MODULE 7: UNDERSTANDING THE CHALLENGES OF CHILDREN WITH DEVELOPMENTAL DISABILITIES Understanding the common characteristics of a disability will be very

helpful. This list of challenges will be significant in helping the instructor work with swimmers with special needs. Children with special challenges need personal care from instructors. It is important to show respect and kindness to all children. A student will respond positively when treated appropriately. Developing this relationship will enable the instructor to learn more about the child and his/her challenges. Below is a partial description of disorders that the instructor may encounter in teaching individuals with special needs. Also included are teaching methodologies that the instructor should take into consideration when setting up goals for the students. It is important to present clear and attainable goals to ensure success. Because this is a partial compilation, the instructor may wish to consult other sources of information such as websites and books specific to the disorders. Some useful sites are listed in the Appendix.

AUTISM AND RELATED DISABILITIES

Autism According to the Autism Society of America, autism is a neurological disorder that effects the communication and processing of sensory information. Autism appears usually before age 3 (National Institutes of Health, 2001). Autism prevents children and adolescents from interacting normally with other people and affects almost every aspect of their social and psychological development. Autism has a wide variety of characteristics ranging in intensity from mild to severe. For instance, some children with autism can speak and some can not. What are the Characteristics of Children with Autism? Children with autism are all unique individuals. Some children with autistic disorder are high functioning, and have the ability to speak and interact with others. Others are more severely affected and may be nonverbal and have cognitive impairments. Children with autism typically: Show a lack of interest in others and have difficulty communicating. May avoid eye contact or do not make eye contact. May engage in repetitious behaviors, such as rocking or hand flapping. May vocalize with repetitious sounds when scared or agitated. May have a limited range of interests and activities.

May become upset by a small change in their environment or daily routine. May experience hypersensitivity to sound, touch, light, odors, or tastes.

RELATED DISABILITIES Aspergers Syndrome (AS) Aspergers Syndrome is a developmental disorder, often diagnosed when a child enters school. It primarily affects a childs success in social relationships and nonverbal communication. What are the Characteristics of Children with Aspergers Syndrome (AS)? Individuals with Aspergers Syndrome do not usually have a delay in spoken language development. However, they can have serious deficits in social and communication skills. People with this neurobiological disorder often have repetitive and ritualistic routines, as well as preoccupations with a particular subject matter. Children with AS can be gifted in language, reading, mathematics, spatial skills, or music. These skills, however, are often accompanied by significant delays in other cognitive functions. Because of the repetitive nature of swimming lessons, this activity may quickly become of favorite pastime of the student with AS. Children with Aspergers Syndrome: May have an absorbing and narrow interest in certain areas. Exhibit repetitive behaviors or rituals. May have socially inappropriate behavior. May have peculiar speech patterns. May have problems with nonverbal communication. May show reluctance to accept. May not understand one-sided social interaction is making it difficult to form friendships. Voice tone can be flat. Motor skills may be awkward. May be highly competitive and intolerant to competition

Pervasive Developmental Disorder Not Otherwise Specified (PDD-NOS) Also known as "atypical autism," PDD/NOS is a diagnosis often considered for children who show some symptoms of autistic disorder but who do not meet the specific diagnostic criteria for the other Pervasive Developmental Disorders.

Childhood Disintegrative Disorder (CDD) Also known as "regressive autism," children with Childhood Disintegrative Disorder typically develop normally for two to four years before developing a condition that resembles autism. Typically language, interest in the social environment, and often toileting and self-care abilities are lost, and there may be a general loss of interest in the environment. Rett Syndrome Rett Syndrome is a complex neurological disorder that primarily affects girls. It is genetic in origin. Individuals with Rett Syndrome generally develop normally until 6 to 18 months of age, at which point a developmental regression is observed. This regression is followed by a deceleration of head growth, loss of purposeful hand movements, and followed by the appearance of midline, stereotypic hand movements. In addition, social, language, motor, and cognitive skills may be severely impaired. Attention Deficit Disorder (ADD) and Attention Deficit/hyperactivity Disorder (AD/HD) Attention-deficit/hyperactivity disorder (AD/HD) is a condition that affects both children and adults. It is characterized by problems with attention, impulsivity, and overactivity. Between 3-7 percent of school-age children and between 2-4 percent of adults are affected with this disorder. While some professionals still use the term Attention Deficit Disorder (ADD), this term is no longer in wide spread use. What are the Characteristics of Children with AD/HD? There are 3 subtypes of AD/HD. Symptoms of each subtype are listed below: AD/HD predominantly inattentive type: (AD/HD-I) Fails to give close attention to details or makes careless mistakes. Has difficulty sustaining attention. Does not appear to listen. Struggles to follow through on instructions. Has difficulty with organization. Avoids or dislikes tasks requiring sustained mental effort. Loses things. Is easily distracted. Is forgetful in daily activities.

