學習/發展及行為問題
Learning, Developmental and Behavioral Problems

學習/發展及行為問題 Learning, Developmental and Behavioral Problems
  1. 過度活躍症
  2. 尿床
  3. 聽覺問題
  4. 學習障礙
  5. 自我傷害
  6. 睡眠問題
  7. 視力問題
  1. Attention Deficit Hyperactivity Disorder
  2. Bed-Wetting
  3. Hearing Problem
  4. Learning Disability
  5. Self Harm
  6. Sleep Problem
  7. Visual Problem

過度活躍症

在幼兒期間始發並持續到成年時期,在家庭,學校,工作,甚至社會引起一連串問題的症候群

6-12 歲會有以下徵狀
  1. 注意力不集中
    • 短暫的注意力時間
    • 心思分散
  2. 衝動性
    • 行動前不會想清楚
    • 難予抑制
    • 影響他人或沒有想過結果就行動
  3. 過度活躍
    • 講話太多
    • 坐立不安
    • 用手撥弄任何他們接觸到的東西
    • 和其他人玩耍會有困難

被懷疑有活躍症的小童應該要轉介到專科醫生評估及治療。藥物及行為糾正都有幫助。

給老師們的貼士
  1. 對待那些注意不集中的學生
    • 讓他們坐到比較前排的座位
    • 安排他們坐到一位品學兼優的同學隔離,產生同伴影響
    • 把功課分為幾部份,每次只給予其中一份之功課
    • 用一些訊號來令小孩子再集中注意,例如:拍拍他的膊頭,敲一敲他的檯等
    • 給小孩指示之前,與他有眼神接觸
    • 給予短及直接的指示
  2. 對待那些衝動性的學生
    • 略過一些輕微的不適當行為
    • 立即提醒他一些即時的不良後果
    • 監察在課室或活動之間的變化
    • 在可行的情況下,告知他正確的行為
    • 和小孩建立一個需要監管的行為的合約
  3. 過度活躍
    • 容許小孩不時站立
    • 容許他做跑腿
相關網址

尿床

  • 只會在晚上睡覺時尿床,而不會在日間出現
  • 不需要在5歲前治療
  • 患病率:百分之十的男孩在五歲前有尿床,百分之三的男孩在十歲前有尿床(女孩比較少)
給家長的建議
  • 通常問題會隨著孩子成長而消失,可以考慮在六歲之後才治療
  • 不要責備,批判或懲罰小孩
  • 讚揚所有改善的跡象
  • 不需要限制小孩每日日間的水份量
  • 避免飲用一些有咖啡因成份的飲品
  • 在睡覺前2至3小時避免飲用任何飲品
  • 臨睡前先去洗手間
  • 使小孩容易行到洗手間(例如長開一盞燈)
  • 不需要叫正在睡覺的小孩起身去洗手間
  • 當換完床單後,鼓勵小孩子回到自己睡床
  • 把尿床及不尿床的日子紀錄下來,可以用獎勵方法鼓勵沒有尿床的日子(例如給星星貼紙)

聽覺問題

衛生署轄下的 50 個母嬰健康院都會為 5 歲以下的小童提供幼兒健康及發展綜合計劃,計劃會在三個關鍵的年歲,分別是 3 個月大、6-9 個月大及 3 歲,觀察他們的身體及心理成長。有些母嬰健康院亦會提供聽力普查。因此,大部份先天的問題都可以在入學前被發現。

後天失聰的原因
  • 耳垢
  • 耳朵受感染﹝中耳炎﹞
  • 外來物件塞在耳朵
  • 小童時期的疾病﹝腦膜炎、猩紅熱、腮腺炎﹞
  • 小童時期曾受傷﹝頭骨骨折、頭部或耳部曾受撞擊,曾聽過過大的聲音及曾有異物意外地進入及破壞了耳部結構﹞
我們怎樣知道小孩有聽覺問題?
  • 幼稚園 (2-6 歲)
    • 觀察學生的行為變化便可提示是否有聽覺問題:
      1. 對於「把球放在桌上」這類指令,小孩有沒有跟著指示做呢?
      2. 小孩有沒有留意到電話聲、電視聲及敲門聲呢?
      3. 留意語言發展遲緩
    • 處理方法
      1. 請家長在家裡留意小童的行為變化﹝例如:聽到巨響或家長的聲音,沒有反應及懷疑語言發展遲緩﹞
      2. 請家長帶小童到政府門診或見私家醫生,由醫生轉介小童去進行聽力測試
  • 小學 (6-12歲)
    • 衛生署的學童保健計劃提供聽覺及視力測試給小一學生,及每年為所有小學及中學生提供健康評估。
    • 當發現有發展延誤的時候,要轉介到衛生署或醫院管理局轄下的兒童測試中心,教育署的特別教育服務中心或適合的專家去確定診斷及跟進處理。
    • 處理方法
      1. 教育統籌局提供教師一個觀察一覽表去查核小學生有沒有言語問題和嚴重學習問題障礙。
      2. 請家長在家裡觀察小童在家裡的任何行為變化,例如:小童對大的聲音有沒有反應或對家長的聲音有沒有反應。
      3. 請家長帶小孩子到門診見醫生,及轉介小孩去進行聽力測試。
相關網址

