Archive for the ‘Learning Disability’ Category

Stress

February 17, 2013

Stress from Google

Everyone is stressed! The fewer the stressors, the more opportunities for learning and development for children of all ages. Our goal is to identify and eliminate as many stressors as possible.

Environmental – Our homes and schools are full of stressors.
o Toxic Chemicals – Lead, mercury, antimony, aluminum, and other “heavy metals” reduce immunity, and interfere with the body’s ability to perform its many functions. Lead is “old news” and we know that any amount is unsafe for cognitive development. Every child should have lead levels tested.
Mercury, antimony, and aluminum are the “new” toxins that are also showing up in the bodies and brains of children with all types of delays. Their sources are power plants, ground water, petroleum plants, dental amalgams from the mother, vaccines, flame retardants, cookware, and other unlikely places. Read more about these metals here  and here.
Green your building with non-toxic materials for flooring, paint, cleaning supplies, building products, art and office supplies.
Chemicals from disinfectants, cleaners, building materials and other supplies “off gas” and when a person breathes them, they are toxic to the body. They are especially harmful to people with compromised immune systems, and those who have asthma.
The standard benchmark for design, construction, and operation of high-performance green buildings is LEED, which stands for Leadership in Energy and Environmental Design and was developed by the U.S. Green Building Council (USGBC). Find a green building in your city, learn who greened it and consult with them.  Here is a handbook on how to green an existing building.
o Air Pollution – Open the windows when possible. When too hot, make sure air conditioning equipment is clean and not moldy. Use HEPA (an acronym for “high efficiency particulate air”) indoor air filters throughout building. HEPA filters can trap a large amount of very small particles that vacuum cleaners recirculate back into the air.
o Fluorescent lighting – Replace with bulbs that do not make noise or flicker. Use bulbs that offer the right color of lighting. Read this article on lighting.
o Noise – Play soft, gentle music, such as Mozart, which is the same rate as the human heart beat. Read more information  on “The Mozart Effect.”
Biological – Our bodies are toxic waste dumps too. Reduce our exposures.
o Water – Good hydration is essential for learning. Ensuring that our drinking water is pure is one of the most important steps we can take for children with developmental delays. Water should be available and offered frequently. Use water filters throughout the building.
o Diet and Nutrition – What kids are eating can be the determining factor between health and sickness. This is especially true for children with developmental delays. Sugar is one of the most damaging of all products ingested. Read more about it here.
Encourage families to cook and not eat “fast food.” Help them understand the importance of a varied diet of natural foods, such as fruits, vegetables, good quality protein and good fats.
Research is showing that eliminating some foods from kids’ diets helps their development and learning tremendously. Many foods are shown to cause ear infections. Two types of foods that are particularly problematic for kids with delays are those containing gluten, the protein from wheat, and casein, the protein from dairy products. Read about gluten and dairy in many websites containing “gfcf.”
Children with Down syndrome have especially high nutritional needs. A company that specializes in the care and feeding of those with this genetic syndrome is Nutri-Chem, in Ottawa, Canada. The founder, Kent MacLeod, a pharmacist has written a book on the importance of diet and nutritional supplementation: Down Syndrome and Vitamin Therapy.
o Allergies – Many kids with developmental issues have allergies, not only to airborne particles, insects, and other environmental pests, but also to foods. Some allergies are life-threatening and immediate, such as shellfish and peanuts. Others are troublesome, causing fatigue, rashes, respiratory and digestive problems, and are delayed, taking hours or even days to show up. Read about the different kinds of allergic reactions here.

Physical – The physical body needs a good sensory diet and sleep to reduce stress.
o Movement – Use every opportunity to move to learn. Little children’s bodies learn by moving and using their senses of touch and having their muscles and joints take in sensations. Two good books about the importance of movement in learning are, Smart Moves: Why Learning is not all in Your Head, by Carla Hannaford, and Physical Activities for Improving Learning and Behavior by Cheatum. Obtain the workbook “Begin Where They Are,” with therapy activities, from http://oepf.org/product/begin-where-they-are-0.
o Reflexes – Over 100 different reflexes are programmed into the body to get the body moving appropriately. If demands on the body are premature, before the reflexes are fully integrated, then delayed development can be the result. Learn about reflexes through an intensive training session. Learn more about reflexes at http://masgutovamethod.com
o Vision – While some children have eyesight problems that can be corrected by glasses, others have vision issues, such as the two eyes not working together, in conditions called exotropia, esotropia and strabismus. Motor activities that are the foundation for vision development and the body must be strong to support binocular vision. The relationship between vision and learning can also be a training session for those at the center. To learn more about vision, read this.
A book explaining the role of vision in learning is How to Develop Your Child’s Intelligence by Getman.
o Hearing – Listening is to hearing as vision is to eyesight. Although a child can hear, his brain may not process what it hears. Several “listening programs” are available to help children give meaning to what they hear. Look here for understanding of this area.
o Sleep – Everyone needs uninterrupted sound sleep for their bodies to heal and repair. Pre-school aged children require 11-12 hours of sleep per night. Young children with disabilities might need more if they are contending with health issues. Help parents and teachers understand their kids’ need for rest periods. Read this.
Educational – Schools are often unknowingly a source of stress too.
o Inappropriate curriculum – All children learn in a predictable developmental sequence, just as they learn to walk before they run. We discourage teaching rote concepts such as the alphabet, counting and naming to young children. These skills will emerge when a child is developmentally ready. Here is an article on this subject.

