Apr 29, 2013

LEARNING DISORDER MANAGEMENT



1. What is Learning Disability?

The World Health Organization defines learning disabilities as “A state of arrested or incomplete development of mind”. Learning disability is not a disease, nor a physical or mental illness. It is not a problem with intelligence. It is caused by a difference in the brain that affects how information is received, processed, or communicated which affects people’s ability to interpret what they see and hear or to link information from the brain. Learning disabilities is a lifelong conditions that may affect a person’s life in school or work, daily routine or family life, Its show in disorder in spoken or written language, coordination, self control, or attention. According to DSM IV (Diagnostic and Statistical Manual Disorder), the criteria and characteristics to diagnose Learning Disabilities can divided into three major categories as follow; Disorders in developmental of speech and language, Disorder in Academic Skills, Other that includes Disorder in Coordination.

1a. Possible Causes of Learning Disability.
Mental health professionals’ stress that no one knows what is the actual reason causes learning disabilities,there are too many possibilities to pin down the cause. Each professional have their say, but in often the specific cause is still unknown. However Scientists do take efforts in study the possibility of causes to identify ways in preventing learning disabilities. Through researches, scientist believe that in many cases,the disorder may begins before birth.

Errors in Fetal Brain Development
Throughout pregnancy, the fetal brain develops from all purpose cells into a complex organ made of billions of specialized, interconnected nerve cells called neurons, which controls basic life functions and later involved with processing sight, sound, and sense, associated with attention, thinking and emotion. If the disruption occurs early, the fetus may die, or the infant may be born with widespread disabilities or possibly mental retardation, but if the disruption occurs later, this may causes learning disabilities.

Genetic Factors
Some researches shows that 50% of the learning disabilities having a genetic link. (Larry, 2009) for example one of the parents or relatives who has writing disorder may have a child with an expressive language disorder, or one of the twins who have attention deficit and the other one having  reading disabilities.

Problems during Pregnancy or Delivery
Complication during pregnancy is one of the possible causes of learning disabilities.  Some cases show that the immune system from the mother reacts to the fetus and attacks it where there is an infection. This will cause newly formed brain cell to settle in the wrong part of the brain. Or during delivery, the umbilical cord twisted and temporary cut off the oxygen to the fetus will cause the child to have learning disability. Research also shows that if the child takes longer time suffers in pain delivery, where Bilirubin exceed the safety level will cause them to have learning disabilities too.

Tobacco, Alcohol and other Drug use
Most of the research shows that a mother’s use of cigarettes, alcohol or other drugs during pregnancy may cause damage effects to the unborn child. Scientists found that those mothers who smoke during pregnancy are likely more to bear a smaller babies. Meanwhile, alcohol and drugs such as cocaine will affect and damaging the development of the brain, including neurons and brain receptors which will leads to learning disabilities.

Toxins in the child’s environment
According to neurological research, Cadmium and lead may possibly disrupting childhood brain development. Cadmium are used in making some steel products, which can gets into soil then into the foods we eat, Leads was common in paint and gasoline and present in some water pipes. National Institutes of Health has done a study on animals and found out it could lead to a changes in brainwave and slowing their ability to learn. The affect on the neurological functions apply in child which causes them to have learning disabilities.

1b. Early Symptoms of Autism, ADHD, Dyspraxia and Dyslexia
Each child will have to go through some development stage, and in this milestone time, if any early signs of development delay can be notices or suspect by the child’s caregiver, then the early intervention program may help the parents to bring changes and understanding to the child.


What is Autism?
Autism Spectrum Disorder (ASD) is known as a complex developmental disability that have been caused by a brain abnormality.  It affect a person’s  social interactions , both verbal and non-verbal communication skills, and having a difficulties  functioning in normal activities such like an element of play. First three years of a child, it's a critical period of brain development, so the symptoms can be notices as early as this time. (Kabat, Masi, & Segal, 2003).