學習障礙

學習障礙是一個或多個理解口語或書寫語文的基本過程出現問題。它表現出一個人在聆聽、思考、說話、閱讀、寫作或串字,或者計數能力方面的障礙﹝儘管有一般的智力﹞。

閱讀問題﹝閱讀困難﹞
  • 一種特別的學習障礙
  • 特點是對準確和/或流暢的認字有困難,以及串字及解碼的能力差
  • 儘管有一般水準或高於一般水準的智力,但只有低於該年紀應有的閱讀及寫作能力
  • 如果文本是讀給他們聽,他們的理解是完整的
  • 引身出來的後果可能包括閱讀理解方面有困難及減少閱讀的經驗,這些都阻礙他/她的詞彙及背景知識的增長
  • 這個問題會在小孩入學後才被發現
幼稚園的先兆症狀
  • 語言發展遲緩
  • 4歲仍不懂得讀童謠
  • 對左右、上下、前後及其他方向性的字眼及概念分辨有困難
  • 對認字母,讀字母或順序寫字母三方面會有困難
入學之後,小孩可能會出現
  • 學習新的中文和英文字都有困難
  • 在學習閱讀、書寫及串字方面都有困難
  • 手寫書法差及拿筆方法差
  • 工作時組織能力差,例如:家課處理

如懷疑有以上問題,小孩應該被轉介到教育心理學家去進行評估。及早的訓練可以有效地影響該小孩的生活質數

診斷
  • 不可以用單一測試去成功診斷
  • 懷疑有該問題的小孩應被轉介到特別中心去進行評估
  • 經過完整的心理及語言的測試,才可確定診斷
處理方法
  • 因為挫敗及缺乏效率,所以對做功課或上課產生嫌惡都是一種自然反應。
  • 治療的目的是希望可以減少焦慮,避開障礙,在沒有學習障礙的範疇多作練習及預備輔導的課程。
  • 由家長、小孩、學校心理學家、兒科醫生、輔導員、特殊教育老師及行政人員組成的小組可以合力發展一個程序來幫助這些小孩。
  • 老師們可以幫助建立一些適合這些小孩能力的功課及補習。例如:減少抄寫工作、考試時可以以口試發問及作答。
轉介
  • 在教育統籌局的協助下,每間學校都會有一個系統去幫助有學習障礙的小孩,老師可以直接轉介小孩到該系統。
  • 如果兒科醫生發現一位小孩有該問題,他/她可建議父母到小孩學校見學生輔導主任,再替其轉介到教育專家去詢求意見。
  • 如果該小孩有多個發展領域的問題,便可轉介他/她到兒童評估中心或社區其他中心,讓他們的專家小組解決問題。
特別教育資源中心

學校教師、家長或專業人士如想轉介一個學習有障礙及過度活躍的孩子接受特殊教育服務的問題,他們可以到以下服務中心查詢。

  1. 香港區:
    香港北角渣華道 323 號 3 樓
    北角特殊教育中心
    電話:2760 6101
    傳真:2744 5315
  2. 九龍區:
    九龍何文田巴富街 6 號
    巴富街特殊教育中心
    電話:2307 6521
    傳真:2711 9644
  3. 新界區:
    新界葵涌麗祖路 77 號 4 樓
    下葵涌特殊教育中心
    電話:2307 6521
    傳真:2744 5315
相關網址

