Promoting success
engagement
and motivation
in
Developmental Disorders
Managing
Risk and Resilience
Simon 10 years
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Few peer friends and not happy
Able and unmotivated
Poor completion and application of work
Reading 3 years behind age
Family not support homework especially reading
If he concentrated better he would read and
understand
• should contribute more in class
• Take responsibility for own work to reach his
potential
Nicholas 10 years
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25 week prem twin died retinopathy hear N
NN follow up and some OT
speech and writing poor
very poor interaction
Inconsistent social skills anxiety
MUCH support to produce outcome
About to move PS to AIS school then HS
Students who struggle
3 main groups
LEARNING / ORGANISING/ OUTPUT / BEHAVE
• Language / Dyslexia Motor / DCD ADHD
• Intellectual disability
• Emotional and /or Psychosocial disorder
GIFTED UNDERACHIEVER
• Subtle language ADHD Motor Anxiety ASD
POOR SOCIAL COMMUNICATION / BEHAVE
• Language ADHD Autism Spectrum Anxiety
• Intellectual disability
• Emotional and /or Psychosocial disorder
All human qualities are a spectrum
A continuum across people and in each and all development domains
Observations and Descriptions = “symptoms” NOT cognitive processes
DIAGNOSIS = IMPAIRMENT in context of demands and known abilities
“Diagnoses “ and “Disorders” often overlap
Percentage of population
Number of Children
68%
13.5%
13.5%
2.5%
2.5%
-2 SD
22.5%
- 1 SD
+ 1 SD
+2 SD
Define “abnormal” / diagnosis / disorder
NATURE OF DISORDERS -QUALITY IS THE KEY
LANGUAGE IMPAIRMENT 10%
DEFICITS/ DYSLEXIA
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content context complexity
ADHD
8%
DISORGANISATION
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fine tuning fluency feedback
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speed
capacity
EXECUTIVE FUNCTION
WORKING MEMORY
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adaptability
flexibility
DYSPRAXIA / DCD 5-10%
PLANNING SEQUENCING
• restricted repertoire inconsistent repetition speed
INTELLECTUAL GIFTED 3% superior 1% high superior “ALL OLDER”
INTELLECTUAL DISABILITY 3% mild 1% moderate “ALL YOUNGER”
AUTISTIC SPECTRUM
1%
SOCIAL INSTINCT SAMENESS
• failure of social symbols poor reciprocity ‘UNSOCIAL’
• fail to generalise restricted repetitive behaviour interests
Health / education interface
• CHERI CONFERENCES
• CHERI mission make a difference 1995 on
• Research + Conference + online resource
http://www.cheri.com.au/presentations.html
• 2007 Putting evidence into practice to reach and
teach ADHD
• 2010 Motor Difficulties And Overlaps
• 2011 Memory and Learning: What Works
• 2012 Resilience
• 2103 Language learning and Literacy
• 2014 Motivation and engagement
“Learning is a dynamic process that consists of making sense and meaning
out of new information and connecting it to what is already known. To
learn well and deeply, students need to be active participants in that
process. This typically involves doing something – for example, thinking,
reading, discussing, problem-solving, or reflecting.” (Barkley, 2010, p. 94)
"The familiar surface learning approach is characterized by information
recall. In contrast, learners who use a deep approach "seek meaning in
study, reflect on what they read and hear, and undertake to create (or
recreate) their personal understanding of things" (Marchese, 1997, p.88).
'Deep learning' is not a description of a quality of learning, nor does it
describe a particular stage of learner development. Rather, 'deep learning'
refers to an approach that students may take to learning, in distinction to a
'surface approach’. (Barry Jackson, Director of Learning Development,
Middlesex University)
http://cte.cornell.edu/teaching-ideas/engaging-students/learning-andteaching-styles.html
http://cte.cornell.edu/teaching-ideas/building-inclusiveclassrooms/inclusive-teaching-strategies.html
Learning Behaviour and Motivation
• As a teacher, your primary job will be to encourage and ensure student
learning and adaptive behavior.
• Learning is a relatively permanent change in behavior or knowledge as a
result of experience. Maturation is not learning. Changes in behavior as a
result of temporary physiological changes are not learning.
• What is learned affects behavior although not all behaviors are a function
of learning.
• Behavior is a different matter. It depends on learning, but it also depends
on motivation.
• the learner's behavior provides the only evidence you can have of his or
her learning. (This will continue to be true until imaging of the brain can
tell us not only that there are neural connections but what is connected by
each one.) Thus, a child who refuses to answer a problem may actually
know the answer, but we have no way of knowing that he knows!
• SO BEHAVIOR BECOMES OUR WINDOW ON THE NEURON.
https://www.cwu.edu/~streetl/Differences%20Between%20Learning%20and%20Beha
vior.html
Motivation
• A reason or reasons for acting or behaving in a particular way
• Desire or willingness to do something; enthusiasm
• A set of facts and arguments used in support of a proposal
http://www.oxforddictionaries.com/definition/english/motivation
• Motivation is defined as the process that initiates, guides, and
maintains goal-oriented behaviors. Motivation is what causes
us to act. It involves the biological, emotional, social, and
cognitive forces that activate behavior
• "The term motivation refers to factors that activate, direct,
and sustain goal-directed behavior... Motives are the "whys"
of behavior - the needs or wants that drive behavior and
explain what we do. We don't actually observe a motive;
rather, WE INFER that one exists based on the behavior we
observe."
