ADA/Disability Resources for Faculty
Disability Descriptions
Attention-Deficit/hyperactivity Disorder (ADHD)
Autism Spectrum Disorder (ASD)
Post-traumatic Stress Disorder (PTSD)
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER (ADHD)
About 15% of the 1800 students with disabilities served by the DRC have ADHD. They are part of a group of students with what are called “hidden disabilities.” They are not visibly identifiable as is the case with students who have physical & mobility impairments. Also included in this group are emotional impairments and learning disabilities. A diagnosis for these conditions requires specialized expertise.
Preface: Although the term Attention-Deficit Disorder (or ADD) is still frequently used, the correct terminology is Attention-Deficit/Hyperactivity Disorder (ADHD). The Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV [American Psychiatric Association], 1994) and all subsequent editions.
Definition: According to the DSM, "the essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development.” A specific cause of ADHD is not known.
Description: Attention-Deficit/Hyperactivity Disorder is usually considered to be a neurobehavioral developmental disorder. It affects about 3 - 5% of children with symptoms typically starting before seven years of age. It is characterized by a persistent pattern of impulsiveness and inattention, with or without a component of hyperactivity. ADHD occurs twice as commonly in boys as in girls. ADHD is generally a chronic disorder with 10 to 40% of individuals diagnosed in childhood continuing to meet diagnostic criteria in adulthood. As they mature, adolescents and adults with ADHD are likely to develop coping mechanisms to compensate for their impairment. Though previously regarded as a childhood diagnosis, ADHD can continue throughout adulthood. ADHD has a strong genetic component. Methods of treatment usually involve some combination of medications, behavior modifications, life-style changes, and counseling.
The DSM categorizes the symptoms of ADHD into three clusters, referred to as subtypes: (1) Inattentive; (2) hyperactive/impulsive; and (3) combined. Most people exhibit some of these behaviors but not to the point where they significantly interfere with a person's work, relationships, or studies. ADHD may accompany other disorders such as anxiety or depression.
Hyperactivity is common among children with ADHD but tends to disappear during adulthood. However, over half of children with ADHD continue to have some symptoms of inattention throughout their lives.
Inattention and "hyperactive" behavior are not the only problems in children with ADHD. ADHD exists alone in only about 1/3 of the children diagnosed with it. Many co-existing conditions require other courses of treatment and should be diagnosed separately instead of being grouped in the ADHD diagnosis. Some of the associated conditions are:
• Oppositional defiant disorder (35%) and Conduct disorder (26%). These are both characterized by anti-social behaviors such as stubbornness, aggression, frequent temper tantrums, deceitfulness, lying, or stealing.
• Primary disorder of vigilance. Characterized by poor attention and concentration, as well as difficulties staying awake. These children tend to fidget, yawn and stretch, and appear to be hyperactive in order to remain alert and active.
• Bipolar disorder. As many as 25% of children with ADHD have bipolar disorder. Children with this combination may demonstrate more aggression and behavioral problems than those with ADHD alone.
• Anxiety Disorders. Such disorders commonly accompany ADHD, particularly Obsessive-Compulsive Disorder. OCD is believed to share a genetic component with ADHD, and shares many of its characteristics.
Although the reasons are not clear, it has long been observed that many children seem to "outgrow" ADHD. These individuals include those both treated and untreated. It is also known that many adolescents and adults develop coping skills as they mature, offsetting impairments.
Descriptive Symptoms and Diagnosis: Six or more of the following symptoms of inattention, hyperactivity-impulsiveness have been present for at least 6 months to a point that is disruptive and inappropriate for developmental level:
Inattention:
1. Often does not give close attention to details or makes careless mistakes in schoolwork, work, or other activities.
2. Often has trouble keeping attention on tasks and activities.
3. Often does not seem to listen when spoken to directly.
4. Often does not follow instructions and fails to finish homework, chores, or duties in the workplace (not due to oppositional behavior or failure to understand instructions).
5. Often has trouble organizing activities.
6. Often avoids, dislikes, or doesn't want to do things that take a lot of mental effort for a long period of time (such as schoolwork or homework).
7. Often loses things needed for tasks and activities (e.g. tools, school assignments, pencils, books, or tools).
8. Is often easily distracted.
9. Often forgetful in daily activities.
Hyperactivity:
1. Often fidgets with hands or feet or squirms in seat.
2. Often gets up from seat when remaining in seat is expected.
3. Often runs about or climbs when and where it is not appropriate (adolescents or adults may feel very restless).
4. Often has trouble playing or enjoying leisure activities quietly.
5. Is often "on the go" or often acts as if "driven by a motor".
6. Often talks excessively.
Impulsiveness:
1. Often blurts out answers before questions have been finished.
2. Often has trouble waiting one's turn.
3. Often interrupts or intrudes on others (e.g., butts into conversations or games
Treatment: Individuals with ADHD can get better with treatment which consists of medication, therapy or a combination of both. The most common medication is the use of stimulants which help with focus, learning and staying calm. These may cause side affects such as sleep problems and stomachaches. Several may need to be tried to find the most effective one. Behavioral therapy can help teach individuals to control their behaviors.
Multifaceted diagnostic evaluation: Because of the challenge of distinguishing normal behaviors and developmental patterns of adolescents and adults (e.g., procrastination, disorganization, distractibility, restlessness, boredom, academic under-achievement or failure, low self-esteem, chronic tardiness or inattendance) from clinically significant impairment, a multifaceted evaluation should address the intensity and frequency of the symptoms and whether these behaviors constitute an impairment in a major life activity.
Alternative Diagnoses or Explanations Should Be Ruled Out: The evaluator must investigate and discuss the possibility of dual diagnoses and alternative or coexisting mood, behavioral, neurological, and/or personality disorders that may confound the diagnosis of ADHD. This process should include exploration of possible alternative diagnoses and medical and psychiatric disorders as well as educational and cultural factors affecting the individual that may result in behaviors mimicking an Attention-Deficit/Hyperactivity Disorder.