自我傷害

簡介
  • 自我傷害在青少件時期是一個普遍現象
  • 在英國有百份之六點九的十五至十六歲青少年曾在過去有故意做出自我傷害的行為
  • 嚴重性由輕微損傷至永久身體上的破壞或致命傷害
自我傷害的方法
  • 切傷
  • 燒傷
  • 撞頭
  • 吞物件
  • 自我閉氣至窒息
  • 服毒
原因
  • 逃避不可遏止的情緒
  • 舒緩緊張
  • 懲罰自己
  • 向其他人顯示他/她有難以形容的情緒痛苦
處理方法
  • 轉介到精神科醫生、臨床心理學家及社工等進行評估及輔導。

睡眠問題

發惡夢
  • 減少發惡夢的建議:
    • 減少壓力
    • 在睡前最少一小時避免看電視
    • 避免在睡前聽一些恐佈的故事
    • 開著夜燈睡覺
    • 鼓勵小孩在第二天講述有關惡夢的內容
  • 如果小孩有以下情況,就應和專家商量:
    • 惡夢會影響小孩的日間性格及行
    • 小孩感到巨大壓力及看似非常焦慮
    • 發惡夢次數增加
夢遊
  • 小孩在這情況時是沒有醒來及不知道當時發生甚麼事情
  • 不需要叫醒小孩, 但要確保他/她不會傷害自己
  • 在經常起來時間前叫醒他們可以減少夢遊
阻塞性睡眠窒息
  • 睡眠窒息的徵狀:
    • 每夜的鼻鼾聲都很大
    • 當睡眠的時候,時常都有呼吸暫停的情況出現
    • 日間時常渴睡及很易入睡
    • 難以集中精神,生產力低及難以完成工作
    • 急躁,易發脾氣,尤其在起床的時候
  • 如懷疑小孩有阻塞性睡眠窒息,就要帶小孩看醫生
  • 相關網頁:

視力問題

大部份小孩在出生至五歲其間都會到母嬰健康院進行視力測試,,而在香港的小孩中,最常見的眼睛問題包括有弱視、斜視及近視。如及早發現,有些視力問題是可以治療的,而偏離正常的視力發展是可以用眼鏡或視力訓練改善

我們怎樣知道小孩子有視力問題?
  • 不正常的眼球位置
  • 當小孩抄書的時候,檢查抄漏字或抄錯字的情況有沒有增加
  • 當抄寫黑板的時候,小孩的姿勢有沒有不斷傾前或出現眼距縮窄
  • 小孩投訴閱讀困難
  • 在閱讀之後,小孩會投訴他/她有頭痛現象
處理方法
  • 請家長帶小孩到私家醫生,政府門診或香港理工大學的眼科視光學診所檢查眼睛
  • 把小孩調到一個容易閱讀及抄黑板的座位
  • 如果有急症,例如突發失明,嚴重眼痛,請立即送小孩到急症室
相關網址
  1. 香港理工大學眼科視光學診所
  2. Children with Special Needs
  3. Singapore Association of the Visually Handicapped

Attention Deficit Hyperactivity Disorder (ADHD)

A group of symptoms that begin in early childhood and can continue into adulthood causing difficulties at home, at school, at work and within the community

Diagnosed at the age of 6-12 with the following symptoms
  1. Inattention:
    • Short attention span
    • Distractible
  2. Impulsiveness
    • Act before thinking
    • Difficult to inhibit responses
    • Interrupt others or act without thinking of consequences
  3. Hyperactivity
    • Talk excessively
    • Fidget
    • Fiddle with anything within reach
    • Difficult to play with others

Suspected children should be referred to specialist for assessment and advice. Medication and behavioral modification can help.

Tips for teachers
  1. For inattentions
    • Seat the child near front
    • Seat the child near the good role model who can be a peer study buddy
    • Cut assignment into segments and give the child one segment at a time
    • Using cues to regain the child's attention (eg touching shoulder, tapping desk)
    • Establish eye contact before giving instruction
    • Give short direct instructions
  2. For Impulsivity
    • Ignore minor inappropriate behaviors
    • Remind immediate bad consequences
    • Supervise transition between classes or activities
    • Acknowledge positive behaviors when possible
    • Set up contract for behaviors that need monitoring
  3. For hyperactivity
    • Allow the child to stand at times
    • Allow running errands
Useful Websites

Bed-Wetting (Nocturnal Enuresis)

