Developing Relationship - Case Study Example

 Developing Relationship Health Children Project (n.d.) defines the term learning disability (LD), “A disorder in basic psychological processes involved in understanding or using language, spoken or written, that may manifest itself in an imperfect ability to listen, think, speak, read, write, spell or use mathematical calculations. The term includes conditions such as perceptual disability, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.” A learning disability must be diagnosed and there are many professionals who are involved in the diagnosis of this disorder. People who work in the specialised areas of speech and language, such as educational specialists and psychologists, are involved in the diagnosis of LD. A professional who can diagnose LD must have the required license and credentials. (Kidder, 2002.) Although a variety of professionals can be involved in the pronouncement of the disorder, the roles and ability to diagnose varies. A clinical psychologist can diagnose LD by providing a thorough psycho/educational testing, or a clinical assessment of the intellectual and emotional functioning of the individual or groups. He/she also provides therapy for those with behavioural and emotional problems. He/she can also diagnose by including an educational assessment by an educational specialist because this specialist cannot deliver the educational testing that is necessary in the diagnosis of LD. A psychometrist, according to Neale (2006) is “a person who has received training in psychology or related field with an emphasis in tests and measurement. The basic function of a Developing Relationship 3 psychometrist is to administer and score psychological tests under the direct supervision of a clinical psychologist. Psychometrists work both in inpatient and outpatient settings. An important goal of the psychometrist in the assessment process, is to determine a patient’s optimal level of performance on a particular battery of tests. In addition to test administration, it is typically the role of the psychometrist to establish rapport with the patient and to structure the assessment to motivate the patient in order facilitate the goal of optimal performance.” A neuropsychologist specialises in the study of brain behaviour relationships. Anatomy, pathology, and physiology are areas of extensive training for a neuropsychologist. Neuropsychologists study brain behavior relationships under very specific circumstances which are both controlled and standardized. As a general rule, this means using tests which have been validated and which have been shown to have acceptable levels of sensitivity and specificity. (What is a Neuropsychologist?, n.d.) An educational psychologist offers his/her patients educational testing. Some are qualified intellectual functioning assessment. If they are not qualified to do these assessments, then they must work with a trained school psychologist or use the results of a PhD level psychologist and use his/her assessment results. There are different levels of LD. Those with profound disability require help with every aspect of daily living. Physical difficulty and communication problems may also afflict those with profound disability. Those with a severe learning disability need lots of assistance in Developing Relationship 4 daily living. Like those with profound disability, physical and communication difficulty may or may not exist. Less daily living assistance is needed by those with a moderate LD. However, they may need help in coping with social and emotional issues. Those with a mild LD usually need little or no assistance. (Levels of Learning Disability, n.d.) This writing shall focus on the case of a female subject, age 21, with a mild to moderate level of LD. She has also been diagnosed with epilepsy and Specific Learning Disability (SLD). She is being cared for by her family as she lives in her parents’ home. According to SLD: Need for Special Education (n.d.) the criteria for SLD includes: Oral Expression Listening Comprehension Written Expression Basic Reading Skill Reading Comprehension Mathematics Calculation Mathematics Reasoning Developing Relationship 5 are considered to provide “regular” care for someone with LD. Caring for Someone with a Disability (2006) states that to be considered substantially caring for someone means that “people should be carrying out a range of tasks, like practical help (going shopping, doing housework) personal care (helping them get washed and dressed) and emotional support. By 'regularly' we mean that usually, people should be caring for around 20 hours a week or more.” The 21 year old LD patient for this case study also has epilepsy. The National Institute of Neurological Disorders and Stroke (2006) defines epilepsy as “Epilepsy is a brain disorder in which clusters of nerve cells, or neurons, in the brain sometimes signal abnormally.” She also deals with her weight problem and women’s heath issues as well as emotional health/behaviour. Along with the issues of LD, the risk factors of being overweight is of concern and something that those who care for the LC patient must also address. Overweight and Obesity (2001-2004) reports, “Overweight and obesity substantially raise the risk of illness from high blood pressure, high cholesterol, type 2 diabetes, heart disease and stroke, gallbladder