AD/HD predominantly hyperactive-impulsive type: (AD/HD-HI) Fidgets with hands or feet or squirms in chair. Has difficulty remaining seated. Runs about or climbs excessively. Difficulty engaging in activities quietly. Acts as if driven by a motor. Talks excessively. Blurts out answers before questions have been completed. Difficulty waiting or taking turns. Interrupts or intrudes upon others.

AD/HD combined type: (AD/HD-C) Individual meets both sets of inattention and hyperactive/impulsive criteria. Special Teaching Considerations for Autism and Related Disabilities Children with autism and related disabilities tend to be visual learners. Picture symbol cards, social stories, and activity schedules work well for most children with autism. Activity schedules break down the skills into components enabling the child to better understand and complete the requested task or tasks and also allow the child to transition into the next activity with greater ease. These materials may consist of picture symbols, text, or a combination of both and are included on the website, www.specialneedsaquatics.org. Private Lessons For safety reasons, some children with severe impairments may not be able to participate in inclusion lessons and would therefore require either smaller group or private lessons. The caregiver should be asked to serve as a water aide if needed. This will allow the instructor to get to know the child and learn which motivation techniques to use. In class, use a safety island to create a home base to work from. A safety island will both stabilize and isolate the child in the water and create two activities: Getting from the island to the wall and getting from the wall to the island. The video on the website is a good reference regarding the use of other materials of interest that can be used for motivation purposes (including mats, toys, slides, and kickboards).

Inclusion Lessons A diagnosis of autism or a related disorder includes a wide variety of characteristics ranging in intensity from mild to severe. Students with mild impairments typically flourish in water activities, and with a little extra assistance will perform with great proficiency. Consistency will be the key to their success. Use the child to demonstrate skills when possible. If the student is sensitive to touch, offer a rash guard or tight fitting T-shirt. Always remind the child of the task before send off. Laminate pictures of children performing swim skills or dressing skills. Make the child the class leader or demonstrator. Avoid open-ended questions; use either/or scenarios. Do you want to swim to the end of the pool on your front or back? Not, Do you want to swim to the end of the pool? Sample of Picture Symbol (Dressing)

Intellectual Impairment A diagnosis of intellectual impairment is defined by three criteria: IQ score below 70. Impairment since childhood. Lack of adaptive living skills in at least two areas: Self-care, self-direction, health, academic functioning, communication, or safety.

Each child with intellectual impairment has a unique set of strengths and weaknesses. There are some who are only slightly slower learners than the general population. If a childs IQ is lower than 50, the challenges will be greater. Individuals with this diagnosis may have multiple disabilities in conjunction with this disorder.

Tips for Teaching Children with Intellectual Impairment Break each skill into simple components. To maximize learning, create routines and repeat them each class. Repeat instructions for clarity. Provide positive feedback. Keep the lesson area clear of distractions. Consider offering longer lessons. What are the Challenges for the Instructor? Praise is the most effective behavior modifier for children with intellectual impairment. These children love to please the teacher. Use praise often to help the student understand expectations. Correct inappropriate behavior quickly using a calm, deliberate voice. Clearly explain the problem and redirect the child to the appropriate behavior. Profoundly impaired individuals will require close supervision. These children may lack understanding of self-preservation and constant supervision will be necessary.