Each Accommodation Recommended by the Evaluator Must Include a Rationale: The evaluator must describe the impact, if any, of the diagnosed ADHD on a specific major life activity as well as the degree of impact on the individual. The diagnostic report must include specific recommendations for accommodations that are realistic and that SLCC's DRC can reasonably provide. A detailed explanation as to why each accommodation is recommended must be provided and should be correlated with specific functional limitations determined through interview, observation, and/or testing. Although prior documentation may have been useful in determining appropriate services in the past, current documentation must validate the need for services based on the individual's present level of functioning in the educational setting. A school plan such as an Individualized Education Program (IEP) or a 504 plan is insufficient documentation in and of itself but can be included as part of a more comprehensive evaluative report. The documentation must include any record of prior accommodations or auxiliary aids, including information about specific conditions under which the accommodations were used (e.g., standardized testing, final exams, licensing or certification examinations) and whether or not they benefited the individual. However, a prior history of accommodations without demonstration of a current need does not in itself warrant the provision of like accommodations. If no prior accommodations were provided, the qualified professional and/or the candidate must include a detailed explanation of why no accommodations were needed in the past and why accommodations are needed at this time.
AUTISM SPECTRUM DISORDER (ASD)
Autism, Asperger’s Syndrome
Autism is one of the five pervasive developmental disorders (PDD), which appear in childhood- usually before age 3 which are characterized by widespread abnormalities of social interactions and communication, and severely restricted interests as well as the exhibition of highly repetitive behaviors.
Other PDD forms include: Asperger syndrome (closely related to autism in signs and likely causes); Rett syndrome and childhood disintegrative disorder which share several signs with autism; and PDD not otherwise specified (PDD-NOS; also called atypical autism) which is diagnosed when the criteria are not met for a more specific disorder.
Background: The word autism is the English version of the Latin word autismus first coined by the Swiss psychiatrist Eugen Bleuler in 1910 as he was defining symptoms of schizophrenia He derived it from the Greek word autos (αὐτός, meaning self), and used it to mean morbid self-admiration, referring to "autistic withdrawal of the patient to his fantasies, against which any influence from outside becomes an intolerable disturbance."
Definition: Autism is a brain development disorder characterized by impaired social interaction and communication, and by restricted and repetitive behavior. These signs all usually begin before a child is three years old.
Incidence Rates and Risk Factors: It's estimated that three to six out of every 1,000 children in the United States have autism — and the number of diagnosed cases is rising. It's not clear whether this is due to better detection and reporting of autism, a real increase in the number of cases, or both. Studies show that boys are three to four times more likely to develop autism than girls are. Research increasingly suggests that having an older father may increase a child's risk of autism. Maternal age, on the other hand, seems to have little effect on autism risk.
What is clear is that though there is no cure for autism, intensive, early treatment can make an enormous difference in the lives of many children with the disorder.
Symptoms: Children with autism generally have problems in three crucial areas of development — social interaction, language and behavior. The most severe autism is marked by a complete inability to communicate or interact with other people. Though each child with autism is likely to have a unique pattern of behavior, these characteristics are common signs of the disorder:
Social skills
• Fails to respond to his or her name
• Has poor eye contact, posture, lack of facial expressiveness
• Appears not to hear you at times
• Resists close personal contact
• Appears unaware of others' feelings
• Seems to prefer playing alone — retreats into his or her "own world"
Language
• Loses previously acquired ability to say words or sentences
• Does not make eye contact when making requests
• Speaks with an abnormal tone or rhythm — may use a singsong voice or robot-like speech
• Can't start a conversation or keep one going
• May repeat words or phrases verbatim, but doesn't understand how to use them
Behavior
• Performs repetitive movements, such as rocking, spinning or hand-flapping
• Develops specific routines or rituals
• Becomes disturbed at the slightest change in routines or rituals
• Moves constantly
• May be fascinated by parts of an object, such as the spinning wheels of a toy car
• May be unusually sensitive to light, sound and touch and yet oblivious to pain
Young children with autism also have a hard time sharing experiences with others. When read to, for example, they're unlikely to point at pictures in the book. This early-developing social skill is crucial to later language and social development.
As they mature, some children with autism become more engaged with others and show less marked disturbances in behavior. Some, usually those with the least severe problems, eventually may lead normal or near-normal lives. Others, however, continue to have great difficulty with language or social skills, and the adolescent years can mean a worsening of behavior problems.
The majority of children with autism are slow to acquire new knowledge or skills and some have signs of lower than normal intelligence. Other children with autism have normal to high intelligence. These children learn quickly yet have trouble communicating, applying what they know in everyday life and adjusting in social situations.
An extremely small number of children with autism are "autistic savants" and have exceptional skills in a specific area, such as art, math or music.
Causes: Autism has no single, known cause. Given the complexity of the disease, the range of autistic disorders and the fact that no two children with autism are alike, it's probable that there are many causes which most likely include genetic and environmental factors. Other factors under investigation include problems during labor and delivery and the role of the immune system in autism. Some researchers believe that damage to the amygdala — a portion of the brain that serves as a danger detector — may play a role in autism.
One of the greatest controversies in autism centers on whether a link exists between autism and certain childhood vaccines, particularly the measles-mumps-rubella (MMR) vaccine and vaccines with thimerosal, a preservative that contains a small amount of mercury. Though most children's vaccines have been free of thimerosal since 2001, the controversy continues. To date, extensive studies have found no link between autism and vaccines.
Treatments and drugs: No cure exists for autism, and there is no "one-size-fits-all" treatment. In fact, the range of home-based and school-based treatments and interventions for autism can be overwhelming. Treatment options may include Behavior and communication therapies and educational therapies. No medication can improve the core signs of autism, but certain medications can help control symptoms. Antidepressants may be prescribed for anxiety, for example, and antipsychotic drugs are sometimes used to treat severe behavioral problems.
Asperger Syndrome or (Asperger's Disorder) is named for a Viennese physician, Hans Asperger, who in 1944 published a paper which described a pattern of behaviors in several young boys who had normal intelligence and language development, but who also exhibited autistic-like behaviors and marked deficiencies in social and communication skills. In spite of the publication of his paper in the 1940's, it wasn't until 1994 that Asperger Syndrome was added to the DSM IV.
