Intellectual disability (ID), also known as general learning disability and mental retardation (MR), is a generalized neurodevelopmental disorder characterized by significantly impaired intellectual and adaptive functioning. It is defined by an IQ score below 70 in addition to deficits in two or more adaptive behaviours that affect every-day, general living. Once focused almost entirely on cognition, the definition now includes both a component relating to mental functioning and one relating to individuals’ functional skills in their environments. As a result of this focus on the person’s abilities in practice, a person with an unusually low IQ may not be considered to have intellectually disability. Intellectual disability is subdivided into syndromic intellectual disability, in which intellectual deficits associated with other medical and behavioral signs and symptoms are present, and non-syndromic intellectual disability, in which intellectual deficits appear without other abnormalities. Down syndrome and fragile X syndrome are examples of syndromic intellectual disabilities.
Intellectual disability affects about 2–3% of the general population. Seventy-five to ninety percent of the affected people have mild intellectual disability. Non-syndromic or idiopathic cases account for 30–50% of cases. About a quarter of cases are caused by a genetic disorder and about 5% of cases are inherited from parents. Cases of unknown cause affect about 95 million people as of 2013.
Children with mental challenge generally do everything late viz: they sit up late, crawl late, walk late and talk late.
Signs of Intellectual disability:
Intellectual disability (ID) begins during childhood and involves deficits in mental abilities, social skills, and core activities of daily living (ADLs) when compared to same-aged peers. There often are no physical signs of mild forms of ID, although there may be characteristic physical traits when it is associated with a genetic disorder (e.g. Down syndrome).
The level of impairment ranges in severity for each person. Some of the early signs can include:
Categories of Intellectual disability
Mild Intellectual disability – The range of 50 to 69 (standardized IQ test) is indicative of mild retardation. Understanding and use of language tend to be delayed to a varying degree and executive speech problems that interfere with the development of independence may persist into adult life.
Moderate Intellectual disability – The IQ is in the range of 35 to 49. Discrepant profiles of abilities are common in this group with some individuals achieving higher levels in visuospatial skills than in tasks dependent on language while others are markedly clumsy by enjoy social interaction and simple conversation. The level of development of language in variable: some of those affected can take part in simple conversations while others have only enough language to communicate their basic needs.
Severe Intellectual disability – The IQ is usually in the range of 20 to 34. In this category, most of the people suffer from a marked degree of motor impairment or other associated deficits indicating the presence of clinically significant damage to or mal development of the central nervous system.
Profound Intellectual disability – The IQ in this category estimated to be under 20. The ability to understand or comply with requests or instructions are severally limited. Most of such individuals are immobile or severally restricted in mobility, incontinent and capable at most of only very rudimentary forms of non-verbal communication. They possess little or no ability to care for their own basic needs and require constant help and supervision.
Cerebral Palsy is considered a neurological disorder caused by a non-progressive brain injury or malformation – meaning that the original condition does not get worse that occurs while the child’s brain is under development. However, since contractures may develop as the child matures functionally this is of little comfort to the person or her family. While Cerebral Palsy (pronounced seh-ree-brel pawl-zee) is a blanket term commonly referred to as “CP” and described by loss or impairment of motor function. Cerebral Palsy is actually caused by brain damage which is caused by brain injury or abnormal development of the brain that occurs while a child’s brain is still developing — before birth, during birth, or immediately after birth. People with CP had lower levels of oxygen (hypoxia) to their brains at some point, but it is not known why this occurs.
Cerebral Palsy affects body movement, muscle control, muscle coordination, muscle tone, reflex, posture and balance. It can also impact fine motor skills, gross motor skills and oral motor functioning. Injury to the cerebrum can result in the loss of nerve functions in widely different areas. The most common feature in cerebral palsy is spasticity (increased muscle tone), which may affect a single limb, one side of the body (Hemiplegia), both legs (Diplegia) and both arms and legs (quadriplegia). In addition to this, there may be sensory abnormalities such as defects of hearing and vision. Speech difficulties are common and seizures may occur. Cerebral Palsy is not a disease – it is actually a term used to describe a range of conditions that typically cause physical impairment.
Signs of Cerebral Palsy
The most common signs of cerebral palsy are:
Early Intervention is always recommended in cases of Cerebral Palsy to bring out positive changes and achieve full potential of the child.
Every case of Cerebral Palsy is unique to the individual
Every case of cerebral palsy is unique to the individual. One person may have total paralysis and require constant care, while another with partial paralysis might have slight movement tremors but require little assistance. This is due in part by the type of injury and the timing of the injury to the developing brain.
Cerebral Palsy is non-life-threatening
With the exception of children born with a severe case, Cerebral Palsy is considered to be a non-life-threatening condition. Most children with Cerebral Palsy are expected to live well into adulthood.
Cerebral Palsy is incurable
Cerebral Palsy is damage to the brain that cannot currently be fixed. Treatment and therapy help manage effects on the body.
Cerebral Palsy is non-progressive
The brain lesion is the result of a one-time brain injury and will not produce further degeneration of the brain.