(Nevid, 2013)
http://psychology.about.com/od/mindex/g/motivation-definition.htm
Martin defines motivation and engagement as, ‘the students’
energy and drive to learn, work effectively, and achieve — and
the thoughts and behaviours that reflect this’
• Noncognitive skills are those attitudes, behaviours, and
strategies which facilitate success in school and workplace,
such as motivation, perseverance, and selfcontrol. These
factors are termed ‘non-cognitive’ as they are considered to
be distinct from the cognitive and academic skills usually
measured by tests or teacher assessments
http://educationendowmentfoundation.org.uk/uploads/pdf/Non
-cognitive_skills_literature_review.pdf
Engagement
• Engagement is the single best predictor of successful learning
for children with learning disabilities (Iovannone et al., 2003).
Without engagement, there is no deep learning (Hargreaves,
2006), effective teaching, meaningful outcome, real
attainment or quality progress (Carpenter, 2010).
• The process of engagement is a journey which connect a child
to their environment ( including people, ideas, materials and
concepts ) to enable learning and achievement ( Carpenter
2013)
Learning Motivation Behaviour Engagement
individual student IS all perspectives; teachers bring them together
All perspectives inform strategies
‘Behaviour’ is an observation ‘Motivation’ is an inference
Coghill D JCPP 55 737-740 July 2014
Developmental Differences and Disorders
compromise success
learning motivation engagement behaviour
Involve STUDENT FAMILY PEERS TEACHER THERAPIST
Individual Strengths and vulnerabilities coexist ‘Labels’ overlap
Early years have mixed difficulties and presentations ‘ESSENCE’
Gillberg C (2010) Research in Developmental Disabilities 31 1543-1551
• Balance demands and resources
IDENTIFY RISK & Resilience
TASK
INSTRUCTION OUTPUT expected SUPPORT ACCLAIM
INTRINSIC (Genes) ‘Neuroscience and Education’
Behaviour and function are the windows on the neuron
The neuron ( and its world / ‘neighbourhood’) are the engine of function
Translate ‘NEUROTALK ‘ to ‘EDUTALK’ to ‘LIFETALK’
BRAIN PROCESS
Teach / Learn
Adapt Success Esteem
Developmental Differences and Disorders
strategies for success
learning motivation engagement behaviour
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IDENTIFY Risk & RESILIENCE
Explain the child contexts collaboration
continuity
SUPPORTS EVIDENCE-BASED approaches
INDIVIDUAL
priority evidence availability effectiveness
MATCH BETWEEN LEARNING TEACHING OUTPUT
WHAT WORKS Does Will
Should Might Doesn't Won‘t
“prepare the world for the child and the child for the world” Giorcelli
Translate ‘NEUROTALK ‘ to ‘EDUTALK’ to ‘LIFETALK’
BRAIN PROCESS
Teach / Learn
Adapt Success Esteem
NEURODEVELOPMENTAL CONFOUNDERS
of LEARNING
BEHAVIOUR MOTIVATION ENGAGEMENT SUCCESS
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LANGUAGE
COGNITIVE ORGANISATION SELF-REGULATION
MOTOR OUTPUT
EXTREMES OF INTELLECT Gifted Intellectual Disability
SOCIAL INSIGHT
ADAPTABILITY
SELF OTHERS GROUPS and THE SYSTEM
• EMOTIONS primary and secondary
ANXIETY DEPRESSION Conduct Disorder Attachment
• CULTURAL AND LINGUISTIC DIVERSITY ( CALD) concepts and behaviour
Eye contact conversation achievement expectations
• OPPORTUNITY ABILITY and ENVIRONMENT
Chronic Illness
FAMILY / CARER / SIBLING STRESS
Illness
Adversity Deprivation Abuse Trauma
CONFOUNDERS of MOTIVATION ENGAGEMENT SUCCESS
LANGUAGE COGNITIVE ORGANISATION
MOTOR OUTPUT
SOCIAL INSIGHT
ADAPTABILITY
SELF OTHERS and THE SYSTEM
EMOTIONS
ANXIETY and
DEPRESSION
http://exzuberant.blogspot.com.au/2011/01/standards-based-gradingeliminating.html Nordin Zuber
CONFOUNDERS of MOTIVATION ENGAGEMENT and SUCCESS
LANGUAGE COGNITIVE ORGANISATION
MOTOR OUTPUT
SOCIAL INSIGHT
SELF OTHERS and THE SYSTEM
EMOTIONS
ANXIETY and
DEPRESSION
Engagement – evidence -based practice
Complex Learning Difficulties and Disorders
http://complexld.ssatrust.org.uk/project-information.html
• 96 schools – special and mainstream UK + others 2009 to 2011
team + teachers+ others
• Engagement profile and scale
• Briefing packs – information + strategies
• Inquiry framework for learning
• Excellent description and how to use Sally Jones (South Australia )
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http://barrycarpentereducation.files.wordpress.com/2014/08/engagement-forlearning.pptx
http://barrycarpentereducation.files.wordpress.com/2012/03/sen-magazine-therules-of-engagement-sept-2011-a4page.pdf
http://www.eciaqld.org.au/images/files/Leadership%20CLDD%20%20by%20Barry%20Carpenter.pdf ( August 2014)
Carpenter et al ( Feb 2015 ) Engaging learners with Complex Learning
Difficulties and Disabilities Routledge www.routledge.com/9780415812740
Student Engagement Professor Barry Carpenter, OBE
Barry Carpenter OBE, Project Director
Complex Learning Difficulties and Disabilities Project
http://complexld.ssatrust.org.uk/
Engagement profile
The aim of the Engagement Profile is to provide a snapshot of how the student demonstrates their engagement.
