5.1. Occupational therapy: Need, assessment, scope, nature of intervention
5.2. Behaviour therapy: Need, assessment, scope, nature of intervention
5.3. Language therapy: Need, assessment, scope, nature of intervention
5.4. Behavioural interventions: Positive behavioural intervention support (PBIS).
5.5. Therapeutic recreation: Need, assessment, scope, nature of intervention
5.1 Occupational therapy: Need, assessment, scope, nature of intervention
Occupational Therapy is a branch of medicine that helps individuals optimise their performances in meaningful activities that occupy their time. For children, this would comprise school, play, and social interaction with friends. Children with LD have difficulties in each of these areas and an occupational therapist helps improve sensory processing skills (understanding, registering and responding to sensory information), fine motor skills (required for writing), attention (by improving sitting tolerance), and social behaviour (interacting with peers). Occupational therapists work on rewiring the brain to enhance such behaviour. This is achieved through meaningful activities that are motivating and fun to children, helping them practice a skill and retain it. For example, an OT session could include sensory based play using swings, monkey bars and obstacle courses, fine motor activities through board games and adaptive aides like the iPad to enhance time management and visual attention.
A learning difficulty can be described as a neurological difficulty with processing certain forms of information. Some learning difficulties are seen in isolation and others alongside each other, for example Dyslexia and Dyspraxia are often seen together.
Learning difficulties is an umbrella term used to describe some of the most frequently occurring conditions such as, Dyspraxia, Dyslexia or Attention Deficit Hyperactivity Disorder (ADHD).
Occupational therapy (OT) can help children with learning disabilities to improve their performance at school and learn more easily. OT is an allied health discipline that targets improving an individual’s independence to ensure they can engage in their chosen “occupation” or everyday tasks/activities, and with their community, as they desire. An occupational therapist can help children who have problems with attention or concentration, difficulties recalling spelling and writing letters or numbers correctly. Often, these problems are indicative of critical issues with visual perception, motor problems, or attention difficulties.
An occupational therapist can work with a child, their school and parents to provide treatment, advice, strategies and techniques to minimise the effects of a learning difficulty on everyday life. It is important that where possible, treatment is started early to minimise the effect on self-confidence and esteem with their peers and in the classroom.
Below are some of the ways that an occupational therapist might forcus on:
Organisational skills
Handwriting
A child with a diagnosis of a learning disability can work with an OT who explores the intrinsic problems causing the difficulties, such as visual perceptual issues, attention problems or motor skills deficits. The OT aims to improve the child’s participation in both the home and school environment. Some familiar strategies an OT uses to work with the child include:
5.2 Behaviour therapy: Need, assessment, scope, nature of intervention
When it comes to education, there are few things that make or break a lesson like behavior management. Instruction is only as good as a student’s ability to receive it. If behaviors are out of control, the learning environment will be undoubtedly compromised. With classrooms of 30 or more students, effective behavior strategies can range far and wide—just like the many personalities in the classroom. While it may often come down to trial and error, some specific behavior techniques are known to be more effective for students with learning disabilities.
One important aspect of behavior management for students with learning disabilities is to create a classroom environment that is structured, but not rigid. Structure provides students with distinct expectations, both academic and behavioral. To set a standard or expectation from the beginning is a proactive way of staving off unsavory behaviors before they even emerge. However, as we all know, behaviors are typically an effect of some specific emotion. When emotions or reactions take over, especially for students with learning disabilities, it is beneficial that educators have a repertoire of behavioral techniques to try.
For students with ADHD…
Consider what is and is not within the child’s control before issuing a punishment or redirection. A child with ADHD is often impulsive and unaware of his or her own outbursts or comments. There is a difference between a child who is disruptive and a child with attention issues who is not intentionally troublesome. Therefore, the behavior techniques for an interruption must fit the circumstances. Instead of harping on the outburst immediately, as in the case of a disruptive student, give the student a silent cue to remind him or her of appropriate behavior in the class setting. Often times, simply making eye contact with a child will remind him or her to think and raise a hand before speaking out.
Another helpful behavior technique for students with attention issues is to use proximity. When a student is placed closer to the adult in the classroom, he or she will be more inclined to listen, track the speaker, and remain focused. Proximity also helps to remind students that they are in plain view of the teacher at all times. This technique assists when executive functioning is compromised and a student’s focus strays easily.
If a student with ADHD seems unusually fidgety or distracted, allow him or her to take a brain break. This one to three-minute movement break allows students to expel pent up energy or anxiety. The small time gap of movement also helps students to refocus and check back in if attention has been lacking.
For students with non-verbal learning disabilities…
Create a simple, structured outline for the day’s lesson. This will help a student who struggles to transition from task to task, or becomes easily frustrated if he or she feels “left behind.”