Cerebral Palsy is permanent
The injury and damage to the brain is permanent. The brain does not “heal” as other parts of the body might. Because of this, the Cerebral Palsy itself will not change for better or worse during a person’s lifetime. On the other hand, associative conditions may improve or worsen over time.
Cerebral Palsy is not contagious; it is not communicable
In the majority of cases, Cerebral Palsy is caused by damage to the developing brain. Brain damage is not spread through human contact. However, a person can intentionally or unintentionally increase the likelihood a child will develop Cerebral Palsy through abuse, accidents, medical malpractice, negligence, or the spread of a bacterial or viral infection.
Cerebral Palsy is manageable
The impairment caused by Cerebral Palsy is manageable. In other words, treatment, therapy, surgery, medications and assistive technology can help maximize independence, reduce barriers, increase inclusion and thus lead to an enhanced quality of life.
Cerebral Palsy is chronic
The effects of Cerebral Palsy are long-term, not temporary. An individual diagnosed with Cerebral Palsy will have the condition for their entire life.
People with cerebral palsy may be extremely bright intellectually, or normal, or have a mental handicap as part of the condition.
It is usually possible to tell if a child has CP by the age of two and sometimes as early as a few months of age.
Few Myths & Realities about Cerebral Palsy
What is Autism/Autism Spectrum Disorder?
Autism spectrum describes a range of conditions classified as neurodevelopmental disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), published in 2013. Individuals diagnosed with autism spectrum disorder (ASD) must present two types of symptoms:
The DSM-5 redefined the autism spectrum disorders to encompass the previous diagnoses of Autism, Asperger syndrome, pervasive developmental disorder not otherwise specified and childhood disintegrative disorder.
It is called a “spectrum” disorder because people with ASD can have a range of symptoms. People with ASD might have problems talking with you, or they might not look you in the eye when you talk to them. They may also have restricted interests and repetitive behaviors. They may spend a lot of time putting things in order, or they may say the same sentence again and again. They may often seem to be in their “own world.” It affects the way the brain works and should be diagnosed by a medical professional – preferably a developmental pediatrician. Autism is an evolving disorder and your child’s symptoms and needs may change as they pass through different stages of development.
Autism’s most-obvious signs tend to appear between 2 and 3 years of age. In some cases, it can be diagnosed as early as 18 months. Some developmental delays associated with autism can be identified and addressed even earlier.
Signs and Symptoms
Although every child with autism is different, children with autism usually have two main types of behaviors: “restricted / repetitive behaviors” and “social communication / interaction behaviors.”
Restrictive / repetitive behaviors may include:
Social communication / interaction behaviors may include:
People with ASD may have other difficulties, such as being very sensitive to light, noise, clothing, or temperature. They may also experience sleep problems, digestion problems, and irritability.
ASD is unique in that it is common for people with ASD to have many strengths and abilities in addition to challenges.
Strengths and abilities may include:
What are the other conditions that may co-occur with Autism?
Autism may occur alone, or may be accompanied by other diagnoses. When autism co-occurs with another condition, it is important that all the interventions the individual receives are autism friendly.
Conditions that commonly co-occur with autism include:
What Causes Autism?
No one knows for sure. Though genetics play a role in the development of the disorder, there are many other factors that affect the onset and severity of autism. As a parent, you need to understand that autism is NOT a result of something you did or did not do for your child.
An important point to keep in mind is that autism is not caused by an unhappy home environment, both parents working, mental stress during the pregnancy, poor handling by the mother, an emotional trauma, or other psychological factors. A parent or home environment cannot cause a person to have autism.
How Can I Help a Child with Autism?
Early intervention is very effective in Autism and improves a child’s ability to cope well with this life-long condition. The earlier the intervention is implemented, the better the outcome for the child. Research also shows that children whose families are strongly engaged and involved make better progress. Consistency and structure are very important. If you can work closely with your child’s therapist and teachers so that everyone is responding the same way, your child will benefit a lot.
The best strategies encourage therapists and parents to work with the child’s own interests or actions to slowly build engagement, interaction, and communication. Play often works better than more directive methods to help children learn. Recent research has shown these approaches to be very effective for children with autism.
The Applied Behavioural Analysis (ABA) approach focuses on the child’s interests and motivation to learn new, more adaptive behaviours. They are based on the principles of reward and reinforcement for appropriate behaviours.
Occupational therapy helps children develop appropriate social, play, and learning skills. The therapist aids the child in achieving normal daily tasks (e.g., getting dressed and playing with other children). Occupational therapists may use aspects of sensory integration therapy in order to help the child appropriately respond to and organize information coming through the senses.
Speech and language therapy is often beneficial for children with autism since about 30-50% of them do not use speech. Conventional methods of speech therapy are not always effective. Therapist should have a good understanding of autism and be able to emphasize non-verbal communication, like pictures and gestures if necessary. For children who speak, a speech & language therapist helps them by enabling them to use their language for social interaction and play. Play is often challenging for children who are verbal.