Individuals with AS can exhibit a variety of characteristics and the disorder can range from mild to severe. Persons with AS show marked deficiencies in social skills, have difficulties with transitions or changes and prefer sameness. They often have obsessive routines and may be preoccupied with a particular subject of interest. They have a great deal of difficulty reading nonverbal cues (body language) and very often the individual with AS has difficulty determining proper body space. Often overly sensitive to sounds, tastes, smells, and sights, the person with AS may prefer soft clothing, certain foods, and be bothered by sounds or lights no one else seems to hear or see. It's important to remember that the person with AS perceives the world very differently. Therefore, many behaviors that seem odd or unusual are due to those neurological differences and not the result of intentional rudeness or bad behavior, and most certainly not the result of "improper parenting".
By definition, those with AS have a normal IQ and many individuals (although not all), exhibit exceptional skill or talent in a specific area. Because of their high degree of functionality and their naiveté, those with AS are often viewed as eccentric or odd and can easily become victims of teasing and bullying. While language development seems, on the surface, normal, individuals with AS often have deficits in pragmatics and prosody. Vocabularies may be extraordinarily rich and some children sound like "little professors." However, persons with AS can be extremely literal and have difficulty using language in a social context.
At this time there is a great deal of debate as to exactly where AS fits. It is presently described as an autism spectrum disorder and Uta Frith, in her book AUTISM AND ASPERGER'S SYNDROME, described AS individuals as "having a dash of Autism". Some professionals feel that AS is the same as High Functioning Autism, while others feel that it is better described as a Nonverbal Learning Disability. AS shares many of the characteristics of PDD-NOS (Pervasive Developmental Disorder; Not otherwise specified), HFA, and NLD and because it was virtually unknown until a few years ago, many individuals either received an incorrect diagnosis or remained undiagnosed. For example, it is not at all uncommon for a child who was initially diagnosed with ADD or ADHD be re-diagnosed with AS. In addition, some individuals who were originally diagnosed with HFA or PDD-NOS are now being given the AS diagnosis and many individuals have a dual diagnosis of Asperger Syndrome and High Functioning Autism.
Diagnostic Criteria for Asperger’s which differ from Autism:
1 There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)
2. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood
BIPOLAR DISORDER
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Background: Bipolar disorder has been estimated to affect more than 5 million Americans—about 3 out of every 100 adults. It affects people without regard to age, race, ethnicity, gender, education or occupation. Not everyone's symptoms are the same and there is no blood test to confirm the disorder. Scientists believe that bipolar disorder may be caused when chemicals in the brain are out of balance.
Definition: Bipolar Disorder is a form of mental illness. It is also called manic-depressive illness. People with this type of brain illness go through unusual mood changes. Sometimes they feel happy and “up” and are more active than usual. This is called mania. Sometimes people feel down and are much less active. This is called depression.
Description: Bipolar disorder is not the same as the normal ups and downs everyone goes through; the symptoms are much more powerful. Relationships can change and people find it hard to keep a job or stay in school. Changes in energy levels and behavior may also be manifest. Individuals can become dangerous and some try to hurt themselves or attempt suicide.
The causes of bipolar disorder are not always clear. Several factors contribute to the disorder. It can be genetic, since it can run in families and may have to do with abnormal brain structures and functioning. Some people have bipolar disorder for years before anyone knows. This is because the symptoms may seem like several different problems like schizophrenia or clinical depression.
Most people who meet criteria for bipolar disorder experience a number of episodes, over the course of time lasting hours, days, weeks, or even months. Rapid cycling is defined as having four or more episodes per year and is found in a significant fraction of individuals with bipolar disorder.
Flux is the fundamental nature of bipolar disorder. Individuals with the illness have continual changes in energy, mood, thought, sleep, and activity. The diagnostic subtypes of bipolar disorder are thus static descriptions — snapshots, perhaps — of an illness in continual flux, with a great diversity of symptoms and varying degrees of severity. Individuals may stay in one subtype, or change into another, over the course of their illness
Symptoms: Sometimes individuals having very strong mood episodes may have psychotic symptoms. These are strong symptoms that cause hallucinations (believing things that are not real). People with mania may believe they are rich and famous or have special powers. People with depression may believe that they have committed crimes or that their lives are ruined. Behavior problems may accompany mood episodes. A person may drink too much or take drugs, take risks, spend too much money engage in reckless sex. Feelings are strong and can be accompanied by extreme changes in behavior and energy levels. These symptoms obviously affect keeping jobs or staying in school.
People who have manic episodes may:
Feel very up or high
Feel jumpy or wired
Talk really fast about a lot of different things
Be agitated, irritable or touchy
Have trouble relaxing or sleeping
Believe they can do a lot of things at ounce
Do risky things
People who have depressive episodes may:
Fee very down or sad
Feel worried and empty
Have trouble concentrating
Forget a lot of things
Lose interest
Feel tired
Think about death or suicide
Treatment: There is no cure for bipolar disorder. But treatment can help with symptoms such as mood changes and behavioral problems and needs to be ongoing. Medication: People respond to medication in different ways and different medication works differently for each person- so the type of medication depends on the person. And, unfortunately people need to use different medications to see what works best. This process can take weeks even months and moods and behaviors might be mitigated (or not) during the process. Therapy: Psychotherapy or “talk” may help and behavior therapy might also help and might include family members. Other therapies: In some case neither medication or therapy helps. Electroconvulsive therapy (ECT) may be available. Such shock therapy may be able to correct problems in the brain.
The disorder is lifelong and it is not unusual for people to go on and off medication, in and out of therapy and have episodes of varying lengths. Regular “life” schedules will be interrupted. The stigma of having a mental illness works against individuals seeking help and discussing their problems with others. A support system of understanding individuals helps.
Background: Everyone occasionally feels blue or sad, but these feelings are usually fleeting and pass within a couple of days. When a person has a depressive disorder, it interferes with daily life, normal functioning, and causes pain for both the person with the disorder and those who care about him or her. Depression is a common but serious illness, and most who experience it need treatment to get better.
Definition: Major depressive disorder (also known as clinical depression, major depression), is a mental disorder characterized by a pervasive low mood, low self-esteem, and loss of interest or pleasure in normally enjoyable activities. Major depression is a disabling condition which adversely affects a person's family, work or school life, sleeping and eating habits, and general health.
Description: Many people with a depressive illness never seek treatment. But the vast majority, even those with the most severe depression, can get better with treatment. Intensive research into the illness has resulted in the development of medications, psychotherapies, and other methods to treat people with this disabling disorder.
