learning disorder involve problems with verbal language skills, such as the ability to retell a story and the fluency of speech, as well as the ability to understand the meaning of words, parts of speech, directions, etc.
Reading difficulties and learning disabilities
There are two types of learning disabilities in reading. Basic reading problems occur when there is difficulty understanding the relationship between sounds, letters and words. Reading comprehension problems occur when there is an inability to grasp the meaning of words, phrases, and paragraphs.
Signs of reading difficulty include problems with:
Writing difficulties and learning disabilities
Learning disabilities in writing can involve the physical act of writing or the mental activity of comprehending and synthesizing information. Basic writing disorder refers to physical difficulty forming words and letters. Expressive writing disability indicates a struggle to organize thoughts on paper.
Symptoms of a written language learning disability revolve around the act of writing and include. They include problems with:
Landau-Kleffner syndrome (LKS) is a childhood disorder. A major feature of LKS is the gradual or sudden loss of the ability to understand and use spoken language. All children with LKS have abnormal electrical brain waves that can be documented by an electroencephalogram (EEG), a recording of the electric activity of the brain. Approximately 80 percent of the children with LKS have one or more epileptic seizures that usually occur at night. Behavioral disorders such as hyperactivity, aggressiveness and depression can also accompany this disorder. LKS may also be called infantile acquired aphasia, acquired epileptic aphasia or aphasia with convulsive disorder. This syndrome was first described in 1957 by Dr. William M. Landau and Dr. Frank R. Kleffner, who identified six children with the disorder.
Signs of Landau-Kleffner syndrome
LKS occurs most frequently in normally developing children who are between 3 and 7 years of age. For no apparent reason, these children begin having trouble understanding what is said to them. Doctors often refer to this problem as auditory agnosiaor “word deafness.” The auditory agnosia may occur slowly or very quickly. Parents often think that the child is developing a hearing problem or has become suddenly deaf. Hearing tests, however, show normal hearing. Children may also appear to be autistic or developmentally delayed.
The inability to understand language eventually affects the child’s spoken language which may progress to a complete loss of the ability to speak (mutism). Children who have learned to read and write before the onset of auditory agnosia can often continue communicating through written language. Some children develop a type of gestural communication or sign-like language. The communication problems may lead to behavioral or psychological problems. Intelligence usually appears to be unaffected.
The loss of language may be preceded by an epileptic seizure that usually occurs at night. At some time, 80 percent of children with LKS have one or more seizures. The seizures usually stop by the time the child becomes a teenager. All LKS children have abnormal electrical brain activity on both the right and left sides of their brains.
Causes Landau-Kleffner syndrome
The cause of LKS is unknown. Some experts think there is more than one cause for this disorder. All of the children with LKS appear to be perfectly normal until their first seizure or the start of language problems. There have been no reports of children who have a family history of LKS. Therefore, LKS is not likely to be an inherited disorder.
Outcome of Landau-Kleffner syndrome
There have not been many long-term follow-up studies of children with LKS. This lack of evidence, along with the wide range of differences among affected children, makes it impossible to predict the outcome of this disorder. Complete language recovery has been reported; however, language problems usually continue into adulthood. The continued language problems can range from difficulty following simple commands to no verbal communication. If recovery takes place, it can occur within days or years. So far, no relationship has been found between the extent of the language impairment, the presence or absence of seizures and the amount of language recovery. Generally, the earlier the disorder begins, the poorer the language recovery.
Most children outgrow the seizures, and electrical brain activity on the EEG usually returns to normal by age 15.
Medication to control the seizures and abnormal brain wave activity (anticonvulsants) usually has very little effect on language ability. Corticosteroid therapy has improved the language ability of some children. Sign language instruction has benefited others.
Autism (say: aw-tih-zum) causes kids to experience the world differently from the way most other kids do. It’s hard for kids with autism to talk with other people and express themselves using words. Kids who have autism usually keep to themselves and many can’t communicate without special help.