When choosing an intervention plan, educate yourself on the options which have been scientifically tested and shown to be effective for managing autism symptoms. Be aware that the internet is full of therapies that lack evidence supporting their use with autism. The best intervention plans are those which incorporate aspects of all of the aforementioned therapies as per the child’s needs and abilities.
Can a Child with Autism Do Well at School?
Children with autism are just like other kids in many ways. Some are very bright; some may be intellectually impaired. Their skills may be strong in some areas (memory, math, music) and weak in others (speech, self-care). Regardless of their abilities, it is important for children with autism to attend school because it provides a structured environment with clearly laid out expectations as well as opportunities for interacting with children of their age. Attending school is great therapy! Talk to your pediatrician or therapist to help you decide the best type of school for your child. Options include a regular school, an inclusive school (in which most children are typical, but some students have special needs), and special schools (meant specifically for children with disabilities).
Asperger syndrome is one of several previously separate subtypes of autism that were folded into the single diagnosis autism spectrum disorder (ASD) with the publication of the DSM-5 Diagnostic Manual in 2013.
Asperger syndrome was generally considered to be on the “high functioning” end of the spectrum. Affected children and adults have difficulty with social interactions and exhibit a restricted range of interests and/or repetitive behaviors. Motor development may be delayed, leading to clumsiness or uncoordinated motor movements. Compared with those affected by other forms of ASD, however, those with Asperger syndrome do not have significant delays or difficulties in language or cognitive development. Some even demonstrate precocious vocabulary – often in a highly specialized field of interest.
Asperger’s disorder generally tends to have a somewhat later onset than Autistic disorder and is more common in boys than in girls.
The following behaviors are often associated with Asperger syndrome. However, they are seldom all present in any one individual and vary widely in degree:
How is Asperger Syndrome diagnosed?
Asperger syndrome often remains undiagnosed until a child or adult begins to have serious difficulties in school, the workplace or their personal lives. Indeed, many adults with Asperger syndrome receive their diagnosis when seeking help for related issues such as anxiety or depression. Diagnosis tends to center primarily on difficulties with social interactions.
Children with Asperger syndrome tend to show typical or even exceptional language development. However, many tend to use their language skills inappropriately or awkwardly in conversations or social situations such as interacting with their peers. Often, the symptoms of Asperger syndrome are confused with those of other behavioral issues such as attention deficit and hyperactivity disorder (ADHD). Indeed, many persons affected by Asperger syndrome are initially diagnosed with ADHD until it becomes clear that their difficulties stem more from an inability to socialize than an inability to focus their attention.
For instance, someone with Asperger syndrome might initiate conversations with others by extensively relating facts related to a particular topic of interest. He or she may resist discussing anything else and have difficulty allowing others to speak. Often, they don’t notice that others are no longer listening or are uncomfortable with the topic. They may lack the ability to “see things” from the other person’s perspective.
Another common symptom is an inability to understand the intent behind another person’s actions, words and behaviors. So children and adults affected by Asperger syndrome may miss humor and other implications. Similarly, they may not instinctually respond to such “universal” nonverbal cues such as a smile, frown or “come here” motion.
For these reasons, social interactions can seem confusing and overwhelming to individuals with Asperger syndrome. Difficulties in seeing things from another person’s perspective can make it extremely difficult to predict or understand the actions of others. They may not pick up on what is or isn’t appropriate in a particular situation. For instance, someone with Asperger syndrome might speak too loudly when entering a church service or a room with a sleeping baby – and not understand when “shushed.”
Some individuals with Asperger syndrome have a peculiar manner of speaking. This can involve speaking overly loud, in a monotone or with an unusual intonation. It is also common, but not universal, for people with Asperger syndrome to have difficulty controlling their emotions. They may cry or laugh easily or at inappropriate times.
Another common, but not universal, sign is an awkwardness or delay in motor skills. As children, in particular, they may have difficulties on the playground because they can’t catch a ball or understand how to swing on the monkey bars despite their peers’ repeated attempts to teach them.
Not all individuals with Asperger syndrome display all of these behaviors. In addition, each of these symptoms tends to vary widely among affected individuals.
It is very important to note that the challenges presented by Asperger Syndrome are very often accompanied by unique gifts. Indeed, a remarkable ability for intense focus is a common trait.
In every cell in the human body there is a nucleus, where genetic material is stored in genes. Genes carry the codes responsible for all of our inherited traits and are grouped along rod-like structures called chromosomes. Typically, the nucleus of each cell contains 23 pairs of chromosomes, half of which are inherited from each parent. Down syndrome occurs when an individual has a full or partial extra copy of chromosome 21.
This additional genetic material alters the course of development and causes the characteristics associated with Down syndrome. A few of the common physical traits of Down syndrome are low muscle tone, small stature, an upward slant to the eyes, and a single deep crease across the center of the palm – although each person with Down syndrome is a unique individual and may possess these characteristics to different degrees, or not at all.
Down syndrome commonly referred to as `Trisomy 21′ is a chromosomal condition in which there is generally an extra copy of the 21st chromosome. This syndrome usually, though not always, results in a person with friendly, sociable disposition, a mental handicap and other conditions.
