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Running head: CHILDREN WITH INTELLECTUAL DISABILITIES 1

Parenting Children with Intellectual Disabilities

Elizabeth McDonald

Emma Bohrer

Serena O’Connor

Jennifer Shoot

Kansas State University

CHILDREN WITH INTELLECTUAL DISABILITIES

Table of Contents

Introduction…………………………………………………………………………………………......page 3

Unit 1: Social Skills……………………………………………………………………………………page 17

Unit 2: Cognitive Therapies and Learning Techniques………………………………...page 23

Unit 3: Medical and Health………………………………………………………………………...page 29

Unit 4: Problem Behaviors…………………………………………………………………………page 36

Conclusion………………………………………………………………………………………………..page 44

Works Cited………………………………………………………………………………………………page 48

Appendix…………………………………………………………………………………………………..page 54

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Introduction

Children with disabilities are a relatively new topic within our culture,

although the issue has existed for centuries, society has not been fully aware of it’s

seriousness until recently. The lack of education amongst parents of children with

disabilities can cause a delay in the child’s developmental, social, and behavioral

functioning. The increasing knowledge within therapeutic fields has allowed for the

enhancement of not only the child’s well being, but also that of the caregivers. The

develop of fields such as Occupational Therapy, Physical Therapy, Music Therapy,

Speech Therapy, Applied Behavioral Therapy and many more have provided the

necessary services families need in order to improve the functioning of daily life as a

special needs child. Teaching parents about their child’s developmental, social, and

behavioral functioning is essential to the family as a whole.

Research has shown that a child’s behavior is a direct reflection of marital

satisfaction (A, D. H., Sayger, T. V., & Horne, A. M., 2003). Children with disabilities

tend to exhibit a vast array of behavioral issues such as self-injurious acts, hurting

others, expressing emotions inappropriately, and numerous others. With early

intervention these behavioral acts can be better understood and possibly more

easily controlled by parents (Alkahtani, 2013).

Research has shown children with special needs who are merged with

children without disabilities within a school environment have a greater success

rate (U.S. Department of Education, 2013). Not only do parents play a key role in

aiding the child, but also the teachers and students involved in their education.

Teachers can play an essential role in educating parents on their child as well. There

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is evidence that says that a teachers interaction with children especially those with

special needs has a direct correlation to the success of the child developmentally

(Hamre et al., 2014).

With the introduction of the Individuals With Disabilities Act (IDEA) in 1975

children disabled or not, were able to receive an education from public schools.

From 1975 to 2004 IDEA has continued to make great strides towards its main goal

of integrating special needs children into the mainstream classroom (U.S.

Department of Education, 2013). The main goal of IDEA was to mainstream, as many

special needs children as possible into regular classrooms instead of segregating

them into their own classrooms with their own curriculums. Through the years

IDEA has changed and evolved but from the very beginning the main goal of this act

was to give mentally and physically disabled children the best education we can

provide in what officials called the “least restrictive environment” (Hague, 2010).

This act is a huge part of our countries history as it relates to the special needs

population.

Empirical Basis

The empirical basis we are using for our program is Vgotsky’s Social

Development Theory. The main aspect of this theory is that social interaction plays

a fundamental role in the development of cognition. The second main aspect of this

theory is that the potential for cognitive development depends upon the "zone of

proximal development" (ZPD): a level of development attained when children

engage in social behavior. Full development of the ZPD depends upon full social

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interaction. The range of skill that can be developed with adult guidance or peer

collaboration exceeds what can be attained alone (Edwards 2002).

Program Format and Target Audience

Our program will focus on educating parents of newly diagnosed mentally

disabled children. The age of the children we will primarily focus on ranges from age

1-5 years old. Our hope for implementing this program is to not only educate

parents, but also rid the taboo in society surrounding the topic of disabled children

and their families. This program will meet once a week for four weeks, each week

focusing on a different area of interest. We are aware that everyone is very busy so

we planned for the program to be held from seven to nine p.m. on Tuesday nights.

Our class will be held on the Kansas State University campus in a large classroom in

Justin Hall. At our very first meeting of the program we will hand out a pre-program

survey asking about their expectations of the class and what they hope to

accomplish by completing this program. See Appendix A for survey.

Social Development

We continue to stress the importance of parents and caregivers being

educated because it is essential to a child’s development. Children with intellectual

disabilities tend to require different steps and approaches when it comes to

enhancing their development. The social development in a child with disabilities

holds such high importance, because it will determine the success and capabilities,

the child will be able to achieve in their adult life. We will focus on a few ideas

behind social development, and why it is so important for parents to be

knowledgeable about all areas of growth.

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Attachment

Children with intellectual disabilities have a harder time growing logically

and mentally than the children who have a “normal” learning ability. These children

struggle with communication, which is why parents should spend extra time

observing, and trying to understand what their child is trying to express when they

act out. These observations will enable a better understanding of the child’s feelings

and emotions, which allow the child to develop a successful attachment style, such

as, secure-attachment.

Bowlby’s, Ethological Theory of Attachment focused on different phases of

attachment. These stages are critical points in a child’s life order to develop properly

in these stages of attachment. We will focus on the battles, and difference’s children

have during the last two phases of Bowlby’s attachment theory (Inc., P. C. 2014).

These stages are, “clear-cut attachment” relating to children eighteen months up to

two years old, along with, “formation of reciprocal relationships” which also focuses

on the ages observed of those with clear-cut attachment.

The most appropriate form of attachment for the well being of a child, and

future success, is the idea of Mary Ainsworth’s Secure Attachment. Ainsworth and

her colleagues performed their well-known Strange Situation Laboratory

Technique. They observed the attachment styles, of children one year up to two

years old; they reasoned, “securely attached infants and toddlers should use the

parent as a secure base” (Wright, P. W., & Wright, P. D. 1998-2014). This type of

attachment is important to every child, but this goal seems to be more complicated

to reach for children with learning disabilities.

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Learning disabilities

Nearly every child with special needs has some sort of learning disability.

These disabilities affect the child’s plasticity, reactivity, and compliance. These

children tend to struggle with keeping on task and understanding the general tasks

at hand. They also struggle to see the importance of these tasks. Children with

special needs tend to battle in nearly every setting, whether; it’s at home, in the

classroom, or during an extracurricular activity. Although these settings are hard to

adapt to, some are less frustrating for the child, because the individuals around

them have made an effort in their adaptation.