In the United States, approximately 3.4% of people with major depression commit suicide, and up to 60% of all people who commit suicide have depression or another mood disorder.
There are several forms of depressive disorders. The most common are major depressive disorder and dysthymic disorder.
Major depressive disorder, also called major depression, is characterized by a combination of symptoms that interfere with a person's ability to work, sleep, study, eat, and enjoy once–pleasurable activities. Major depression is disabling and prevents a person from functioning normally. An episode of major depression may occur only once in a person's lifetime, but more often, it recurs throughout a person's life.
Dysthymic disorder, also called dysthymia, is characterized by long–term (two years or longer) but less severe symptoms that may not disable a person but can prevent one from functioning normally or feeling well. People with dysthymia may also experience one or more episodes of major depression during their lifetimes.
Some forms of depressive disorder exhibit slightly different characteristics than those described above, or they may develop under unique circumstances. However, not all scientists agree on how to characterize and define these forms of depression. They include:
Psychotic depression, which occurs when a severe depressive illness is accompanied by some form of psychosis, such as a break with reality, hallucinations, and delusions.
Postpartum depression, which is diagnosed if a new mother develops a major depressive episode within one month after delivery. It is estimated that 10 to 15 percent of women experience postpartum depression after giving birth.
Seasonal affective disorder (SAD), which is characterized by the onset of a depressive illness during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not respond to light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy.
Bipolar disorder, also called manic-depressive illness, is not as common as major depression or dysthymia. Bipolar disorder is characterized by cycling mood changes-from extreme highs (e.g., mania) to extreme lows (e.g., depression). Visit the NIMH website for more information about bipolar disorder.
Signs and symptoms of depression: People with depressive illnesses do not all experience the same symptoms. The severity, frequency and duration of symptoms will vary depending on the individual and his or her particular illness.
Symptoms include:
• Persistent sad, anxious or "empty" feelings
• Feelings of hopelessness and/or pessimism
• Feelings of guilt, worthlessness and/or helplessness
• Irritability, restlessness
• Loss of interest in activities or hobbies once pleasurable, including sex
• Fatigue and decreased energy
• Difficulty concentrating, remembering details and making decisions
• Insomnia, early morning wakefulness, or excessive sleeping
• Overeating, or appetite loss
• Thoughts of suicide, suicide attempts
• Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment
Depression often co–exists with other illnesses. Such illnesses may precede the depression, cause it, and/or be a consequence of it. It is likely that the mechanics behind the intersection of depression and other illnesses differ for every person and situation. Regardless, these other co–occurring illnesses need to be diagnosed and treated.
Anxiety disorders, such as post–traumatic stress disorder (PTSD), obsessive–compulsive disorder, panic disorder, social phobia and generalized anxiety disorder, often accompany depression.3,4 People experiencing PTSD are especially prone to having co-occurring depression. PTSD is a debilitating condition that can result after a person experiences a terrifying event or ordeal, such as a violent assault, a natural disaster, an accident, terrorism or military combat.
Alcohol and other substance abuse or dependence may also co–occur with depression. In fact, research has indicated that the co–existence of mood disorders and substance abuse is pervasive among the U.S. population.
Depression also often co–exists with other serious medical illnesses such as heart disease, stroke, cancer, hiv/aids, diabetes, and Parkinson's disease. Studies have shown that people who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition, and more medical costs than those who do not have co–existing depression. Research has yielded increasing evidence that treating the depression can also help improve the outcome of treating the co–occurring illness.
There is no single known cause of depression. Rather, it likely results from a combination of genetic, biochemical, environmental, and psychological factors.
Treatment: Depression, even the most severe cases, is a highly treatable disorder. As with many illnesses, the earlier that treatment can begin, the more effective it is and the greater the likelihood that recurrence can be prevented. Once diagnosed, a person with depression can be treated with a number of methods. The most common treatments are medication and psychotherapy.
Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.
For all classes of antidepressants, patients must take regular doses for at least three to four weeks before they are likely to experience a full therapeutic effect. They should continue taking the medication for the time specified by their doctor, even if they are feeling better, in order to prevent a relapse of the depression. Medication should be stopped only under a doctor's supervision. Some medications need to be gradually stopped to give the body time to adjust. Although antidepressants are not habit–forming or addictive, abruptly ending an antidepressant can cause withdrawal symptoms or lead to a relapse. Some individuals, such as those with chronic or recurrent depression, may need to stay on the medication indefinitely.
Antidepressants may cause mild and often temporary side effects in some people, but they are usually not long–term. The most common side effects include: headaches, nausea, insomnia, agitation and sexual problems, dry-mouth, constipation, bladder problems, blurred vision and drowsiness.
Several types of psychotherapy–or "talk therapy"–can help people with depression. Some regimens are short–term (10 to 20 weeks) and other regimens are longer–term, depending on the needs of the individual. Two main types of psychotherapies–cognitive–behavioral therapy (CBT) and interpersonal therapy (IPT)-have been shown to be effective in treating depression.
For cases in which medication and/or psychotherapy does not help alleviate a person's treatment–resistant depression, electroconvulsive therapy (ECT) may be useful. ECT, formerly known as "shock therapy," once had a bad reputation. But in recent years, it has greatly improved and can provide relief for people with severe depression who have not been able to feel better with other treatments.
Helping others: Individuals with depression can be helped by offering emotional support, engaging them in conversation and listening, offering hope, inviting them for walks and activities. Comments about suicide should be taken seriously
The largest group of individuals (16%) with disabilities registered with the DRC are those with specific Learning Disabilities (LD). These are among a group of students who have what are called “hidden” disabilities along with ADHD and emotional impairments. These students are not visibly identifiable like those with physical and mobility impairments. Learning disabilities are much less likely to be addressed through treated as they are through interventions (listed below).
Background: The term learning disability (LD) refers to a group of disorders that affect a broad range of academic and functional skills. A learning disability is not indicative of low intelligence. Indeed, research indicates that may people with learning disabilities have average or above-average intelligence.
Definition: The National Joint Committee on Learning Disabilities (NJCLD) defines the term learning disability as: a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. These disorders are intrinsic to the individual and presumed to be due to Central Nervous System Dysfunction. Even though a learning disability may occur concomitantly with other handicapping conditions (e.g. sensory impairment, mental retardation, social and emotional disturbance) or environmental influences (e.g. cultural differences, insufficient/inappropriate instruction, psychogenic factors) it is not the direct result of those conditions or influences. The NJCLD uses the term to indicate a discrepancy between a child’s apparent capacity to learn and his or her level of achievement.
