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What is a behavioural Optometrist? Visual Perceptual Assessment (VPA) What is a Behavioural Optometrist? A Behavioural optometrist has a more holistic approach in the treatment of vision and visual perceptual problems in relation to classroom perfromance. Vision plays a vital role in the reading process. In fact more than 80% of the information children receive about the world comes through their eyes. First and foremost children must have crisp, sharp eyesight in order to read print clearly. Yet sharpness of sight or visual acuity is only one measure of a child's visual function. Children must be able to co-ordinate their eye movements as a team so that the print doesn’t appear double or the words ‘swim’ around. They must have good depth vision. The eyes must make accurate reading eye movements to prevent the child skipping words or lines when scanning across and down the page. If they cannot accomplish this then they may have to use their finger as a marker to keep their place. They must be able to sustain clear focus when reading for a prolonged period or make quick focusing changes when looking up to the board and back to their books, otherwise they may experience sore eyes, blurred vision or even headaches. And they must be able to analyse and accurately process what they are seeing. If a child has inadequate visual skills in any of these areas they may experience difficulty in school, particularly with reading. In fact recent studies have suggested that approximately one in four Australian children have some form of vision problem. All children should have their eyes tested before they begin school and preferably at two yearly intervals thereafter. Common Vision Disorders 1. Visual acuity Visual acuity refers to clarity of sight, 20/20 or 6/6 vision being the normal standard. 2. Refraction Refraction is the process of determining the optical power of the eyes. Emmetropia is the normal refractive condition of the eye. An individual who is emmetropic would be expected to have good visual acuity of 6/6 or better. Ametropia refers to any refractive condition other than emmetropia, which includes myopia (short-sightedness), hyperopia (long-sightedness) and astigmatism. 3. Myopia (short-sighted) Shortsighted children can see clearly up close but not in the distance. Myopia affects only 3% of children aged 5 to 9 years, 8% of those aged 10-12, and 17% of teenagers. Shortsightedness is due to hereditary factors and visual stress. Studies have shown that 85% of all shortsighted children have at least one shortsighted parent. Symptoms of myopia include squinting, and blurred distance vision such as when viewing the blackboard at school. 4. Hyperopia (long-sighted) Most school-age children are in fact a little longsighted. Hyperopic children must exert extra effort to bring their near vision into sharp, clear focus. Symptoms may include; fatigue and or headaches after closework; rubbing of the eyes; close reading distance; difficulty maintaining clear focus when performing sustained close work; and difficulty adjusting focus. 5. Astigmatism Astigmatism is a distortion in the curvature of the cornea the clear window of the eye. Instead of the cornea having a perfectly spherical shape like that of a soccer ball, the curvature is more shaped like a rugby ball. Mild amounts of astigmatism may cause headaches, fatigue and discomfort. Higher degrees result in distorted or blurred vision. Treatment is with prescription spectacles, which correct the distorted astigmatic focus.
Click on the following link to view the effect of astigmatism on vision. 6. Accommodation Accommodation put simply is the ability to see clearly when reading yet more specifically refers to the process by which the crystalline lens within the eye changes shape in order to focus near (close) targets clearly on the retina. The ability of the crystalline lens to perform this task is under the control of the ciliary muscle within the eye. Prolonged near visual tasks such as reading, writing and computer work place stress on the eyes particularly if we are at an age where we have not yet developed adequate focussing stamina or if we have a significant degree of long-sightedness. The visual effort required to cope with these tasks can sometimes cause a breakdown in the visual system leading to focussing problems. 7. Accommodative Insufficiency Accommodative insufficiency refers to the situation where the eyes are either unable to focus the necessary amount or are unable to sustain focus for long periods when reading; which may lead to eyestrain, headaches and blurred vision. 8. Accommodative Excess Accommodative excess refers to the situation where the eyes exert excessive amounts of focus when reading. This can affect the child's ability to sustain focus for prolonged periods, adjust focus from reading material to the blackboard and may lead to symptoms such as eyestrain, headaches and blurred vision.