Kids with autism often can’t make connections that other kids make easily. For example, when someone smiles, you know the smiling person is happy or being friendly. But a kid with autism may have trouble connecting that smile with the person’s happy feelings.
A kid who has autism also has trouble linking words to their meanings. Imagine trying to understand what your mom is saying if you didn’t know what her words really mean. It is doubly frustrating then if a kid can’t come up with the right words to express his or her own thoughts.
Autism causes kids to act in unusual ways. They might flap their hands, say certain words over and over, have temper tantrums, or play only with one particular toy. Most kids with autism don’t like changes in routines. They like to stay on a schedule that is always the same. They also may insist that their toys or other objects be arranged a certain way and get upset if these items are moved or disturbed.
If someone has autism, his or her brain has trouble with an important job: making sense of the world. Every day, your brain interprets the sights, sounds, smells, and other sensations that you experience. If your brain couldn’t help you understand these things, you would have trouble functioning, talking, going to school, and doing other everyday stuff. Kids can be mildly affected by autism, so that they only have a little trouble in life, or they can be very affected, so that they need a lot of help
Autism affects about 1 in every 150 kids, but no one knows what causes it. Some scientists think that some kids might be more likely to get autism because it or similar disorders run in their families. Knowing the exact cause of autism is hard because the human brain is very complicated.
The brain contains over 100 billion nerve cells called neurons (say: nur-ahns). Each neuron may have hundreds or thousands of connections that carry messages to other nerve cells in the brain and body. The connections and the chemical messengers they send (called neurotransmitters) let the neurons that help you see, feel, move, remember, and work together as they should.
For some reason, some of the cells and connections in the brain of a kid with autism — especially those that affect communication, emotions, and senses — don’t develop properly or get damaged. Scientists are still trying to understand how and why this happens.
Figuring out if a kid has autism can be difficult. A parent is usually the first to suspect that something is wrong. Maybe the kid is old enough to speak but doesn’t, doesn’t seem interested in people, or behaves in other unusual ways. But autism isn’t the only problem that can cause these kinds of symptoms. For example, kids who have hearing problems might have trouble speaking, too.
Usually, the results of lab tests and other medical tests are normal in kids with autism, but doctors may do them to make sure the kid doesn’t have other problems. These medical tests can include blood and urine tests, a hearing exam, an EEG (a test to measure brain waves), and an MRI (a picture that shows the structure of the brain). Intelligence (IQ) tests also might be done.
Often, specialists work together as a team to figure out what is wrong. The team might include a pediatrician, a pediatric neurologist, a pediatric developmentalist, a child psychiatrist, a child psychologist, speech and language therapists, and others. The team members study how the child plays, learns, communicates, and behaves. The team listens carefully to what parents have noticed, too. Using the information they’ve gathered, doctors can decide whether a child has autism or another problem
There is no cure for autism, but doctors, therapists, and special teachers can help kids with autism overcome or adjust to many difficulties. The earlier a kid starts treatment for autism, the better.
Different kids need different kinds of help, but learning how to communicate is always an important first step. Spoken language can be hard for kids with autism to learn. Most understand words better by seeing them, so therapists teach them how to communicate by pointing or using pictures or sign language. That makes learning other things easier, and eventually, many kids with autism learn to talk.
Therapists also help kids learn social skills, such as how to greet people, wait for a turn, and follow directions. Some kids need special help with living skills (like brushing teeth or making a bed). Others have trouble sitting still or controlling their tempers and need therapy to help them control their behavior. Some kids take medications to help their moods and behavior, but there’s no medicine that will make a kid’s autism go away.
Students with mild autism sometimes can go to regular school. But most kids with autism need calmer, more orderly surroundings. They also need teachers trained to understand the problems they have with communicating and learning. They may learn at home or in special classes at public or private schools.
Autism Spectrum Disorder
Asperger syndrome (AS) is a neurobiological disorder that is part of a group of conditions called autism spectrum disorders. The term “autism spectrum” refers to a range of developmental disabilities that includes autism as well as other disorders with similar characteristics.