Description: Learning disabilities can be categorized either by the type of information processing that is affected or by the specific difficulties caused by a processing deficit. Learning disabilities fall into broad categories based on the four stages of information processing used in learning: input, integration, storage, and output.
• Input: This is the information perceived through the senses, such as visual and auditory perception. Difficulties with visual perception can cause problems with recognizing the shape, position and size of items seen. There can be problems with sequencing, which can relate to deficits with processing time intervals or temporal perception. Difficulties with auditory perception can make it difficult to screen out competing sounds in order to focus on one of them, such as the sound of the teacher's voice. Some children appear to be unable to process tactile input. For example, they may seem insensitive to pain or dislike being touched.
• Integration: This is the stage during which perceived input is interpreted, categorized, placed in a sequence, or related to previous learning. Students with problems in these areas may be unable to tell a story in the correct sequence, unable to memorize sequences of information such as the days of the week, able to understand a new concept but be unable to generalize it to other areas of learning, or able to learn facts but be unable to put the facts together to see the "big picture." A poor vocabulary may contribute to problems with comprehension.
• Storage: Problems with memory can occur with short-term or working memory, or with long-term memory. Most memory difficulties occur in the area of short-term memory, which can make it difficult to learn new material without many more repetitions than is usual. Difficulties with visual memory can impede learning to spell.
• Output: Information comes out of the brain either through words, that is, language output, or through muscle activity, such as gesturing, writing or drawing. Difficulties with language output can create problems with spoken language, for example, answering a question on demand, in which one must retrieve information from storage, organize our thoughts, and put the thoughts into words before we speak. It can also cause trouble with written language for the same reasons. Difficulties with motor abilities can cause problems with gross and fine motor skills. People with gross motor difficulties may be clumsy, that is, they may be prone to stumbling, falling, or bumping into things. They may also have trouble running, climbing, or learning to ride a bicycle. People with fine motor difficulties may have trouble buttoning shirts, tying shoelaces, or with handwriting.
Deficits in any area of information processing can manifest in a variety of specific learning disabilities.
• Reading disability (ICD-10 and DSM-IV codes: F81.0/315.00)
Of all students with specific learning disabilities, 70%-80% have deficits in reading. The term "dyslexia" is often used as a synonym for reading disability; however, many researchers assert that there are different types of reading disabilities, of which dyslexia is one. A reading disability can affect any part of the reading process, including difficulty with accurate and/or fluent word recognition, word decoding, reading rate, prosody (oral reading with expression), and reading comprehension.
Common indicators of reading disability include difficulty with phonemic awareness -- the ability break up words into their component sounds, and difficulty with matching letter combinations to specific sounds (sound-symbol correspondence).
• Writing disability (ICD-10 and DSM-IV codes F81.1/315.2)
Speech and language disorders can also be called Dysphasia/aphasia (coded F80.0-F80.2/315.31 in ICD-10 and DSM-IV).
Impaired written language ability may include impairments in handwriting, spelling, organization of ideas, and composition. The term "dysgraphia" is often used as an overarching term for all disorders of written expression. Others, such as the International Dyslexia Association, use the term "dysgraphia" exclusively to refer to difficulties with handwriting.
• Math disability (ICD-10 and DSM-IV codes F81.2-3/315.1)
Sometimes called dyscalculia, a math disability can cause such difficulties as learning math concepts (such as quantity, place value, and time), difficulty memorizing math facts, difficulty organizing numbers, and understanding how problems are organized on the page.
• Nonverbal learning disability [this disorder is not listed in the ICD-10]
Nonverbal learning disabilities often manifest in motor clumsiness, poor visual-spatial skills, problematic social relationships, difficulty with math, and poor organizational skills. These individuals often have specific strengths in the verbal domains, including early speech, large vocabulary, early reading and spelling skills, excellent rote-memory and auditory retention, and eloquent self-expression..[3]
• Dyspraxia
Sometimes called motor planning, dyspraxia refers to a variety of difficulties with motor skills. Dyspraxia can cause difficulty with single step tasks such as combing hair or waving goodbye, multi-step tasks like brushing teeth or getting dressed, or with establishing spatial relationships such as being able to accurately position one object in relation to another.
• Disorders of speaking and listening
Difficulties that often co-occur with learning disabilities include difficulty with memory, social skills and executive functions (such as organizational skills and time management).
• Auditory processing disorder
Difficulties processing auditory information include difficulty comprehending more than one task at a time and a relatively stronger ability to learn visually.
Diagnosis: IQ-Achievement Discrepancy: The presence of a learning disability is sometimes suspected by a child's parents long before problems are seen at school. However, the issues typically become visible when a child begins having difficulty at school. Difficulty learning to read is often one of the first signs that a learning disability is present.
Learning disabilities are often through a combination of intelligence testing, academic achievement testing, classroom performance, and social interaction and aptitude. Other areas of assessment may include perception, cognition, memory, attention, and language abilities. The resulting information is used to determine whether a child's academic performance is commensurate with his or her cognitive ability. If a child's cognitive ability is much higher than his or her academic performance, the student is often diagnosed with a learning disability. This “discrepancy model” is used in the DSM-IV and many school systems and government programs diagnose learning disabilities in this way.
Although the discrepancy model has dominated the school system for many years, there has been substantial criticism of this approach among researchers. Recent research has provided little evidence that a discrepancy between formally-measured IQ and achievement is a clear indicator of LD. Furthermore, diagnosing on the basis of a discrepancy does not predict the effectiveness of treatment. Low academic achievers who do not have a discrepancy with IQ (i.e. their IQ scores are also low) appear to benefit from treatment just as much as low academic achievers who do have a discrepancy with IQ (i.e. their IQ scores are higher).
Some critics of the concept of learning disabilities and of special education take the position that every child has a different learning style and pace and that each child is unique, not only capable of learning but also capable of succeeding. These critics assert that applying the medical model of problem-solving to individual children who are pupils in the school system, and labeling these children as disabled, systematically prevents the improvement of the current educational system.