Considering when their student is highly engaged, staff should fill in each circle with how that student demonstrates
each indicator of engagement, making it a very personalised document. This could be through actions, behaviour,
expression, gesture and body language.
Engagement scale
The purpose of the scale is to charts the students’ journey towards meaningful engagement and sustained learning,
through a process of staff reflecting on students' learning and their own professional practice.
Using the profile as a benchmark for high engagement, staff focus on a target in an area which the student currently
demonstrates low engagement. Staff then complete regular scales to assess the student's engagement and highlight
ideas for strategies to use next time by breaking the session down into 7 indicators of engagement. Over time,
completed scales can show the effectiveness of strategies implemented and the progress students have made, if
successful.
Staff have reported that use of the engagement tools has allowed them structured time to consider the individual
student and their learning in a more focused and creative way.
Point
Engagement is the single best predictor of successful
1 ..learning for children with learning disabilities (Iovannone et al., 2003). Without engagement,
there is no deep learning (Hargreaves, 2006), effective teaching, meaningful outcome, real
attainment or quality progress (Carpenter, 2010).
The Engagement Profile and Scale is a classroom tool..
Point
2 ..developed through SSAT’s research into effective teaching and learning for children with
complex learning difficulties and disabilities. It allows teachers to focus on the child’s
engagement as a learner and create personalised learning pathways. It prompts studentcentred reflection on how to increase the learner’s engagement leading to deep learning.
Point
3
Point
4
Engagement is multi-dimensional..
.. and encompasses awareness, curiosity, investigation, discovery, anticipation,
persistence and initiation. By focusing on these seven indicators of engagement,
teachers can ask themselves questions such as: ‘How can I change the learning
activity to stimulate Robert’s curiosity?’ ‘What can I change about this experience
to encourage Shannon to persist?’
The adaptations made and the effect on the student’s level of
engagement…
.. can be recorded, together with a score on the engagement scale. Over time, it is possible to
chart the success of interventions and adjustments, and the effect this has had on the
student’s levels of engagement.
Initiation
Engagement Profile
Responsiveness
Curiosity
Persistence
Engagement
Profile
Name:
Date:
Task Undertaken:
Independently
With Prompting
With Support
Anticipation
Investigation
Discovery
Based on the work of Barry Carpenter/ Beverley Cockbill, 2013; personalised by Sally Jones
Developmental Neuroscience
and individual success
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Describe cognitive processes
strengths and difficulties
developmental ages compared to demands
Describe likely impacts - success and struggle
Epidemiology overlaps evidence outcomes
Specific causes with expected patterns
Prioritize interventions
Relevance of neuroscientific data to education ?
Relevance of neuroscientific data to therapies?
Relevance of neuroscientific data to medication?
Neuroscience and Education References
National Forum for Neuroscience and Education( UK)
http://www.naht.org.uk/welcome/news-and-media/key-topics/special-education-needs/national-forum-for-neuroscience-forumin-special-education/
http://www.ssatuk.co.uk/wp-content/uploads/2012/09/NeuroSeminar-4.7.12.pdf
Royal Society ( UK) Neuroscience Implications for education and lifelong learning
http://royalsocietypublishing.org/brainwaves2
http://blogs.royalsociety.org/in-verba/2011/02/24/neuroscience-implications-for-education-and-lifelong-learning/ Brief YouTube
intro
http://barrycarpentereducation.com/2013/06/22/the-promise-of-neuroscience/
Myths and facts for teachers about Neuroscience and Education
www.brainfacts.org
Teacher knowledge and ‘neuromyths’ Bellert A and Graham L, 2013
http://barrycarpentereducation.files.wordpress.com/2013/10/abellert-graham-neurofacts-neuromyths-powerpoint.pdf
Mind Brain and Education: Implications for Educators
LEARNing Landscapes vol5 ,(1) Autumn 2011
http://www.learninglandscapes.ca/images/documents/ll-no9-final-lr-1.pdf#page=115
Relevance of neuroscientific data to education?
http://deevybee.blogspot.com.au/2014/01/what-is-educational-neuroscience.html Jan 25 2014
Bishop DVM 2013 JCPP 54, 247-259
http://onlinelibrary.wiley.com/doi/10.1111/jcpp.12034/pdf
Coltheart M
http://theconversation.com/weird-neuroscience-how-education-hijacked-brain-research-10663
Taylor E (Sept 2104) Can neuroscience add to clinical practice ?