They are known as spectrum disorders because the symptoms of each can appear in different combinations and in varying degrees of severity: two children with the same diagnosis, though they may share certain patterns of behavior, can exhibit a wide range of skills and abilities.
As a result, general terms such as “low-functioning,” “high-functioning,” “autistic tendencies,” “pervasive developmental disorder,” and others are often used to describe children whose behaviors fall within the spectrum. Kids with AS share many of the same symptoms as those with “high-functioning autism.”
Signs and Symptoms
Because the symptoms of AS are often hard to differentiate from other behavioral problems, it’s best to let a doctor or other health professional evaluate your child’s symptoms. It’s not uncommon for a child to be diagnosed with attention deficit hyperactivity disorder (ADHD) before a diagnosis of AS is made later.
These signs and symptoms might be present in a child with AS:
inappropriate or minimal social interactions
conversations almost always revolving around self rather than others
“scripted,” “robotic,” or repetitive speech
lack of “common sense”
problems with reading, math, or writing skills
obsession with complex topics such as patterns or music
average to below-average nonverbal cognitive abilities, though verbal cognitive abilities are usually average to above-average
odd behaviors or mannerisms
It’s important to note that, unlike kids with autism, those with AS might show no delays in language development; they usually have good grammatical skills and an advanced vocabulary at an early age. However, they typically do exhibit a language disorder — they might be very literal and have trouble using language in a social context.
Often there are no obvious delays in cognitive development or in age-appropriate self-help skills such as feeding and dressing themselves. Although kids with AS can have problems with attention span and organization, and have skills that seem well developed in some areas and lacking in others, they usually have average and sometimes above-average intelligence
Causes Asperger Syndrome
Researchers and mental health experts are still investigating the causes of autism and AS. Many believe that the pattern of behavior that characterizes AS may have many causes. There seems to be a hereditary component to AS, and research indicates that in some cases AS may be associated with other mental health disorders such as depression and bipolar disorder. Researchers are also looking into whether environmental factors that affect brain development might play a role.
Contrary to the incorrect assumptions some may make about people with the disorder, AS is not caused by emotional deprivation or the way a person has been brought up. Because some of the behaviors exhibited by someone with AS may be seen by others as intentionally rude, many people wrongly assume that AS is the result of bad parenting — it isn’t. It’s a neurobiological disorder whose causes are not yet fully understood.
Rett syndrome is a neurodevelopmenal disorder that affects girls almost exclusively. It is characterized by normal early growth and development followed by a slowing of development, loss of purposeful use of the hands, distinctive hand movements, slowed brain and head growth, problems with walking, seizures, and intellectual disability.
The disorder was identified by Dr. Andreas Rett, an Austrian physician who first described it in a journal article in 1966. It was not until after a second article about the disorder, published in 1983 by Swedish researcher Dr. Bengt Hagberg, that the disorder was generally recognized.
The course of Rett syndrome, including the age of onset and the severity of symptoms, varies from child to child. Before the symptoms begin, however, the child generally appears to grow and develop normally, although there are often subtle abnormalities even in early infancy, such as loss of muscle tone (hypotonia), difficulty feeding, and jerkiness in limb movements. Then, gradually, mental and physical symptoms appear. As the syndrome progresses, the child loses purposeful use of her hands and the ability to speak. Other early symptoms may include problems crawling or walking and diminished eye contact. The loss of functional use of the hands is followed by compulsive hand movements such as wringing and washing. The onset of this period of regression is sometimes sudden.
Apraxia — the inability to perform motor functions — is perhaps the most severely disabling feature of Rett syndrome, interfering with every body movement, including eye gaze and speech.
Children with Rett syndrome often exhibit autistic-like behaviors in the early stages. Other symptoms may include walking on the toes, sleep problems, a wide-based gait, teeth grinding and difficulty chewing, slowed growth, seizures, cognitive disabilities, and breathing difficulties while awake such as hyperventilation, apnea (breath holding), and air swallowing.