The Early Symptoms of Autism
According to the CSBS DP Infant-Toddler Checklist, the symptoms can be notice through 7 categories, which is Emotion and Eye Gaze, Communication, Gestures, Sound, Words, Understanding and Object Use.
When the child wasn’t express joyful emotion or smiles, doesn’t show interest to parent’s sound within the 6 months, no babbling sounds or baby talks like “papa”, “mama”; no imitates of sounds, no simple gestures as “bye-bye”, “give me”; doesn’t responds to own name at 12 months; couldn’t  understand or follow simple direction, doesn’t have a spoken word by 18 months; doesn’t combines 2 words like “mummy come”, “more milk”; doesn’t imitates meaningful sounds at 24 months;  after 2 years old, if the child still not able to understand or answers simple question and request, delay in language development or having a parrot talk, poor in eye contact, doesn’t aware of what is happening surrounding, doesn’t have a pretend play skill, and usually stick to one toys or interest, they tend to have limited interests and activities, it shows that they have a desire to maintain sameness in their routine and surroundings, then they maybe an autistic child.
The Early Symptoms of ADHD
ADHD means Attention-Deficit Hyperactive Disorder.  According to DSM-IV, ADHD diagnose criteria are separated by 3 categories, which is “Inattention”, “Hyperactivity” and “Impulsive”. If the child is having 6 or more symptoms from each category from the past 6 months till presents, he will be diagnosed as ADHD.
The symptoms shows that the child will have difficulty in keeping attention on task and play activities, they will easily get distracted, often forgetful in daily activities, poor in social skill and organizational skills, unable to follow instruction well and having difficulties in paying attention to listen when talk to them. They always loses things needed such like pencils, book, tools or toys, they tends to avoids doing things which required a lot of mental effort or long period of time. That is why they are always fail to finished their school works or duty.  They often fidgets with hands or feet, unable to sit still, always remain hyper in action such like, running, jumping, climbing, they maybe talkative or making a lot of noise,  they always blurts out answer before questions finished, unable to wait for one’s turn, always interrupts others in conversation or games times. They are always “On the Go” or “Driven by a motor”.
Some symptoms that cause impairment were present before age of 7, but most of these symptoms being notice when the child enters into the age of 3-4.

The Early Symptoms of Dyspraxia
Dyspraxia is a development disorder showing impairment of praxis, disorder in sensory integration and motor function. It is also known as Development Coordination Disorder (DCD). The early symptoms of Dyspraxia can be notified as early as in infant and toddler, which show poor in feeding and development delay in motor milestone, for example poor in crawling, sitting, walking, squatting, jumping or skipping. It shows delay in language after 2 to 3 years old and delay in gross motor skills, like late riding tricycle or cannot ride bicycle.  They often show clumsiness like dropping things, unable to estimate the distance and position between things will cause them having difficulty to catch the ball or bumping into things. They often have difficulty in balancing and always fall down from seats, stair case or walking. The child has difficulty not only in gross motor but also fine motor, some simple daily activities such like eating, buttoning shirt, tie shoe lace or unpacking food will seen tough for them. The child typically shows poor performance in sport and poor handwriting. They are also having difficulties in pronouns of some phonic sounds like “f”, “h”, “v”, “z”.  The child has short attention span, poor organizing of language and deficits in language comprehension. They having difficulty to understand the comprehension or carrying out instruction, having low self-esteem which shows in their immature behavior and cause them socially withdraw.

The Early Symptoms of Dyslexia.
Learning disabilities occur in very young children, but they are usually not recognized until the child reaches school age. If a child complains that they are having dizziness, headaches or seeing non-existent movement while reading, writing or copying, then they might be dyslexic. The early symptoms can be notice in a child’s writing and reading, showing repetitions, additions, transposition, missing, reversals or inversions in writing, numbers or words, for example b wrote as d; p wrote as q; 6 become 9; 14 become 41; u wrote as n; cat wrote as cta; cake wrote as cak; difficulty in differentia between letters or words look similar such like there and three, they will have difficulties in copying letters or words especially from board or book to paper, often leaves sentences incomplete; having difficulty in identifying the beginning, middle and ending sounds in spoken words, being confused by direction left and right, difficulty in time concept such like before and after, 6am or 9am,  confused with math symbols such as + / - ; difficulty in learning math multiplication,  having difficulty in reading, slow in word retrieval, and may rereads with little comprehension,  having difficulty putting their thoughts into words, stuttering under stress, difficulties in gross motor and fine motor skills tasks like hopping, using scissors and pencil grip. Having difficulties in attention and most of them are daydreamer.