Child Adolesc Ment Health 19(3):161-2
COMPLEX LEARNING DISABILITIES -SPECIAL CONTEXTS
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Specific Language and speech and motor impairments dyslexia
Specific impairments executive function
working memory attention
Sensory impairments in Hearing and Vision
Developmental Dyspraxia / DCD
Cerebral Palsy Physical Disability
Global Learning Disability ( Intellectual Handicap)
Gifted
Autism
CNS e.g. Tic Disorder epilepsy brain injury cerebral palsy
Severe physical illness
Sleep apnoea
Mood
Anxiety Depression Conduct Disorder Bipolar
Cultural and Linguistic Diversity ( CALD)
FAMILY / CARER / SIBLING STRESS
Adversity
Attachment
Deprivation Neglect
Abuse
Collaboration
e.g. Student – centred Schooling
• Teacher + aide
effective instruction personalisation adjustments inclusion
• Speech /language pathologist
language literacy study social
feed augmented
• Psychologist
Social Worker
cognitive behaviour
family adjustment
• Occupational Physio Music Therapist
specific skills writing computer mobility response
• Doctor
answers advocacy anxiety medication
• PARENTS AND FAMILY
• Support Groups engage individual parents and all others
Sharing Information
Translate ‘NEUROTALK ‘ to ‘EDUTALK’ to ‘LIFETALK’
BRAIN PROCESS
Teach / Learn
Adapt Success Esteem
• Student early patterns action assessments
view of difference e.g. www.adhdvoices.com ( Singh)
• Family patterns life experiences
• School comments reports (re) interpret
patterns assessments grades profiles
explain personalized adjustments
information about special educational needs
http://www.queensmead.net/sen/
• Case Discussions why who when what whither
ADVOCACY FOR ALL AVOID BLAME MANAGE BULLYING
Neurological Impairments
•
Processing of complex language , social clues, executive function and planning to
goals are the greatest cognitive demands
• Inherent or acquired brain problems can have wide variety of effects not only
models of ‘local’/ focal function and pathology
• PREMATURITY
44% have >1 weak domain ; controls 16% (Roberts G et al 2011)
Educational Support Needs Odds Ratio=7 , Mulder et al 2010)
particularly caused by poor Processing Speed and Working Memory
Inattention 4 x fullterm if < 32 weeks SDQ by Parent + teacher ( Brogan et al 2014)
Emotional contexts “Social Synapse” (Champion P SSAT 2013 )
Teaching implications (Wolke D SSAT 2103 and RSM 2014 )
Neuroscience and Special Education Forum UK ( 2013)
http://barrycarpentereducation.files.wordpress.com/2013/05/prematurity-positionstatement.pdf
• Seizures Hydrocephalus “Cerebral palsy”
• Brain Trauma Infection
Chemotherapy
• Tic Disorder – ADHD 70% Specific LD OCD
If condition is present BE AWARE for language literacy LD ADHD DCD
Genetics
Risk and Resilience
FAMILY HISTORY cognitive and emotions
• Traits and 25 % risk of ‘disorder’ in close relatives
• Strengths struggles strategies ‘spectre’ stamina
SPECIFIC CONDITIONS
• Sex Chromosome XXY XYY 1/500 Language ADHD ?ASD
• Fetal Alcohol Effects 1/100 to 1/1000? ADHD Intellect low ASD
• 22q11 deletion ( VCFS) 1/3000 Language ADHD Anxiety Depress
• Fragile X
1/2000 Intellect Language ADHD ( carrier anxiety)
• Down
1/2000
Int Dis Language articulation
• Neurofibromatosis 1
1/3000
ADHD Specific LD
• Williams
1/3000
language pragmatics ADHD
• Copy Number variants CGH microarray emerging
rarechromo.org for information and variability
“Teachers deal in ndividuals behavioural geneticists deal in populations” Marc Smith
http://psychologyineducation.wordpress.com/2013/11/17/genes-should-we-fearthem/
Specific Learning Disability
“dys*****ia “
IF ADHD DYSLEXIA DYSPRAXIA LANGUAGE THINK ALL
• Defined by academic achievement BUT
• Reading / Maths / Spelling /ADHD all overlap
• 50% Overlap language and dyslexia ( McArthur 2000)
• Co-occur more commonly in family (Wilcutt,; Greven CU 2014 JCPP )
Reading Difficulty MZ Twins 55% DZ 40%
• Boy 60 % risk if Father RD; 40% if Mother RD ; girls less
(Snowling et al 2003 Torppa et al 2010)
• Preschool delays identify risk ( Nash HM et al 2013)
• School identify poor Comprehension Phonology
• Avoidance year 1 (Eklund, KM et al 2013).
• Centre for Effective Reading ( major literacy problems )
100 patients 15 % Anxiety D 60 % ADHD (Hodge A et al 2013)
www.cer.education.nsw.gov.au
HOW IS LANGUAGE POSSIBLE ?
"The speed and naturalness with which most
children pick up spoken and written language
can fool us into underestimating the enormity
of the intellectual task which faces them, and
thus the enormity of the task facing those
who have to solve learning problems when
they arise.”
David Crystal
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Quality inefficient ? Impairing
Relate to level scatter of abilities
Context of task
expectations
Observed behaviour function
How is it interpreted
How is it supported
Impact on strengths
Impact on emotions
IMPACT OF LANGUAGE IMPAIRMENT
• Behave play interact and learn at level of language
• Examine complexity and quality not only basic level
• How does it contribute to described difficulty in learning
behaviour motivation engagement
• Complex written output uses and challenges many abilities
• Interacting effects on literacy vocabulary learning
• Adolescence Impact : complex reasoning, language of new
subjects and countries , academic and work output, social
belonging, verbal and social pragmatics, introspection,
setting future goals
• ‘talking therapy’ uses abstract language insight
implementation
• Psychiatry Clinics & Language Clinics 40% overlap diagnoses
• Juvenile Justice 45% Specific Language ADHD Intellect Disab
Language impairment Outcomes
ADAM 18 years “English is one of my most difficult
subjects . I often know the answers but don’t know
how to express it in words.This gets in the way during
exams for other subjects. My organisation and study
skills are not well developed . I have a keen interest
in computers. but find my learning disability prevents
me from getting the marks that I want.”