Specifically, these children struggle with social skills and social competence.

It is important that parents work for their child to develop specific reactions,

responses, techniques, and strategies for their child to use in social situations.

(www.pbs.org/) Parents also need to keep track of their child’s performance and

work with them in improving the outcome in a situation. Children with learning

disabilities have difficulty expressing their emotions, which commonly causes them

to struggle when interacting with peers.

Interaction with peers

Interaction with peers is so important for children with special needs. It

enables them to form friendships with children who have a greater learning

capacity, which can help the child in developing and communicating. The interaction

benefits the child with special needs and allows children without t disabilities to

have a better understanding and patience for the children who do have them. The

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bond a child with disability’s forms with their peers proves to be successful in their

future providing practical help and building a foundation for potential relationships.

If the child does not interact with peers at an early age, they tend to have

further issues in interaction. There are many reasons for this, but the main one is a

child without a learning disability can communicate their emotions better than

children with disabilities. The lack of communication will likely cause more

frustration for the child with special needs and learning disabilities; because the

child with disabilities is less sensitive to their needs and normally does not

understand what those needs might be.

The parents/ caregivers of these children should request to present to their

child’s peers the disabilities that the child has and the best ways to interact wit him

or her. If the parents educate their child’s peers, bullying could be prevented, along

with disturbances in the classroom or outside activities.

Cognitive Therapies and Learning Techniques

Parents who attend the program may vary from individuals to families who

have recently discovered that their child has been diagnosed with a cognitive

disability and are searching for therapies or techniques to further enhance their

child’s life. The ideal situation is to reach parents at the beginning of the searching

process in order to discuss the vast array of resources available. There are

numerous therapies available to parents with disabled children. (Center for Disease

Control and Prevention, 2014)

Parents should be aware of their children’s background, even before

diagnosis was determined. Having knowledge of the behaviors displayed,

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development milestones achieved or unachieved, social and emotional attentiveness

as well as numerous other symptoms can aid in the therapy process. Parents may be

unaware of the importance of developmental screening and monitoring even if their

child has already been diagnosed. Screening is an essential part of the diagnostic

and therapy process. Emotional highs and lows can cause misperception and

misunderstanding for parents throughout the beginning stages. (Center for Disease

Control and Prevention, 2014) I want to make parents aware of this and further

educate them on the resources available for each diagnosis possible. My portion of

the program will seek to help parents assess their present circumstances and aid

them with materials and teachings on the variety therapies and learning techniques

obtainable. Information will be relayed and practiced on during each session.

Types of Therapies

Occupational Therapy is a growing field with expanding knowledge for

parents and children with disabilities of all types. Occupational Therapist offer a

variety of techniques to aid in the development and functioning of children with

diagnosed disabilities such as; music therapy, sensory integration, frustration

tolerance, gross and fine motor skills, and many more. (Roseann C. Schaff, 2012) As

well as sensory integration, a different approach has been gaining more attention

from therapists and parents. Music therapy is another technique being offered to

those with disabled children. It is also being used within elderly facilities to enhance

cognitive functioning. Research observing the effects of music on the learning and

communication processes of individuals is increasing. These techniques may offer

an altered, unique approach to treatment for parents. (Rainey Perry, 2003) I would

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like to discuss how the techniques used by Occupational Therapist including

sensory integration and music therapy could enhance the life of the disabled child as

well as that of the parent. I would provide parents with local OT’s information in

order to create a possible connection for them.

Equine therapy is technique that has been on the rise when dealing with

various types of disorders. There is research being presented to confirm correlation

between mental health and equine therapy. (Keren, 2012) I hope by presenting an

out of the box technique, such as equine therapy to parents our program will be

better able to reach a vast array of parents and children. Therapy doesn’t have to

take place in a building! It can be exploratory and adventurous even when faced

with Down syndrome, Autism, Asperger’s, or any other mental health disorder.

I would also like to discuss with parents the importance of Physical Therapy.

Physical activity and movement-based activities play an intricate role in

development. There has been research presented examining the correlation among

children’s mental health and physical activity. (Soyeon Ahn, 2011) It is even more

essential for children with cognitive disabilities to maintain activity. Parents should

be educated on exercises and activities that could be useful for enhancing their

child’s functioning. (Winders, 2001) Our program would provide information on

these techniques as well as Physical Therapist in the area.

Statistics

I would now like to provide families with data and statistics based on the

information discussed on cognitive therapies and techniques. National Early

Intervention Longitudinal Study, NEILS, provides information on a study of children

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with disabilities who partook in intervention services. The study followed a group of

over 3,000 infants and toddlers until kindergarten. The study aimed to find out

about the traits of service providers in early intervention programs, the services

that children and families received, and the outcomes that resulted from these

experiences. (SRI International , 2014) It is reported in the state of Kansas 16% of

children ages 2-17 years have one or more emotional, behavioral, or development

condition. (National KIDS COUNT , 2014) Center for Disease Control and Prevention

offers various other resources with data and statistics I would like to share with

parents participating in the program. Offering an outlook to some of the numbers

specific to Kansas may help parents grasp the support available.

Medical and Health Interventions

What would seem like an obvious area of importance for parents with newly

diagnosed mentally disabled children are their medical needs. I say that it seems to

be obvious because when that parents child is being diagnosed chances are there is

a medically certified doctored standing across from them telling them the news.

However, what most parents are not aware of is with the advancements we have

made in the medical and research fields there are hundreds of new therapies built

specifically for their child’s needs. Especially in the beginning stages of parenting a

child with special needs the parents are overwhelmed with information regarding

their child’s health. But the goal of this lesson plan is to help those parents sift

through the mountain of material to find hopefully find the best medical therapies

for his or her child.

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Medical Field

The medical field as it relates to children with intellectual disabilities is both

very vast and very small. Much like most medical fields research regarding

intellectual disabilities is growing and expanding each year. According to one article

in the Journal of Intellectual Disability Research, research in all areas of

intellectually disabled adults and children is on a major rise (Feldman et al.,2014).