Down syndrome is a genetic condition that results in slower physical and intellectual development. It is one of the most common genetic conditions, affecting approximately 1 out of every 660 births, occurring irrespective of race, religion and socio-economic status. People with
Down syndrome have 47 chromosomes instead of the usual 46. Chromosomes are thread like structures composed of DNA and other proteins. They are present in every cell of the body and carry the genetic information needed for a cell to develop.
People with Down syndrome look remarkably similar, regardless of race or color. Their heads are often small and shaped slightly differently from people with 46 chromosomes. Their special facial features include almond-shaped eyes, a protruding tongue and a flattened nose. Their hands are usually small and broad with broad fingers and they are often short and stocky in build.
Parents who have already had a baby with Down syndrome, mothers or fathers who have a re-arrangement involving chromosome 21, and mothers over 35 years of age are most likely to have a baby with Down syndrome. The chance of having a baby with Downs increases with age, from about 1 to 1250 for a woman at age 25, to 1 – 1000 at the age 30, to 1-400 at the age 35 and 1-100 at the age 40.
Are There Different Types of Down syndrome?
There are three types of Down syndrome: trisomy 21 (nondisjunction), translocation and mosaicism.
Trisomy 21 (Nondisjunction)
Down syndrome is usually caused by an error in cell division called “nondisjunction.” Nondisjunction results in an embryo with three copies of chromosome 21 instead of the usual two. Prior to or at conception, a pair of 21st chromosomes in either the sperm or the egg fails to separate. As the embryo develops, the extra chromosome is replicated in every cell of the body. This type of Down syndrome, which accounts for 95% of cases, is called trisomy 21.
In translocation, which accounts for about 4% of cases of Down syndrome, the total number of chromosomes in the cells remains 46; however, an additional full or partial copy of chromosome 21 attaches to another chromosome, usually chromosome 14. The presence of the extra full or partial chromosome 21 causes the characteristics of Down syndrome.
Mosaicism (or mosaic Down syndrome) is diagnosed when there is a mixture of two types of cells, some containing the usual 46 chromosomes and some containing 47. Those cells with 47 chromosomes contain an extra chromosome 21.
Mosaicism is the least common form of Down syndrome and accounts for only about 1% of all cases of Down syndrome. Research has indicated that individuals with mosaic Down syndrome may have fewer characteristics of Down syndrome than those with other types of Down syndrome. However, broad generalizations are not possible due to the wide range of abilities people with Down syndrome possess.
Signs of Down syndrome:
Does Down syndrome Run in Families?
All 3 types of Down syndrome are genetic conditions (relating to the genes), but only 1% of all cases of Down syndrome have a hereditary component (passed from parent to child through the genes). Heredity is not a factor in trisomy 21 (nondisjunction) and mosaicism. However, in one third of cases of Down syndrome resulting from translocation there is a hereditary compontent – accounting for about 1% of all cases of Down syndrome.
The age of the mother does not seem to be linked to the risk of translocation. Most cases are sporadic – chance – events. However, in about one third of cases, one parent is a carrier of a translocated chromosome.
What Impact Does Down syndrome Have on Society?
Individuals with Down syndrome are becoming increasingly integrated into society and community organizations, such as school, health care systems, work forces, and social and recreational activities. Individuals with Down syndrome possess varying degrees of cognitive delays, from very mild to severe. Most people with Down syndrome have cognitive delays that are mild to moderate.
Due to advances in medical technology, individuals with Down syndrome are living longer than ever before. In 1910, children with Down syndrome were expected to survive to age nine. With the discovery of antibiotics, the average survival age increased to 19 or 20. Now, with recent advancements in clinical treatment, most particularly corrective heart surgeries, as many as 80% of adults with Down syndrome reach age 60, and many live even longer. More and more Americans are interacting with individuals with Down syndrome, increasing the need for widespread public education and acceptance.
Prader-Willi syndrome is defined as a congenital (present from birth) disease characterized by obesity, low muscle tone, limited mental capacity and hypogonadism.
PWS is a complex genetic disorder affecting appetite, growth, metabolism, cognitive function and behavior. It is typically characterized by low muscle tone, short stature (when not treated with growth hormone), incomplete sexual development, cognitive disabilities, behavioral problems, and the hallmark characteristics – chronic feelings of insatiable hunger and a slowed metabolism that can lead to excessive eating and life-threatening obesity. Those who have PWS need intervention and strict external controls, sometimes including padlocking access to food, to maintain normal weight and to help save their lives
But what is Prader-Willi Syndrome?
Prader-Willi is caused by the deletion of a gene on chromosome 15. For unknown reasons, in normal development, only the father’s copy of this gene is active. The maternal copy of this gene is turned off in all people. When there is a deletion of this gene on that one paternal copy received, the disease occurs. This is because the child is left with only the maternal copy, which is inactive in all people.
Signs of Prader-Willi can be seen at birth. New infants with the condition are often small and very floppy (hypotonic). Baby boys may have undescended testicles. The growing child often exhibits slow mental and delayed motor development, increasing obesity and small hands and feet.