  • Wet bed only at night during sleep, not during daytime
  • Treatment before the age of 5 not necessary
  • Prevalence: 7% boys at 5 years old and 3% boys at 10 years old (girl less frequent)
Advice for parents
  • Usually outgrow the problem, treatment may be considered for children older than 6 years old
  • Do not blame, criticize or punish the child
  • Praise all signs of improvement
  • No need to limit a child's fluid intake during the day
  • Avoid drinks that contain caffeine
  • Do not drink within 2 to 3 hours of bedtime
  • Visit the toilet before going to bed
  • Make it easy for the child to reach the toilet - leave a light on
  • Lifting a sleeping child to toilet not recommended
  • Encourage the child to return his own bed after bedsheet changed
  • Record wet and dry nights. Reward dry nights (e.g. keep star chart)

Hearing Problem

Child health and developmental surveillance is offered to all children from birth to 5 years of age, by the Department of Health through its 50 Maternal and Child Health Centers. Comprehensive Observation Service (COS), at three key ages: 3 months, 6-9 months and 3 years to monitor their physical and psychological developments. Some MCH also offer Otoacoustic automatic emissions system (OAE) hearing test for their clients. Therefore, most of the cases due to congenital causes can be screened out before school.

Possibilities of hearing loss due to non-congenital causes
  1. Earwax
  2. Ear infection (Otitis Media)
  3. Objects in the ears
  4. Childhood diseases (Meningitis, Scarlet fever, Mumps)
  5. Childhood injuries (Skull fracture, sharp blow to the head or ears, loud noise exposure, and items accidentally inserted into ears resulting in damage).
How can we know the child has hearing problem?
  • Kindergarten (2-6)
    • Access the change of student's behavior might indicate a hearing loss, e.g.
      1. Does the child follow requests such as "get the ball and put it on the table"?
      2. Dose the child notice sounds such as telephone ringing, TV sound and knocking at the door?
      3. Pay attention to any speech delay
    • Management
      1. Ask parents to observe for any behavior changes at home (such as child doesn't startle to loud sounds or respond to your voice, suspect speech delay).
      2. Tell the parents to bring the child to see a private doctor or GOPD to have a referral for ENT examination and hearing test.
  • Primary school (6-12)
    • The Student Health Service of the Department of Health provides hearing and vision screening for primary one students and an annual health assessment for all primary and secondary school students.
    • When developmental delay is detected, referral to child assessment centers of the Department of Health or the Hospital Authority, special education services centers of the Education Department or appropriate specialists will be made for confirmation of the diagnosis and follow-up management.
    • Management
      1. The Education Department provides Observation Checklist for teachers to identify primary pupils with speech problems and severe learning difficulties.
      2. Ask parents to observe for any behavior changes at home such as child doesn't startle to loud sounds or respond to your voice.
      3. Ask the parents to bring the child to see a private doctor or GOPD to have a referral for ENT examination and hearing test.
Useful web sites for hearing impairment
  1. Children's Hearing Foundation (Helping Deaf Children Learn to Listen and Speak)
  2. Taiwan Provincial Taichung School and Education Resource for the Deaf
  3. Auditory-Verbal International
  4. British Association of Teachers of the Deaf
  5. Oral Deaf Education
  6. American Speech-Language-Hearing Association (ASHA)

Learning Disability (LD)

Learning Disability (LD) is a disorder in one or more of the basic processes involved in understanding spoken or written language. It may show up as a problem in listening, thinking, speaking, reading, writing or spelling, or in a person's ability to do maths, despite at least average intelligence.

Reading disorder (Dyslexia)
  • A specific learning disability
  • Characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities
  • It results in below-age reading and written language development despite average or above average intelligence
  • Comprehension of these children is intact if the text is read to them
  • Secondary consequences may include problems in reading comprehension, and reduced reading experience that can impede growth of vocabulary and background knowledge
  • It is detected after a child begins school
Kindergarten warning signs
  • Delayed speech
  • Inability to rhyme by age 4
  • Confusion over left versus right, above versus below, before versus after, and other directionality words and concepts
  • Difficulty learning the names of the letters or sounds of the alphabet, difficulty writing the alphabet in order
After entry into school, the child may have
  • Difficulty in learning new words in both Chinese and English
  • Difficulty in learning to read, write and spell
  • Poor handwriting and pencil manipulation
  • Poor organization of tasks such as home work management

The child should be referred to education psychologist for assessment if suspected to have the problem. Early training can make a significant difference in the quality of life of the child.