This research in the medical field can help us one to better diagnose children with

intellectual disabilities but to also better be able to treat them.

Therapies

As mentioned earlier with the expansion of knowledge and research within

the medical field there has been great advances towards more effective medical

therapies for children with disabilities. Depending on a child’s disability and

progression level doctors can make a personalized plan specifically for their family.

Therapies are used to help ease the child and family’s lives as well as helping to

progress the child developmentally. These therapies can range from speech

pathology to cognitive behavioral therapy and research shows can play a significant

role in bettering a child with intellectual disabilities life ("Home | AHRQ Effective

Health Care Program"). This care can come from medical institutions but for the

majority this care comes from the child’s educational care facility. This is due in

part to the IDEA, which promoted the well being and education of special needs

children in the school system.

Although there is no know treatment for disorders on the autism spectrum

and similar intellectual disorders there are other avenues parents, teachers, and

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health professionals can explore to help better a child’s life. These approaches can

be broken down into four main categories; behavior and communication

approaches, dietary approaches, medication, complementary and alternative

medicine ("Treatment"). When dealing with the health of intellectually disabled

children it is important to remember that not every child reacts or is affected the

same way to each edification or intervention.

Financial Obligations

A growing problem in our society is the cost of healthcare. The average cost

of raising a child without disabilities up until the age of eighteen is around $250,000.

However, families raising a child with special needs experience an added financial

burden of 91.2 percent. Caring for a child with special needs pay that $250,000

average for raising a child plus an average added $774 per year out-of-pocket costs

to raise their child with disabilities (Martin, 2014). Under the Individuals with

Education Act funding was finally put towards the equipment, staff, and educational

processes necessary to give children with disabilities the correct medical attention

in the school system.

Challenging Behaviors

Intellectual disabilities are usually life-long and affect day-to-day activities.

The program focuses on this type of disability because often times this disability

affects how a child learns. If a child has more difficulty learning than others they will

inevitable fall behind in school and be at a disadvantage. It’s important that parents

are educated about their child’s disability and know how to handle it. Starting

therapy and intervention programs as soon as possible is extremely important,

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especially for the child’s developmental processes. This helps to avoid

developmental delays, even though some delays may be inevitable (Shin, Y. 2009).

Family Intervention

The first step to helping a child with behavior problems is to understand why

they have these behaviors. These behaviors might be related to an event that is

happening at school, such as how they are being treated by a teacher or other

students. Sometimes these behaviors might be happening because of conflicts in the

home. Just like children without disabilities those with disabilities are also affected

by all these life changes. Children with disabilities typically have an even more

difficult time with change or conflict because of the other challenges they are facing,

such as communication, sensory, or motor challenges. Family conflict is one of the

leading reason children with and without disabilities act out. It’s important for the

entire family to be willing to make changes in the household if they want to see

progress in their child’s behavior (Vrijmoeth, C., Monbaliu, E., Lagast, E., & Prinzie, P.

2012).

Signs of Challenging Behaviors

Once an individual begins to display very harmful acts of behavior it is

difficult to control them or minimize them. There has been research done that

proves early intervention is the best way to tackle this issue. Children with more

severe intellectual disabilities have a higher risk of displaying these behaviors.

Those with social impairments or the presence of repetitive behaviors are also

typically at a higher risk of showing signs of severe behaviors. The presences and

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severity of these harmful acts are associated mainly with repetitive and impulsive

behaviors (Oliver, C., Petty, J., Ruddick, L., & Bacarese-hamilton, M. 2012).

Types of Interventions

Once a parent has discovered their child has challenging behaviors they then

need to learn to minimize them or at least cope with them. The best way to prevent

these behaviors from escalading in the future is to intervene early (Alkahtani, K. D.

F. 2013). Studies have shown the involvement of the family in the interventions

have a huge impact on the effectiveness of the programs. It has also been proven

that the more the intervention is implemented into the child’s natural life as a daily

routine the more effective it is. Positive behavior intervention and support (PBIS) is

an intervention technique that strongly encourages family involvement (Vrijmoeth,

C., Monbaliu, E., Lagast, E., & Prinzie, P. 2012).

A common type of intervention that many therapists use is Sensory-

Integration Therapy (SIT). 82% of Occupational Therapist report that they use some

type of SIT when working with children with Intellectual disabilities, specifically

children with Autism (Devin S. Healy. 2011). Professionals have described the

problem of sensory integration that many individuals with Intellectual or other

developmental disabilities have as “the inefficient neurological processing of

information received through the senses, causing problems with learning,

development and behavior” (Stock Kranowitz 1998, p.292). SIT’s main goal is to

help children with sensory dysfunctions by providing sensory stimulation so the

brain can learn to process and organize these sensations (Devin S. Healy. 2011).

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Behavior therapy is another approach to dealing with children with

challenging behaviors. The basis of this approach is to use positive reinforcement

and negative reinforcement. This kind of therapy can be used to get a child to

complete a task such as reading schoolwork, or cleaning their room. This therapy

can also be used when a child has misbehaved and one wants to correct their

behavior (Devlin S. 2011).

It’s important for parents to be able to understand their child with an

intellectual disability. The first way to do this is by pointing out if they have any

repetitive or impulsive behaviors. These are signs that their child might currently

have challenging behaviors or that they will display them later on. Parent’s

education in Sensory Integration Therapy and Behavior Therapy is essential for the

child to learn these techniques as well. The more rehearsed the parents are the

better they can use these techniques to educate their children and the better their

children can benefit from them.

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Social Skills

Jennifer Shoot

Unit Agenda

Time ACTIVITY

7:00-7:05 P.M. Question of the Parent’s Knowledge: Discussion

7:05-7:15 P.M. “Welcome to Holland” video presentation

7:15- 7:25 P.M. Questions about “Welcome to Holland” video

7:25- 7:35 P.M. Relationship-based approach

7:35- 8:00 P.M. Role-playing

8:00- 8:10 P.M. Discussion of the Scenarios

8:10- 8:30 P.M. Crafts

8:30- 8:40 P.M. Questionnaire and Discussion

8:40- 8:50 P.M. Facts

8:50- 9:00 P.M. Questions for the Educator

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Unit 1: Social Skills

Jennifer Shoot

Overall Program Goal: Provide parents of intellectually disabled children with the

knowledge and skills to address issues of social development, challenging behaviors,

cognitive therapies, and medical and health interventions.