1c. Treatment Approaches
Many people find efforts to study the new formula and treatments in order to help people with autism to adapt to the society needs. Although some may be useful but believing that everyone is different, there is no specific one approach which is effective for all the people of Autism.  The parents, teachers and therapies may have different opinions and technique helping the autistic child, where there are some common approaches includes Treatment and Education of Autistic and Related Communication Handicapped Children (TEACCH), Applied Behavior Analysis (ABA), Picture Exchange Communication System (PECS), Sensory Integration (SI), Play Therapy, Sand Tray Therapy, Speech Therapy, Occupational Therapy and Food and Nutritionals Control.  One of the intervention programs that widely known in Hong Kong and been use is “Louise Program”, the founder Yolanda Wong (Hong Kong) is a woman successfully helping her autistic child to adapt various skill and education learning.  Louise program is an intervention program for Autistic and Learning Disorder child, it is a combination concepts and skills that being modified from TEACCH, ABA, Sensory Integration, Occupational Therapy and Montessori Program which commonly use by most of the peoples, and now being use in these program as a teaching methods and training program. Louise program emphasis the holistic training on the child, it includes cognitive learning, attentive and behavior. Which trained the child independently in self help, helping the child to have Receptive and Expressive communication, using Visual, Audio, Kinetics materials for teaching and play in the child’s learning. Some skills design in building the child’s attention and some skills design for the purpose of modification in the child’s behavior. This program is easy to understand and it is design for the parents to teach their own child in every situation and anytime. Although it may not suit every child, but there are many parents testify that Louise Program has successfully helps their autistic child to cope with his or her ability.

Conclusion
Learning Disorders are not disease; it cannot fully cure, but to overcome the difficulties through different ways.  It is important that the parents, teacher, child caregiver or those who work with the children could identify the symptoms in earlier stage, and bring intervention to the child, because it may lead to a serious behavior problem if the child is not being understand or mistreated by the parents, teachers and their peers which it will affect their self-esteem and cause them socially withdraw.



Apr 28, 2013

情绪背后的意义和动力


愤怒 ﹕准备对一个不能接受的情况作出改变的行动。
痛苦 ﹕使我们避开危险。
忧虑 ﹕把精力集中去处理一件当时最重要的事。
讨厌 ﹕需要摆脱或者改变。
悲伤 ﹕从失去之中取得智能去更珍惜尚拥有的。
后悔 ﹕从一个得不到最好效果的做法中找出意义。
惭愧 ﹕一件表面完结的事尚有需要做事的部份。
紧张 ﹕需要额外的能力去保证成功。
踌躇 ﹕在内心里,两个或以上的价值有相同地位。
无可奈何 ﹕已知的方法全不适用,需要创新突破思考。
困难 ﹕觉得须付出的大过可得到的。
害怕 ﹕不甘愿付出自己以为需要付出的。


资料取自:EQ 情绪管理讲义

Apr 15, 2013

完行治疗解决未了情意结….

某天P小姐来找我,她来见我的时候,并没有说出要解决什么,只告诉我有些事情还未做到,来见我想谈谈,放松自己。于是我带她放松,然后很自然的使用一个技 巧就是《说故事》。 她开始进入状况,情绪起伏很大,我意识到她在潜意识中想起已故的妈妈,这股思念令她久久无法释怀。于是带领她,让她与妈妈“再次见面”,让她有足够的时 间,抱着妈妈,跟妈妈说话,也让她想象妈妈会跟她说什么。她在潜意识中处理了她与妈妈的未了情意结,最后愿意好好的活下去,因为她深信,这是妈妈对她最后 的心愿。处理之后,她脸上露出满意的微笑,并且不住的感谢我,还说这是她今年收到最好的礼物。 以上的技巧属于菲兹士。波尔士(Fritz Perls)的完行治疗法(Gestalt Therapy)。完行治疗法是帮助当事人处理和解决心中还未完成之事或未了之心结,让当事人不会因着某些事情而影响日常生活,也让所有生命中的遗憾或内 疚得以透过完行治疗法而得到处理和解决。 在说故事环节中,由于P小姐心中刚好有未了之情结,便很快在治疗中浮现,当我一步一步的带领她去处理内心深处的心结后,她就能因此得到释怀,不再被情绪影响,也不会耿耿以怀了。