During the first few years of life, a child with Prader-Willi feels ravenously hungry. This leads to uncontrollable eating and subsequent obesity. Respiratory failure with hypoxia (low blood oxygen levels) and corpulmonale (right-sided heart failure) are also common. The child has slow mental development, and the IQ seldom exceeds 80.
Signs of Prader-Willi Syndrome
Prader–Willi syndrome is frequently associated with a constant, extreme, ravenous insatiable appetite which persists no matter how much the patient eats, often resulting in morbid obesity. Caregivers need to strictly limit the patients’ access to food, usually by installing locks on refrigerators and on all closets and cabinets where food is stored. It is the most common genetic cause of morbid obesity in children. There is currently no consensus as to the cause for this symptom, although genetic abnormalities in chromosome 15 disrupt the normal functioning of the hypothalamus. Given that the hypothalamus arcuate nucleus regulates many basic processes, including appetite, there may well be a link. In the hypothalamus of people with PWS, nerve cells that produce oxytocin, a hormone thought to contribute to satiety, have been found to be abnormal.
People with Prader–Willi syndrome have high ghrelin levels, which are thought to directly contribute to the increased appetite, hyperphagia, and obesity seen in this syndrome. Cassidy states the need for a clear delineation of behavioral expectations, the reinforcement of Behavioural limits and the establishment of regular routines.
The main mental health difficulties experienced by people with PWS include compulsive behaviour (usually manifested in skin picking) and anxiety. Psychiatric symptoms, for example, hallucinations, paranoia and depression, have been described in some cases and affect approximately 5–10% of young adults. Patients are also often extremely stubborn and prone to anger. Psychiatric and behavioural problems are the most common cause of hospitalization.
It is typical for 70–90% of affected individuals to develop behavioral patterns in early childhood. Aspects of these patterns can include stubbornness, temper tantrums, controlling and manipulative behavior, difficulty with change in routine, and compulsive-like behaviors.
Positive behavioral support is an essential tool for all caregivers of a person with Prader-Wili syndrome. It is best to implement positive behavioral strategies early in a child’s life – even before behavioral challenges emerge. It is an important proactive and preventative step to become familiar with and implement positive behavioral strategies.
A positive behavioral strategy can help:
A positive behavioral support strategy uses a person’s strengths and interests to help motivate them to achieve non-preferred goals and activities. It is a way to do some behavioral problem solving in a fun, creative, and effective way.
It is also important to pay attention to the link behind good behavior and appropriate food management at home and in other settings.
Here are some great behavioral resources for you:
Attention-deficit/hyperactivity disorder (ADHD) is a brain disorder marked by an on-going pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
People with symptoms of inattention may often:
People with symptoms of hyperactivity-impulsivity may often:
Diagnosis of ADHD requires a comprehensive evaluation by a licensed clinician, such as a pediatrician, psychologist, or psychiatrist with expertise in ADHD. For a person to receive a diagnosis of ADHD, the symptoms of inattention and/or hyperactivity-impulsivity must be chronic or long-lasting, impair the person’s functioning, and cause the person to fall behind normal development for his or her age. The doctor will also ensure that any ADHD symptoms are not due to another medical or psychiatric condition. Most children with ADHD receive a diagnosis during the elementary school years. For an adolescent or adult to receive a diagnosis of ADHD, the symptoms need to have been present prior to age 12.
ADHD symptoms can appear as early as between the ages of 3 and 6 and can continue through adolescence and adulthood. Symptoms of ADHD can be mistaken for emotional or disciplinary problems or missed entirely in quiet, well-behaved children, leading to a delay in diagnosis. Adults with undiagnosed ADHD may have a history of poor academic performance, problems at work, or difficult or failed relationships.
ADHD symptoms can change over time as a person ages. In young children with ADHD, hyperactivity-impulsivity is the most predominant symptom. As a child reaches elementary school, the symptom of inattention may become more prominent and cause the child to struggle academically. In adolescence, hyperactivity seems to lessen and may show more often as feelings of restlessness or fidgeting, but inattention and impulsivity may remain. Many adolescents with ADHD also struggle with relationships and antisocial behaviors. Inattention, restlessness, and impulsivity tend to persist into adulthood.
Treatment and Therapies
While there is no cure for ADHD, currently available treatments can help reduce symptoms and improve functioning. Treatments include medication, psychotherapy, education or training, or a combination of treatments.
For many people, ADHD medications reduce hyperactivity and impulsivity and improve their ability to focus, work, and learn. Medication also may improve physical coordination. Sometimes several different medications or dosages must be tried before finding the right one that works for a particular person. Anyone taking medications must be monitored closely and carefully by their prescribing doctor.
The most common type of medication used for treating ADHD is called a “stimulant.” Although it may seem unusual to treat ADHD with a medication that is considered a stimulant, it works because it increases the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.
Under medical supervision, stimulant medications are considered safe. However, there are risks and side effects, especially when misused or taken in excess of the prescribed dose. For example, stimulants can raise blood pressure and heart rate and increase anxiety. Therefore, a person with other health problems, including high blood pressure, seizures, heart disease, glaucoma, liver or kidney disease, or an anxiety disorder should tell their doctor before taking a stimulant.