9. Eye Teaming Our eyes are designed to work as a team. When we look at a target each eye forms an image of the object. The two separate images from each eye are transmitted to the brain, which combines them into a single percept. For the visual system to work correctly, each eye must aim at the exact same point in space so that the images being recorded are identical. However, if the eyes are not aiming (converging) together then the brain is unable to 'fuse' the two images, which results in double vision.
Unfortunately, about ten percent of school-aged children have eye-teaming problems, which are also known as vergence dysfunctions. These include convergence insufficiency and convergence excess. Children with convergence insufficiency find it difficult to maintain the inward eye aim required for reading. As the eyes tire, they drift apart and end up aiming behind the page (at a further distance). Convergence excess occurs when the eyes are working too hard. The eyes “over-point” which forces the eyes to strain unnecessarily such that they aim in front of the page (at a closer distance).
Children with eye teaming problems are only able to aim their eyes together correctly for short periods of time. Reading and comprehension become increasingly difficult as the child strains to aim both eyes at the same point to keep the print from blurring, jumping, or splitting apart. In addition, children with eye teaming problems can be highly distractible, finding it difficult to concentrate and remain on a task when the strain on their eyes is great. Other symptoms of eye teaming problems include loss of place as the print "swims" and moves; eyestrain; fatigue; headaches; and frustration.
Left
undiagnosed and untreated, eye teaming problems may impair learning and
behaviour. In fact recent research has found that convergence insufficiency is
three times more common in children with Attention
Deficit Hyperactivity Disorder (ADHD) than in other children. Convergence
insufficiency makes it more difficult to concentrate on reading, which is also
one of the signs of ADHD. 10. Stereopsis (depth perception) Stereopsis is the ability to perceive objects in three dimensions or in depth, which is critically dependent on the alignment of the eyes. Stereopsis occurs when the two eyes see an object from slightly different angles. If the misalignment of the eyes is too great then stereopsis will not be perceived because each eye will be looking in different directions. Children with eye turns even if they are slight will have difficulty with depth perception. Thus stereopsis is a very sensitive measure of the eye’s co-ordination (eye teaming) ability.
All these skills are crucial to learning in particular reading, yet there is a whole range of other visual skills which are no less important. To understand their influence we must first understand the reading process. Reading There are three stages in learning to read, which are known as the logographic, alphabetic and orthographic stages. When children learn to read for the first time they establish a sight word vocabulary, where they recognise words by their visual pattern, using cues such as overall shape, length of the word or identifying the first letter. Certain letters attract children’s attention because of their shape. For example in a word like ‘magnet’, the letters that attract most attention are usually the letters at the end of words and any letters which hang below or stick up above the level of surrounding letters (m_g__t). There are three high visibility letters in the word ‘magnet’; therefore the child may be insensitive to the middle sounds such as the ‘a’ and ‘e’. The child may therefore guess at the word and confuse it with similar looking words such as ‘midget’ or ‘maggot’. Children often have more difficulty processing smaller words than longer words since longer words have more high visibility letters and often don't appear like other words. Whereas telling the difference between 'of' and 'if' requires much closer inspection. This is compounded by the fact that when reading there is a tendency to read ahead and spot longer words at the expense of paying attention to the smaller words. This is the logographic stage and this strategy predominates for the first year or so of learning to read. Progress in this year is associated with good visual analysis skills, which more specifically relate to the skills of matching, discrimination, recall, sequencing, directionality and visualisation. When reading the child must discriminate between similarly spelled words such as ‘run’ and ‘ran’, ‘spot’ and ‘spit’ and words which look the same but face different directions such as ‘bib’ and ‘did’. The child must process letters and words in correct sequence; otherwise they may transpose all or parts of words. For example they may confuse ‘form’ with ‘from’, ‘angle’ with ‘angel’, ‘clam’ with ‘calm’, ‘god’ with ‘dog’. As children become more familiar with the letter-sound relationships, they move into the alphabetic stage. During this stage the child learns to appreciate that letters can be represented by sounds. This gives the child a whole new power namely the ability to sound out unfamiliar words as they read, which is also known as phonics. The development of phonics is critically related to the child’s auditory perceptual skills, which refers to the ability to make sense of information received through the ears. It includes the ability of a child to tell the difference between similar sounds (auditory discrimination). Certain letters in the English language sound very similar, such as ‘b’ & ‘d’ and ‘m’ and ‘n’, as a result many children find it difficult to discriminate between them, which is compounded by the fact that they also look similar. Auditory processing skills also refer to auditory memory which is the amount of vocal information that a child can retain in their memory. A simple way to test this is to ask a child to repeat a simple series of random numbers. Most young children