David 17 yrs : Verbal insight++ learning and strategies
“Essay like A Grade Yr 10 not A Grade Yr 12
Written Essays like email not crafted letter”
ADHD LANGUAGE and LEARNING
• Always assess basic and higher language in ADHD
• Concepts of space time and sequence; pragmatics;
output
• Adolescent outcome of language disorder
• Teacher not assume that in ADHD without language
or reading difficulty student does comprehend
everything
• Target academic cognitive language AND behaviour
• Synchronise medication to academic demands &
support
Language learning disorder and overlaps references
AWARENESS of Language Disorder (UK)
www.youtube.com/rallicampaign
http://www.thecommunicationtrust.org.uk/projects/what-works/
Language / Specific LD / ADHD/ DCD interwoven
Rosemary Tannock
www.cas.uio.no/Publications/Seminar/Convergence_Tannock.pdf
• Educating ADHD Optimally In The Schools
Dorothy Hill Presentations October 2011
• http://www.psych.on.ca/forum/forum_posts.asp?TID=551&get=last
"Out of the Lab and Into the Classroom”
• http://www.youtube.com/watch?v=Lsq5oeEunsw
Rogers, M. & Tannock, T. (in press). Are classrooms meeting the psychological needs of children
with ADHD symptoms? A Self-Determination Theory perspective.. J Atten Disord. 2013 Dec 10.
[Epub ahead of print]
Overlap with ADHD Greathead P, ADHD in Practice 2012, 4,10-13.
These impairments overlap and exist into adulthood ,www.thomasebrown.com
and even in high intellectual ability; more risk of anxiety (Brown, Reichel & Quinlan, 2007)
learning disorder and overlaps references
Outcome of Language Impairment
Risks in learning , attention , self-esteem, socialisation, employment
Cohen et al (2000) JCPP 41, 353-362
Beitchman et al 199
Snowling, Bishop et al JCPP 47(8), 759-765, 2006
Overlap with anxiety
e.g Selective Mutism 1/700 1/3 Lang Disorder ( Gillberg ; Keen DV, 2008)
Gifted with Learning Difficulty “twice-exceptional”
Model for screening GLD within response to intervention paradigm
McCallum RS et al Gifted Child Quarterly 2103 57 , 509
DOI: 10.1177/0016986213500070
Differences between Children with Dyslexia who are and are not gifted in verbal reasoning
Berninger V and Abbott RD Gifted Child Quarterly 2103 57 , 233
DOI: 10.1177/0016986213500342
Causes of ADHD
• Thapar et al (2013) JCPP 54, 3-16 DOI: 10.1111/j.1469-7610.2012.02611.x
Educational strategies and language impairments
references
Julia Starling – Adolescent Language
• Recognizing language impairment in secondary school student populations
Aust J Learning Diff 2011 , 1-14 Starling et al
• LINKing Language With Secondary School Learning
Resource in preparation 2014 IS EXCELLENT
Oral language interventions
http://educationendowmentfoundation.org.uk/toolkit/oral-language-interventions/
Developing Oral language in Classroom McCandlish S 2012
http://www.decd.sa.gov.au/northernadelaide/files/links/Taking_a_slice_of_Oral_Lan.
pdf
UK Evidence base for Speech Language Communication Needs (SLCN )
https://www.gov.uk/government/publications/what-works-interventions-for-childrenand-young-people-with-speech-language-and-communication-needs
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/219
623/DFE-RR247-BCRP10.pdf
Educational strategies references
Literature review : Student-Centred Schools make the difference
Harris J Spina N Ehrich LC Smeed J June 2013
Australian Institute for Teaching and School Leadership
http://www.aitsl.edu.au/verve/_resources/
Lit_Review__Student_centred_Schools_Harris_et_al_2013.pdf
Student Centred Teaching Checklist http://mams.rmit.edu.au/e8unxk9vkjtp.pdf
DIVERSITY OF STUDENTS
http://cte.cornell.edu/teaching-ideas/engaging-students/index.html
http://cte.cornell.edu/teaching-ideas/engaging-students/increasing-studentparticipation.html
http://cte.cornell.edu/teaching-ideas/building-inclusive-classrooms/index.html
https://www.dlsweb.rmit.edu.au/bus/public/transnational/pdf/Teaching%20practice%
20-%20Engaging%20students%20through%20learning%20activities.pdf
Educational strategies references
Education Endowment Foundation UK
Toolkit -34 topics and evidence for effects
http://educationendowmentfoundation.org.uk/toolkit
http://educationendowmentfoundation.org.uk/toolkit/behaviour/
http://educationendowmentfoundation.org.uk/toolkit/meta-cognitive-and-self-regulationstrategies/http://educationendowmentfoundation.org.uk/toolkit/social-and-emotional-aspectsof-learning/
How teachers evaluate their interventions
http://educationendowmentfoundation.org.uk/uploads/pdf/EEF_DIY_Evaluation_Guide_%28201
3%29.pdf
Research in schools
http://educationendowmentfoundation.org.uk/news/educating-ethics-how-and-why-and-theeef-trials-what-works-in-schools/
http://psychologyineducation.wordpress.com/2014/07/12/can-teachers-really-be-researchers/
TRAINING MODULES and RESOURCES and Audiovisual library UK
Speech Language ASD LD ADHD Behaviour Social Mild ID http://www.advancedtraining.org.uk/
Severe Profound Complex LLD http://www.complexneeds.org.uk/
Motor Difficulty
“Developmental Coordination Disorder” / Dyspraxia
• Complex planning and sequencing
• Inconsistency and effort = frustration = anxiety
and poor self-esteem
• Writing and speech the most complex
• Overlap with language / narrative from young
• Overlap with ADHD and ASD
• Be aware of anxiety
• Strategies ( Prof Amanda Kirby)
• www.boxofideas.org
• www.spldtransitions.co.uk
Motor Impairments and Overlaps
references
Language social cognition and motor broad mix of impairments
• Impact of motor development on language and social cognition Systematic
review Leonard HC Hill E Chid Adolesc Ment Health 2014 19(30 163-170
Hill, E L, 2001. Int J Lang. Comm. Dis
• FM deficits in poor readers more associated with language impairment
than with literacy problems.