Apr 3, 2013

认识忧郁症 - 心灵的感冒

 忧郁症是种什么样的疾病呢?
* 任何人有可能罹患忧郁症,他也被称为心灵的感冒。只要好好的接受治疗,几乎所有的患者都能痊愈。
患者的心情
* 痛苦到要死”
* 每个人都有心情难过的心情,与心爱的人分开、考试失败、工作失败等都会感到非常痛苦及心情低落。但这些一般都只是一时性的心情,在家人和朋友的鼓励和安慰下,就会慢慢遗忘,不知不觉恢复以往的活力。
* 但是忧郁症患者的这些情绪却是长时间无法消失,而且忧郁的心情和强度非常强烈,甚至痛苦到想死。
* 对于他们,我们要特别注意他们的自杀倾向。 


忧郁症的特征
家人、朋友等身边的人在一旁看到的忧郁症的症状:
1. 没有活力
2. 看起来总是很忧伤的感觉
3. 常常叹气
4. 动作慢吞吞
5. 优柔寡断、无法下定决心
6. 整天无所事事,总是在睡觉
7. 不做自己应该做的事、工作或念书时会偷懒
8. 不想与人见面
9. 静不下来(坐立不安)

 忧郁症的身体症状
1. 睡眠障碍
2. 消化器官症状:茶饭不思、胃不适、大便异常、想吐、腹痛、胀气…
3. 自律神经症状:呼吸困难、压迫感、胸口苦闷、心悸、脉搏异常、频尿/残尿感、口渴、出汗、头 晕、头重…
4. 其他:丧失活力,总是感到疲倦、各种疼痛、肌肉酸痛、性欲减退…
5. 这些症状有时健康的人也会出现好几项,而且也不一定影响正常生活,就是说,光看这些症状还是很难判断是否罹患忧郁症。
6. 这些症状中,典型的忧郁症会: 心情“持续忧郁”、“持续不安”、“持续失眠”;在身体方面,会出现懒散、没有食欲、腹泻、便秘、头痛及肩膀酸痛等。

* 这些症状出现的时间和感受的强度都有助于医师做诊断。

* 忧郁症是情绪障碍的一种,还可分为重度忧郁、轻郁症以及未分类之忧郁症。   

 我们可以根据美国精神医学会 DSM – IV (精神疾病诊断与统计手册第4版)中的分类与症状作为参考。
  
 DSM-IV 情绪障碍的分类
A.忧郁症(只有忧郁症状): 重度忧郁, 轻郁(忧郁症状轻微,但持续2年以上) ,

未分类之忧郁症
 B.躁郁症(有躁症症状的时期):   

重度忧郁症
1. 心中充满悲伤、心情郁闷、意志消沉
2. 对过去喜欢的东西不再感兴趣
3. 丧失食欲,或反过来暴食,体重明显变化
4. 失眠或过度睡眠
5. 动作慢、回应少,或反过来焦虑得静不下来
6. 容易疲倦、体力衰退
7. 不断责备自己
8. 集中力与思考力降低,难以作决定
9. 常想到死的问题或想死

如果同时出现 5 项,并持续两个星期以上,在生活中也出现困难,就可能被诊断为重度忧郁。

* 忧郁症也有“日内转变”的现象:早上状态不好,到了下午或晚上时,情况慢慢好转。

* 忧郁症变得严重时,也会出现以下几种妄想:
 1. 虚无妄想 - 认为自己的财产或地位会丧失
 2. 被害妄想 - 认为自己被欺负
 3. 罪孽妄想 - 认为自己的罪孽深重
 4. 虑病妄想 - 认为自己已经患上不治之症

 
如何引起忧郁症? 与生俱来的个性(遗传) 家庭与社会教育及环境 发展因素(婴幼儿时期) 抗压力低(体质因素)  