o Non-ergonomic furniture – Sitting in small chairs when the trunk and head are not stable only results in compensatory techniques like tilting the head and rotating the hips. Replace hard, wooden chairs with soft gym mats, beanbags, cushions and pillows to help children develop core strength.

Emotional – Families have so many situations that add stress.
o Unreasonable expectations – This stressor is tied to the one above related to an inappropriate curriculum. Children want to please adults, and when they cannot comply with expectations, they become discouraged. Make sure that requirements are consistent with a child’s developmental age.
o Worries and fears – Some kids like being around many people; others find crowds difficult. It appeared that many of the children we saw were somewhat fearful of having so many adults watching and prodding them. Observations should be limited to one or two adults at a time until a child is comfortable emotionally.
o Family Issues – Today’s families, especially those with multiple children with disabilities, are under a great deal of stress. They need support systems to help them cope. Offer parent and sibling support groups where adults and children can share their experiences and learn from each other.

Behavioral – Treating symptoms is never the right answer.
o Medications – Pharmaceutical and over-the-counter drugs all have side effects which can cause behavioral symptoms as benign as restlessness and irritability, and as serious as rashes, seizures and fevers. They can also interfere with sensory processing, such as cause double vision and tactile defensiveness. Instead of treating symptoms, look for natural alternatives to prescription drugs, and search for underlying causes of illness, such as food allergies and toxicity,.
o Screen Time – While young children are attracted to the bright colors, sounds and movement of objects on computers, iPads, and iPhones, these two-dimensional objects are not good for development. To learn, children need to touch and see objects in three dimensions, not on flat screens. Please consider replacing electronic toys with playthings made out of natural materials. For non-verbal children, speaking with real people is superior to speaking to a machine. Psychologist Jane Healy is the expert on brain development and screen time. Please refer to her books, Failure to Connect: How Computers Affect Our Children’s Minds — and What We Can Do About It, and Your Child’s Growing Mind: Brain Development and Learning From Birth to Adolescence.

Summary
Even with loving, supportive parents and teachers, the our lifestyle and environment add stress to the lives of our children with developmental delays. Start with the physical environment, and reduce exposures to noise, light, toxins and sensory overload. Every time you replace a product, purchase one of higher quality with fewer toxins. Gradually, stressors will reduce, and the home and school will be more conducive places for learning and growing.

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Strabismus: Implications for Development

January 19, 2010

I received a beautiful holiday card from a lovely couple showing several pictures of their two young children. The three-year-old boy is playing ball and laughing. The year-old-girl is wearing glasses and staring into space unfocused with her mouth open. I last saw these children about a year ago, when the girl was just an infant; I had not spoken with her parents since.

It appears to me that this little lady has crossed eyes, also known as strabismus. Her development concerns me greatly.  Unknown to me is what treatment she is receiving. I know from experience that strabismus is a serious visual condition that affects the ability of the eyes and the brain to communicate. A strabismus rarely goes away untreated; children generally do NOT outgrow it.

No one knows this better than neuroscientist, Sue Barry, the author of Fixing My Gaze. I just finished reading her remarkable book, and recommend it highly.  You don’t have to be a scientist to understand the impact of going through life with misaligned eyes. 

What happens normally? As we scan our environment, not only must our two eyes simultaneously aim at the same object, but our brains must integrate a message from each eye into a single image. The process of fusion (combining the pictures from each eye into a single picture) enables us to perceive three-dimensional depth and helps us to determine our relationships to objects in our environment. Vision emerges as the primary sense when a typical child integrates it with touch, movement and the other senses.

What goes wrong?  In children with developmental delays, signs of incomplete or inefficient eye teaming (binocularity) usually appear around eighteen months, just when expressive language is emerging. However, later onset is not uncommon. Poor eye teaming can be associated with neurological disturbances related to heavy metal toxicity, high fevers and childhood illnesses such as strep or pneumonia. Dr. Melvin Kaplan found that about half of the children with autism that he examines have an undiagnosed strabismus.

Initially, the inability to efficiently and effectively team the eyes may appear only at times of illness, fatigue or intense concentration. However, frequently, the vulnerable binocularity can worsen; strabismus and amblyopia or a “lazy eye” can result. 