will only be able to repeat 2 or 3 numbers whereas an older child may be able to remember a sequence of 6 or 7 numbers. During the alphabetic stage the child learns the pronunciation rules of sounding out words. Certain sounds are different depending upon the other letters around them. For example the sound ‘ou’ when combined with ‘gh’ makes an ‘off’ sound as in the word ‘cough’, but in the word ‘enough’ it makes the sound ‘uff’, and in the word ‘bough’ it makes the sound ‘ow’. Did you realise that the word ‘ghoti’ could be pronounced ‘fish’? The ‘gh’ makes the ‘f’ sound like in the word ‘enough’, the ‘o’ makes an ‘i’ sound like in ‘women and the ‘ti” makes the ‘sh’ sound as in the word ‘nation’. The child learns to realize that certain vowel sounds can sound exactly the same. For example in the word ‘button” the ‘o’ sound could be replaced by ‘a’, ‘e’ ‘i’ or ‘u’ and the word would still sound the same. The English language really is complex! In fact there are 1120 ways of representing 44 sounds by different letters or letter combinations. During this phase writing and spelling help develop children’s letter-sound awareness because these skills draw the child's attention to individual letters and their sounds. At the start of the alphabetic stage, children can usually read many more words than they can spell. As the child becomes familiar with text they move into the orthographic stage. During this stage the child does not need to sound out words instead they recognise the sight and sound of parts of words that correspond to units of meaning (morphemes). As they learn to recognise words by sight, their reading speed and fluency increases. Although sounding out skills are an essential part of reading it is a slower and more laborious method. Children need to be able to read quickly and fluently otherwise they are in danger of forgetting what they’ve read, which subsequently affects their comprehension. Sight word readers learn to read ahead. Words provide clues as to what other words are around them. For example the sentence 'The boy placed the toy #% the wagon' has a missing linking word, which is most likely 'in'. Good readers expect print to make sense and therefore predict what words are. In fact they don't process each word in a sentence instead they are reading by shape and context and sub-consciously filling in the missing information. We in fact use this so much that you may experience trouble with the next task. Count the number of ‘F's’ in the following text.
RESULT OF YEARS OF SCIENTIFIC STUDY COMBINED WITH THE EXPERIENCE OF YEARS. How many did you count? If you answered six you are correct. If you didn't find that many check again. Word structure knowledge enables you to read more quickly by glancing only at the important details. The child learns to understand grammar and punctuation. ie. How do the commas, spaces and full stops affect the meaning of the story.
During
the orthographic stage the child’s reading comprehension increases greatly, instead
of learning to read they are finally reading to learn. Unfortunately not all children reach the orthographic stage at the same time. Children who are word guessers may be considered to be in the logographic stage where they try to guess words by their shape, which indicates that they haven’t developed adequate sounding out skills. Other children who haven’t advanced from the alphabetic stage are continually forced to sound words out because they haven’t learnt to relate sounds with their visual form, which makes them slow dysfluent readers who generally have poor comprehension. Reading is indeed a complex process, adequate auditory and visual perceptual skills are necessary for a child to be a competent reader. As part of a thorough eye examination the Optometrist may recommend a visual perceptual assessment. Visual Perceptual Assessment (VPA) A visual perceptual assessment evaluates a child's ability to process visual information. A simple analogy is to think of vision like a computer, we have hardware and software. The hardware consists of the structures of the eye such as the eye muscles, which need to be working well for the child to see clearly and singly; whereas the software is the higher order 'thinking' program in the brain which interprets the images the eye receives. Visual analysis skills are a group of abilities, which include matching, discrimination, recall, sequencing, directionality and visualisation. Visual analysis skills begin developing after birth. Children learn to recognise certain visual patterns early in life. Eg. Their parents and siblings faces. By the age of three, the average child is able to discriminate accurately between a circle, a square, a plus sign and a triangle. They will be able to identify matching pairs of shapes, point to a shape on request and even name some of them. This is evidence of developing visual analysis yet this is still not at the level required by school. It is not until the average child is 5 or 6 years of age that their visual analysis skills are mature enough to begin reading. Sadly even at this age some children have immature visual analysis, which locks them out of the reading process. Consider the task of copying from the blackboard, which is one of the most common difficulties teachers observe in the classroom. When copying from the board not only does the child need to constantly change focus from their book to the board but they must find their place as quickly as possible. They must make eye tracking movements as they look across and up and down the board. They must remember what is written on the board as they look back to their books and then they must reproduce this on their page. On top of this if the child is sitting at an angle to the board then they must mentally rotate this image in their mind. A child who has a problem in any of these areas (eye focusing, eye co-ordination, eye tracking, memory, spatial awareness, fine motor skills) will find copying from the board slow and tedious.