Brookman A et al (2013) PeerJ 1:e217 http://dx.doi.org/10.7717/peerj.217
• Preschool SLI have 25% DCD and this persists to school
Gaines Missiuna 2007 Ch Care H Dv Webster R et al 2005 J Ped 146 80-85
• Impact social and play success; need for routines
http://canchild.ca/en/canchildresourcesearlyidentificationspeechandmotor.as
p
• Assess motor ability , sequencing, planning for DCD
Kirby et al 2013 doi:10.1136/archdischild-2012-303569
DCD and overlaps with anxiety
• Inconsistency and effort = frustration = anxiety and
poor self-esteem
• more common in DCD from preschool ( Piek J)
• Anxiety + depress DZ twins + motor > DZ or control
Pearsall-Jones, Piek, Levy et al 2011 Res Dev Dis 32 1245-1252
• Anxiety and executive function + memory
• Preschool anxiety memory and updating poor
Visu-Petra et al Int J Behav Dev 2011 35 36-47
• Behaviour regulation worse in ADHD + anxiety
Sorensen et al 2011 J Att Dis 15 56-66
SIMON 10 years - LEARNING DISABILITY
• Literacy LD for grade(3yrs<) Severe LD for ability(5yrs<)
reading spelling PIQ 125 VIQ 103 (nb scatter)
• Language Disorder
essays off-topic not listen peer problems
subtle comprehension problem solving pragmatics
auditory discrim attention working memory executive
• Maths
comprehension / problem / sequence / space / time
• Written output narrative skills / coordination )
• Organisation attention 6/7 impulsivity 3/6 DSM IV
SIMON 10 years : Action
• Speech Pathologist
comprehension word finding word narrative social
• Occupational Therapist
sequence space
typing
• Psychologist
structure encourage individual family
• Explain success in chess science
• Output modify quantity / method /time;computer
• Behaviour class play
home
• Medication share wait targets optimise
Diagnosed Attention Deficit Hyperactivity Disorder
and Learning Disability: United States, 2004-2006
http://www.cdc.gov/ncbddd/adhd/data.html
CORE of ADHD
(threshold; genes + environs)
www.drthomasebrown.com
• How the brain controls thinking learning and behaviour
executive functioning planning and prioritising to a goal
working memory
hold in mind while processing
attention
focus sustain switch
speed
inhibition
monitor select regulate action and emotion
“cool” attention and WM and “hot” affect significance
• A neurodevelopmental learning difference/ disorder described/
defined/ interpreted as a behaviour disorder
complex language understanding and use
motor planning visuo-spatial poor time sense (con) sequences
are most vulnerable in complex outputs
extended writing
social interactions
deadlines work
Castellanos FX Sonuga-Barke EJS,Milham MP Tannock R(2006) Trends in
Cognitive sciences. 10(3),117-123
Overview of management
ADJUST THE LOADS
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Get updated comprehensive information
Look for patterns of strength and difficulty
Treat the most obvious e.g. language and learning
Is “behaviour “ at developmental level or not
Targets for cognitive organisation
Use medication clearly and collaboratively
Use medication thoroughly e.g. TDS and enough
Review and readjust
ADHD and Emotional disorder
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Anxiety commonest
Effect on ‘symptoms’ and their interpretation
Effect on Supports – therapy medication
Efron Practice study 8% reported
Anxiety survey in sleep study group
6 different anxiety disorders
392 cases from 21 practices
No 36% 1 Anxiety D 26% >2 Anxiety D 39%
>2 AnxD Social Phobia 48% GAD 34% Separ 32%
OCD 8% PTSD 6% Panic 2%
Sciberras et al Pediatrics (2014) 133, 801-808
ANDREW
Andrew
included gifted special
8 years – bright boy, reading effort avoids writing
FH dyslexia ; Diagnoses of ‘dyslexia’ and Dyspraxia
• Can't get imaginative ideas on paper
• “Fiddles with shelves in lieu of direct attention to task in
hand; needs to settle with alacrity; boundless enthusiasm.”
• Parents concerned about future and self-esteem
• Verbal IQ 98C Nonverbal 98C digits 25C Read 7 yrs
• Tutor + Spalding + Occupational Therapy
13 years Oral expression >> written writing very poor
• Diagnosis of DCD reiterated by teachers
• Verbal IQ 86C Nonverbal 84C W Memory 2C Spell 11 yrs
Andrew 14 years
• Some subjects good improvement BUT still
downgraded class = demoralised and distracted
“Poor memory – can’t get right word; must go over
several times to organise flow of facts and ideas;
I can concentrate.”
“more time = great work , less time = terrible.”
• Parents + tutor + support + case conference
• Adjustments - visuals, glossary, time and laptop
• Discuss WM training and medication.
