A careful analysis of the child should be undertaken. Observe very closely and record any possible areas of concern. Further information on Educational Observations for Teachers
The analysis should include:
Attention Span (short)
A child with hydrocephalus may present with difficulties with attention e.g. may become restless and easily distracted. This can be attributed to a number of different reasons such as difficulties in other areas of learning, e.g. visual perception, memory, motivation, etc.
Child may appear forgetful and misses the point of questions and explanations. There may be difficulty in remembering instructions. Visual memory difficulties hinder copying from the whiteboard successfully.
A child with hydrocephalus may present with difficulties in visual-motor skills and visual spatial awareness.
The child may require a verbal prompt or stimulus to get started. Other innate difficulties, e.g. poor hand function, short-term memory, poor hand-eye coordination, and poor eye-scanning ability may prevent successful achievement of tasks.
Ability to Generalise
Difficulties in reasoning, affects a child’s ability to form concepts and generalise. The child may be unable to use knowledge gained in one area and transfer it to another area, e.g. translating mathematical concepts to concrete examples. A child with specific difficulties in sensory or motor organisation will display poor reasoning ability.
Due to hydrocephalus, the brain can have difficulty processing information quickly, efficiently and in sequence. A child may have a difficulty in remembering a sequence of tasks; a number of instructions, e.g. Get your pen and copy book out, turn to page 5 and count how many dogs there are on the page. The child may have difficulty in making prompt decisions. Comprehension may be poor due the child’s inability to sequence what is said correctly.
Concept of Time and Speed
Words like ‘yesterday’, ‘tomorrow’, or ‘hurry up’ may hold no meaning to a child with hydrocephalus. Due to this lack of understanding children may require more time to complete tasks and tests.
Children with hydrocephalus may display poor manual dexterity and immature arm movements. As a result more practice and teaching will be required as hand function does not improve with age and will require assiduous teaching.
Unlike their peers, a child with hydrocephalus may present with underdeveloped skills and under performance generally in relation to tasks such as pencil and paper tracing, free-hand drawing, and copying from the whiteboard. Their work may resemble that of a considerably younger child and will benefit from focused training in this area.
Children with hydrocephalus may have difficulty in acquiring good writing skills, this may be due to visuo-motor, visuo-perception, and visuo-spatial difficulties such as wiring become a tedious task.
Because of difficulties in making spatial judgements, letters may be too widely or narrowly placed in relation to each other. Letters may be badly formed, sometimes reversed. Spacing and size of words and letters are uneven and writing may be badly aligned. As such, a considerable amount of practice in letter formation will be required.
Discourage ‘pattern copying’ when teaching writing skills as transferring this skill to regular writing will hold its own difficulties, particularly if the child has difficulty in their ability to generalise and with visual perception. As a number of children with hydrocephalus are left-handed they may require a lot more guidance and support when learning to write. In order to help a child with poor handwriting, identify the underlying reason for the difficulty: (a) hand function, (b) visual perception, (c) poor memory, sense direction or sequencing, (d) concentration.
Children with hydrocephalus can present with exceptional skills in certain aspects of number work and then much poorer levels in other areas. Poor visuo-spatial ability can make it harder for them to arrange the figures in the appropriate columns or they may have difficulty in setting out written sums.
Their ability may be affected by (a) visual perceptual difficulties (b) left to right discrimination (c) frequent hospitalisation (d) poor attention span (e) poor eye-scanning and (f) poor memory organisation (difficulty in identifying the correct digits on which to carry out computations).
Progress in number work may also be hampered by reading and writing skills. It is important to identify the areas affected quickly so that appropriate preventative or remedial action can be taken.
Further Strategies to help with Classroom Learning
Early identification is the most important tool for overcoming learning disabilities. In the best-case scenario, the child with hydrocephalus will have undergone comprehensive evaluation by an experienced neuropsychologist, preferably in the preschool years. In reality, however, many children receive only adequate to insufficient evaluation from a tester who is not experienced with hydrocephalus or with the more complex issues involved.
Task analysis - breaking an activity into smaller, achievable steps - is an excellent strategy. Using strengths (especially verbal) and allowing alternate means of expression (such as a tape-recorder or a computer) can be very helpful. Motivation is also key.
Physical disability may affect behavioural and emotional development. Children may appear less mature and anxieties, tensions and frustrations are often concealed. Children may react to such emotions by appearing ‘passive’ in nature.
Children with hydrocephalus often exhibit behaviours that are mistakenly attributed to disruptive tendencies. If the child’s behaviour deteriorates rapidly, think shunt; if the onset is insidious, it is likely to be due to the problematic behaviour caused by the hydrocephalus.
Further Strategies to help with Behaviour, Social and Emotional Issues
It is extremely important for the social and emotional issues simply to be acknowledged. They can then be better defined through testing and included in the child’s IEP. Early intervention is absolutely crucial. Even if a child does more or less catch up with her peers, it will probably happen over time and some skills may always be missing.
The first step is a neuropsychological evaluation by an experienced neuropsychologist, this evaluation can pinpoint areas of deficiency and identify the necessary strategies.
Practice Makes Perfect
Parents and teachers can help children with hydrocephalus learn more effective social skills by talking about social rules and playing games in which children guess the feelings that go with facial expressions and tones of voice, and figure out appropriate responses.
For some children, it may help to write out scenes describing new, or even everyday, social interactions, so that they can learn what is expected of them. In rehearsing these scenarios, they can also learn what kinds of phrases and emotional responses are expected of them.
Some children with hydrocephalus may develop early puberty. It is seen more often in girls than in boys. Preparation of the child for the onset of periods and sexual development needs to be handled sensitively.
Many parents and teachers worry that if a child with hydrocephalus joins in with the games and sports that their friends enjoy, then damage to the shunt is likely to follow. Shunts are, in fact, difficult to break or dislodge and most sports - with few exceptions - should be encouraged.
If a child has a physical disability associated with paralysis and skin sensitivity, please be vigilant with the following in the classroom and school environment.
Children with paralysis will not feel pain in the area of their paralysis and therefore should not sit next to a radiator as this may burn them and because of paralysis they will not feel their skin burning.
Likewise if a child falls and breaks a bone, this may not be felt and should be assessed by medical personnel or first-aid staff to ensure no break has occurred. Hot items such as laptops left on laps can also cause skin damage and severe burns if left for long periods.
Common sense should prevail and children with a physical disability should not be discriminated against or treated differently because of their paralysis. It is the responsibility of school personnel to ensure the safety of their pupils in a way that does not exclude them.