children are complex
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children are complexTRANSCRIPT
Learning without limits
Professor Amanda Kirby
Aims of the lecture
• Are children different today?
• Why might this be?
• What has new knowledge brought to our understanding?
• Implications for education in the future
Learning results in ....
Resources of the Child
Outcomes
Environment in which Manner of
Activity occurs presentation
What has changed today?
Individual
Environment
Task
In schools children may present today
• with several labels
• with new labels
• with no label but not succeeding optimally
Changes interact with one another
ENVIRONMENTAL
BEHAVIOURAL
NEURAL
GENETIC
“Meshes of influence”Turvey,2006
What do we know about the effect of genes and
environment on outcomes for children
educationally?
Simple linear approach
Genes symptoms diagnosis
environment
We know more about the genetics of some learning difficulties than others…
Varying expression
Different genes have differing roles
e.g. ADHD
DRD4 influences persistence of ADHD over time (El-Faddagh et al, 2004).
MAOA associated with antisocial behaviour in ADHD but not with ADHD itself (Thapar et al, 2006).
The environment has an effect
on genes
Critical and sensitive times in brain development
• Children need necessary experiences at the ages they need them– to develop skills and abilities
• E.g.
– early social interaction necessary for emotional brain regions ( e.g.Moriceau, Wilson et al, 2006)
– Social interaction in childhood and adolescence optimizes emotional regulation (e.g. Chronis-Tusacano, 2009)
Conception
Ref: Giedd
Early years
Typical
Atypical
Overproduction and pruning
Maternal stress
child anxiety
loneliness
depression
5HTTLPR gene
Shortalleles***
Cervilla et al,2006
Maternal stress
child anxietyloneliness
depression
5HTTLPR geneShort
alleles***
Caspi, 2003
5HTTLPR geneLong
alleles
Overlap may also be linked to Shared genes
e.g. in ADHD and DCD
1285 twin pairs aged 5 and 16 years from the volunteer Australian Twin Registry (ATR).
The DCD-fine motor and ADHD-Inattentive were most strongly linked using the DSM-IV based scale.
(Martin ,Piek and Hay, 2006)
At a cellular level
At brain mass level
ADHD differences
Overall reduction in brain volumeTypical cerebral volume reduction is ~ 3%Frontal lobes ~ half of the overall reduction Basal GangliaAbnormalities up until around age 16, then less soCerebellumA consistent finding is posterior-inferior lobe reduction
Different routes to get to the same place
Some may take longer than others
What about environment influences?
Gene – environment interaction
Crucial times of development-In the fetus-Early years
Amphetamine use
Nutrition of the mother
ALSPAC study
Low maternal seafood intake was also associated with increased risk of suboptimum outcomes for prosocialbehaviour, fine motor, communication, and social development scores (11,775 women)
http://www.bristol.ac.uk/alspac/
Exposure in early years
› Took blood levels at 30 months in 582 children
› A doubling in lead concentration was associated with a 0.3 point (95% CI -0.5, -0.1) lower grades at 7 years.
› Exposure to lead early in childhood has effects on subsequent educational attainment
( ALSPAC study)
What other changes are occurring?
Eating together
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
Every day 4-6 times 1-3 times never
1991 -National telephone
survey parents of 12-17
year olds
2008
Diet during childhood….
Children eating a diet high in 'junk food' in early childhood were more likely to be more hyperactive at 7 years.
? long-term nutritional imbalances
Or
differences in parenting style
Impact of poor nutrition
Gesch ( 2002) 231 young adult prisoners a multivitamin and fatty acid sample in a double blind placebo RCT comparing disciplinary offences before and during supplementation.
Compared to baseline, the effect on those taking active supplements for a minimum of 2 weeks was an average 35.1% reduction of offences
Nutrition + longer term…..
Liu et al ( 2004) followed up a group of 3 year olds with poor nutrition examined them at 8, 11 and 17 years for antisocial, aggressive, and hyperactive behaviour.