Andrew 3 to 9 months later
• Methylphenidate to 50 mg over 3 doses/ day then 40mg RitalinLA
long acting +/- evening
• Discusses his work; settles; reads for pleasure
• Happier, trying hard , goal to advance class
“everything better; I didn’t rush exams”
ALL SUBJECTS
“excellent focus, method, application, reasoning , written work”
“A really wonderful year from a mature intelligent and witty student“
• Mid year - from rank 130-175/190 to 14-75/190
• Late year, 1st and 3rd in 2 subjects
• Moved to top classes next year !
• “I study at higher level = more content in exam”
Able with ADHD ( commoner in DCD ASD/ HFA)
117 High-IQ youths with ADHD
Working Memory Index (WMI)
Percent of Ss with WMI 1 and 2 SD below VCI or POI
PROCESSING SPEED INDEX ( 80% - 42%) STORY MEMORY INDEX (88%- 37%)
100%
90%
80%
74.4%
70%
60%
50%
40%
40.2%
30%
22.9%
20%
10%
0%
4.9%
ADHD
STD. Sample
(Brown, Reichel & Quinlan, 2007)
Figure 1.
Carlos 6.yrs
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no skills no remorse
active +++
Other origin and language (CALD)
marital dysfunction
father illiterate/ alcohol / anger
? ADHD ? AUTISM
? Parenting ?Culture ? Attachment ?Abuse
always slow speech & play
PIQ 80 ( 95 – 45) VIQ 48 ( language 3.2 yrs)
special class
family behaviour support
RAYMOND 6 yrs
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Age 5.2 years IQ 55 sociable language 2.0 year level
Denied Support Class ( cut off IQ 52) so in kindergarten (22)
Settled term 1 some play & drawing
Term 2 went abroad for 2 months to country of origin
HI ++ IA++ aloof ? Not relate to peers + resist++ even 1 to 1
Poor sleep crying more abdo pain on school days
?need medication
? ADHD ? ANXIETY ? AUTISM
SUPPORT CLASS ( 7 students) + signs + visuals
SETTLED quickly
Autism spectrum disorder
new definition DSM 5 history + current
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Social impairment and insight “too literal”
Restricted intense interests need sameness
“sensory symptoms”
Isolated strengths usually nonverbal
Family history of traits to disability
Adolescence and ANXIETY ADHD
ACCEPT QUALITY
LEVEL OF LANGUAGE
use visuals prediction rote-learning “ scripts” drama
Colloquial “he’s on the spectrum”
Models of successful “autibiographies”
Curious incident of the dog in night time
The Rosie Project
Spectrum of communication disorder
useful model but outdated terms
From Bishop DVM J.Child Psychol. Psychiatry (1998) 39 pp.879-891
Autism and ADHD
• DSM –IV <7y; NOT coexist DSM -5 <12y; coexist
www.dsm5.org/Documents/ADHD%20Fact%20Sheet.pdf
• In ASD Anxiety ADHD and ODD all about 28%
Simonoff 2008 JAACAP , 2008, 47,921-929
• Overlap genetically 6771 twin families at 8 y
ASD criteria 41% suspect ADHD; ADHD 22% susp ASD
Ronald et al JCPP 2008, 49,535-542
• Severe ID +/- ASD 122 7-15y IQ 30-69
• MPH up to 1.5mg/kg/D effective 50%
Simonoff et al JCPP 2013 54, 527-535
Intellectual disability ( ID )
ADHD when inappropriate for developmental age
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ID – neurogenetic complexity / syndromes
Complexity of function and management
Mental health disorders 4 X N IQ<70 6xN <50 epilepsy
Comprehensive support baseline and “targets”
ADHD / ANXIETY / DEPRESSION
Simonoff et al JCPP 2013 54 186-194
• Dose manipulation complex, side effects more
• MPH EFFECTIVE 50 % IN IQ 30-65 1/3 WITH ASD
Simonoff E et al 2013 JCPP 54, 527-535
• Multiple medications more likely (international)
Hsia et al 2014 Psychopharmacology 231 999-1009
Medication and Collaboration
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Expectations of medication
Expectations of managing medication
Experience of medication
Knowledge about medication
Science summary scanty anecdotal
Myths opinions and prejudices
Professional
personal
SHARING OF TARGET SYMPTOMS
Medications for ADHD
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Rigorous knowledge science safety success
Individual patterns of response heterogeneity
Responsible collaborative use
Personal experience of educators and others
Misconceptions and media
Over reliance be realistic
Should all children with special education needs be
considered for methylphenidate trial to mitigate their
disability and enhance effectiveness of supports ? How
would we know?
(Professor Uta Frith UK Neurosciences Forum 2012)
• Bolea-Almanac J Psychopharmacology 2014 ,1-25
• LONG-ACTING Coghill et al ( European )
• http://www.biomedcentral.com/1471-244X/13/237
Approaches to using medication
• Indications - TARGET SYMPTOMS monitoring
• Individual responses
language motor academic behaviour emotions
• Effect on other interventions
• Which medication
• Which alternatives
• Likely adverse effects
• Plan of trial and sharing observations
• Commitment
• Review
MEDICATIONS FOR ADHDImprove efficiency of information Processing
Methylphenidate Dexamphetamine Atomoxetine
• MPH DEX - Dopamine / Noradrenaline balance
• Onset 30-40 min
• last 3 to 4 hours
• MPH DEX first line
• 70 to 90% success
• 5 to 20% adverse effects
INDIVIDUAL RESPONSES
• Controlled prescribing
• Long acting have different release profiles
• Morning dose RITALIN LA 50% CONCERTA 25% of total VYVANSE
Long acting preparations European review Banaschewski et al (2008)
• Atomoxetine build up over 6 weeks
• ?tics substance use ?Long term ? Mood
Using methylphenidate
• Titration to steady state over 2 to 3 weeks paeds differ
• Up to 3 doses per day of immediate release
Before school 7.30 ( get going) MID-MORNING ( cover playground)
after school 4 p.m. for play and home work
• teacher observe gains wear off and different doses
• Trial adequate doses before say not effective
• Start during sequence of therapy and during term
• Change dose mid-week
• Continue at weekends and in holidays ( parents evaluate )
• Work through minor side effects
• Work through choices MPH to DEX at same dose, then ? ATX
• Extended release preparations have different release profiles
• Complex brains respond more / less or more frequent
Tuning Medication to Teaching and Life
ADHD SYMPTOMS
SCHOOL HOURS
7 am
RECESS
11 am
LUNCH
1 p.m.