disease, arthritis, sleep disturbances and problems breathing, and certain types of cancers. Obese individuals also may suffer from social stigmatization, discrimination, and lowered self-esteem. Obesity is a result of a complex variety of social, behavioral, cultural, environmental, physiological, and genetic factors. Efforts to maintain a healthy weight should start early in childhood and continue throughout adulthood, as this is likely to be more successful than efforts to lose substantial amounts of weight and maintain weight loss once obesity is established.” Developing Relationship 6 Learning Disability Support Call (2006) states that a survey suggests, “Seven in 10 families caring for someone with severe learning disabilities are close to or has reached breaking point.” The article also reports that councils are not legally required to relieve families of LD patients of responsibilities, not even for a few hours. The article quotes Adams (2006) who cares for an 18-year old grandson, “I have a feeling of permanent tiredness. It has affected my marriage, health, socialising, my thinking - you are constantly living not your life, but the life of somebody else. I can't carry on much longer and I shouldn't have to." These issues can also be problems for the carers, or caregivers. The good news is that these factors can be controlled and in exercise and activities that help prevent and minimize emotional, physical, and women’s health issues can also combat social issues. Physical activities and games can be performed in social settings. By combining physical activity in a social setting (also balanced with solo exercise such as walking, jogging, etc.) can provide the supportive environment that is crucial for the mental and physical health of our case study LD patient, others with LD, and those who provide their daily care. (O’Donnell, 2004.) Relationships can be hindered not only due to the physical, emotional, and financial burdens involved in caring for a family with LD. Relationships can be hindered due to the inability of communication, self expression, and understanding (interpreting). Pockney (2006) suggest various Developing Relationship 7 solutions to these problems, “visual cues and practical activities such as the use of photographs, diaries and life-maps were used to assist the participants to express their views. The second phase of the research involved a period of service user observation and on-going discussions. Observation and discussions took place in tandem, at times and in settings that participants engaged in social interactions. Discussions were conducted pragmatically to take account of the individual research participant's needs and abilities and additional visual cues were used to facilitate communication.” It is crucial that healthy relationships be formed for those with LD and this is not due to increased proximity, activity, and conformity. Those who counsel and assist the families of individuals with LD and the LD patients themselves should not focus on the amount of social time and activities but on the quality of the relationships that they cherish. It is also important that those with LD be able to spend time with those they care about in their location of choice. (Pockney, 2006.) The environment for an individual with LD and those who care for that person should be one that is healthy and safe. Recognising hazards, warnings, following guidelines, having an emergency plan (in case of fire, tornadoes, and other natural disasters; in case of an accident, etc.), proper placement of items, and caution in cooking and chores are just a few things that will make the environment a healthier, happier, and safer environment. Good communication skills, learning how to disagree, and how to handle conflict are ways to provide an environment that will encourage good mental and emotional health for all. (Safe, Healthy Learning Environments, n.d.) Developing Relationship 8 The carers of those with LD will need advocacy, empowerment, and good communication skills on behalf of their family member(s) with learning disabilities. The carer, or caregivers, will initiate contacts with and works co-operatively with other professional groups, carers and voluntary organisations. (Dictionary.com Unabridged, 2006.) It is important that those who care for our case study patient to have the previously mentioned skills and support in order to help her and to assist our patient in developing her own skills and network of support. It is also important that those with LD be involved in the community and to develop relationships outside of their own families. There are service-learning programs which engage individuals in the learning process, encourage relationships beyond the family, and help meet the needs of the communities. Service-Learning and Individuals with Disabilities Performing Service (2003) lists a few articles and resources that deal with service-learning programs and their benefits: Constitutional Rights Foundation. “Service Learning and Special Education”. Service Learning Network 9 no. 2 (2002). Service-Learning NETWORK takes a look at schools and community groups that are applying service-learning to special populations. Cynthia McCauley describes an innovative program at Bay County High in Florida where special-education and mainstream students work in cooperative-learning groups to address community needs. Oregon