A visual perceptual assessment evaluates the child's visual, auditory and visual-motor skills. All tests are standardised, which allows us to assess whether your child's perceptual development is at a level expected for their age or grade. This assessment takes about 2 hours to perform and costs $250, with the results being tabulated and reports sent to the child’s teacher. Should vision therapy be required as a result of this assessment then a program designed around the child’s specific needs is developed. In-office visits are scheduled for every 3-4 weeks to demonstrate each exercise and to assess the child’s ability and progress.Below is a summary of the above mentioned skills. Learning requires all of these skills to be used concurrently therefore each skill should not be viewed independently of the others. The learning pyramid identifies the role each skill has in a child's overall development. Those near the bottom are critical at a younger age and form the foundation for the development of the higher skills. A deficiency in any one area can affect the child's academic, physical and social development. Visual-Spatial SkillsOptometric vision therapy is a series of programmed activities undertaken to improve either poorly developed visual, visual motor or visual perceptual skills, or procedures to further enhance the present visual skills to a higher level of efficiency and / or stamina. Vision therapy may be used in the treatment of such conditions as :
We offer the following computerised vision therapy programs to patients with focusing, eye teaming or visual perceptual difficulties. Perceptual Therapy System (PTS2) Perceptual Visual Tracking Program (PVT) Home and In-Office vision therapy is available. Each program is designed to meet the specific needs of the individual. The frequency of consultation, the amount of home training and the duration of a course of vision therapy will vary depending on the nature and severity of the problem being treated and the specific needs of the patient. Ergonomics It is important when reading that the room lighting is bright and even. Children need to complete their near work at the Harmon distance. This is a measured distance between the eyes and the nearpoint materials that should be maintained during seated deskwork. Some children are so close to their papers that undue stress is placed on the visual system. The eyes are forced to work harder to keep the print clear because of the close distance. By keeping a standard distance from the paper the visual system relaxes and performs more efficiently. The Harmon distance is measured by the child placing their closed fist under their chin. The point at the end of their elbow represents the closest distance the child should be from their near work. Usually if the child’s back is against their ‘pushed in’ chair, this distance will be maintained. The most suitable furniture for close work is a desk with a top sloped at 10 degrees to the horizontal. The sloping desks allow the spine to be in a more upright position, relieving muscular tension. If a sloped desk is not available it is possible to obtain an adjustable slope board to rest on the desktop.