Nearly all cases of Rett syndrome are caused by a mutation in the methyl CpG binding protein 2, or MECP2 (pronounced meck-pea-two) gene. Scientists identified the gene — which is believed to control the functions of many other genes — in 1999. The MECP2 gene contains instructions for the synthesis of a protein called methyl cytosine binding protein 2 (MeCP2), which is needed for brain development and acts as one of the many biochemical switches that can either increase gene expression tell other genes when to turn off and stop producing their own unique proteins. Because the MECP2 gene does not function properly in individuals with Rett syndrome, insufficient amounts or structurally abnormal forms of the protein are produced and can cause other genes to be abnormally expressed.
Not everyone who has an MECP2 mutation has Rett syndrome. Scientists have identified mutations in the CDKL5 and FOXG1 genes in individuals who have atypical or congenital Rett syndrome, but they are still learning how those mutations work. Scientists believe the remaining cases may be caused by partial gene deletions, mutations in other parts of the gene, or additional genes that have not yet been identified, and they continue to look for other causes.
There is no cure for Rett syndrome. Treatment for the disorder is symptomatic — focusing on the management of symptoms — and supportive, requiring a multidisciplinary approach. Medication may be needed for breathing irregularities and motor difficulties, and anticonvulsant drugs may be used to control seizures. There should be regular monitoring for scoliosis and possible heart abnormalities. Occupational therapy can help children develop skills needed for performing self-directed activities (such as dressing, feeding, and practicing arts and crafts), while physical therapy and hydrotherapy may prolong mobility. Some children may require special equipment and aids such as braces to arrest scoliosis, splints to modify hand movements, and nutritional programs to help them maintain adequate weight. Special academic, social, vocational, and support services may be required in some cases.
Some kids with CP use wheelchairs and others walk with the help of crutches or braces. In some cases, a kid’s speech may be affected or the person might not be able to speak at all.
Cerebral palsy (say: seh-ree-brel pawl-zee) is a condition that affects thousands of babies and children each year. It is not contagious, which means you can’t catch it from anyone who has it. The word cerebral
means having to do with the brain. The word palsy
means a weakness or problem in the way a person moves or positions his or her body.
A kid with CP has trouble controlling the muscles of the body. Normally, the brain tells the rest of the body exactly what to do and when to do it. But because CP affects the brain, depending on what part of the brain is affected, a kid might not be able to walk, talk, eat, or play the way most kids do
Types of CP
There are three types of cerebral palsy: spastic
(say: spass-tick), athetoid
(say:ath-uh-toid), and ataxic(say: ay-tak-sick). The most common type of CP is spastic. A kid with spastic CP can’t relax his or her muscles or the muscles may be stiff.
Athetoid CP affects a kid’s ability to control the muscles of the body. This means that the arms or legs that are affected by athetoid CP may flutter and move suddenly. A kid with ataxic CP has problems with balance and coordination.
A kid with CP can have a mild case or a more severe case — it really depends on how much of the brain is affected and which parts of the body that section of the brain controls. If both arms and both legs are affected, a kid might need to use a wheelchair. If only the legs are affected, a kid might walk in an unsteady way or have to wear braces or use crutches. If the part of the brain that controls speech is affected, a kid with CP might have trouble talking clearly. Another kid with CP might not be able to speak at all.
For some babies, injuries to the brain during pregnancy or soon after birth may cause CP. Children most at risk of developing CP are small, premature babies (babies who are born many weeks before they were supposed to be born) and babies who need to be on a ventilator (a machine to help with breathing) for several weeks or longer. But for most kids with CP, the problem in the brain occurs before birth. Often, doctors don’t know why
For a kid with CP, the problem with the brain will not get any worse as the kid gets older. For example, a kid who has CP that affects only the legs will not develop CP in the arms or problems with speech later on. The effect of CP on the arms or legs can get worse, however, and some kids may develop dislocated hips (when the bones that meet at the hips move out of their normal position) or scoliosis (curvature of the spine).