Unit Goal: By the end of the lesson parents will be knowledgeable in ways to

promote their child’s social enhancements.

Unit Objectives

Parents will be able to identify different techniques to improve their child’s

behavior inside the classroom, on the playground, and during extracurricular

activities.

Parents will be able to apply their knowledge when identifying their child’s

needs.

Parents will be able to practice patience through the knowledge earned in

the course.

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Social Skills

The teaching unit will provide the skills parents need in order to develop

their child’s social abilities. The parents will learn the effects their child’s intellectual

disabilities have on their relationships among their peers. These parents will be

taught the importance of consistently incorporating a relationship-based approach

at home. The approach will be used in different environments for enhancement in

their child’s social ability inside the classroom, on the playground, and during

extracurricular activities. The unit will also explain to parents the importance of

social interaction for their child with these disabilities.

Agenda and Activities

The parent educator will begin the class by asking the parents the question,

“What do you know about the struggles your child experiences when socializing

with peers one-on-one or in a group environment?” Time will then be taken to

analyze and discuss the answers given by the parents in the class. Now that the

educator has an understanding of where the parents stand on the topic. The video

“Welcome to Holland” will be presented.

Welcome to Holland by Emily Perl Kingsley was originally written in order to

help others understand the feelings of parents when their child is diagnosed with an

intellectual disability (Kingsley, E.P., 1987). The essay was then converted into a

film. The film allows parents to understand the knowledge they need in order for

their child to thrive with their abilities instead of looking at the disabilities. The

video will help the parents in relating to one another for the duration of the class.

After the video is presented the educator will ask the parents if they can relate to

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the analogy presented by Kingsley. Then they will be asked if the video gives them a

new insight about the importance of working on their child’s social skills every day.

When the discussion of the film is over the parents will learn that their child

with intellectual disabilities does not know how to interact in social situations. A

relationship-based approach is important to teaching social skills (Cox, A., 2004).

This concept focuses on the ideology that there is no “logical” approach to

socializing (Cox, A. 2004). Each skill and role introduced will be manipulated to

satisfy the needs as the parent’s child. The educator will now spend the majority of

the time using the parents as models in activities of role-playing. The activity will

establish common scenarios that occur as their child with disabilities are in social

stations.

The students (parents/caregivers) will be asked to perform three scenarios

that could be encountered inside of the classroom, on the playground, and at an

extracurricular activity. The teacher will ask for three volunteers. She will then ask

them to develop a situation. In one of the scenarios, the child with the intellectual

disability will use voice modulation, such as, over repeating oneself. The other

situation will involve turn taking, and lastly making eye contact. The scenarios, will

share the struggle those with disabilities have with expressing one’s emotions and

empathizing with their peer (Cox, A., 2004).

After each of the role-playing, activities have been discussed and observed.

An in class craft activity will be completed by the parents to take home to use with

their child. The parents will make models for their child in order for them to express

their emotions at home. A paper handout of faces that share different emotions will

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be cut out glued onto a straw (Alexander, D., & Wistrom, E., 2012, January 5). See

Appendix C for handout. This will be a great tool, for those children who struggle

with verbalizing his or her emotions. The parents will be asked for their child use

these tools daily until they begin recognizing their emotions or are able to express

their emotions verbally.

After the class activity, the parents will be asked to pick the top three

emotions their child struggles to communicate. The educator will then pass out

worksheets, which will be used as the parents describe an incidence, which has

occurred with each emotion. See Appendix B for handout. The educator will then

use these for future references. Then the educator will ask why each parent chose

the emotions.

In the last thirty minutes, class facts will be introduced to the parents. A

course wrap up will be provided summarized what was taught and hopefully

learned by the educator and the parents/ caregivers. Social skills are those

communications of, problem solving, decision-making, self-management, and peer

relation’s abilities that allow one to initiate and maintain positive social

relationships with others. Deficits or excesses in social behavior interfere with

learning, teaching, and the classroom's orchestration and climate. Social

competence is linked with the acceptance of peers, the teacher’s acceptance,

including success, and post school success (www.ldonline.org). It is said that a lack

of social skills commonly follows with rejection by peers (LLC, U. U. 2014). Social-

skill training “is a general term for instruction conducted in (behavioral) areas that

promote more productive/ positive interaction with others. We teach these skills to

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students who are presently unskilled with others. This is done in order to promote

acceptance by teachers, other adults and peers.” It is important for parents to work

on their child’s manners, appropriate classroom behaviors, ways to handle their

emotions, and ways for them to resolve conflict. If there are any other questions

that the parents may have for the educator they will be asked in the last five minutes

of class. At the very end with the class, the educator will hand out an emotion

pinwheel for the parents/caregivers to take home to their children. See Appendix D

for pinwheel. The instructor will then dismiss the class by giving a short

introduction to next week’s lesson, cognitive therapies and learning techniques.

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Cognitive Therapies and Learning Techniques

Emma Bohrer

Unit Agenda

Time Activity

7:00-7:15 Class Introduction and Presentation of Goals and Objectives

7:15-7:30 Introduction of Therapies

7:30-7:45 Discuss Occupational Therapy Services

7:45-7:50 Break Up Into Groups For Activity

7:50-8:05 Sensory Integration-Tactile Play

8:05-8:15 Break

8:15-8:30 Come Back Together-Discuss Tactile Play Activities

8:30-845 Large Group Discussion

8:45-9:00 Closing Comments, Questions, What To Expect Next Time

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Unit 2: Cognitive Therapies and Learning Techniques

Emma Bohrer




Unit Goal: Caretakers will gain a deeper understanding and awareness of the

various therapies available for children with intellectual disabilities.

Unit Objectives:

Caretakers will accurately identify four different services Occupational

Therapists provide.

Caretakers will be able to identify six different sensory integration activities

used through tactile play.

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Creating the Learning Environment

The program will be held in Justin Hall on the Kansas State University

campus. The first day and each session following the environment will properly be

furnished with all materials and equipment needed in order to properly teach the

caretakers. Parents/caretakers will enter a specified room in Justin Hall that is

structured for group discussion and activities. Seating will be arranged in a pattern

that allows for ease of conversation and viewing of PowerPoint materials. The

educator will provide a PowerPoint presentation outlining major points, following

the agenda. The educator will also provide parents/caretakers with the slides in

note form to refer back to during and after the session. The PowerPoint is simply a

guide for the session in order to better mange time and allow for active discussion.

Class Introduction and Presentation of Goals and Objectives

Parents/Caregivers will enter the room and be instructed where to sit. After

mostly everyone has been seated the educator will introduce him or herself,

welcome all attendees, and then explain the overall goal of the program. The

educator will then explain the unit goals and objectives for that week’s session.

Parents/Caregivers will then be prompted to introduce themselves as well as share

the age and diagnosis of their child. After introductions, the PowerPoint

presentation will commence. The PowerPoint will be used as a guide throughout the

session concentrating on basic information.

Introduction of Therapies

During this portion of the presentation the educator will explain various

therapies and learning techniques available to parents and caregivers. The educator

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will discuss Occupational Therapy, Physical Therapy, equine therapy, Speech

therapy, as well as a variety of other therapy practices. This is an opportunity for the

educator to offer a glimpse of the endless resources accessible for parents of

children with intellectual disabilities. The educator will use the PowerPoint to

emphasize target points to the attendees. The PowerPoint will allow the educator to

transition into discussing Occupational Therapy services more in depth.

Discuss Occupational Therapy Services

At this time the educator will explain the vast services Occupational

Therapist offer. Occupational Therapist works with children with a wide variety of

disabilities using numerous techniques with each child. This type of therapy is

patient oriented based on diagnosis, therefore allowing therapist to use techniques

varying from music therapy to sensory integration. After mentioning these

variations, the educator will explain sensory integration more in depth. After the

explanation of this specific technique the educator will instruct parents and

caregivers to move into an area for group activity, tactile play.

Sensory Integration-Tactile Play

The activity is intended to be fun and insightful for parents and caregivers. It

is designed to help them gain an appreciation and better understanding of sensory

integration and tactile concerns. Tactile play is a great way to incorporate various

textures into the child’s environment.

Multiple activity stations will be set up around the room before the session

begins with various tactile play activities. One station will consist of cookie sheets

covered with shaving cream, bath foam, and lotion. Toys such as cars will also be

26


provided at this station in order to initiate play in the differing textures. Another

station will consist of differing fabrics squares such as velvet, corduroy and satin.

Attendees will use their bare feet to walk across the different fabrics exploring each

texture. Another station will consist of small tubs of theraputty of various

resistances. Beads and other small objects will be placed in the putty. Attendees will

use their fingers to grasp and pull the beads from the putty. Theraputty is also great

for developing fine motor skills. Another station will consist of several brushes with

varying types of bristles. Parents will be asked to run the brushes across different

surfaces of their body such as hands, arms, face, or legs in order to grasp the texture

and sensitivity better. Each parent or caregiver will take turns engaging in each

station. Approximately five minutes will be spent at each station. When every

individual has participated in each activity, the group will be dismissed for a ten-

minute break.

Break Time

When all individuals have completed the activities or allotted time has

diminished, educator will dismiss the group for a break. Parents or caregivers will

be allowed to use facilities, make phone calls, etc.

Come Back Together-Discuss Tactile Play Activities

During this time the group will be asked to share their thoughts about the

various activities they participated in before the break. The PowerPoint will provide

prompted questions in order to better guide the discussion. Questions will include,

“What would it be like to have this ailment every day?” “Which station was most

challenging?” “Do any of your children struggle with tactile issues?” “Do you think

27


sensory integration could be beneficial?”. Discussion during this allotted time will be

focused strictly on the activities the individuals participated in. Participants will be

asked to name any other sensory integration activities that may be helpful for their

child specifically. The PowerPoint will list six different sensory integration activities

specific to the program.

Large Group Discussion

At this time parents and caregivers will be granted the opportunity to ask

questions or discuss any material covered throughout the session. At this time the

educator will display a slide of four different services Occupational Therapists

provide as well as contact information for local professionals. The educator will

provide any additional information he/she feels necessary at this time.

Closing Comments, Questions, What To Expect Next Time

The educator will close the session by answering any final questions from the

attendees. The educator will conclude with comments about the overall program as

well as reviewing what the goals and objectives of the night’s session were.

Information on what to expect during the next weeks session will be presented as

well as displayed on the PowerPoint. The meeting will dismiss at 9:00 pm.

28


Medical and Health

Elizabeth McDonald

Unit Agenda

Time Activity

7:00-7:10 Introduction to Instructor/Topic

7:10-7:30 Lecture Presentation

7:30-7:45 Activity 1: Parent Frustrations

7:45-8:00 Break

8:00-8:15Activity 2: Medical Terminology

Crossword

8:15-8:30 Activity 3: Medical Therapy Bingo

8:30-8:50 Review of Activities/ Discussion

8:50-9:00 Questions/ Preview of next week’s topic

29


Unit 3: Medical and Health

Elizabeth McDonald




Unit Goal: Upon completion of this unit of the program these parents of mentally

disabled children will be able to determine the best medical and health

interventions for their children as well as able to understand more in the depth

some of the common medical problems resulting from their child’s disability.

Unit Objectives:

Parents will individually identify their three major frustrations with the

medical field they deal with and how that affects their raising a child with

disabilities.

Parents will successfully be able to complete a crossword puzzle of common

medical terminology associated with their child’s disability.

Parents will successfully be able to play bingo over some common medical

therapies and health interventions their child may have to face in the future.

30


Creating the Learning Environment

Since this unit will be held in a classroom in Justin Hall on the Kansas State

University campus it will be important to set up an appropriate learning

environment for the parents. Setting up the room to facilitate openness within the

group as well as room to move around for active participation in learning is

something I think is very important. Often times medical talk can be very confusing

and also very cold and dry so I think living up the room with pictures and other

stimulating things would set a good tone for the class.

Introductions

Since this is the first time the class would be meeting me and having me

instruct them I would do a brief introduction. I would also go around the room and

have everyone introduce themselves because although they have had a few weeks of

class they may still not know each other’s names quite yet and this also gives me an

opportunity to get to know them for the first time. During these introductions I

would have each of the couples state their names, their child’s name, their child’s

intellectual disability and any other information that would like to share with the

class. While this is going on I would be sure to write down what each couple’s

disability was so I could better gear stuff for the class as a whole and for individual

couples when lecturing and discussing material. After these quick introductions I

would simply introduce the topic of medical and health and how it relates to their

children’s intellectual disabilities. During this time I would also present my goal for

this class period and the objectives that I would like for them to hopefully

accomplish by the end of our time together.

31


Lecture Presentation

The next part of the class would consist of a short PowerPoint presentation

put together by me, the instructor. My goal of having this presentation is to help the

parents better understand some of the medical terminology as well as the medical

and health interventions available for their child. The PowerPoint I am presenting is

merely there for visual aide and not meant to be the only source of the learning for

these parental couples. The vast majority of the information that I will be lecturing

on is straight from research that I have compiled on the subjects. During this time I

would suggest that parents take notes of some sort over the material because this

will be both helpful later on in the class as well as for future use as their child grows

up. To make sure the lecture is as interactive as possible I would show a term or a

group of terms to the class then ask the participants to raise their hand if they knew

the definition. This gives the parents an opportunity to express their understanding

of the material as well as learning new information or adding material to their

knowledge. I would start by first going through some common medical terminology

they may have already come across or may in the future with their child’s

disabilities. I would next go through some of the possible medical or health

interventions that they may also come in contact with due to their child’s

disabilities. With the interventions I would be sure to go through not only what the

interventions to but what the research says as far as the benefits and any risks if

there are any. At the end of my presentation I would give the class an opportunity

to quickly ask any questions or review any material before moving on.

32


Activity 1

To begin the active learning portion of this section of the program I would

start off with this first activity to get the ball rolling and to also fulfill one of the

objectives of the class. I would ask each couple to either individually or collectively

write down their top three frustrations or concerns with the medical field as it

relates to their child’s disability and health. See Appendix E for worksheet. Once

they are done I would ask that they go around the room and find at least one person

per frustration or concern that shares that same feeling and have them initial next to

it on their worksheets. This activity will hopefully get the parents to not only to

voice their frustrations and concerns but to also show them that they are not alone

in their thoughts and others share these ideas and feelings with them. Once

everyone has completed the activity we would come back together and discuss

briefly as a group what they learned and talk through some of those frustrations and

concerns together. We would then take a fifteen-minute break before continuing on

to the next activity.

Activity 2

Following the break we would jump right back into the class by doing

another active activity. This time the participants will complete a crossword puzzle

over the medical terminology we reviewed at the beginning of the class period. See

Appendix F for puzzle. I would give the class the opportunity to use their notes and

depending on the class’s choice I could leave a word bank up on the board in the

front of the room if they so choose. The first couple to accurately complete the

puzzle would get a prize so this hopefully gives the participants an incentive.

33


Activity 3

Upon completion of the crossword puzzle activity we would swiftly

transition to the next activity that has to do with medical and health interventions. I

created a bingo type of game that we parents would allow the whole class to

participate in actively. See Appendix G for bingo board. Each couple would have a

bingo board that has the names of different medical and health interventions we

reviewed at the beginning of the class period. As the instructor I would stand at the

front and randomly read off different definitions and if the couple had that

particular intervention on their board then they could cross it out. Similar to the

last activity the first couple to correctly get “bingo” would win a prize to keep the

activity fun and give participants an incentive.

Review of Activities/Discussion

This portion of the program would be designated solely towards allowing the

whole class to come together and review the information learned through the

activities. Collectively, we could review any information or material they wanted to

learn more about or did not feel they fully understood. I would also facilitate some

discussion over how this information is relevant to these parents’ lives and

specifically their child’s disability. During this time also, the parents have the

opportunity to discuss with each other about their situations to other couple’s and

hopefully relate to one another.

Questions/Preview of Next Week

This final portion of the program would be allotted for parents to have the

opportunity to ask any final questions they have. Finally, we would very briefly

34


introduce the topic for the following week would be so they could come prepared

with any questions they may have.

35


Problem Behaviors

Serena O’Connor

Unit Agenda

Time Activity

7:00-7:10 Topic Introduction

Give feedback on Survey’s from last session

Discuss the importance of being educated in

their child’s disability

7:10-8:10 Objective One and Two

Discuss the different risk factors that a child

might exemplify if they are at risk of exhibiting

problem behaviors

Explain Handouts

Go over different interventions techniques

8:10-8:20 Break

8:20-8:45 Demonstration and Role-play

Live demonstration of the Behavior Therapy and

Sensory Integrated Therapy

Get a partner and practice the Sensory

Integration Therapy and Behavior Therapy

techniques that are recommend for specific child

8:45-9:00 Questions and Survey

36


Unit 4: Problem Behaviors

Serena O’Connor

Overall Program Goal: The goal of this program is to provide parents of children

with intellectual disabilities with the education and skills to address issues of social

development, challenging behaviors, cognitive therapies and medical and health

issues.

Unit Goal: After completing this program the parents of children with intellectual

disabilities will have the knowledge and skills to educate their child to minimize

challenging and harmful behaviors.

Unit Objectives:

Participants of this program will be able to identify the two main risk factors

of later onset of challenging and harmful behaviors. The main risk factors are

children who display repetitive or impulsive behaviors.

The participants of this program will learn Sensory Integration Therapies

such as using weighted vest, swinging, or playing with sand. The parents will

also learn different Behavioral Therapy techniques and learn which

technique is the best fit for their child.

Participants of this program will have practiced these techniques enough

that they will be able to implement these interventions with their child

successfully.

The Basis for this Program Unit

37


1.5 million people in the world are affected by brain disorders, and this

number is predicted to increase as the life expectancy increases. Many brain

disorders affect development and learning abilities. Therefore many brain disorders

are considered developmental disabilities. Starting therapy and intervention

programs as soon as possible is extremely important especially for the child’s

developmental processes. This helps to avoid developmental delays, even though

some delays may be inevitable (Shin, Y. 2009).

Often time’s children with developmental disabilities display behavioral

problems. These behaviors can cause increased stress for the child specifically in

learning environments. This is why it is very important to implement behavior

programs and behavior therapy for children with disabilities who show signs of

behavior issues. Some of the common behaviors that are displayed in these children

are self-injury, aggression, tantrums, and hurting others. A study was done to test

the affects of educating these children with behavior problems to see if medical

intervention was more effective than behavior interventions. The results showed

that the children that had both medical interventions and behavior therapy at the

same time exhibited less problem behaviors as well as completed more tasks than

those that only had one or the other intervention. (Carr, E. G., & Blakeley-Smith, A.

2006). This shows the importance of both interventions.

About 40% of individuals with an intellectual disability display challenging

behaviors that lead to harming themselves or others. Many of these cases are minor

behaviors such as scratching or hitting but others exhibit behaviors that are

extremely harmful such as biting, punching, throwing objects. In some cases these

38


individual are moved to specialized residential placements (Oliver, C., Petty, J.,

Ruddick, L., & Bacarese-hamilton, M. 2012).

Since harmful acts of behavior are typically hard to control or minimize there

has been research that proves early intervention is the best way to tackle this issue.

Children who have a harder time with social connection in school tend to be more

likely to display these problem behaviors than those who have many friends in

school. Children who display repetitive and impulsive behaviors are at a higher risk

of showing signs of challenging behaviors as well (Oliver, C., Petty, J., Ruddick, L., &

Bacarese-hamilton, M. 2012). The point of this unit is to educate parents with

children of intellectual disabilities how to handle problem behaviors. This process

will be helpful for parents of the child, and the child with behaviors, such as: hitting,

biting, scratching, not obeying orders, throwing tantrums, difficulty with transitions,

difficulty in concentrating in school, and other.

Introduction to Program

The instructor of this program will begin by introducing him/herself to the

class and go over the objectives of the class. The instructor will have already looked

over the survey that was handed out at the last session and give the students

feedback. The feedback will either be answer questions from the survey that the

students had or it will be explaining how the instructor will implement their

questions or concerns into the program. The Instructor will also discuss the

importance of the parent’s involvement in the child therapy. The best way to

prevent challenging behaviors from escalading in the future is to intervene early

(Alkahtani, K. D. F. 2013). As stated earlier Positive behavior intervention and

39


support (PBIS) is an intervention technique that strongly encourages family

involvement. The parents will be encouraged to use behavioral techniques in

everyday life so that the child would have the opportunity to gain health habits

(Vrijmoeth, C., Monbaliu, E., Lagast, E., & Prinzie, P. 2012).

Objective One and Two of the Program

The instructor will then discuss the different risk factors that are associated

with challenging and harmful behaviors in children with intellectual disabilities. For

example a study that included 970 children with severe intellectual disabilities

concluded that those that exhibited repetitive behaviors, that seem to be out of ones

control, usually escaladed into harmful acts on themselves or others (Oliver, C.,

Petty, J., Ruddick, L., & Bacarese-hamilton, M. 2012). To better understand this

concept the students will be given two handouts. The first hand out is a concept

map that explains where the problem behaviors stem from and what the parents

can be helpful to minimize them. See Appendix I for handout. The other handout is

an example chart that is explaining a specific boys behaviors and what kind of

function he is seeking from those behaviors. See Appendix H for handout. This will

help the students understand their children’s behaviors and understand how they

can help minimize the problem behaviors.

Once the instructor feels the students have a good grasp of why children

exhibit the challenging behaviors they will begin to go over different types of

therapies that can help these behaviors. The two therapies that are explored in this

program are Sensory Integration Therapy and Behavioral Therapy. Sensory

Integration Therapy has been proven to be helpful because many times when a child

40


with an intellectual disability, is displaying challenging behaviors it is due to a

sensory issues (Devlin S. Healy. 2011).

The Instructor will then explain the many ways the parents could implement

Sensory Integration Therapy. The students will take turns using a scooter, weight

vests, preforming joint compressions and using body brushes. This will help the

parents understand how the sensations feel to their child and help them to acquire

the skills to preform them correctly. These simple tasks that could be preformed by

a professional or by a family member at home have been proven to effectively

enhance the child’s ability to focus in school, therapy, and social environments. SIT

also decreases the rate at which an individual would participate in self-injurious

behaviors along with harming others. The instructor will explain that these types of

sensory activities have been proven to help children focus in school, therapy and

social environments. One of SIT’s biggest benefits is that it increases cognitive

activity, specifically in language and reading skills (Devlin S. 2011).

Next the instructor will discuss the second approach, which is behavior

therapy. The basis of this approach is to use positive reinforcement and negative

reinforcement. An example of this type of therapy would be giving a child an

academic demand (such as complete this puzzle). The child would have 2 seconds

(possibly long depending on the child’s ability) to start the task. If the child

completed the task within the allotted time then he/she would be rewarded with a

tangible item that they prefer. If the child did not complete the task in the amount of

time then the command would be repeated and the child would be redirected to the

task until the task was complete. The child does not receive a reward until he has

41


completed the task. This is called an errorless learning procedure. The errorless

learning procedure reduces student’s mistakes by ensuring a high level of correct

responses (Devlin S. 2011). The Instructor of the program would then go through

some other Behavioral Therapy Techniques with the parents.

Break

The parents now receive a 10-minute break to go to the bathroom or to

review the material they have just learned so they can be prepared for the Role-Play.

Demonstration and Role Play

Once the students have returned from their break the instructor will bring in

a child (volunteer) to demonstrate a few of the behavioral therapy techniques that

were just learned. An example the instructor might demonstrate is a child who has

difficulty with transitioning from one activity to another. The technique being used

with this child is called Differential Reinforcement and Alternative Behaviors and

Extinction. The child would be given a toy or activity that he/she prefers to play

with for a couple minutes. After the allotted time is up he instructor would direct the

child elsewhere by saying something like “Let’s go sit over here.” If the child

complies with the demand without a fuss then the child will get the toy back

immediately. If the child shows signs of being aggressive the instructor will block

the blow, avoid eye contact with the child and redirect them in the direction he/she

was asked to go. After the child becomes aggressive he/she will not receive the toy

again. If after he/she becomes aggressive they then perform the task after being

asked again then he/she will receive a toy they like but that is less preferred than

the previous toy (Devlin S. 2011). After this demonstration the students will be

42


asked to pair up and role-play the behavioral therapy techniques they believe will

best benefit their child.