Children need to take regular breaks to avoid visual stress. Certain subjects or periods throughout the day may produce more visual stress than others. Usually seated work sessions that require the child to concentrate on a given task is an example of a nearpoint stress period. Prolonged nearpoint focussing should be limited to periods of 30 minutes. After each period the child should be encouraged to flex their focussing abilities at both near and far. This involves looking at a distant object, back to the nearpoint material, and up to the distance again. This needs to be done at least twice before resuming another 30 minute intensive focussing period. When reading it is important that the child keeps their head still. Moving the head and eyes to scan across a page is a slow and immature technique. Children are more likely to lose their place if both their head and eyes are moving to follow the print. If the head is still and acts as a fixed reference point then this allows the eyes to scan the text more efficiently. Poor eye movement control may cause a child to lose their place when reading, have difficulty copying from the blackboard, and cause the skipping or omitting of letters and small words when reading. Children with poor eye tracking control are often slow readers, have poor fluency and often report that words appear to move on the page; they often compensate for this problem by using their finger as a marker when tracking along a line of print. At school children should sit so that they're facing the blackboard. Many schools make the task of copying or learning from the blackboard more difficult by having children sit side on or with their backs to the board. When copying the child has to analyse what is on the board then has to form a mental picture of this image as he attempts to copy it to his book. Children who already have problems maintaining mental images, are forced to mentally manipulate the image 90 or 180 degrees if they are sitting side on or with their back to the blackboard. When playing computer games it is important that the child sit as far away from the TV or computer screen as possible. Learning Difficulties Dyslexia Dyslexia is a learning disability that affects approximately 10 per cent of the population. Despite having average or above average intelligence, people with dyslexia have difficulty in reading, and in other language-based tasks such as writing and spelling. There are three primary types of dyslexia known as dyseidesia, dysphonesia and dysnemkinesia. Yet children can demonstrate one, two or all three of these types. For example a child with all three types would have Dysnemkinphoneidesia. A child with dysphonesia has difficulty with the units of language known as phonemes. Phonemes (pronounced: fo-neems), are the smallest meaningful units of language. For example 'cat' contains three phonemes: kuh, aah and tuh. There are 44 phonemes in the English language. For most people, the process of breaking words into phonemes occurs automatically, without conscious thought. Just as we break down phonemes without thinking about it, we also merge them in our speech automatically: "cat" is one syllable, but made up of three distinct sounds. Between the ages of 4 to 6, most children are aware that phonemes make up words. Children with dysphonesia struggle to make the connection between the sound and the letter symbol for that sound, and to blend sounds into words. Brain imaging techniques have demonstrated that people with dyslexia process phonological information (i.e. sound-based information) in a different area of the brain than non-dyslexics.
Areas in the
back of the brain that are usually activated when normal readers sound out words are
significantly less activated in dyslexics' brains. Moreover, areas in the
front of the brain displayed more activity in dyslexics' brains than in the
brains of normal readers. A child with dysnemkinesia would have difficulty with written symbols. Most very young children demonstrate signs of dysnemkinesia when first learning to write letters, yet in most children these difficulties resolve before the age of 8. The signs of dysnemkinesia include:
A child with dyseidesia generally has a good grasp of phonetic concepts but has difficulty with whole word recognition and visual analysis. In particular they have difficulty with visual processing. Children with dyseidesia typically spell words in a way that you can easily decipher phonetically, but they may be far from correct. For example, the word 'phonics' might be spelled 'foniks', which indicates the child has difficulty remembering the visual form of the word.
Behavioural Optometrists are not able to diagnose dyslexia but can suggest to parents whether
the child may be showing signs suggestive of dyslexia. In order for a formal
diagnosis to be made an assessment by a child
psychologist is required.
Attention Deficit Hyperactivity Disorder (ADHD) What is ADHD? ADHD is a frequently encountered disorder that affects children’s behaviour, but is often difficult to diagnose. Although there are a number of common symptoms, many of them occur to a smaller or greater extent in all children. All children have difficulty paying attention, following directions, or being quiet from time to time, but for children with ADHD, these behaviours occur more frequently and are more disturbing to the children and those around them. One of the most common of these is an inability to concentrate or focus. Children with ADHD tend to be impulsive and easily distracted; they find it hard to sit still and pay attention in school. Originally simply called ADD (Attention Deficit Disorder) it was renamed in 1994 by the addition of “hyperactivity” in deference to this particularly frequent behavioural symptom. Attention Deficit Hyperactivity Disorder (ADHD) is subdivided into ADHD Inattentive Type, or ADHD Impulsive-Hyperactive Type, or ADHD Combined Type. In the recent past the terms attention deficit disorder "with" or "without" hyperactivity were also commonly used. The more common symptoms of ADHD Inattentive Type are: ► Carelessness in schoolwork and other activities; ► Inability to sustain attention in tasks or play activities; ► Apparent listening problems; ► Difficulty following instructions; ► Difficulty in organizing tasks and activities; ► Dislike of and avoidance of tasks that require mental effort; ► Tendency to lose things like toys, notebooks, or homework; ► Ease of being distracted; ► Forgetfulness in daily activities. 2. Further symptoms that occur in ADHD impulsive-hyperactive subjects include: ► Fidgeting or squirming; ► Difficulty remaining seated; ► Excessive running or climbing; ► Difficulty playing quietly; ► An excess of energy; ► Excessive talking; ► Answering questions before they have been completed; ► Difficulty waiting for a turn or in line; ► Frequently interrupting or intruding. 3. Subjects may also be encountered who display a combination of some symptoms from each of these categories. What causes ADHD? No one cause of ADHD has been identified. It is known that there are biological origins to ADHD, but these have not been clearly defined. There is also evidence to support the belief that some children have a genetic predisposition towards ADHD, as it would appear to be more common amongst children who have close relatives with the disorder. Behavioural Optometrists are not able to diagnose ADHD but can suggest to parents whether the child may be showing signs suggestive of ADHD. In order for a formal diagnosis to be made an assessment by a child psychologist is required. Dyspraxia Dyspraxia is a learning disorder that affects an individual’s ability to plan and carry out motor movements. Dyspraxia is often subdivided into two types: developmental dyspraxia, also known as developmental coordination disorder, and verbal dyspraxia, also known as developmental apraxia of speech. Developmental Dyspraxia can affect both gross and fine motor skills. Children with developmental dyspraxia may demonstrate the following signs:
Verbal dyspraxia is a speech disorder that interferes with a child's ability to correctly pronounce sounds, syllables and words. It is the loss of ability to consistently position the articulators (face, tongue, lips, jaw and palate) for the production of speech sounds and for sequencing those sounds into syllables or words. Generally, there is nothing wrong with the muscles themselves. The child does not have difficulty with non-speech activities performed with the muscles such as coughing, chewing or swallowing. However, the ability to perform a "motor plan" for the production of speech is poorly developed. For example when asked to put their tongue to the top of their mouth or asked to show how they kiss, a child with oral dyspraxia can find these movements difficult. They can often do these movements automatically (when not thinking about them) but are unable to do them when asked. These children may demonstrate many of the similar symptoms to children with developmental dyspraxia yet they may also demonstrate:
Dyspraxia is thought to affect between 8 to 10% of all children. Though not always, dyspraxia often co-exists with other learning disabilities, such as dyslexia and dyscalculia (difficulty with mathematics); as well as ADHD. The symptoms from these learning disabilities can be similar to those of a person with dyspraxia. Dyscalculia Dyscalculia is a learning disorder which affects a person's ability to understand, remember, and/or manipulate numbers and/or number facts (e.g. the multiplication tables). The child often has a poor ability to conceptualize numbers which is also known as “number sense” and has difficulty with mathematical reasoning. The term is also often used to refer specifically to the inability to perform arithmetic operations. Dyscalculia is a lesser known disability but is thought to be related to dyslexia and dyspraxia. It is thought that anywhere up to 5% of the general population may suffer with dyscalculia.
Autism Spectrum Disorder Autism spectrum disorder (ASD) is a lifelong developmental disability that affects approximately one in 400 people. Characteristics of the disorder include poor social skills, impaired communication, obsessive behaviour and sensory processing difficulties. Autism spectrum disorders, range from a severe form, called autistic disorder, to a milder form, Asperger syndrome. If a child has symptoms of either of these disorders, but does not meet the specific criteria for either, the diagnosis is called pervasive developmental disorder not otherwise specified (PDD-NOS). Children with ASD may demonstrate some of the following signs.