Describing current instructional methods as homogenization and lockstep standardization, alternative approaches are proposed, such as the Sudbury model of democratic education schools, an alternative approach in which children, by enjoying personal freedom thus encouraged to exercise personal responsibility for their actions, learn at their own pace rather than following a chronologically-based curriculum. Proponents of un-schooling have also claimed that children raised in this method do not suffer from learning disabilities.
Treatment-Response to Intervention (RTI): Much current research has focused on a treatment-oriented diagnostic process known as response to intervention (RTI). Researcher recommendations for implementing such a model include early screening for all students, placing those students who are having difficulty into research-based early intervention programs, rather than waiting until they meet diagnostic criterion. Their performance can be closely monitored to determine whether increasingly intense intervention results in adequate progress. Those who respond will not require further intervention. Those who do not respond adequately to regular classroom instruction (often called "Tier 1 instruction") and a more intensive intervention (often called "Tier 2" intervention) are considered "nonresponders." These students can then be referred for further assistance through special education, in which case they are often identified with a learning disability. Some models of RTI include a third tier of intervention before a child is identified as having a learning disability.
A primary benefit of such a model is that it would not be necessary to wait for a child to be sufficiently far behind to qualify for assistance.[7] This may enable more children to receive assistance before experiencing significant failure, which may in turn result in fewer children who need intensive and expensive special education services. In the United States, the 2004 reauthorization of the Individuals with Disabilities Education Act permitted states and school districts to use RTI as a method of identifying students with learning disabilities. RTI is now the primary means of identification of learning disabilities in Florida.
There are still concerns about the use of RTI, particularly in that it requires a strong intervention program before students can be identified with a learning disability. If students' receive poor quality interventions, they can be judged non-responsive and thus as having a learning disability when the cause is really only poor instruction.
Interventions: Poor academic achievement can be addressed with a variety of interventions. Although the underlying processing difficulty is usually considered to be a lifelong disorder, academic skills themselves can be improved with targeted interventions. Some (adjustments, equipment and assistants) are designed to accommodate or help compensate for the disabilities while others (specialized instruction) are intended to make improvements in the weak areas. Practice is a particularly important component in developing competence, regardless of the starting point. Children who start out with a weakness in a basic skill, such as reading, may miss out on the necessary practice because of the need to catch up with their chronological age peers. Thus a small weakness can snowball into a larger problem.
Interventions include:
• Mastery model:
Learners work at their own level of mastery.
Practice
Gain fundamental skills before moving onto the next level
Note: this approach is most likely to be used with adult learners or outside the mainstream school system.
• Direct Instruction:
Highly structured, intensive instruction
Emphasizes carefully planned lessons for small learning increments
Scripted lesson plans
Rapid-paced interaction between teacher and students
Correcting mistakes immediately
Achievement-based grouping
Frequent progress assessments
• Classroom adjustments:
Special seating assignments
Alternative or modified assignments
Modified testing procedures
• Special equipment:
Electronic spellers and dictionaries
Word processors
Talking calculators
Books on tape
• Classroom assistants:
Note-takers
Readers
Proofreaders
• Special Education:
Prescribed hours in a special class
Placement in a special class
Enrollment in a special school for learning disabled students
POST-TRAUMATIC STRESS DISORDER (PTSD)
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Post-traumatic stress disorder is most associated with trauma arising from incidents occurring during military service and is a frequently a secondary condition of physical injuries incurred by returning servicemen from Iraq and Afghanistan (See historical information about Vietnam veterans at the end of this description). PTSD can also occur as a result of traumatic, non-military events experienced by children as well as adults.
Background: Post-traumatic stress disorder (PTSD) is an anxiety disorder that can develop after exposure to one or more terrifying events that threatened or caused grave physical harm. PTSD is a condition distinct from traumatic stress, which has less intensity and duration, and combat stress reaction, which is transitory. PTSD has also been recognized in the past as railway spine, shell shock, battle fatigue, traumatic war neurosis, or post-traumatic stress syndrome (PTSS).
Definition: Post-traumatic stress disorder(PTSD) is a severe and ongoing emotional reaction to an extreme psychological trauma. This stressor may involve someone's actual death, a threat to the patient's or someone else's life, serious physical injury, or threat to physical or psychological integrity, overwhelming psychological defenses. In some cases it can also be from profound psychological and emotional trauma, apart from any actual physical harm. Often, however, the two are combined.
Description: Vulnerability to PTSD presumably stems from an interaction of biological factors, early childhood developmental experiences, and trauma severity. Predictor models have consistently found that childhood trauma, chronic adversity, and familial stressors increase risk for PTSD and there appear to be some biological markers for PTSD. Proximity to, duration of, and severity of the trauma also make an impact; and interpersonal traumas cause more problems than impersonal ones.
Two criterion are used for diagnosis both of which must apply for a diagnosis of PTSD. The first requires that "the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others." The second requires that "the person’s response involved intense fear, helplessness, or horror." The DSM stressor criterion have specified the traumatic event should be of a type that would cause "significant symptoms of distress in almost anyone," and that the event was "outside the range of usual human experience."
Incidence Rates: Although most people (50-90%) encounter trauma over a lifetime, only about 8% develop full PTSD. The National Comorbidity Survey Report provided the following information about PTSD in the general adult population: The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women (10.4%) twice as likely as men (5%) to have PTSD at some point in their lives. Since the introduction of DSM-IV, the number of possible PTSD traumas has increased and one study suggests that the increase has been dramatic- around 50%
Symptoms: Diagnostic symptoms include re-experience, such as flashbacks and nightmares, avoidance of stimuli associated with the trauma, increased arousal such as difficulty falling or staying asleep, anger and hyper-vigilance. Per definition, the symptoms last more than 6 months and cause significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships). Typical problems associated with PTSD:
Bad Dreams
Flashbacks
Scary thoughts
Feeling worried, guilty or sad
Felling alone
Trouble sleeping
Angry outbursts an feeling on edge
Thoughts of hurting self of others
Treatment: Many forms of psychotherapy have been advocated for trauma-related problems such as PTSD. Basic counseling for PTSD includes education about the condition and provision of safety and support. Cognitive therapy shows good results, and group therapy may be helpful in reducing isolation and social stigma. The psychotherapy programs with the strongest demonstrated efficacy include cognitive behavioral programs, variants of exposure therapy, stress inoculation training (SIT), variants of cognitive therapy (CT), eye movement desensitization and reprocessing (EMDR), and many combinations of these procedures.