That is why therapy is so important. Kids with CP usually have physical, occupational, or speech therapy to help them develop skills like walking, sitting, swallowing, and using their hands. There are also medications to treat the seizures that some kids with CP have. Some medications can help relax the muscles in kids with spastic CP. And some kids with CP may have special surgeries to keep their arms or legs straighter and more flexible
Living With CP
Cerebral palsy usually doesn’t stop kids from going to school, making friends, or doing things they enjoy. But they may have to do these things a little differently or they may need some help. With computers to help them communicate and wheelchairs to help them get around, kids with CP often can do a lot of stuff that kids without CP can do.
Kids with cerebral palsy are just like other kids, but with some greater challenges that make it harder to do everyday things. More than anything else, they want to fit in and be liked.
Be patient if you know someone or meet someone with CP. If you can’t understand what a person with CP is saying or if it takes a person with CP longer to do things, give him or her extra time to speak or move. Being understanding is what being a good friend is all about, and a kid with CP will really appreciate it
Problems Learning and Functioning
There’s a kid at school who seems different. You’ve heard people say he’s “retarded,” but you’ve also heard people use that word to make fun of each other.
Mental retardation (say:ree-tar-day-shun) is a term that was once commonly used to describe someone who learns and develops more slowly than other kids. But it’s not used as much anymore because it hurts people’s feelings.
Instead, you might hear terms like “intellectual disability” or “developmental delay.” But all these words mean basically the same thing. Someone who has this kind of problem will have trouble learning and functioning in everyday life. This person could be 10 years old, but might not talk or write as well as a typical 10-year-old. He or she also is usually slower to learn other skills, like how to get dressed or how to act around other people.
Just like other health problems, an intellectual disability can be mild (smaller) or major (bigger). The bigger the disability the more trouble someone will have learning and becoming an independent person
Causes Intellectual Disabilities
Intellectual disabilities happen because the brain gets injured or a problem prevents the brain from developing normally. These problems can happen while the baby is growing inside his or her mom, during the baby’s birth, or after the baby is born. Many times, though, doctors don’t know the cause.
Here are some problems that can cause intellectual disabilities:
There’s a problem with the baby’s genes, which are in every cell and determine how the body will develop. (Genes are inherited from both parents, so a baby might receive genes that are abnormal or the genes might change while the baby is developing.)
There’s a problem during the pregnancy. Sometimes, the mom might get an illness or infection that can harm the baby. Taking certain medicines while pregnant can cause problems for the baby. Drinking alcohol or taking illegal drugs can also damage a baby’s developing brain.
During childbirth, the baby doesn’t get enough oxygen.
The baby is born way too early.
After being born, the baby gets a serious brain infection.
Any time in life, a serious head injury can hurt the brain and cause intellectual disabilities. Some of these disabilities are temporary and others can be permanent. (That’s why it’s important to wear your bike helmet and always wear a seatbelt in the car!)
Doctors figure out that someone has an intellectual disability by testing how well the person thinks and solves problems. If a problem is spotted, doctors and other professionals can work with the family to decide what type of help is needed.
Aphasia is a disorder that results from damage to portions of the brain that are responsible for language. For most people, these are areas on the left side (hemisphere) of the brain. Aphasia usually occurs suddenly, often as the result of a stroke or head injury, but it may also develop slowly, as in the case of a brain tumor, an infection, or dementia. The disorder impairs the expression and understanding of language as well as reading and writing. Aphasia may co-occur with speech disorders such as dysarthria or apraxia of speech, which also result from brain damage.
Aphasia is caused by damage to one or more of the language areas of the brain. Many times, the cause of the brain injury is a stroke. A stroke occurs when blood is unable to reach a part of the brain. Brain cells die when they do not receive their normal supply of blood, which carries oxygen and important nutrients. Other causes of brain injury are severe blows to the head, brain tumors, brain infections, and other conditions that affect the brain.
Types of aphasia
There are two broad categories of aphasia: fluent and non-fluent.