Social SymptomsFrom the start, typically developing infants are social beings. Early in life, they gaze at people, turn toward voices, grasp a finger, and even smile. In contrast, most children with ASD seem to have tremendous difficulty learning to engage in the give-and-take of everyday human interaction. Even in the first few months of life, many do not interact and avoid eye contact. They seem indifferent to other people, and often seem to prefer being alone. They may resist attention or passively accept hugs and cuddling. Later, they seldom seek comfort or respond to parents' displays of anger or affection in a typical way. Children with ASD also are slower in learning to interpret what others are thinking and feeling. Subtle social cues—whether a smile, a wink, or a grimace—may have little meaning. To a child who misses these cues, "Come here" always means the same thing, whether the speaker is smiling and extending her arms for a hug or frowning and planting her fists on her hips. Without the ability to interpret gestures and facial expressions, the social world may seem bewildering. To compound the problem, people with ASD have difficulty seeing things from another person's perspective. Most 5-year-olds understand that other people have different information, feelings, and goals than they have. A person with ASD may lack such understanding. This inability leaves them unable to predict or understand other people's actions. Although not universal, it is common for people with ASD also to have difficulty regulating their emotions. This can take the form of "immature" behaviour such as crying in class or verbal outbursts that seem inappropriate to those around them. The individual with ASD might also be disruptive and physically aggressive at times, making social relationships still more difficult. They have a tendency to "lose control," particularly when they're in a strange or overwhelming environment, or when angry and frustrated. They may at times break things, attack others, or hurt themselves. In their frustration, some bang their heads, pull their hair, or bite their arms. Communication DifficultiesBy age 3, most children have passed predictable milestones on the path to learning language; one of the earliest is babbling. By the first birthday, a typical toddler says words, turns when he hears his name, points when he wants a toy, and when offered something distasteful, makes it clear that the answer is "no." Some children diagnosed with ASD remain mute throughout their lives. Some infants who later show signs of ASD coo and babble during the first few months of life, but they soon stop. Others may be delayed, developing language as late as age 5 to 9. Some children may learn to use communication systems such as pictures or sign language. Those who do speak often use language in unusual ways. They seem unable to combine words into meaningful sentences. Some speak only single words, while others repeat the same phrase over and over. Some ASD children parrot what they hear, a condition called echolalia. Although many children with no ASD go through a stage where they repeat what they hear, it normally passes by the time they are 3. Some children only mildly affected may exhibit slight delays in language, or even seem to have precocious language and unusually large vocabularies, but have great difficulty in sustaining a conversation. The "give and take" of normal conversation is hard for them, although they often carry on a monologue on a favourite subject, giving no one else an opportunity to comment. Another difficulty is often the inability to understand body language, tone of voice, or "phrases of speech." They might interpret a sarcastic expression such as "Oh, that's just great" as meaning it really IS great. While it can be hard to understand what ASD children are saying, their body language is also difficult to understand. Facial expressions, movements, and gestures rarely match what they are saying. Also, their tone of voice fails to reflect their feelings. A high-pitched, sing-song, or flat, robot-like voice is common. Some children with relatively good language skills speak like little adults, failing to pick up on the "kid-speak" that is common in their peers. Without meaningful gestures or the language to ask for things, people with ASD are at a loss to let others know what they need. As a result, they may simply scream or grab what they want. Until they are taught better ways to express their needs, ASD children do whatever they can to get through to others. Repetitive BehavioursAlthough children with ASD usually appear physically normal and have good muscle control, odd repetitive motions may set them off from other children. These behaviours might be extreme and highly apparent or more subtle. Some children and older individuals spend a lot of time repeatedly flapping their arms or walking on their toes. Some suddenly freeze in position. As children, they might spend hours lining up their cars and trains in a certain way, rather than using them for pretend play. If someone accidentally moves one of the toys, the child may be tremendously upset. ASD children need, and demand, absolute consistency in their environment. A slight change in any routine—in mealtimes, dressing, taking a bath, going to school at a certain time and by the same route—can be extremely disturbing. Perhaps order and sameness lend some stability in a world of confusion. Repetitive behaviour sometimes takes the form of a persistent, intense preoccupation. For example, the child might be obsessed with learning all about vacuum cleaners, train schedules, or lighthouses. Often there is great interest in numbers, symbols, or science topics. Sensory problems When children's perceptions are accurate, they can learn from what they see, feel, or hear. On the other hand, if sensory information is faulty, the child's experiences of the world can be confusing. Many ASD children are highly attuned or even painfully sensitive to certain sounds, textures, tastes, and smells. Some children find the feel of clothes touching their skin almost unbearable. Some sounds—a vacuum cleaner, a ringing telephone, a sudden storm, even the sound of waves lapping the shoreline—will cause these children to cover their ears and scream. In ASD, the brain seems unable to balance the senses appropriately. Some ASD children are oblivious to extreme cold or pain. An ASD child may fall and break an arm, yet never cry. Another may bash his head against a wall and not wince, but a light touch may make the child scream with alarm. The autism spectrum disorders can often be reliably detected by the age of 3 years, and in some cases as early as 18 months. Parents will often be aware of signs in the child which don't seem quite right, for example the child may avoid eye contact or resist being cuddled. Thus the parents observations are the first hint that there may be a problem. Signs of ASD may also be detected in a developmental screening test by a paediatrician yet the diagnosis of ASD is generally a co-ordinated effort between a number of professionals including a psychologist, neurologist, psychiatrist, paediatrician, general practitioner, speech therapist and behavioural optometrist.
Other Professionals Speech pathologist A Speech Pathologist works with children with a variety of communication disorders. Speech pathologists are able to diagnose and treat disorders associated with any of the following language skills: 1. Articulation. This refers to the physical production of sounds. A child who is difficult to understand may have an articulation disorder. Speech pathologists are able to diagnose oral dyspraxia, which is a difficulty making spontaneous movements of the mouth, which involves the lips, tongue and palate. 2. Receptive Language: This refers to the comprehension (understanding) of spoken language. A child who has difficulty following instructions may have a receptive language difficulty. 3. Expressive language: Refers to the production (speaking) of language. This includes grammar and sentence structure. A child who has difficulty grammatically constructing a sentence ie. “The boy fast goed the road”. May have an expressive language difficulty. 4. Phonological processing: Refers to the use of speech-sound information in processing both written and oral language forms. This includes phonemic awareness, which is the ability of the child to identify or manipulate the sounds in words. It is the realisation that words are made up of sound units. Eg. The word “cat” is constructed by combining the “kuh”, "aah" and "tuh" sounds. 5. Fluency. Reading Fluency is the ability to read with accuracy, and with an appropriate rate, expression and phrasing. Disorders of fluency include stuttering.
Speech Pathologists In the St George Area Talking Heads Speech Pathology Director: Sonia Bestulic 14 Gray Street Kogarah NSW 2217 Phone: 9553-1400 Email: enquiries@talkingheads.net.au
Occupational Therapist Occupational therapists are able to diagnose and manage learning difficulties such as dyspraxia associated with impairment in motor, spatial and visual perceptual skills. An assessment by an occupational therapist includes; 1. Cognition and perception assessment. This is an assessment of the child’s memory skills, attention skills and visual processing skills. 2. Gross motor skills assessment. Involves tests of body awareness, eye-hand co-ordination, balance, spatial awareness and bilateral co-ordination. 3. Fine motor skills assessment. Involves tests to determine pre-writing skills, writing skills and manipulative skills. This includes assessments of tactile awareness, finger and hand strength, wrist and forearm control, fluency of finger movements, and spatial organisation (space and letter formation). Occupational therapists and developmental optometrists share professional concepts and have been working closely with children with learning disabilities for many years. Elements of a developmental vision examination and an occupational therapy assessment will be similar. Child Psychologist Child psychologists are able to diagnose and manage learning disabilities such as Dyslexia and Attention Deficit Disorder (ADD). An assessment by a child psychologist includes, 1. Behavioural and developmental history. Is a record of the child’s growth in areas such as walking, learning and talking. 2. Psychometric assessment. Involves tests to ascertain potential intellectual functioning. 3. Learning difficulties assessment. Involves tests of academic performance. 4. Auditory processing disorders assessment. Auditory processing disorders are conditions in which the child has normal hearing (ie. normal ability to detect sound) but has difficulty analysing and interpreting the sensory information from the ears. 5. Quantified electro-encephalogram. Are tests that measure the electrical activity of the brain. The qEEG enables the psychologist to determine which learning tasks pose the most difficulty for the child. This information is then used via neurosensory feedback to train the child to modulate their attention on these learning tasks. 6. Tests of variable attention. These tests enable the psychologist to test for attention deficit disorders such as ADHD.
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