OTHER DISORDERS Cerebral Palsy Cerebral palsy refers to a number of neurological disorders that appear in infancy or early childhood and permanently affect body movement and muscle coordination but dont worsen over time. It is caused by abnormalities in parts of the brain that control muscle movements. The majority of children with cerebral palsy are born with it, although it may not be detected until months or years later. What are the Characteristics of a Child with Cerebral Palsy? The early symptoms of cerebral palsy usually appear before the age of 3 years old. The most common symptoms are: A lack of muscle coordination when performing voluntary movements (ataxia), stiff or tight muscles and exaggerated reflexes (spasticity), walking with one foot or leg dragging, walking on the toes, a crouched or scissored gait, and muscle tone that is either too stiff or too floppy. What is the Treatment for Cerebral Palsy? Cerebral palsy cant be cured, but treatment will improve a child's functionality. Treatment may include physical and occupational therapy, speech therapy, drugs to control seizures, relax muscle spasms, and alleviate pain; surgery to correct anatomical abnormalities or release tight muscles, braces and other orthotic devices, wheelchairs

and rolling walkers, and communication aids such as computers with attached voice synthesizers. What are the Challenges for the Instructor? Swimming is a very good therapy for children with Cerebral Palsy and relaxes the childs muscle tone with proper therapy enabling greater range of motion. Because of the medical equipment used by these children, knowledge about the proper handling of the equipment as well as learning the technical aspects of transferring the child is necessary. Also, if a child experiences communication deficits, many of the interventions discussed previously in the manual can be utilized. Because of the instability of some children, utmost precautions around the pool must be taken.

Tourette Syndrome Tourette Syndrome is believed to be an inherited disorder caused by a chemical imbalance in the brain. Symptoms of Tourette Syndrome can appear between the ages of 3 to18, but most onsets begin between 6 to7 years of age. There are no medical tests for diagnosis of this disorder. Diagnosis is made based mainly on the presence of motor and vocal tics. What are the Characteristics of Children with Tourette Syndrome? Frequent and severe motor tics. Verbal tics. A small number of children with Tourette Syndrome use and repeat inappropriate language. May have attention deficit/ hyperactivity disorder (AD/HD). May have obsessive compulsive disorder (OCD). May feel compelled to act on his thoughts/ideas to relieve anxiety. What are the Challenges for the Instructor? Children with Tourette Syndrome need structure. A child dealing with this disorder can hold back certain tics or behaviors for short periods of time but he/she can not stop them. The instructor should work closely with teachers and caregivers to understand the nature and severity of this childs disorder.

Down Syndrome Down Syndrome is a genetic disorder caused by the presence of an extra 21st chromosome. Down Syndrome is almost always identified at birth. Down Syndrome usually, although not always, results in intellectual impairment. Congenital heart defects are frequently present. What are the Characteristics of Children with Down Syndrome? Children with Down Syndrome have recognizable physical characteristics which include inhibited growth and development, such as: Short limbs and neck. Obesity (not always present). Small mouth with protruding tongue. Small skull. Almond-shaped eyes. What are the Challenges for the Instructor? These children love the water and can be delightful to work with due to their sweet and some time childlike nature. Many children with Down Syndrome have learned all four strokes and compete in the Special Olympics. The instructor should always ask caregivers and teachers what method of behavior modification is being used at home or in the classroom for use during the lesson to provide continuity. * See the previous section on Intellectual Impairment for more information.

Traumatic Brain Injury This is an injury to the brain that could have been caused by a severe blow to the head. Car accidents, falls, and athletic injuries are the most common causes of TBI. Traumatic brain injury may result in cognitive, physical, behavioral, and/or emotional impairment. What are the Characteristics of Children with Traumatic Brain Injury? The result of traumatic brain injury can range from mild to severe depending on the location of the injury to the brain.

Physical Impairments may include: Incoordination. Muscle spasticity. Speech impairment. Loss of vision. Seizures. Hearing loss. Confusion and slowness. Paralysis. Inadequate bowel or bladder control.

Behavioral Impairments may include: Depression. Low self-esteem. Lack of motivation. Can be impulsive

Cognitive Impairment may include: Short- or long-term memory loss. Short attention span. Speech impairments. What are the Challenges for the Instructor? This student may be easily frustrated because of the loss of abilities due to brain injury. Keep the rules for class simple and request appropriate behavior. Consistent consequences such as timeout are helpful and allow the child time to compose themselves and return to class.

Juvenile Rheumatoid Arthritis Arthritis is a progressive disease of the joints and one of the major causes of impairments in young children. Early stages usually affect the joints of the hands and feet. Inflammation and stiffness will be present in affected joints.

What are the Challenges for the Instructor? Water warm-up and gradual stretching exercises are suggested before lessons begin. Swimming and water exercises are safe and highly recommended for these children. The temperature of the water should be lower than 92 degrees.