teacher Bev Jackson writes about an effective program that uses service-learning as a key Developing Relationship 9 teaching methodology to keep at-risk students in school. Cynthia Belliveau and Sarah John of the Pennsylvania Student Service Alliance discuss the importance and feasibility of creating strong service-learning partnerships and collaboratives in their special-education initiatives. Kleinert, H. and Owens, J. Inclusive Service Learning. [PowerPoint Presentation]. Kentucky Peer Service Learning Project, 2003. This PowerPoint slideshow from the University of Kentucky Peer Service-Learning Project explains how to develop and implement an inclusive service-learning program for youth with disabilities. Moraes, R. Outdoor Programs: Using Service Learning as an Educational Tool. National Center on Accessibility, 2003. For special needs students with behavioral problems, service-learning projects can engage students in the learning process. This online article presents examples of how outdoor programs can use service-learning to benefit students with emotional and behavioral problems. Morales, W. “Project SUCCESS: Service-Learning and Students with Disabilities.” The Tutor (Spring 1999). Project SUCCESS is a multi-state, community- and school-based service-learning program that pairs school-aged students into two-person service teams. By design, each team is comprised of one youth with a disability and one youth without a Developing Relationship 10 disability. Working together, these teams research and assess community needs. Once an issue is identified, the students develop and coordinate a community service project that benefits the community…They work as equals-collaborating to overcome obstacles and embracing their team's diversity. Attachment security or insecurity no matter the age of the individual who has LD is an issue that must be addressed. The family member or carer will have to deal with the securities and insecurities of the person he/she is caring for. Our 21-year old female may not have as many insecurities as a child, for example, however she will become attached to her carer in one way or another, negatively or positively. Steele, Kaniuk, Hodges, et al state, “Attachment security…is denoted by a capacity to express negative feelings and behaviours upon separation from a parent and even more importantly to settle and return to often joyful play and exploration during the reunion with parents; in other words to use the parent as a secure base. Attachment insecurity…is observable when…is either avoidant or resistant (inconsolable) upon reunion following a separation. These patterns are considered to be organised strategies, developed in response to actual care-giving behaviour over time. These interactions impact…and provoke a habitual style of responding to the relationship which either dampens their own displays of emotion in the avoidant classifications or heightens the emotional displays in the resistant patterns. Both of these are seen to function as useful defensive Developing Relationship 11 strategies, which shield the individual from pain in the case of the avoidant strategy or are attempts to draw the care-giver near as in the resistant category.” As with children who have learning disabilities, our 21 year old subject also faces educational needs that are non-traditional. Special education is usually the term that is used for needs that will assist those with LD. Wikipedia (2006) lists the meaning of special education, “describes an educational alternative that focuses on the teaching of students with academic, behavioral, health, or physical needs that cannot sufficiently be met using traditional educational programs or techniques.” It is suggested that people learn best by using different sensory modalities. By engaging different parts of the brain in activities and lessons that involve the visual, auditory, and kinesthetic ability of the individual, learning is better achieved. “Multi-modal teaching is usually addressed when discussing how to best help students with learning disabilities, but it actually helps all learners. Much like the ramps that were built to address the needs of wheelchair users, multi-sensory teaching techniques not only help students with LD/ADHD but all students of all ages. When the needs of students with LD/ADHD are addressed the benefits extend to both traditional and non-traditional learners (English language learners, students experiencing depression or trauma, and students who learn best using visual and kinesthetic modes),” reports Ghselli (n.d.). Relationships are harder to come by and require more time and effort for those with LD. The LD patient in this report is 21 years old and along with LD, she faces other problems such Developing Relationship 12 as being overweight and the health issues that women face. Having to be cared for by family members and practitioners may cause relationship challenges. Even her dating and romantic relationships may be hindered. Only two percent of people with learning disabilities in Scotland are married, according to a major new survey. (Love, Marriage, and Relationships, 2006). Women face different issues than men. Women are usually considered to be the main ones responsible for household duties and childrearing. (addwomen, 2006.) The chosen client for this report may feel insecure as she may take the need for assistance