An outline or small sticky note indicating the day’s lesson will also prevent a student’s need to ask repetitive or unnecessary questions. These behaviors are typical for student with a non-verbal learning disability (NVLD)—including the inability to read facial expressions or interpret body language.
A student with a NVLD may also appear clumsy, careless, or uncoordinated. Preferential seating, either close to the teacher’s desk, pencil sharpener, door, etc., helps keep this type of learner from unnecessary roaming.
he purpose behind behavior modification is not to understand why or how a particular behavior started. Instead, it only focuses on changing the behavior, and there are various different methods used to accomplish it. This includes:
Positive reinforcement is pairing a positive stimulus to a behavior. A good example of this is when teachers reward their students for getting a good grade with stickers. Positive reinforcement is also often used in training dogs. Pairing a click with a good behavior, then rewarding with a treat, is positive reinforcement.
Negative reinforcement is the opposite and is the pairing of a behavior to the removal of a negative stimulus. A child that throws a tantrum because he or she doesn't want to eat vegetables and has his or her vegetables taken away would be a good example.
Punishment is designed to weaken behaviors by pairing an unpleasant stimulus to a behavior. Receiving a detention for bad behavior is a good example of a punishment.
Flooding involves exposing people to fear-invoking objects or situations intensely and rapidly. Forcing someone with a fear of snakes to hold one for 10 minutes would be an example of flooding.
Systematic desensitization is also used to treat phobias and involves teaching a client to remain calm while focusing on these fears. For example, someone with an intense fear of bridges might start by looking at a photo of a bridge, then thinking about standing on a bridge, and eventually walking over a real bridge.
Aversion therapy is the pairing of an unpleasant stimulus to an unwanted behavior in order to eliminate that behavior. Some people bite their finger nails, and in order to stop this behavior, there's a clear substance you can paint on your finger nails that makes them taste awful. Painting your nails with it helps stop the behavior of biting nails.
Extinction is the removal of all reinforcement that might be associated with a behavior. This is a powerful tool and works well, especially with young children.
5.3 Language therapy: Need, assessment, scope, nature of intervention
Learning Disability refers to difficulties with acquiring, organizing, remembering, or understanding information. A person with a learning disability may have impaired language processing, phonological processing, visual spatial processing, processing speed, memory and attention, and/or executive functions (e.g. planning and decision-making). These difficulties impact upon oral language, reading, writing, and math. People with a learning disability still have average intelligence, thinking and reasoning skills, which makes it different from a global delay. A red flag that a child may have a learning disability is unexpected underachieving despite high effort and support. Learning disabilities are life long, so getting help from a professional to help facilitate success in school is important.
A Speech-Language Pathologist can help with learning disabilities. They can assess the different language-based skill areas (e.g. reading, writing, oral language, information processing, memory, attention, etc.) and help improve performance in these areas. They can work one-to-one with the student but will also connect with the school/teacher to give suggestions on how they can best help the student in the classroom.
Treatment with the Speech-Language Pathologist usually focuses on:
· specific skill instruction
· accommodations
· compensatory strategies
· self-advocacy skills
Some children struggle with understanding and speaking and they need help. They may not master the language milestones at the same time as other children, and it may be a sign of a language or speech delay or disorder.
Language development has different parts, and children might have problems with one or more of the following:
Language and speech disorders can exist together or by themselves. Examples of problems with language and speech development include the following:
Language or speech disorders can occur with other learning disorders that affect reading and writing. Children with language disorders may feel frustrated that they cannot understand others or make themselves understood, and they may act out, act helpless, or withdraw. Language or speech disorders can also be present with emotional or behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) or anxiety. Children with developmental disabilities including autism spectrum disorder may also have difficulties with speech and language. The combination of challenges can make it particularly hard for a child to succeed in school. Properly diagnosing a child’s disorder is crucial so that each child can get the right kind of help.
Speech and language therapy can be beneficial to people with learning difficulties to enable them to communicate to the best of their ability. Speech and language therapists will be able to develop and implement an individual therapy programme whilst working together with an individual’s family as well as them, aiming to reduce the communication difficulties faced on a daily basis. This may include implementing new ways of communicating through the use of signing, symbols and communication aids. This will hopefully lead to a new way of communicating and make the individual feel more confident about communicating with others.
The speech and language therapist will carry out an initial assessment to evaluate the individual’s speech, language, communication and swallowing abilities. The speech and language therapist will then use this information to create an individualised treatment plan. This treatment plan will be tailored to the individual’s specific needs and abilities. The speech and language therapist will focus on the positive aspects of an individual’s communication and use this to help them to communicate to their full potential.
After an initial appointment, speech and language therapy may include assessments, reports, reviews, therapy programmes, support groups, training, advice and education.