Talk with a doctor if you see any of these side effects while taking stimulants:
A few other ADHD medications are non-stimulants. These medications take longer to start working than stimulants, but can also improve focus, attention, and impulsivity in a person with ADHD. Doctors may prescribe a non-stimulant: when a person has bothersome side effects from stimulants; when a stimulant was not effective; or in combination with a stimulant to increase effectiveness.
Although not approved by the U.S. Food and Drug Administration (FDA) specifically for the treatment of ADHD, some antidepressants are sometimes used alone or in combination with a stimulant to treat ADHD. Antidepressants may help all of the symptoms of ADHD and can be prescribed if a patient has bothersome side effects from stimulants. Antidepressants can be helpful in combination with stimulants if a patient also has another condition, such as an anxiety disorder, depression, or another mood disorder.
Adding psychotherapy to treat ADHD can help patients and their families to better cope with everyday problems.
Behavioral therapy is a type of psychotherapy that aims to help a person change his or her behavior. It might involve practical assistance, such as help organizing tasks or completing schoolwork, or working through emotionally difficult events. Behavioral therapy also teaches a person how to:
Parents, teachers, and family members also can give positive or negative feedback for certain behaviors and help establish clear rules, chore lists, and other structured routines to help a person control his or her behavior. Therapists may also teach children social skills, such as how to wait their turn, share toys, ask for help, or respond to teasing. Learning to read facial expressions and the tone of voice in others, and how to respond appropriately can also be part of social skills training.
Cognitive behavioral therapy can also teach a person mindfulness techniques, or meditation. A person learns how to be aware and accepting of one’s own thoughts and feelings to improve focus and concentration. The therapist also encourages the person with ADHD to adjust to the life changes that come with treatment, such as thinking before acting, or resisting the urge to take unnecessary risks.
Family and marital therapy can help family members and spouses find better ways to handle disruptive behaviors, to encourage behavior changes, and improve interactions with the patient.
For more information on psychotherapy, see the Psychotherapies webpage on the NIMH website.
Education and Training
Children and adults with ADHD need guidance and understanding from their parents, families, and teachers to reach their full potential and to succeed. For school-age children, frustration, blame, and anger may have built up within a family before a child is diagnosed. Parents and children may need special help to overcome negative feelings. Mental health professionals can educate parents about ADHD and how it affects a family. They also will help the child and his or her parents develop new skills, attitudes, and ways of relating to each other.
Parenting skills training (behavioral parent management training) teaches parents the skills they need to encourage and reward positive behaviors in their children. It helps parents learn how to use a system of rewards and consequences to change a child’s behavior. Parents are taught to give immediate and positive feedback for behaviors they want to encourage, and ignore or redirect behaviors that they want to discourage. They may also learn to structure situations in ways that support desired behavior.
Stress management techniques can benefit parents of children with ADHD by increasing their ability to deal with frustration so that they can respond calmly to their child’s behavior.
Support groups can help parents and families connect with others who have similar problems and concerns. Groups often meet regularly to share frustrations and successes, to exchange information about recommended specialists and strategies, and to talk with experts.
Tips to Help Kids and Adults with ADHD Stay Organized
Parents and teachers can help kids with ADHD stay organized and follow directions with tools such as:
A professional counselor or therapist can help an adult with ADHD learn how to organize his or her life with tools such as:
Speech and language disorders refer to problems in communication and related areas such as oral motor function. These delays and disorders range from simple sound substitutions to the inability to understand or use language or use the oral-motor mechanism for functional speech and feeding. Some causes of speech and language disorders include hearing loss, neurological disorders, brain injury, intellectual disabilities, drug abuse, physical impairments such as cleft lip or palate and vocal abuse or misuse.
A child’s communication is considered delayed when the child is noticeably behind his or her peers in the acquisition of speech and/or language skills. Speech disorders refer to difficulties producing speech sounds or problems with voice quality. Speech disorders may be problems with the way sounds are formed, called articulation or phonological disorders, or they may be difficulties with the pitch, volume or quality of the voice. There may be a combination of several problems. People with speech disorders have trouble using some speech sounds, which can also be a symptom of a delay.
Examples, Subsets and Synonyms for Communication Disorders:
There may or may not be an identifiable reason for the difficulty. Some of the common identifiable causes for speech and language disorders may be: – mental handicap, autism, a learning disability, hearing loss, cerebral palsy, head injury.
14% to 20% of pre-school children have delayed or disordered speech and language.
Signs of Speech and Language/Communication disorders:
Hearing problems, hearing impairment and being deaf can affect many children and adults either temporarily (e.g. fluctuating hearing loss in children) or permanently. Hearing loss in childhood can severely delay speech, language, and literacy development, and most adults will experience deterioration in their hearing as they get older. Thankfully, hearing aid technology has moved a long way in recent years. Digital hearing aids are now much smaller, are able to pick up less background noise, and tune in more specifically to speech frequencies. Unfortunately, amplification of sound will never replace normal hearing. The development of cochlear implants however, has provided many profoundly deaf children and some adults with a hearing system that allows them to hear speech more clearly as well as develop their own speech skills. Neonatal screening programs are also leading to early detection of hearing loss and allowing parents and professionals to prepare earlier for the deaf child and put appropriate systems in place to facilitate communication and learning.