Medications have shown benefit in reducing PTSD symptoms, but rarely achieve complete remission. Standard medication therapy useful in treating PTSD include serotonin inhibitors and antidepressants.
There are data to support the use of beta blockers) if there are significant symptoms of "over-arousal". These may inhibit the formation of traumatic memories by blocking adrenaline's effects on the amygdala, has been used in an attempt to reduce the impact of traumatic events or they may simply demonstrate to the patient that the symptoms can be controlled thereby assisting with "self efficacy" and helping the patient remain calmer.
There is also data to support the use of medication for: mood-stabilization, uncontrolled mood or aggression, help with dissociation, mood and aggression, and short-term anxiety relief.
Historical Addendum & Veteran issues: The National Vietnam Veterans' Readjustment Study (NVVRS) found 15.2% of male and 8.5% of female Vietnam Vets to suffer from current PTSD at the time of the study. Life-Time prevalence of PTSD was 30.9 for males and 26.9 for females. In a reanalysis of the NVVRS data, along with analysis of the data from the Vietnam Veterans Project, found that, contrary to the initial analysis of the NVVRS data, a large majority of Vietnam veterans suffered from PTSD-symptoms. Four out of five reported recent symptoms when interviewed 20-25 years after Vietnam.
In recent history, catastrophes (by human means or not) such as the Indian Ocean Tsunami Disaster may have caused PTSD in many survivors and rescue workers. Today relief workers from organizations such as the Red Cross and the Salvation Army provide counseling after major disasters as part of their standard procedures to curb severe cases of post-traumatic stress disorder.
The diagnosis was removed from the DSM-II, which resulted in the inability of Vietnam veterans to receive benefits for this condition. In part through the efforts of anti Vietnam war activists and the anti war group Vietnam Veterans Against the War and Chaim F. Shatan, who worked with them and coined the term post-Vietnam Syndrome, the condition was added to the DSM-III as posttraumatic stress disorder and has been retained in newer DSM versions.
In the United States, the provision of compensation to veterans for PTSD is under review by the Department of Veterans Affairs (VA). The review was begun in 2005 after the VA had noted a 30% increase in PTSD claims in recent years. The VA undertook the review because of budget concerns and apparent inconsistencies in the awarding of compensation by different rating offices.
This led to a backlash from veterans'-rights groups, and to some highly-publicized suicides by veterans who feared losing their benefits, which in some cases constituted their only income. In response, on November 10, 2005, the Secretary of Veterans Affairs announced that "the Department of Veterans Affairs (VA) will not review the files of 72,000 veterans currently receiving disability compensation for post-traumatic stress disorder..."
The diagnosis of PTSD has been a subject of some controversy due to uncertainties in objectively diagnosing PTSD in those who may have been exposed to trauma, and due to this diagnosis' association with some incidence of compensation-seeking behavior.
The social stigma of PTSD may result in under-representation of the disorder in military personnel, emergency service workers and in societies where the specific trauma-causing event is stigmatized (e.g. sexual assault).
Many US veterans of the wars in Iraq and Afghanistan returning home have faced significant physical, emotional and relational disruptions. In response the United States Marine Corps has instituted programs to assist them in re-adjusting to civilian life - especially in their relationships with spouses and loved ones - to help them communicate better and understand what the other has gone through. Similarly, Walter Reed Army Institute of Research developed the Battle-mind program to assist service members avoid or ameliorate PTSD and related problems.
Information was culled from a variety of sources including federal publications, AHEAD, Wikipedia, NAMI, NAMI-Utah.
Background: Schizophrenia (pronounced /ˌskɪtsəˈfrɛniə/ or /ˌskɪtsəˈfriːniə/) comes from the Greek roots schizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-, "mind"). Onset of symptoms typically occurs in young adulthood with approximately one half a percent of the population affected. Diagnosis is based on the patient's self-reported experiences and observed behavior. No laboratory test for schizophrenia currently exists.
Definition: Schizophrenia is a chronic, sever and disabling brain disorder characterized by abnormalities in the perception or expression of reality. It most commonly manifests as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking with significant social or occupational dysfunction. . People with schizophrenia are likely to have additional (comorbid) conditions, including major depression and anxiety disorders; the lifetime occurrence of substance abuse is around 40%.
Description: The disorder is thought to mainly affect cognition, but it also usually contributes to chronic problems with behavior and emotion. Psychotic symptoms usually emerge in men in their late teens and early 20s and in women in the mid-20s to early 30s. They seldom occur after age 45. Social problems, such as long-term unemployment, poverty and homelessness, are common. Furthermore, the average life expectancy of people with the disorder is 10 to 12 years less than those without, due to increased physical health problems and a higher suicide rate.
People with Schizophrenia are not especially prone to violence and often prefer to be left alone. Studies show that if people have no record of criminal activity before they develop it and are not substance abusers, they are unlikely to commit crimes after they become ill. Violence, if it does occur is often directed at family members and occurs at home.
People with Schizophrenia attempt suicide more often than people in the general population. About 10% (especially young adult males) succeed. Suicide is hard to predict, so if someone talks about it, professional help should be sought right away.
Some people who abuse drugs show symptoms similar to those of Schizophrenia and people with Schizophrenia may be mistaken for people who are high on drugs. Drug abuse can reduce the effectiveness of treatment and can make the effects of the disorder worse. The most common form of drug abuse is nicotine addiction. The addiction rate is three times the rate of the general population (75% vs. 25%). Smoking cessation strategies should include nicotine replacement methods, since withdrawal may cause psychotic symptoms to get worse.
Symptoms: People with Schizophrenia may hear voices other people don’t hear or believe that others are reading their minds, controlling their thoughts or plotting to harm them. These experiences are terrifying and can cause fearfulness, withdrawal or extreme agitation. They may sit for hours without moving or talking much. People with this disorder have difficulty holding jobs, caring for themselves or sustaining activities such as school work. These symptoms can be mistaken for laziness or depression. The symptoms fall into three broad categories:
Positive symptoms are unusual thoughts or perceptions, including hallucinations, delusions, thought disorder and disorders of movements.