First, Strabismus… In strabismus, one eye accurately aims at the object of regard, while the other eye misses it by aiming above, below or to the left or right of it. Double vision (diplopia) then results. The misalignment may be constant or intermittent, and thus not always noticeable.  Disorganization and confusion follow as the brain struggles to integrate competing messages.

Next, Amblyopia…. In order to minimize the disorganization and confusion, sometimes the unconscious mind adapts to strabismus by suppressing signals from the faulty aiming eye.  Eventually, visual suppression leads to amblyopia or “lazy eye,” in which the nerves that transport and interpret visual information lose some of their ability. The result is poor vision in one eye, due to an interference in the neurological interpretive mechanism. 

In many instances the reduced vision cannot be corrected with glasses or surgery.  With the eyes functioning at less than 100% efficiency, any sustained visual activity such as reading may require extra effort and strain. As in strabismus, the only obvious sign of amblyopia may be an eye turn. However, some people with amblyopia may turn or tilt their heads to see certain things or close one eye when reading.  I diagnosed a possible strabismus in a child after looking at photos in which his head was tilted to the left in each and every one. 

Proper early developmental vision examinations by an optometrist trained to look at the whole child are essential. Eye turns cannot always be observed and require special testing. Untreated binocular vision problems can pose obstacles to development in many areas.

Strabismus & Amblyopia Affect Spatial Relations and Balance Usually, such as in the holiday photo, cosmetic aspect of misalignment is obvious. Even more important are the effects on function and vision, because strabismus disrupts the ability to orient oneself in space.  A good number of the eye’s neural fibers bring information to the body’s balance system. If they deliver inaccurate information, the person’s sense of where he is in space can be compromised.  

The Psychological Effects of Strabismus –  Strabismus and double vision can adversely affect social-emotional development.  A child who is disoriented in space experiences himself and his environment as unstable and unpredictable. He may grow increasingly inward, become belligerent or demonstrate sensory defensiveness, all characteristics of “autism”

Treatment and Referral – Strabismus and amblyopia always require attention. Surgery, even when done when a child is young, may cosmetically straighten the eyes but usually does not improve visual function, especially without pre- and post-surgical vision therapy. Clinical studies indicate that fewer than 20% of patients who undergo strabismic surgery acquire depth perception.  Patching the “strong” eye to force the “lazy” eye to see is also of limited value.  Barry is one of surgery’s failures.

Effective treatment programs using vision therapy combine involve lenses, prisms and motor activity designed to teach the eyes, body and brain to work together.  Research shows that vision therapy can be effective at any age, but more treatment is needed the longer the condition has existed. Barry is one of vision therapy’s most prominent successes. 

At 50 years of age, she danced among falling snowflakes, experienced skyscrapers looming toward her, and tree branches projecting upward and outward, “enclosing and commanding palpable volumes of space” for the first time in her life. 

If you suspect that a child’s eyes don¹t work together, as I do with my friends’ child, go to the vision section in the Practitioner Directory at http://www.devdelay.org/ to find a qualified eye care practitioner in your area. This section lists organizations that train and certify optometrists to work with children and adults with a variety of vision issues. Go either to www.covd.org or www.oepf.com For a  complete explanation of this common problem, go also to http://www.strabismus.org/ .

The Medicated Child

November 15, 2009

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PBS stations nationwide ran a documentary last week on FRONTLINE entitled The Medicated Child. Marcela Gaviria produced this piece in an effort to respond to the dramatic increase in the number of children with serious psychiatric diagnoses, including bipolar disorder. The program also was to focus on the one-size-fits-all treatment with untested pharmaceutical medications that doctors are prescribing for these children. 

According to child psychiatrist Dr. Patrick Bacon, trying medications on young children is really an experiment…a gamble… we do not know what’s going to work. I tuned in with great anticipation, hoping at last to see some expert reporting on alternatives to drugs, whcih can cause serious short-term reactions and unknown long-term effects.  What I saw instead were many sick kids with black circles under their eyes, obvious vision problems and nutritional deficiencies that no one was talking about!

The trailer promised that the producer would “confront psychiatrists, researchers and government regulators about the risks and benefits of prescription drugs for troubled children.”  Yet this film and its doctor experts offered few alternatives.   

The Parents’ Guide written by Harvard Medical School child psychiatrist Joshua Sparrow to accompany the documentary “provides background on the issues associated with treating a child with psychiatric medications.”  Unfortunately, it too falls short of giving parents and teachers any practical alternatives. 

In the section entitled Observing, Describing and Understanding Your Child’s “Out-of-Control” Behavior, Sparrow offers several bullet points.  I reproduce them here with my edition of the type of information I wish he had provided.

