There are many other disorders that can affect a child’s ability to learn, but are less common, misunderstood or not acknowledged. Unfortunately, when such issues go unidentified and thus, untreated, the child suffers severe frustration, anxiety, and often ridicule or mistreatment in school. Hopefully, the following information will serve as awakening an awareness that can lead to further research and understanding.
Traumatic Brain Injury
A traumatic brain injury (TBI) is caused by a forceful bump, blow, or jolt to the head or body, or from an object that pierces the skull and enters the brain. Not all blows or jolts to the head result in a TBI.
Some types of TBI can cause temporary or short-term problems with how the person thinks, understands, moves, communicates, and acts, which may also look like ADHD symptoms. Some injuries are considered primary, meaning the damage is immediate; others are secondary, meaning they can occur gradually over the course of hours, days, or weeks later. Although there are two main types of head injuries, non-penetrating & penetrating, our focus is on non-penetrating since these are the ones that may go undetected in children and cause learning difficulties. These injuries are also known as closed head injury or blunt TBI and are caused by an external force strong enough to move the brain within the skull. With early diagnosis and ongoing therapeutic intervention, the severity of these symptoms may decrease. “Symptoms can vary greatly depending on the extent and location of the brain injury. Impairments in one or more areas (such as cognitive functioning, physical abilities, communication, or social/behavioral disruption) are common” (Brain Injury Association of America, https://www.biausa.org/ ). Causes uses include falls, motor vehicle crashes, sports injuries, blast injury, or being struck by an object.
In children, the signs to look for are:
- changes in interest
- inability to give attention to tasks
- changes in sleep patterns, moods, and eating
- dizziness, balance, vomiting
- inappropriate behaviors, especially if not seen before
- brief loss of consciousness
- fatigue or restlessness
These symptoms may appear to be ADHD or a behavior problem, but call for a much different response. If your child has experienced a blow to the head (fell off trampoline or bicycle, had a four-wheeler wreck, received a hard baseball hit in the head) a medical examination is required to diagnose TBI.
America Speech Language Hearing Association (ASHA), Signs and Symptoms
Tourette Syndrome is one type of Tic Disorder. Tics are involuntary, repetitive movements and vocalizations.
- In Individuals with Disabilities Education Act (2004), Tourette syndrome is included under the category of Other health Impairment which is defined as having limited strength, vitality, or alertness, including a heightened alertness to environmental stimuli, that results in limited alertness with respect to the educational environment. https://sites.ed.gov/idea/regs/b/a/300.8
Tics are primary symptoms of a group of childhood-onset neurological conditions known collectively as Tic Disorders, of which there are three different types:
- Tourette Syndrome (TS),
- Persistent (Chronic) Motor or Vocal Tic Disorder, and
- Provisional Tic Disorder.
It depends on the types of tics present (motor, vocal/phonic, or both) and the length of time that the tics have been present, as to which tic is diagnosed. Diagnosis must be determined by a medical professional.
- eye blinking
- facial grimacing
- head bobbing, jerking
- neck movements, stretching
- arm jerking
- shoulder shrugging
- combination of the above
- throat clearing
- blurting out a phrase out of context
- swearing, ethnic slurs or socially unacceptable words (this only occurs in 10-15% of the cases)
I have noticed that many children exhibit some of these behaviors at some point in their early development, so it is not uncommon to have a child that clears her throat excessively or blinks her eyes continuously. The key is how long it last. Anxiety can produce tics in children that may be situational and will cease when the situation changes, but if it persists for over a year, then it is uncontrollable. Observe and take notes to determine if your child needs a medical examination.
Tourette Association of America, https://tourette.org/about-tourette/overview/
Speech/language disorders is a separate category of IDEA and is not placed under learning disabilities. However, many children with learning disabilities are also eligible for speech/language services. United States Department of Education, IDEA (2004) https://sites.ed.gov/idea/regs/b/a/300.8
1. Speech is how we say sounds and words. A child with speech disorders may have trouble with:
- Stuttering=repeats sounds or pause when speaking
- Voice=speaks with a raspy or hoarse voice
- Articulation=doesn’t say sounds correctly
2. Language is the words we use to share ideas and get what we want. A child with a language disorder may have problems with understanding language, talking, reading, and writing.
- Most children can pronounce sounds correctly by age four.
- Children with persistent ear infections will be delayed in pronounce sounds correctly because they hear them muffled.
Receptive language is understanding. They may have trouble:
- Understanding what people mean when they use gestures, like shrugging or nodding
- Following directions
- Answering questions
- Pointing to objects and pictures
- Knowing how to take turns when talking with others
Expressive language is talking. They may have trouble:
- Asking questions
- Naming objects
- Using gestures
- Putting words together into sentences
- Learning songs and rhymes
- Using correct pronouns, like “he” or “they”
- Knowing how to start a conversation and keep it going
- Changing how they talk to different people and in different places. For example, you speak differently to an adult than a young child. You can talk louder outside than inside.
TIP: Language Deficits Produce Behavior Problems
When a child has a language deficit and cannot communicate his needs (hunger, pain, desires, thoughts), his options are limited in gaining the attention for others to understand what he is trying to communicate. Therefore, burst of anger, crying, throwing objects, self-injurious behavior or hurting others become forms of communication. Rather than continual punishment, it is wise to teach this child other forms of communication, until language is achieved. Sign language, assistive technology like iPads, and picture communication provide a few communication alternatives.
- Receptive and expressive language problems should be noted during pre-school.
- Speech-language pathologists (SLPs), can help identify these problems and provide the appropriate therapy.
American Speech-Language-Hearing Association, https://www.asha.org/default.aspx