Hearing voices
Seeing things not there
Smelling odors not there
Belief that others are cheating
Delusions of persecution
Thought blocking- abrupt stoppage of speech
Neologisms- making up unintelligible words
Immobility and unresponsiveness
Negative symptoms represent a loss or decrease in the ability to initiate plans, speak, express emotions, or find pleasure in every day life.
Flat affect (monotone voice, no facial expression
Infrequent speaking, even when forced to interact
Neglecting hygiene
Cognitive symptoms (or deficits) are problems with attention, memory, and executive functions that allow for planning and organizing. They are most disabling in terms of leading a normal life.
Loss of working memory (recently learned information)
Poor planning
Poor decision making
Inability to sustain attention
Treatment: The causes of Schizophrenia are still unknown even though research suggests a genetic component. Treatment focuses on the elimination of symptoms largely though use of antipsychotic medication. No one can predict beforehand how a medication will affect a particular individual and several must be tried before the right one is found. Adjusting to new medications can affect normal activities including driving a car and can cause skin rashes and irritations.
Older antipsychotic medications include Thorazine, Haldol, Etrfon, Trifalon and Prolixin. These medications can cause muscle spasms, tremors and restlessness. New medications called atypical antipsyotics such as Clozaril are effective but cause a loss of white blood cells which requires continual monitoring. Other medications such as Risperal, Zyprexa, Seoguel and Geodon may cause weight gain and increased risk of diabetes and high cholesterol.
When first using medications people generally become drowsy, experience dizziness, have blurred vision, rapid heart beat and menstrual problems. Adding antidepressants to the drug regimen is often necessary.
Blurred vision
Loss of senses
Ringing in the ears or hearing loss
Psychomotor
Loss of sex drive
Lack of energy
Change in sleep patterns, such as insomnia or over-sleeping
Poor muscle coordination and motor movement
Loss of balance and coordination and weakness or muscle paralysis
TRAUMATIC BRAIN INJURY (TBI)
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There has been a recent surge in TBI due largely to returning service personnel from IRAQ. Many of these individuals are entering college for re-training. Faculty and staff should familiarize themselves with the following information.
Background: Traumatic brain injury (TBI) is an extremely common type of injury. According to the Health Resource Center each year in America over one millions people sustain head injuries. Of the million individuals approximately 700,000 individuals are hospitalized and 140,000 people die from their injuries. The majority of individuals suffering from TBI are between the ages of 15 and 24. Five to ten percent of all head-injured individuals are unable to return their pre-injury level of function.
Description: It is important to remember that brain injury can be a catastrophic event, which dramatically changes a person and their way of life. Individuals suffering from traumatic brain injury may not have visible injuries; this is called a 'hidden disability’. An injury such as a concussion, stroke, or whiplash can cause brain damage without evidence of serious trauma. Individuals suffering from TBI have similar problems as individuals with learning disabilities. The differences between these two groups of individuals are that the individual suffering from TBI will have variability in the rate and pattern of the recovery process. The individual may change rapidly in the early months following the injury and then the changes begin to taper off. It is critical to remember that students with learning disabilities who have been properly diagnosed and received appropriate educational accommodations, can expect to progress with minimum amount of changes in the accommodation. The individual suffering from TBI can expect accommodation to change frequently as the recovery process occurs.
Definition: The National Head Injury Foundation defines a traumatic brain injury (TBI) as "an insult to the brain, not of a degenerative or congenital nature, but caused by an external physical force that may produce a diminished or altered state of consciousness which results in impairment of cognitive abilities".
There are two types of head injuries that can lead to damage within the brain - closed head and penetrating head injury.
Closed head injury occurs when the head is suddenly stopped while in motion and the brain hits the inside of the skull. For example, when the head hits the windshield during an automobile accident. A closed head injury can also occur without external trauma to the head, when the brain moves back and forth during whiplash.
Penetrating head injury occurs when an external object penetrates the skull, for example, a bullet. Penetrating head injuries make up 75% of all TBI.
It is important to note that the location of the closed head injury or penetrating head injury may not be the site of the most significant brain damage. For example, if the frontal lobe receives a direct blow and is damaged (primary injury) the individual may suffer from impulsive behavior, however during the injury the brain moves back and forth rapidly within the skull, causing damage to the back of the brain or occipital lobe (secondary injury). The damage to the occipital lobe may cause failure to recognize and respond to visual input. The secondary damage is considered more severe than the primary damage because failure to respond to visual input will cause severe limitations.
Damage to the brain can be either focal or diffused. Focal damage is localized and usually occurs at the point where the object struck or entered the skull. Diffused damage occurs when the brain hits the skull during a closed head injury. The three areas of the brain most susceptible to damage are the brain stem, temporal lobes, and the frontal lobes. Damage to these areas can occur in three ways: bruising (bleeding), tearing, and swelling.
Damage to the brain stem can result in frustration, disorientation, and anger.
Damage to the temporal lobes can result in behavioral disorders, seizures, and communication difficulties.
Damage to the frontal lobe can result in impulsiveness and lack of judgment.
Possible Limitations and Symptoms: All of the limitations and symptoms listed below may be primary or secondary injuries. Primary injuries are injuries suffered because of the direct brain damage; for example damage to the temporal lobe may result in poor coordination of the muscles required for speech production. A secondary injury may be the paralysis of these muscles due to swelling or bleeding that takes place after the injury occurs. At times the secondary limitation and symptoms are more difficult for the individual to adjust to because they may happen over a long period of time, they may come on suddenly months after the initial TBI, or they may happened as a result of having to adjust to new limitations.
Cognitive
Persistent mild headaches
Poor memory
Poor concentration
Poor attention
Poor organizational ability
Poor decision making (acting without contemplating the consequences)
Confusion
Difficulty solving problems
Difficulty with spatial orientation
Communication
Difficulty with expressive and/or receptive language (writing, reading, speaking, and listening)
Difficulty with pragmatics (such as interrupting, talking out of turn, dominating discussion, speaking too loudly or rudely, standing too close to the listener)
Psychosocial
Difficulty forming interpersonal relationships
Poor coping strategies
Mood changes
Personality and/or emotional disorders
Anxiety
Sensory/Perceptual
Dizziness
Sensitivity to light