  • Warning signs – Early risk factors for behavioral and learning issues include:
    • Missed developmental steps, such as no crawling  
    • Repeated infections, such as strep, ear infections
    • Skin problems, such as eczema and serious diaper rash
    • Chronic diigestive problems, such as reflux, diarrhea or constipation
    • An eye turn, called a strabismus
    • Hyper- or hypo-reactivity to sensory stimulation such as lights, sounds and touch
  • Triggers – All behaviors are reactions to something in the environment. Common triggers are:
    • Foods. Some kids’ digestive systems react to popular foods, such as dairy products, gluten (the protein in wheat and other grains), eggs, chocolate and soy.  In babies who have any of the above digestive warning signs, food is suspect.  The reaction may not be immediate.  I watched one child gradually dissolve an hour after a lunch of pizza and milk. 
    • Food additives. Artificial colors, flavors and preservatives, such as BHT cause behavioral issues in susceptible kids.  The Feingold Association has known this for years and is available to help.  Excitotoxins, such as fluoride, MSG and aspartame can all cause behavioral and psychiatric problems.
    • Pesticides and cleaners.  Many kids react to products used to exterminate bugs and eliminate bacteria.  Behavioral issues are more common on Mondays than any other day, due to schools being cleaned on Friday and closed up all weekend.
    • Chemicals from carpets, paints and other building materials.  Any building with new construction or renovation is suspect.  Formaldehyde from new cabinetry, fabrics and carpets can set off many kids.  The fumes from new paint are also toxic. 
    • Perfumes and air fresheners.  Some people become literally psychotic from breathing the artificial smells from these products. 
    • Contexts, settings – The cafeteria and playground are common “meltdown” arenas.  Why?  Because of the noise levels, bright lights in the former and possible mold, sprays and pollen in the latter.  I know one boy who acted out every time he went to the “reading room” where the teacher had placed a lovely, toxic, area rug.  Everyone thought he hated reading.  What he hated was the rug, and when it was removed, he was fine!
  • Symptoms – Symptoms are very individual and sometimes subtle. Doris Rapp, MD has been an expert on this for many years.  Some kids go into meltdowns.  Others may get spacey, talk too loudly, put their hands over their ears, stomp their feet, run in circles, scream, cry, kick, self-stimulate, throw things.  Some may be seeing double, become unfocused, stare out the window, look “depressed,” get sleepy, blink, look out of the corner of their eyes, fiddle with their clothes, masturbate, mouth objects. Any and all of these symptoms must be looked at diagnostically, rather than as behaviors to extinguish. 
  • Aftermath – Timing, frequency and recovery periods are crucial to evaluate. Keeping good records will help in the Sherlock Holmes process of pinpointing and eliminating triggers. 
  • Effect on overall functioning – Environmental reactions can interfere with a child’s learning, social relationships, sports performance and consume a family’s emotional and financial resources. Make changes for all family members and the whole class rather than just for the behaviorally reactive child.   

Consider non-pharmaceutical alternatives

If only FRONTLINE had included these interventions:

  • Change the diet – Consider eliminating colors, flavors, preservatives, excitotoxins.  Learn about Feingold, the Body Ecology Diet, the gluten-free dairy-free (GFCF) diet
  • Up the nutrition with foods and supplements – Add essential Omega 3 fats such as cod liver oil and flaxStudies show conclusively that good quality fats are efficacious alternatives to drugs
  • See an occupational therapist (OT) – Have the child evaluated for sensory integration problems by a private therapist who can pinpoint underlying reflex integration issues, tactile defensiveness, vestibular dysfunction or auditory processing problems.  Sensory-based OT can program the nervous system to respond in a more balanced way.
  • See a developmental optometrist (OD) – Make sure the two eyes are working together as a team and that the brain is giving proper meaning to what it sees.  With an eye turn, depth perception is impossible. Sometimes eye turns occur only intermittently and must be diagnosed by an expert.  Therapeutic lenses and vision therapy that includes activities to help the eyes and brain work better together can alleviate behavioral and learning issues.

Congratulations to FRONTLINE for recognizing the serious risks medications for bipolar and other disorders pose. We heartily  agree with them that research and insurance coverage for non-medication treatments are under-funded, and recommend that treatments such as these deserve further investigation.    

We can also concur that the forty-fold increase in the number of children and adolescents diagnosed with bipolar disorder over the past 10 years might be due to preventable causes. The simultaneous increase in environmental toxins, reliance on technology such as computers and television, and changes in food nutrient contents and genetic engineering are just a couple of obvious areas to    consider.

Thank you to the parents who took the time to tell their own stories of drug horrors and success with the Feingold program, naturopathy and other “natural’ solutions.  Add yours!  Maybe one day PBS will give us a useful commentary on how to prevent and help kids without drugs.  I sure hope so!  In the meantime, you can find out about more therapies that work in my book EnVISIONing a Bright Future