Specific therapy approaches which might be used for individuals with learning difficulties include:
An initial assessment will be carried out by one of our speech and language therapists. This will highlight any worries and difficulties concerning communication and speech. It will also provide a chance for you to share any concerns you may have, and allow you to discuss what you would like to work on and improve.
5.4 Behavioural interventions: Positive behavioural intervention support (PBIS).
Historically, schools found reasons to exclude students with disabilities from general education settings. With the passage of the Individuals with Disabilities in Education Act (IDEA) and its amendments, Congress recognized schools must be inclusive of all students and use evidence-based approaches to support the behavioral needs of students with disabilities. PBIS is the only approach specifically mentioned in the law for preventing exclusion, improving educational outcomes, and addressing the behavior support needs of students with disabilities. In addition to PBIS, the law states education for students with disabilities can be more effective when schools:
Positive Behavioral Interventions and Supports (PBIS) is an application of a behaviorally-based systems approach. It is based on research regarding behavior in the context of the settings where it occurs. Schools, families,and communities work with this approach to design effective environments to improve behavior. Such environmental interventions, in turn, serve to make problem behavior less effective, efficient, and relevant and desired behavior more functional. In addition, the use of culturally appropriate interventions is emphasized.
Key principles of practice
Children and youth with disabilities benefit from free, appropriate, public education designed to meet their unique needs. At the same time, we serve students with disabilities best when we integrate their general and specialized supports into the larger school-wide framework.
Tier 1
Students with disabilities benefit from Tier 1 supports by including the school-wide language for expectations in their individualized education plan (IEP) and goals. Adopting these expectations and applying them during specialized instruction is important, too. School personnel teach students behavioral expectations using the core PBIS lessons and use the school-wide acknowledgement system for appropriate behaviors. Within classrooms, children with and without disabilities benefit from lots of opportunities to respond, positive acknowledgements, and reminders like prompts and pre-corrections.
Tier 2
At Tier 2, students receive targeted interventions beyond what are provided at Tier 1 support. Students with disabilities may benefit from Tier 2 supports the same as any other student in the school. One consideration when placing students with disabilities on Tier 2 supports is to insure the Tier 2 support does not reduce or replace services outlined in the student’s IEP.
Tier 3
Tier 3 supports a few students who engage in chronic, severe behaviors and who haven’t responded to Tier 1 and Tier 2 supports. Part of the Tier 3 framework includes designing Behavior Intervention Plans (BIP) with interventions driven by Functional Behavioral Assessments (FBA). Teams may apply a person-centered or wraparound process. These processes place student and family needs at the center of the support provided for students with complex needs. Students with disabilities access Tier 3 interventions in two ways
If the individualized behavior supports are part of the student’s IEP, school teams follow procedural safeguards afforded students with disabilities through IDEA. When a student is suspected to have a disability, teams follow their district policies and procedures to comply with IDEA regulations.
Many kids struggle with behavior in school. When schools react only with punishment, students don’t learn the skills they need to improve. That’s where positive behavioral interventions and supports (PBIS) comes in.
PBIS is a proactive approach schools use to improve school safety and promote positive behavior. The focus of PBIS is prevention, not punishment.
At its heart, PBIS calls on schools to teach students positive behavior strategies , just as they would teach about any other subject — like reading or math. In schools that use PBIS, all students learn about positive behavior. This includes kids with IEPs and 504 plans.
PBIS recognizes that students can only meet behavior expectations if they know what the expectations are. Everyone learns what’s considered appropriate behavior. And they use a common language to talk about it. Throughout the school day — in class, at lunch, and on the bus — students understand what’s expected of them.
According to research, PBIS leads to better student behavior. In many schools that use PBIS, students get fewer detentions and suspensions. They also earn better grades. There’s also some evidence that PBIS may lead to less bullying.
5.5 Therapeutic recreation: Need, assessment, scope, nature of intervention
Perhaps nothing reveals so much about individuals as how they choose to play - how they invest their time and energy for leisure time. Leisure is that time free from demands of school, work, or required activities of daily living. Everyone needs regular recreation that develops skills, promotes good health, relieves stress, facilitates social interactions, and provides a general joy for living.
For recreation, we choose activities at which we can be successful. Good readers read. Athletes seek sports' activities. Musicians lose themselves in music. Visual artists paint or draw. Craftspeople create. Social individuals engage in group activities. Observers appreciate the efforts of others - whether a basketball game, painting, fine meal, or concert.
Children, adolescents, and adults with learning disabilities may find themselves with limited opportunities to fully enjoy leisure time. A lack of perceptual, motor, memory, linguistic, or organizational skills may cause them as much difficulty for leisure as they have at school or work. Fear of failure may limit their reaching out to access recreational activities. Just as we teach children with dyslexia to read, those with math disabilities to understand math, those with linguistic problems to better comprehend and use language, we must teach skills and provide practice so individuals with learning disabilities can achieve some recreational proficiencies. When skills are not as well developed as necessary and compensations are not made, agencies, institutions, instructors, and coaches can be helped to make necessary accommodations. Satisfying leisure time for persons with learning and other disabilities is as important as accomplishments at home, school, and work.