Damage to the temporal lobe (the side portion) of the brain may result in a fluent aphasia called Wernicke’s aphasia (see figure). In most people, the damage occurs in the left temporal lobe, although it can result from damage to the right lobe as well. People with Wernicke’s aphasia may speak in long sentences that have no meaning, add unnecessary words, and even create made-up words. For example, someone with Wernicke’s aphasia may say, “You know that smoodle pinkered and that I want to get him round and take care of him like you want before.” As a result, it is often difficult to follow what the person is trying to say. People with Wernicke’s aphasia usually have great difficulty understanding speech, and they are often unaware of their mistakes. These individuals usually have no body weakness because their brain injury is not near the parts of the brain that control movement.
A type of non-fluent aphasia is Broca’s aphasia. People with Broca’s aphasia have damage to the frontal lobe of the brain. They frequently speak in short phrases that make sense but are produced with great effort. They often omit small words such as “is,” “and,” and “the.” For example, a person with Broca’s aphasia may say, “Walk dog,” meaning, “I will take the dog for a walk,” or “book book two table,” for “There are two books on the table.” People with Broca’s aphasia typically understand the speech of others fairly well. Because of this, they are often aware of their difficulties and can become easily frustrated. People with Broca’s aphasia often have right-sided weakness or paralysis of the arm and leg because the frontal lobe is also important for motor movements.
Another type of non-fluent aphasia, global aphasia, results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language.
There are other types of aphasia, each of which results from damage to different language areas in the brain. Some people may have difficulty repeating words and sentences even though they can speak and they understand the meaning of the word or sentence. Others may have difficulty naming objects even though they know what the object is and what it may be used for.
In some cases, a person will completely recover from aphasia without treatment. This type of spontaneous recovery usually occurs following a type of stroke in which blood flow to the brain is temporarily interrupted but quickly restored, called a transient ischemic attack. In these circumstances, language abilities may return in a few hours or a few days.
For most cases, however, language recovery is not as quick or as complete. While many people with aphasia experience partial spontaneous recovery, in which some language abilities return a few days to a month after the brain injury, some amount of aphasia typically remains. In these instances, speech-language therapy is often helpful. Recovery usually continues over a two-year period. Many health professionals believe that the most effective treatment begins early in the recovery process. Some of the factors that influence the amount of improvement include the cause of the brain damage, the area of the brain that was damaged, the extent of the brain injury, and the age and health of the individual. Additional factors include motivation, handedness, and educational level.
Aphasia therapy aims to improve a person’s ability to communicate by helping him or her to use remaining language abilities, restore language abilities as much as possible, compensate for language problems, and learn other methods of communicating. Individual therapy focuses on the specific needs of the person, while group therapy offers the opportunity to use new communication skills in a small-group setting. Stroke clubs, regional support groups formed by people who have had a stroke, are available in most major cities. These clubs also offer the opportunity for people with aphasia to try new communication skills. In addition, stroke clubs can help a person and his or her family adjust to the life changes that accompany stroke and aphasia.
Family involvement is often a crucial component of aphasia treatment so that family members can learn the best way to communicate with their loved one.
Family members are encouraged to:
Simplify language by using short, uncomplicated sentences.
Repeat the content words or write down key words to clarify meaning as needed.
Maintain a natural conversational manner appropriate for an adult.
Minimize distractions, such as a loud radio or TV, whenever possible.
Include the person with aphasia in conversations.
Ask for and value the opinion of the person with aphasia, especially regarding family matters.
Encourage any type of communication, whether it is speech, gesture, pointing, or drawing.
Avoid correcting the person’s speech.
Allow the person plenty of time to talk.
Help the person become involved outside the home. Seek out support groups such as stroke clubs.
Other treatment approaches involve the use of computers to improve the language abilities of people with aphasia. Studies have shown that computer-assisted therapy can help people with aphasia retrieve certain parts of speech, such as the use of verbs. Computers can also provide an alternative system of communication for people with difficulty expressing language. Lastly, computers can help people who have problems perceiving the difference between phonemes (the sounds from which words are formed) by providing auditory discrimination exercises.