Those with signs of malnutrition were more:› aggressive or hyperactive at age 8 years› more externalizing problems at age 11› greater conduct disorder and hyperactivity at 17.
The worse the malnutrition levels the greater the degree of difficulties.
Lots of claims about Omega 3 supplementation in children
effecting children's learning and behaviour
New knowledge..... New children?
Prematurity and cerebral palsy
0
2
4
6
8
10
12
14
16
22-27 28-31 32-36 36+
%
%
Later impact on prematurity
Moderate to significant negative neurodevelopmental outcomes – lower IQ scores
– language delay and impairment
– social and behavioral problems
– school-related difficulties, and employment and relationship issues in adulthood
50% of extreme LBW babes had some NDDs’
Extreme prematurity 25 weeks- outcomes at 11 years
(ADC, 2009)
307 childrenSignificantly lower scores than classmates for
– cognitive ability– reading– mathematics
13% attended special schoolsIn mainstream
– 55% required SEN resource provision – Teachers rated 50% of EP children with attainment
below the average range compared with 5% of classmates
But overlap is the rule
As many as 65% of children with ADHD will have one or more co-morbid psychiatric or other disorders (Beiderman et al, 1991).
ADHD + (n =579)
OppositionalDefiant Disorder
40%
Tics11%
Conduct Disorder14%
ADHD alone31%
Anxiety Disorder
34%
Mood Disorders 4%MTA Cooperative Group. Arch Gen Psychiatry 1999;
56:1088–1096
Speech and Language Impairment
+DCD
Early years speech difficulties- higher risk of those children having associated motor difficulties- 60%
( Missiuna et al, 2007)
Hill(1998),
Rintala (1998)
Carte, Nigg, & Hinshaw, (1996)
Elbert, (1993)
Powell and Bishop (1992)
Kirby and Salmon,2007
DCD+ ADHD
Gillberg Gillberg, C. (1998) Hyperactivity, inattention and motor control problems: Prevalence, comorbidity and background factors. Folia Phoniatrica et Logopaedica, 50,107-117.
ADHD + Asperger’s
ADHD
ASDAspergers21%
ASD Traits36%
(Lecavalier ,2006,Fombonne et al ,2001; Fitzgerald and Corvin, 2001)
Dyscovery Centre copyright 2009
ADHD + ASD
50-75% of children referred to clinics for PDD also present with significant ADHD symptoms, for example inattention, hyperactivity, impulsivity.
(Goldstein & Schwebach, 2004; Sturm, Fernell, & Gillberg, 2004; Yoshida & Uchiyama,2004;Lecavalier ,2006,Fombonne et al ,2001)
ADHD + dyslexia
25%-
40%3-6%3-6%
Early manifestation of delayed language & inattention
ADHD +dyslexia + maths
Approximately 33% of children with ADHD have been noted to have specific problems in spelling, reading and mathematics, unaccounted for by low intelligence (Szatmari et al, 1989).
ADHD + dyslexia + DCD
A Canadian population study (Kaplan, Crawford, Wilson & Dewey, 1997)
Out of those showing DCD had also 25 % ADHD +Dyslexia
22% + Dyslexia
10% + ADHD
Behaviour + Language
Children with poor understanding have more behavioural difficulties
Children with difficulty expressing themselves- more socially withdrawn and anxious
Summary by the Centre for Integrated Healthcare Research, 2006
Diagnostic categoryNumber of students
identified
Dyslexia 4Developmental Coordination
Disorder 0
Joint Hypermobility Syndrome 2Attention Deficit Hyperactivity
Disorder 2
Autistic Spectrum Disorder 1
Moderate Learning Disability 5
Conduct Disorder 1
Language Disorder 8
14 children in a PRU
Mean RA 4.5 years behindMean SA 4.7 years behind
Conclusions
• Children are presenting with new labels.
• Important to consider the ‘whole child’
• Understanding of the neurocognitive profile will be important to understand the child’s needs
• Inclusive practices are more important than ever