BENEFITS OF RECREATION PARTICIPATION
Why should a person with learning disabilities engage in recreation activities? Simply because they can derive many benefits from recreation participation. One benefit is learning from the experience. When the recreation activity experience has captivated the participant, this individual brings particular personality styles of learning, motivation, and expectations about the experience to the setting. The person faced with a specific environment, interpreted by the person or not, promotes one or more learning experiences. These learning experiences can be motor learning, understanding game directions, or performing a skill, all to meet the demands of that setting. These experiences may come from involvement in a structured recreation program and may be exhibited as part of the information outcomes of participation. Researchers in the field of learning and educational psychology have discovered a variety of learning outcomes. The following outcomes can be present because of participation in recreation activities: behavior change and skill learning, direct visual memory, information (factual) learning, concept learning, schemata learning, metacognition learning and attitude, and value learning (Roggenbuck, Loomis, & Dagostino, 1991).
The physiological benefits of recreation participation were derived from studies where people engage in physical activity of some kind (e.g., exercise, cycling, swimming, walking, jogging, running, hiking, weight lifting, etc). Specific results from involvement in a physical recreation activity are an increased lung capacity, reduced resting heart rates and lower blood pressure levels. Other benefits consist of decreased body fat mass, increased lean body mass, increased muscle strength, and improved structure and function of connective tissues (ligaments, tendons, cartilage) and joints. Weight-bearing and strength-building activities help sustain bone mass and reduce the incidence of trauma-induced fractures (Paffenbarger, Hyde, & Dow, 1990). Moderate physical recreation activities are known to reduce the symptoms of mild or moderate depression and anxiety through improved self-image, social skills, and mental health (Taylor, Sallis, & Needle, 1985). Noted psychological benefits of recreation activity are as follows:
Involvement in recreation activities releases stress and tension from the perils of society. Braum (1991) recalls the findings of researchers that state,"relaxation tends to alleviate many of the symptoms of stress. Activities that fill leisure time, performed within a group, strengthen social support ties known to negate stress" (p. 407). The idea of choice in leisure presents opportunities where one can recreate.
One's environment can be a determinant to stress reduction. Natural environments can be pleasant, relaxing, and stress-reducing for many people, but large urban cities also provide the same experience. Having too much free time and limited access to various recreation activities of one's liking can produce stress. So, for those individuals living out in the country who have access to transportation, the joy of partaking in cultural events in the city on a weekly or monthly basis provides the opportunity for a stress-limited lifestyle. The same can be said for people living in the city who recreate in the country.
Social integration of children and adults with learning disabilities into community recreation programs offers the chance to develop a positive self-image through successful experiences and satisfying relationships with peers. McGill (1984) reports that integrated play opportunities are stimulating and highly motivating experiences for disabled children, offering them opportunities to imitate and model the play behavior of nondisabled peers. Social integration also enhances relationships between family members. We've all heard of the old adage,"The family that plays together stays together." This adage infers that leisure experiences promote family satisfaction and stability. Recreation activities provide opportunities for couples and families to interact and negotiate individual and collective interests. Orthner and Mancini (1991) state some benefits to the family:
Leisure experiences promote opportunities for developing equity. Unlike many other environments within which people interact, leisure experiences promote opportunities for each individual to maximize her or his own interests and minimize competition. It is during leisure time when husbands and wives, and parents and children, are most apt to practice by negotiating family roles and reaching new definitions of consensuses.When individual interests are promoted over maximum joint interest, family bonds are weakened. Shared leisure experiences encourage opportunities to negotiations and improve the historical comparisons upon which subsequent negotiations are based. (p. 294)
Benefits of leisure in social integration are also noted in people without disabilities. The chance to learn from and to socialize with nondisabled peers has been cited as one benefit for individuals with disabilities participating in integrated and fully inclusive programs. Research in the 1980s determined that positive attitudes of children not having disabilities toward peers having disabilities were cultivated or increased when involved with an integrated recreation activity (Schleien & Ray, 1988). Recreation service providers also learn from this experience. Due to the Americans With Disabilities Act of 1990, all private, public, and nonprofit agencies delivering recreation services to the public must supply accommodations and modifications within their programs to persons with disabilities (as requested). These professionals may not have any knowledge of providing accommodations and/or modifications to participants with learning disabilities. The person with learning disabilities, upon disclosure, thus needs to educate the professional about what accommodations and/or program modifications should be arranged to enable full participation in recreation programs. This social interaction not only contributes awareness of this situation to another person but also demonstrates how important it is for individuals with disabilities to participate in a particular recreation activity like everyone else.