Hearing impairment can occur for several reasons:
Some babies are born deaf, usually due to genetic reasons, or some form of trauma during the pregnancy or birth
Once hearing impairment has occurred it may be more likely to affect high or low frequency sounds, or both, depending on the nature and extent of the impairment. Hearing impairment can affect the outer and middle ear (conductive loss) or the inner ear (sensori-neural loss).
Conductive hearing loss
Conductive hearing loss occurs when there is a problem occurring at the outer and/or middle ear, and hinders the sound from reaching the inner ear. Some conductive hearing loss is temporary and treatable. With the outer ear, anything that blocks the auditory canal (wax, foreign object, swelling from infection etc), can impede sound.
Conductive hearing loss is common among children with around 6% of children experiencing at least one episode, mainly due to otitis media (”glue ear”) of the middle ear. For some children the problem persists or recurs and this may affect speech and language development. Conductive loss can be caused by infections, a perforated eardrum, wax blockage, damage to the ear or ossicles (bones on in the middle), and disease. Oto-sclerosis is another disorder that can cause a conductive hearing loss and is caused by abnormal bone growth within the middle ear (although it is a rare disorder).
Otitis Media (Glue Ear)
Otitis media or “glue ear” is the most common cause of conductive hearing loss in children and is a general term to describe a number of conditions affecting the middle ear. Infections can cause a lot of pain, the tympanic membrane (ear drum) to rupture, and fever. The inflammation of the middle ear caused by this infection can affect the conduction of sound. Otitis media with effusion is an infection of the middle ear which also causes a collection of fluid in the middle ear space. If this fluid remains for a period it can become thick and glue like (hence the term “glue ear”), hindering the middle ear to effectively carry sound.
Otitis media can be a long term infection and can keep recurring over the early years of a child’s life. It is important to be aware that your child’s hearing could be impaired and you may not have any obvious signs. If you have concerns ask your doctor for a referral to an audiologist or Ear, Nose and Throat (ENT) Specialist, because prolonged deafness in the early years can cause a delay in speech and language development.
Antibiotics are generally used to clear an otitis media infection, or if the infection persists a tympanostomy tube (often called a “grommet”) may be inserted to drain the fluid and equalize the pressure in the middle ear. Grommet’s can be highly effective and generally just fall out of the ear after several weeks or months. Parents have often noticed huge changes in their child’s communication and behaviour following the fitting of grommets.
Sensory-neural hearing loss
Sensory-neural loss is a result of damage to the inner ear (cochlear) and/or the auditory pathways that carry sound to the brain. There are a number of factors that are responsible for sensorineural loss including injury, exposure to loud noise, disease, certain ototoxic drugs, meningitis, tumours, stroke and genetic causes. The most common cause of sensory-neural loss is by presbycusis which may be responsible for up to 90% of hearing impairment amongst adults. Presbycusis is an age related hearing loss and describes what happens to most people as they get older. As we age the nerve cells in our cochlear die and get damaged and we see decline in our hearing ability. With children, around 50% of cases of sensory-neural loss will have a genetic cause, and loss may also be caused by birth prematurity or infection during pregnancy. Sensory-neural loss is most likely to affect our ability to hear higher frequency sounds. Inner ear hearing problems may also include recruitment, which makes the ear more sensitive to louder sounds, so although there is a hearing loss, a sound level slightly above the level of hearing can be painful.
Tinnitus can also accompany hearing impairment in later life, with a constant or intermittent sound in one, or both ears. This sound can be very distracting and unpleasant, especially when trying to get to sleep. There are a number of different devices that can help with tinnitus such as devices that produce soothing background noise to help with sleep or when trying to concentrate in a very quiet environment. Some people have also found complementary therapies such as acupuncture may help. It is always best to discuss any treatments or therapies with your doctor before embarking on them.
Mixed hearing loss
A mixed hearing loss is less common, but it is possible for an individual to have both a conductive and sensorineural hearing loss, a mixed hearing loss.
If there is a family history of hearing impairment, a diagnosed syndrome associated with hearing impairment, or you have had certain infections during pregnancy it is important to have your child’s hearing checked early. The same is true if the baby was premature or has suffered difficulties during birth. In the first 2 years of life it is important to be aware that a hearing difficulty can arise from meningitis, head trauma, certain ototoxic medications, and otitis media. Babies should display certain behaviours if their hearing is working . Young babies should:
Older children may display a number of other signs that they have a hearing impairment:
Treatment for Deafness
There are a number of ways to treat deafness and hard of hearing. To read more about treatment for deafness, hearing aids and cochlear implants, click here to go to our Hearing Treatment section.
Top 10 tips to help communication with a deaf or hearing impaired child
There are many things we, and those around us, can do to make life easier when hearing impairment occurs:
The human eye is like a camera that collects, focuses, and transmits light through a lens to create an image of its surroundings. In a camera, the image is created on film or an image sensor. In the eye, the image is created on the retina, a thin layer of light-sensitive tissue at the back of the eye.