Questions and Survey

Once the students finish their role-playing they are free to ask any questions

or address any concerns they might have about their program or their specific

children. Before they leave they are asked to fill out a post program survey to see

whether or not the entire program met their expectations or not and what can be

done in the future to make the program as a whole better. See Appendix J for

survey.

Conclusion

43


The purpose of this program was to educate parents of children with

intellectual disabilities. Our hope was to teach parents about the social

development, learning techniques, problem behaviors, and mental and health

interventions that would benefit their children. Throughout the course of each unit

materials and activities were implemented in order to help apply the knowledge and

give the parents practice. A week before the program begins we would distribute a

survey asking what the parents want to learn from this program then give a follow

up survey at the conclusion of the last session asking if they were satisfied (See

appendix A and B). By having these surveys we hope to gain an understanding of

what the expectation of the parents are and to evaluate whether we met these

expectations or not.

Needs Evaluation

If more time were allotted for the program we would conduct an open

discussion session with the participants before the program began. This would be

beneficial so that we could learn to accommodate to any cultural or environmental

variations. Each participant might have different expectations for this program due

to these cultural or environmental differences and we hope to be able to achieve all

of these needs. We would attempt to accommodate these needs by formatting our

program to address their specified expectations. If needed we could implement

more time and private sessions with these specific individuals in order to confront

their individualize goals.

Input Evaluation

44


Our grogram is based off research about children with intellectual

disabilities. This information comes from all accredited sources such as special

education teachers, Occupational Therapist, Physical Therapist, Doctors,

researchers etc. All information that is used to enhance the program later will also

be accredited resources. This will ensure that the information we give to the parents

is valid. The program will ensure that any advances that are made in the future

about this topic will be implemented into our program in years to come.

Process Evaluation

In order to monitor the process of each unit we could offer a period of time

for the participants to voice their suggestions for improvement for upcoming units.

This would also help the effectiveness because we could make improvements as the

program progresses week by week. An example of this would be if a parent voiced

theirs and others attention span during the program. The following week the

educator could adjust the program in order to offer more breaks in hopes of

increasing the attention and satisfaction of the attendees. We hope to show the

parents that the educators are flexible and they value their opinions and needs.

Outcome Evaluation

A longitudinal study would be good option if the funds were available to

follow up on the participants. This would ensure that the program was successful

and that it achieved the overall goal. This study would ask similar questions to the

pre and post program surveys. This would measure the effectiveness of the program

and the amount of information that was useful over a long period of time. Through

this process we hope to discover what information was useful and what information

45


was not relevant. This would help ensure that the program would be successful in

the future because the unnecessary information would be eliminated. Including a

section that asks the feedback of the parents of what they wish they had learned

would be beneficial to later implement those issues. This would allow us to collect

data on what information was utilized through the parents and what information

was truly helpful.

There are a significant amount issues affecting parents of intellectually

disabled children. Our program has covered a large portion of the major issues

parents face, but as educators we still feel it is important to discuss a few more

looming topics such as: independency preparation, self-care of parent/caregiver,

and sexual education for special needs individuals. In order to function in society

individually, parents need to properly educate and provide resources for children

with intellectual disabilities. Parents need to implement a plan of action for the child

for when they are no longer able to care for them and the child is forced to be on

their own. A parent cannot properly care for an individual unless they are caring for

themselves as well. Providing information for parents on this topic may allow them

to feel more comfortable and enable them to take time apart from their child. Sex

education offered within the school system is not adequate for intellectually

disabled children, therefore providing education for parents to appropriately

address the issue with their child is essential to their overall health.

We believe this program will succeed in educating parents with intellectually

disabled children because our chosen topics have been specifically adapted to meet

the needs and expectations of the attendees. The information provided throughout

46


each unit is based on scholarly research and further measured to account for the

success level of the program as a whole. Without this program there would a large

amount of parent left in dark about how to help their children. Without parents who

are educated or that know what is best for their children, these children would

struggle immensely in academic and social tasks.

47


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Appendix A


Pre-Program Survey

1. As a parent what do you hope to learn from this program?

2. What topics do you feel would be most beneficial to learn about during the duration

of this program?

3. In order for the educators to best accommodate your needs of you and your child

please describe your child’s intellectual disability.

4. What is the age of your child? Also, please describe any active daily living struggles

that you encounter on a daily basis.

5. What is your biggest concern as a parent of a child with intellectual disabilities?

54


6. Please describe any negative or positive feelings you have regarding this class, if any.

Appendix B

Questionnaire

Give three incidences where your child was unable to express their emotions

Example #1- Hysterical

Example #2- Scared

Example #3- Hurt

55


Appendix C

Class Activity: Emotions

56


Appendix D

Pinwheel of Emotions

57


Appendix E

Frustrations/Concerns

Please write down three frustrations or concerns that you have with the medical field related to your child’s disability. After you have written down your thoughts

please find at least one person in the class to initial next each of your frustrations/concerns that they either also have written down or can relate to as

well! Good luck and have fun!

1. ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

___

2. ________________________________________________________________________________________

________________________________________________________________________________________

________________________________________________________________________________________

___

3. ________________________________________________________________________________________

________________________________________________________________________________________

58


________________________________________________________________________________________

___

See Appendix F

59

CHILDREN WITH INTELLECTUAL DISABILITIES 60


Appendix G

Appendix H

62

Medical Therapies and Health Interventions

Applied Behavioral

TherapyMusic Therpy Medications Physical

Therapy

Occupational Therapy

Responsive Prelinguistic Milieu

Teaching

Picture Exchange Communication

Systems

FREEBIEFree Space

Speech Therapy

Vitamin%2FMineral Supplements Diet Sensory

Integration

Play Therapy Massage Therapy Floortime Model Acupuncture


Appendix I

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Appendix J


Post-Program Survey

1. Did our program meet your expectations? How or how not?

2. What topics did we not cover that you wish we would have?

3. What information was most relevant to you and your child?

4. What did you enjoy most about the program?

5. What did you dislike about the program?

6. Do you have any further suggestions for our program in the future?

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