STIMULANT
DOSE
DOSE TIMING
Group/hard work
Homework
4 p.m.
9 p.m.
DOSE TIMING
ADHD SYMPTOMS
Other Medications
less science more side effects ?once daily
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Clonidine sedative for sleep H/A
Melatonin for sleep
Anti-anxiety
SSRI s
Fluoxetine Sertraline
Obsessive , stereotyped , anxiety
Risperidone BUT adverse weight motor
Aggression high activity agiataion sterotyped
Valproate
ALL TITRATE SLOWER
GIVE WITH GREAT CARE and COLLABORATION
Robert Dravet Epilepsy age 8
• Physical Disability Class 6 yr
• Fatigues forgets attend
• Draw self-help v poor
• 1-1 all tasks ? anxious
• Few absences a day
• Parents separated
• 7 y ?ASD ?ADHD ?OCD
• Home never sit
• Rote rules aggressive
• Restricted topics
• Toiletting Visuals not work
• Reading maths write v poor
NOT ACCESS CURR IN SP CLASS !
• UPDATE ASSESSMENTS
Robert Dravet Epilepsy age 8
• Physical Disab Class 6 yr
• Fatigues forgets attend
• Draw self-help v poor
• 1-1 all tasks ? anxious
• Few absences a day
• Parents separated
• 7 y ?ASD ?ADHD ?OCD
• Home never sit
• Rote rules aggressive
• Restricted topics
• Toiletting Visuals not work
• Reading maths write v poor
NOT ACCESS CURR IN SP CLASS !
• UPDATE ASSESSMENTS
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Tall 90 c (= 8 yr)
Sleep study N
Grommets done
Anticonvulsants steady
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No behaviour plan
Lang Recep 5c Expr 40c
Visual percep average
Visual Motor 3 yr
COGN Verbal 18c Visual 7c
Visual spatial v poor
SEVERE attn W Mem Pr Speed
Verbal+visual memory average
Robert Dravet Epilepsy age 8
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ATTENTION MEMORY
MOTOR COORDINATION
PLAN SEQUENCE
COMPREHENSION
SELF CARE
FRUSTRATION
SEVERE ADHD
TRIAL METHYLPHENIDATE
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SEIZURES &/or
ANTICONVULSANTS
DRAVET
pattern trigger arousal
VIDEO EEG OK DOSE OK
MPH and seizure risk
MPH DEX ATX compare
SET TARGET SYMPTOMS
Parent teacher therapists
CLOSE CONTACT
Robert Dravet Epilepsy age 8
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METHYLPHENIDATE (MPH) 10 mg TRIAL 28 kg
Start Low go up to 40 mg /day before say not effective
7 a.m. Mid-morning ( for school and playground) At Home
Attention Distractibility fatigue frustration
Aggression Social interaction with peers
On task Complete Less 1-1 needed Therapy sessions
Comprehension expression Motor Self care toiletting
BEHAVIOUR PLAN
Mother + Father + school reinforce methods and praise
Psychologist needed to support ? Community ? Private
SPECIAL CLASS ESSENTIAL
Therapy essential
Robert Dravet Epilepsy age 8
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MPH 10 mg TRIAL 28 kg
WITH CURRENT TEACHER
Low up to 40 mg /day
7 a.m. Mid-morn Home
Attend Distract Aggress
On task Less 1-1 Therapy
Comprehend Motor Selfcare
BEHAVIOUR PLAN
Mother + Father + school
Psychologist
SPECIAL CLASS ESSENTIAL
Therapy essential
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5 mg some benefit in 2 days
2 doses school OK
3 doses home better
10 mg 10 not last 10
3 pm not 4 pm is better
Casual teacher not good
2 weeks VG WORK
No behaviour toilet issues
Understands better
OT settled beautifully
15 mg quiet but lasts well
10 ?12.5 mg ?SLOW RELEASE
Summary
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Match abilities and demands
Updated information of realistic abilities
Relate to observed performance behaviour
Language cognitive organisation & regulation
What works what doesn’t what might
Relative targets for medication
Review and refine priorities
Sharing and collaboration
ADVOCACY FOR ALL
Managing
Risk and Resilience
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Demands >> ability
Scattered abilities
Major specific problem
Overlapping impairments
‘Secondary ‘ impairments
Known patterns /
phenotypes
Trajectory and outcomes
Family Experiences
struggles spectres
impairments
Cultural concepts
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Scenarios of risk and reality
Collaborative info insights
Evaluate the ‘expectable’
Comprehensive assess
Support all abilities
Adjust loads
Opportunity to achieve
Acclaim gives self-esteem
Utilize family strengths
strategies and experiences
• Cultural awareness
• Managing bullying