Like a camera, the human eye controls the amount of light that enters the eye. The iris (the colored circular part of the eye) controls the amount of light passing through the pupil. It closes up the pupil in bright light and opens it wider in dim light. The corneais the transparent, protective surface of the eye. It helps focus light, as does the lens, which sits just behind the iris.
When light enters the eye, the retina changes the light into nerve signals. The retina then sends these signals along the optic nerve(a cable of more than 1,000,000 nerve fibers) to the brain. Without a retina or optic nerve, the eye can’t communicate with the brain, making vision impossible.
What Is Visual Impairment?
Many people have some type of visual problem at some point in their lives. Some can no longer see objects far away. Others have problems reading small print. These types of conditions are often easily treated with eyeglasses or contact lenses.
But when one or more parts of the eye or brain that are needed to process images become diseased or damaged, severe or total loss of vision can occur. In these cases, vision can’t be fully restored or corrected to a “normal” level with medical treatment, surgery, or corrective lenses like glasses or contacts. It is a loss of vision that makes it hard or impossible to do daily tasks without specialized adaptations. Vision impairment may be caused by a loss of visual acuity, where the eye does not see objects as clearly as usual. It may also be caused by a loss of visual field, where the eye cannot see as wide an area as usual without moving the eyes or turning the head. Nearly two-thirds of children with vision impairment also have one or more other developmental disabilities, such as mental retardation, cerebral palsy, hearing loss, or epilepsy.
What Causes Visual Impairment?
People rarely lose their eyesight during their teen years. When they do, it’s usually caused by an injury like getting hit in the eye or head with a baseball or having an automobile or motorcycle accident.
Some babies have congenital blindness, which means they are visually impaired at birth. Congenital blindness can be caused by a number of things — it can be inherited, for instance, or caused by an infection (like German measles) that’s transmitted from the mother to the developing fetus during pregnancy.
What is a Learning Disability?
A learning disability is a neurological disorder. In simple terms, a learning disability results from a difference in the way a person’s brain is “wired.” Children with learning disabilities are as smart or smarter than their peers. But they may have difficulty reading, writing, spelling, reasoning, recalling and/or organizing information if left to figure things out by themselves or if taught in conventional ways.
A learning disability can’t be cured or fixed; it is a lifelong issue. With the right support and intervention, however, children with learning disabilities can succeed in school and go on to successful, often distinguished careers later in life.
Parents can help children with learning disabilities achieve such success by encouraging their strengths, knowing their weaknesses, understanding the educational system, working with professionals and learning about strategies for dealing with specific difficulties.
Not all great minds think alike
Did you know that Albert Einstein couldn’t read until he was nine? Walt Disney, General George Patton, and Vice President Nelson Rockefeller had trouble reading all their lives. Whoopi Goldberg and Charles Schwab and many others have learning disabilities which haven’t affected their ultimate success.
Facts about learning disabilities
Common learning disabilities
Common Signs of Learning Disability:
The good news about learning disabilities is that scientists are learning more every day. Their research provides hope and direction.
If parents, teachers, and other professionals discover a child’s learning disability early and provide the right kind of help, it can give the child a chance to develop skills needed to lead a successful and productive life. A recent National Institutes of Health study showed that 67 percent of young students who were at risk for reading difficulties became average or above average readers after receiving help in the early grades.
Parents are often the first to notice that “something doesn’t seem right.” If you are aware of the common signs of learning disabilities, you will be able to recognize potential problems early. The following is a checklist of characteristics that may point to a learning disability. Most people will, from time to time, see one or more of these warning signs in their children. This is normal. If, however, you see several of these characteristics over a long period of time, consider the possibility of a learning disability.
The Disability Certificate is the most important document and every person with disability must have this document. The disability certificate is necessary to avail any of the services and facilities provided by the government.
The medical board of doctors authorized by the Chief Medical Officer conducts assessments and ascertains the percentage of disability for the disability certificate. Any person with a disability (may be physical, visual, speech and hearing or mental) of more than 40%, is issued a disability certificate.
Note: A disability certificate is issued only to persons with disability and not to persons suffering from any illness or disease.
Where can I get my disability certificate made in Vadodara?
|PLACE||CONTACT NUMBER||DAY & TIME|
|Sir Sayaji General Hospital, Vadodara||(0265) 2424848, 2423122||Daily|
|Jamnabai General Hospital, Vadodara||(0265) 2518134, 2517915, 2517919||Every Thursday|
|Hospital for Mental Health, Karelibag, Vadodara||(0265) 2462078, 2461493||Every Monday
9 to 12 & 4 to 6
What documents do I need to bring with me?
Who can I appeal to in case I am not satisfied by the assessment of the Medical Board ?
In case someone is not satisfied by the assessment of the Medical Board, they can submit an appeal to the Chairman of the medical board/ CMO of the concerned hospital.
What is the stipulated time limit for the Disability Certificate to be made?
Within 3 working days
If not getting the service within the specified time limit, complain can be made to: