ADD & ADHD | Bipolar Disorder | Epilepsy | Traumatic Brain Injury | Learning Disabilities |
FYI on some specific disabilities
ATTENTION DEFICIT DISORDER (ADD)
and
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
Overview
Attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are related to, but different from, learning disabilities. According to the Learning Disabilities Association of America (ADA), 50%-80% of those with ADD/ADHD also have learning disabilities. In the book ADD and the College Student, Dr. Patricia Quinn states that about 40% of those with ADD/ADHD are learning disabled.
Even though professionals may disagree about the percentage of overlap, they do agree that some people only have ADD/ADHD, others only have learning disabilities, and still others have both.
By the time students with ADD/ADHD enter college, the hyperactivity component has usually been outgrown or diminished.
Just what is ADD/ADHD? Attention Deficit Disorder is a neurological disorder that affects both behavior and learning. It becomes a disability when it substantially limits a major life function, for example, the ability to learn. According to Quinn, ADD/ADHD affects from 5%-10% of the population depending on which studies you read.
The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) states that the “…essential feature…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.”
DSM-IV goes on to say that some of the symptoms have to be present before the age of 7, even though the ADD/ADHD diagnosis is often made years later. Some impairment must occur in at least two settings, for example, at home and in school or at work, and there must be “clear evidence of interference with developmentally appropriate social, academic, or occupational functioning.”
DSM-IV divides ADD/ADHD into three subtypes; predominantly hyperactive – impulsive type, predominantly inattentive type, and combined type.
As mentioned previously, the hyperactivity component has usually been outgrown by adulthood; thus, this discussion will focus on the symptoms of the Predominantly Inattentive Type, symptoms most prevalent among college students.
At least six of the following symptoms of inattention must have persisted for a minimum of six months “to a degree that is not adaptive and inconsistent with developmental level”:
As mentioned previously, one person would not exhibit all of these characteristics. But all individuals with attention deficit disorder or attention deficit hyperactivity disorder exhibit some characteristics that prevent them from excelling as adults in certain life situations at the same level as their peers.
Eligibility for Services
As with all other disabilities, students and prospective students with learning disabilities must contact the Office of Special Needs and schedule an intake appointment with the Coordinator.
Written documentation must be provided, including Individual Education Plans (IEPs), psychological reports, neurological reports, and testing results. Appropriate test instruments may include those that provide information on intelligence, aptitude, achievement, and vocational interest.
Based on the personal interview and on the written documentation, the Coordinator determines eligibility for resources or support services and approves appropriate accommodations on a case by case basis.
Accommodations and Resources
Tutors
BIPOLAR DISORDER
or
MANIC-DEPRESSIVE ILLNESS
Overview
Mood changes are very common for most people. However, the roller coaster highs and lows of bipolar disorder are not normal. A person with bipolar disorder, which has also been called manic-depressive illness, experiences mood swings from periods of intense elation to periods of intense sadness and despair. This illness can disrupt every facet of a person's life.
The National Institute of Mental Illness defines the disorder as follows:
Bipolar disorder is a mental illness involving episodes of serious mania and depression. The person's mood usually swings from overly “high” and irritable to sad and hopeless, and then back again, with periods of normal mood in between. Bipolar disorder typically begins in adolescence or early adulthood and continues throughout life. It is often not recognized as an illness, and people who have it suffer needlessly for years or even decades.
Nearly ten percent of the population will experience this disorder at some time in their lives. Research indicates that only one third of those with major depression will get treatment and only two thirds of those with any kind of mood disorder who do receive treatment will be misdiagnosed.
Cause
Bipolar disorder tends to run in families and is believed to be inherited in many cases. Although much research has been done, a specific genetic defect associated with the disease has not been found. Biological factors that affect the balance of brain chemicals called neurotransmitters may also trigger bipolar disorder. The illness may occur at any age, however is most common between the ages of fifteen and forty-four. It effects men and women equally.
Treatment
More than seventy percent of those people suffering from bipolar disorder can obtain substantial stabilization of their mood swings from medication. The most effective and commonly prescribed drug is lithium carbonate. It helps to reduce the number and intensity of manic and depressive episodes. Several other medications have proven to be effective in treating the symptoms of bipolar disorder. Medications along with professional counseling provide significantly positive results.
Signs and Symptoms
The National Depressive and Manic-Depressive Association describes the following as signs and symptoms of bipolar disorder:
Depression
Mania
Emergency management
In the most severe cases persons with bipolar disorder may talk of suicide when in a depressive state or have hallucinations when in a manic state. Contact Linda Brogan or security if a student displays these symptoms.
Academic performance
Students with bipolar disorder who receive proper and effective treatment often lead productive and satisfying lives. However, consistency of treatment is the key. It is not uncommon for a person with bipolar disorder to feel they are “cured” while on medication. As a result, he or she may stop treatment. Although debilitating bouts of depression are characteristic of the disorder, the liberating, energizing manic periods are often missed by the bipolar patient. In addition, while in the manic phase of the disease, the feeling of indestructibility and euphoria lead to resistance to treatment.
Students may demonstrate poor work effort, low academic achievement, problems with peer relationships, and a lack of interest in extra curricular activities while in a depressive period. In contrast, the manic phase can cause an inability to concentrate, inappropriate classroom behavior and a belief that everything is terrific when in fact the student is falling further and further behind.
Eligibility for services
Students with bipolar disorder, as with any other disability, must contact the Office of Special Needs and schedule an intake appointment with the Director.
Based on the personal interview and on any written documentation, the Director will determine eligibility for resources and support services and will approve appropriate accommodations on a case by case basis.
Accommodations and Resources
Overview
Brain cells produce various patterns of electrical discharges. If these discharges become disorganized or are disrupted, convulsions or seizures may occur. A single episode does not necessarily constitute a seizure disorder. However, recurring episodes are diagnosed as epilepsy or more recently as seizure disorder.
The Epilepsy Foundation of America defines the disorder as follows:
Epilepsy is a neurological condition that from time to time produces brief disturbances in the normal electrical functions of the brain. Normal brain function is made possible by millions of tiny electrical charges passing between nerve cells in the brain and to all parts of the body. When someone has epilepsy, this normal pattern may be interrupted by intermittent bursts of electrical energy that are much more intense than usual. They may affect a person's consciousness, bodily movements or sensations for a short time.
The unusual bursts of energy may occur in just one area of the brain (partial seizures), or may affect nerve cells throughout the brain (generalized seizures). Normal brain function cannot return until the electrical bursts subside. When seizures continue to occur for unknown reasons or because of an underlying problem that cannot be corrected, the condition is known as epilepsy. Epilepsy affects people of all ages, all nations, and all races.
More than two million people in the United States have some form of epilepsy. Seventy percent of them are over the age of eighteen. Fifty percent of cases develop before the age of twenty-five.
Cause
The cause of epilepsy is unknown in about seventy percent of cases. The remaining thirty percent can be traced to head trauma, brain tumor or stroke, lead poisoning, alcoholism, infections like meningitis, encephalitis, lupus, measles, mumps and others, and injury or infection during the mother's pregnancy. Genetic causes are assumed to be greater if no other factors are identified.
Treatment
Many treatment methods can fully or partially control seizures in about eighty-five percent of patients. However, some infants and children with seizure disorders are highly resistant to current treatments. Options include long-term anticonvulsant drug therapy, dietary restrictions including a high fat, low carbohydrate, and low calorie diet, electrical brain stimulation by a device implanted in the brain, and surgical removal of seizure causing brain tissue if it is confined to a small area and can be safely removed. Though many treatment options are available, about thirty percent of cases do not have complete seizure control or are totally resistant to current drug therapy.
Type of seizures
Epileptic seizures may vary greatly in appearance, effect, and management requirements.
Absence (petit mal) cause momentary loss of awareness. Facial twitches, blinking, or arm movements may occur. Full awareness resumes after an episode.
Simple partial seizures occur in one area of the brain. The person may not be able to control body movements but will not lose consciousness. Distortion of the senses may occur leading to seeing, hearing, or smelling something that is not real. Confusion may occur.
Complex partial seizures (psychornotor or temporal lobe epilepsy) may produce several different automatic behaviors and clouded consciousness. The person may seem to be sleepwalking or drugged, be unresponsive or respond inappropriately. Although these seizures last only a couple of minutes, confusion afterwards may last for awhile. Memory loss during the seizure is likely.
Generalized tonic-clonic (grand mal) seizures begin with loss of consciousness, a fifteen to twenty second period of muscle rigidity (tonic phase), followed by a one to two minute period of violent, rhythmic convulsions (clonic phase). Breathing may be shallow or even stop momentarily but returns to normal as the convulsion end. The seizure ends with a few minutes of deep, relaxed sleep before consciousness returns. The person will have no memory of the seizure and may seem confused. Headache and drowsiness are common.
Other generalized seizures (akinetic, atonic, myoclonic) may cause sudden falls or jerking of the whole body. These are difficult to control and may require the person to wear a protective helmet.
Emergency management
Instructors are encouraged to request that students with seizure disorders inform them at the beginning of the semester. If a student has a seizure in the classroom the following procedure is suggested:
Academic performance
Most people with epilepsy test in the average I.Q. range. However, research indicates that many students with seizure disorders achieve at a lower level than their test scores indicate. Possible reasons for this discrepancy are outlined by the Epilepsy Foundation of America:
It is important to remember that these problems may or may not occur in a student with epilepsy. Many students with this disorder do quite well in school without any of these difficulties.
Eligibility for Services
As with all other disabilities, students and prospective students with epilepsy must contact the Office of Special Needs and schedule an intake appointment with the Director.
Based on the personal interview and on the written documentation, the Director determines eligibility for resources or support services and approves appropriate accommodations on a case by case basis.
Accommodations and Resources
Overview
Brain injury can range from quite minor to devastating. It may not always be visible, but can be quite complex. It can cause physical, cognitive, social, and vocational difficulties that may last for only a short time or a lifetime. The extent and location of the injury will dictate a variety of symptoms.
The Individuals with Disabilities Education Act defines traumatic brain injury as follows:
… injury to the brain caused by an external physical force, resulting in total or partial functional disability or psycho-social impairment, or both, that adversely affects (an individual's) educational performance. The term applies to open or closed head injuries resulting in impairments in one or more areas, such as cognition; language; memory; attention; reasoning; abstract thinking; judgment; problem-solving; sensory, perceptual, and motor abilities; psycho-social behavior; physical functions; information processing; and speech. The term does not apply to brain injuries that are congenital or degenerative, or to brain injuries induced by birth trauma.
Every fifteen seconds a person sustains a traumatic brain injury in America . Of the two million Americans who sustain a brain injury, over 373,000 are hospitalized, about 56,000 die, and another 100,000 are permanently disabled. Traumatic brain injury (TBI) is the leading killer and disabler of American children and young adults.
Cause
There are two basic types of brain injury, “closed head injury” (CHI) and “open head injury” (OHI). Open head injuries are caused by objects penetrating the brain, such as a bullet. Closed head injuries are more common. A rapid movement of the head during which the brain is moved quickly and severely back and forth within the skull usually causes it. Closed head injuries often occur as a result of falls or motor vehicle crashes. The stress of this rapid movement pulls apart and stretches nerve fibers or axons, breaking connections between different parts of the brain. It can also cause brain “contusions” (bruises), especially in the frontal parts of the brain, which help control behavior and emotions. In many cases blood vessels may rupture causing a blood clot or “hematoma” that may enlarge and cause a buildup of pressure within the skull. An important complication of brain injury is anoxia, or loss of oxygen to the brain. This can be caused by choking, cardiac arrest, stroke, or near drowning. The combination of anoxia and TBI can be devastating and lead to severe and permanent disability.
Treatment
Rehabilitation for individuals with traumatic brain injury has grown considerably in the last twenty years. Nearly all persons who have experienced TBI can benefit from some level of specialized rehabilitation. The exact type and intensity of rehabilitation that is best for each individual depends on many factors. General rehabilitation programs include behavior modification, transitional living, independent living, home and personal assistant care, and vocational programs. The cognitive and communication problems of traumatic brain injury are best treated early. This early therapy will frequently center on increasing skills of alertness and attention. The therapist will provide oral-motor exercises in cases where the individual has speech and swallowing problems.
Long term rehabilitation may be performed individually, in groups, or both, depending upon the needs of the individual. Intensive therapy with speech-language pathologists, physical therapists, occupational therapists, and neuropsychologists may also be needed. Most individuals respond best to programs tailored to their backgrounds, interests, and needs.
Types of Brain Injury
Mild Brain Injury . A mild brain injury, also known as “concussion,” is one in which there may be only a brief or momentary loss of consciousness without any major complications such as hematoma. A relatively subtle amount of reversible brain damage may occur even after a mild concussion. This is often followed by “post-concussion syndrome” that can include temporary headaches, dizziness, mild mental slowing, and fatigue. The most important element in the management of mild brain injury is recognizing that the symptoms are real and can be treated. Symptoms almost always improve over one to three months.
Moderate Brain Injury . A moderate brain injury may result in a loss of consciousness usually lasting only minutes or a few hours followed by a few days or weeks of confusion. Brain contusions or hematomas may accompany it. Persons sustaining a moderate brain injury will usually have cognitive and psyco-social impairments that can last for many months. However, with treatment these individuals are generally able to make a nearly complete recovery.
Severe Brain Injury . Severe brain injury almost always results in prolonged unconsciousness or coma lasting days, weeks or even longer. Persons in a coma appear to be asleep, but cannot be awakened, and there is no meaningful response to stimulation. Such persons often have brain contusions, hematomas, or damage to the nerve fibers or axons, and some may have suffered from anoxia. Although persons who sustain severe TBA can make significant improvements in the first year after injury and can continue to improve at a slower pace for many years, they will often be left with some permanent physical, behavioral and/or cognitive impairments.
Signs and Symptoms of Traumatic Brain Injury
Physical Disabilities . Individuals with TBI may have problems speaking, seeing, hearing, and using their other senses. They may have headaches and often feel fatigued. They may also have trouble with skills such as writing or drawing. Their muscles may suddenly contract or tighten. Seizures may also occur. Their balance and walking may be affected. Partial or complete paralysis on one or both sides of the body may also occur.
Cognitive Disabilities . Injury to the brain often causes short term and long term memory problems. Persons with TBI may have trouble concentrating and only be able to focus their attention for a short time. They may think slowly and have trouble talking or listening to others. These individuals may also have trouble reading, writing, planning, understanding the order in which events happen (sequencing), and judgment.
Social, Behavioral, or Emotional Disabilities . These difficulties may include changes in mood, anxiety, and depression. Individuals with TBI may have trouble relating to others. They may be restless and laugh or cry often. They may also lack motivation or control over their emotions.
Academic Performance
Almost all of symptoms of traumatic brain injury can affect a student's academic performance. These symptoms can vary greatly depending on where the brain is injured and how severely. Traditional intelligence tests may not accurately assess cognitive recovery after a brain injury and may bear little relationship to the mental processes required for everyday functioning. Individuals with brain injuries might perform well on brief, structured, artificial tasks but have significant deficits in learning, memory, and other functions that enable them to cope with everyday situations. Recovery of the brain can be inconsistent. A student might take one step forward, two steps back, do nothing for awhile, and then unexpectedly make a series of significant gains. Functional improvement is usually ongoing, but the rate of that improvement can vary greatly.
Eligibility for services
Students who have suffered traumatic brain injury, as with any other disability, must contact the Office of Special Needs and schedule an intake appointment with the Director.
Based on the personal interview and on any written documentation, the Director will determine eligibility for resources and support services and will approve appropriate accommodations on a case by case basis.
Accommodations and Resources
Overview
Learning disabilities are the most frequently diagnosed learning problems reported by college students who seek accommodations through Special Needs /Disabled Student Services Offices. Nationwide about 1/3 of the identified community college students with disabilities report a learning disability as their primary disability.
The first widely accepted definition of learning disabilities is the federal U.S. Office of Education definition of 1977:
The term “specific learning disability” means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, speak, read, write, spell or to do mathematical calculations. The term includes such conditions as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include children who have learning disabilities which are primarily the result of visual, hearing, or motor handicaps, or mental retardation, or emotional disturbance, or of environmental, cultural, or economic disadvantage. ( United States Office of Education. (1977). Definition and criteria for defining students as learning disabled. Federal Register, 42:250, p.65083. Washington, DC: U.S. Government Printing Office.)This definition has been revised and refined many times as more knowledge has been gained about these varied and complex disorders. Among other things, the revised definitions have stressed that learning disabilities are permanent conditions that are not outgrown in adulthood. The 1988 revised definition by the National Joint Committee on Learning Disabilities is acceptable to most advocacy and professional organizations:
Learning disabilities is a generic term that refers to 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, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not by themselves constitute a learning disability. Although learning disabilities may occur concomitantly with other handicapping conditions (for example, sensory impairment, mental retardation, serious emotional disturbance) or with extrinsic influences (such as cultural differences, insufficient or inappropriate instruction), they are not the result of those conditions or influences. (National Joint Committee on Learning Disabilities. (1988). Collective perspectives on issues affecting learning disabilities: Position papers and statements. Austin, TX: PRO-ED.)Regardless of which specific definition is being used in a post-secondary institution, learning disabilities must not be confused with mental retardation.
Individuals who have learning disabilities have average or above-average intelligence.
Their learning problems are not the result of low intelligence but rather because of a disorder in one or more of the central nervous system processes involved in perceiving, understanding, and/or using concepts through verbal or non-verbal means.
College students with learning disabilities vary tremendously in the range and degree of difficulties they encounter. Each student has a unique combination of strengths (abilities) and weaknesses (deficits). Some are impacted in all aspects of their lives—employment, education, social interactions, independent living—while others are impacted in one or two areas. Even in one particular area, education, for example, some students may encounter severe difficulties in written language, reading, math, and study skills, while other students may struggle primarily in just one type of subject area or basic skill.
However, the vast majority of these students will face at least one barrier that is significant enough for them to request assistance in order to succeed in college.
The Heath Resource Center, The American Council on Education, and the National Adult Literacy and Learning Disabilities Center have provided a learning disabilities checklist to illustrate the kinds of characteristics that may be exhibited by adults with learning disabilities:
As mentioned previously, one person would not exhibit all of these characteristics. But all individuals with learning disabilities exhibit some characteristics that prevent them from excelling as adults in certain life situations at the same level as their peers.
Eligibility for Services
As with all other disabilities, students and prospective students with learning disabilities must contact the Office of Special Needs and schedule an intake appointment with the Director.
Written documentation must be provided, including Individual Education Plans (IEPs), psychological reports, neurological reports, and testing results. Appropriate test instruments may include those that provide information on intelligence, aptitude, achievement, and vocational interest.
Based on the personal interview and on the written documentation, the Director determines eligibility for resources or support services and approves appropriate accommodations on a case by case basis.
Accommodations and Resources