Diagnosis
  • Cannot be diagnosed using one single test.
  • Suspected children should be referred to special centers for evaluation.
  • Diagnosis can be made with full psycholinguistic assessment.
Management
  • Aversion to homework or school is a natural response to frustration and lack of efficacy
  • Aim of treatment is to reduce anxiety, circumvent the handicap, practice areas without disability and prepare a remedial program
  • Multidisciplinary team with parents, children, school psychologists, pediatrician, counselors, special education teachers and administrators can develop program to help these children
  • Teachers can help to develop approaches to homework and remedial work that are consistent with the child's ability. Examples include: less copying tasks; having examination questions given and answered orally.
Referral
  • Every school has a system, supported by Education Department, helping children with learning difficulties. Teachers can directly refer the child to the system.
  • If pediatrician encounters a child with this problem, parents are advised to approach the student guidance personnel in the child's school and through them to seek further education specialist's advise as indicated.
  • For children whose problems involve multiple developmental areas, they can be referred to CAC (Child Assessment Center) or to other centers in the community that have multidisciplinary teams to cater for these problems.
Special Education Resource Center

School teachers, parents or professional workers who wish to refer a child with ADHD, specific learning disorders or other disorders to special education service can write to the service center located at:

  1. Hong Kong:
    North Point Special Education Service Center, 3/F, 323 Java Road, North Point, Hong Kong
    Tel No.: 2561 3441
    Fax No.: 2516 7854
  2. Kowloon:
    Perth Street Special Education Services Center, 6 Perth Street, Homantin, Kowloon
    Tel No.: 2760 6101
    Fax No.: 2711 9644
  3. New Territories:
    Ha Kwai Chung Special Education Services Center 4/F, 77 Lai Cho Road, Kwai Chung, NT
    Tel No.: 2307 6251
    Fax No.: 2744 5315
Useful Websites

Self Harm

  • Self-harm is common among teenagers
  • In England, 6.9% of 15-16 year olds reports carrying out a deliberate act of self-harm in the previous year
  • Severity varies from mild to causing permanent physical damage or life-threatening danger
Types of self-harm
  • Cutting
  • Burning
  • Head banging
  • Swallowing objects
  • Self suffocation
  • Self poisoning
Underlying reasons
  • Escape from overwhelming emotions
  • Release tension
  • Punish one-self
  • To show others the emotional pain which cannot be expressed in words
How to handle?

Refer to psychiatrist, clinical psychologist and social worker for assessment and counselling

Sleep Problem

Nightmares
  • Advice to decrease nightmares
    • Decrease stress
    • Avoid television at least an hour before bedtime
    • Avoid telling scary bedtime stories
    • Sleep with a night light
    • Encourage to talk about the nightmares on the next day
  • Consult professional if
    • Nightmares associated with changes in daytime personality or behaviour
    • Under lots of stress or seems very anxious
    • Increasing nightmares
Sleepwalking
  • The child is not awake and not aware of what he/she is doing
  • Not necessary to wake the child up but make sure he/she cannot hurt him/herself
  • Wake him/her up before the time he/she typically wakes up can disrupt the cycle and decrease sleepwalking.
Obstructive Sleep Apnoea
  • Symptoms of sleep apnoea
    • Snoring loudly each night
    • Frequent pauses in breathing during sleeping
    • Daytime sleepiness and fall asleep easily
    • Difficulty in concentrating, being productive, and completing tasks at work
    • Irritable and angry, especially first thing in the morning
  • Consult doctor for assessment if obstructive sleep apnoea is suspected
  • Related Website:

Visual Problem

Most children have their visual screening in Maternal and Child Center from birth till 5 years old. The most common eye problems that children might have in Hong Kong are amblyopia (lazy eyes), strabismus (deviating eyes), squint and myopia (shortsightedness). Some vision problems that are detected early can be treated before any loss of vision occurs. Deviation from normal development can often be corrected with glasses or vision training.

How can we know if the child has visual problem?
  • Abnormal eye alignment
  • Check the writing of the child for any increased missing or wrong spelling during copying
  • Posture changes such as narrowing the eyes, trunk lean forward when doing some blackboard copying
  • Child complaint of difficult in reading
  • Child may complaint of headache after reading
Management
  • Ask the parents to take the child to have a visual examination either by private physicians, in GOPD or in optometry clinic of the Hong Kong Polytechnic University.
  • Rearrange seat for the child for easy reading and copying the blackboard
  • If emergency, such as sudden loss of vision, severe eye pain, please send the child to A&E department
Useful Website
  1. The Hong Kong Polytechnic University Optometry Clinic
  2. Children with Special Needs
  3. Singapore Association of the Visually Handicapped