导致: 压力 ~ 身体疾病 ~ 脑内物质的变化 (神经传导物质中的血清素及正肾上腺素就会极端减少

引发:忧郁症 个性的因素 * 循环性格-拥有豪爽及悲观倾向的性格,摇摆在活泼与缓慢之间。

* 强逼性格-集中力强,对事物执着,做事彻底、一丝不苟,富有责任心、正义感,因此容易太过努力而感到疲惫不堪,进而爆发忧郁症。
*忧郁亲切性格-注重次序,认为事务和人际关系也要有条理,因此对于次序改变、或是消失非常敏感,因此当面临晋升、退休、搬迁、结婚、生子或死别的时候;也容易因为太为别人着想而接受超过自己能力的工作。

压力的因素 
 * 不同的人在承受压力时会受到当时的情况、环境、成长过程或个性因素影响。 * 然而,我们仍可归纳出一些普遍上令人感到压力的事件:

1. 负面事件(Negative events):负面的事件比正面的事件较能产生压力的重叠,这因为负面的事件让人们觉得需要花费更多的力量来应付。负面的事件也可能造成激烈的情绪反应和身心反应,这可能源于负面的事件有威胁到自我概念或失去自尊的可能。
 2. 失控事件(Uncontrollable events):无法预期的事件比能够预期的事件较容易产生压力反应。控制感可以减低压力的生理反应。如果个人可以预测事件的发生,而事件也在控制的范围内,应对压力的能力也会增加。
3. 隐晦的事件(Ambiguous events):隐晦的事件比光明正大的事件较容易叫人感到压力,这是因为隐晦的事件叫人无从回应或采取行动,然而个人却必须费心力去了解潜伏的压力。光明正大的压力事件让人能马上行动,解决问题。例子:工作上含糊的职份。
4. 工作过量(Overload) :工作过量比工作量少比较容易让人感到压力。太多的职务,太短的时间完成工作一般容易叫人感到压力。
5. 压力事件所涉及的人生层面 :一个重视家庭的人面对婚姻危机会比重视事业的人面对相同的婚姻危机更感到压力。我们不该只单一个生活层面或某个人,而是应该扩大生活的层面和支援系统,避免某一件压力事件就足以粉碎全部生活的情况。

忧郁症的治疗
* 在忧郁症的治疗上,药物治疗及正常作息是两大特点,接着才是配合状况采用心理治疗。 * 充分的休息:忧郁症患者不论身心都是极度疲倦、缺乏能量的,若是上班族最好能休假,若是家庭主妇也要休息一段时间不要做家务,让身体得到充分的休息,进一步在进行能放松心情的活动和积极运动提升能量。

如何避免忧郁症再度复发?
* 在预防患者复发的方法中,维持药物是很重要的。关于要服用多少药量、服用多久,都必须遵照医生的指示,以避免忧郁症复发。
* 如果了解引发患者爆发忧郁症的导火线,也应该在事前回避那种状况,或事先作好应对的准备,才能预防再度引起忧郁症。
*有些人在忧郁症痊愈后,焦急要赶上落后的工作等,都有复发的风险。最好慢慢步上轨道是很重要的。  

家人与周遭人应注意之事项:
* 如果当事人跟平常不太一样,或一直持续这样的情况,都要注意。
* 家人陪同患者就医,让医师能够从其他的人听取病情,或当被诊断为忧郁症后,家人能一起聆听有关治疗方面的重要讯息,对照顾患者商会有很大的帮助。

 家人与朋友如何与患者接触?
* 不要“鼓励”患者-因为当患者做不到时,旁人的鼓励反而让他更痛苦。
* 与患者交谈时,尽可能聆听,让患者觉得安心。
* 不要让患者在忧郁期间做重大的决定,如辞职、退学或有关签合约、金钱等事项。
* 注意患者有没有表达出“不想活了”、“活着没有意义”等,要告知医师,同时不要让患者独处,并常常对他说,“我们需要你”、“你很重要”、“不要死”等话语。  


参考书目:精神疾病检测百科。主妇友社编。三采文化。2005