personally as she cannot care for the home as she wishes. She may not be happy with her weight which can lead to depression, insecurity, and other emotional problems. These factors can affect the relationships in her life including any romantic relationships that she has or longs for. With LD, she may take have difficulty expressing her thoughts (orally or in writing), have a low tolerance level for frustration, and have a poor history of work habits and relationships. Her self esteem may be low due to many factors including “feeling stupid” or “feeling fat”. She may feel clumsy due to poor motor skills and feel that she has no control of situations around her. The client may also take jokes literally and they may hurt her feelings. All of these may lead to difficulty in dealing with others and in keeping relationships whether they are business or personal. All these things can create a vicious cycle. Developing Relationship 13 By understanding the issues that our client faces, practitioners can better enhance her quality of life along with the quality of life and responsibilities of those who care for her in the home. “Having a comprehensive evaluation of cognitive, social, emotional, motor and academic skills is the first step. Referrals can be made to licensed psychologists specializing in assessment of LD. The assessment can identify particular learning strengths and weaknesses and offer recommendations for remediation,” reports Learning Disabilities: A Brochure for Psychologists (n.d.). In learning more about the issues that were discussed in this writing, practitioners can assist those who care for individuals with LD. Practitioners, various programs, organizations, individuals, and volunteers can assist those with LD and those who care for these patients. There are many programs offered to develop skills, understanding of the disorder, treatments and medicines related to LD. It is important that our client and her family work with practitioners and with groups in handling the issues that come with the care of a loved one with LD. Our client most likely dislikes the thought of being “labeled”. Through the right people, education, medications and treatments (if necessary), a healthy environment, and appropriate accommodations, people who have LD and those who care for them can have a very high quality of life in all areas and on all levels (mental, physical, and financial). Developing Relationship 14 Bibliography addwomen (2006). Retrieved September 19, 2006, from http://health.groups.yahoo.com/group/addwomen/ Caring for Someone with a Disability (2006). Retrieved September 15, 2006, from http://www.stoke.gov.uk/ccm/navigation/social-care/carer-support-and-assessments/caring-for-someone-with-a-learning-disability/ Dictionary.com Unabridged (2006). Retrieved September 19, 2006, from http://www.tn.regentsdegrees.org/courses/syllabi/ECED2010.htm Ghselli (n.d.). Retrieved September 19, 2006, from http://www.ldresources.org/?p=1268#more-1268 Health Children Project (n.d.). Retrieved September 15, 2006, from http://www.healthychildrenproject.org/glossary/ Kidder, K. (2002). Who Can Diagnose LD and/or ADHD. Retrieved September 16, 2006, from http://www.ldonline.org/article/6027 Developing Relationship 15 Learning Disabilities: A Brochure for Psychologists (n.d.). Learning Disabilities Worldwide. Retrieved September 16, 2006, from Learning Disability Support Call (2006). BBC News, September 4, 2006. Adams, E. (2006) Retrieved September 16, 2006, from http://news.bbc.co.uk/1/hi/health/5306474.stm. Levels of Learning Disability (n.d.). Retrieved September 16, 2006, from http://www.macintyrecharity.org/about_us/Understanding_Learning_Disability/levels_of_learn ing_disability.html Love, Marriage, and Relationships (2006). Retrieved September 16, 2006, from http://living.scotsman.com/topics.cfm?tid=729&id=900222006 Neale, K. (2006). What is a Psychometrist? National Association of Psychometrists. Retrieved September 16, 2006, from http://www.birf.info/home/library/med_person/medper_psychom.html Overweight and Obesity (2001-2004). Retrieved September 19, 2006, from http://agingwell.state.ny.us/prevention/overweight.htm Developing Relationship 16 O’Donnell, M. (2004). Creating Workplace Environments to Combat Obesity. Retrieved September 16, 2006, from http://www.niehs.nih.gov/drcpt/beoconf/postconf/overview/odonnell.pdf#search=%22physical %20activity%20combat%20social%22 Pockney, R. (2006). The Role of Valued Relationships in Facilitating People with Learning Disabilities Social Inclusion: An Ethnographic Study. Retrieved September 18, 2006, from http://www.refer.nhs.uk/ViewRecord.asp?ID=1555 SLD: Need for Special Education (n.d.). Retrieved September 16, 2006, from ://72.14.203.104/search?q=cache:Bsy- L5jBeFYJ:dpi.wi.gov/sped/ppt/ldcriteria.ppt+what+is+SLD&hl=en&gl=us&ct=clnk&cd=9 Safe, Healthy Learning Environments (n.d.). Retrieved September 18, 2006, from http://www.google.com/search?q=providing+healthy+environment+for+learning+disability&h l=en&lr= Steele,M.; Kaniuk, J.; Hodges, J. et al (n.d.). The use of the Adult Attachment Interview: Implications for assessment in Adoption and Foster Care. The Anna Freud Centre. Retrieved September 19, 2006, from http://www.annafreudcentre.org/baaf.htm Developing Relationship 17 The National Institute of Neurological Disorders and Stroke (2006). NINDS Epilepsy Information Page. Retrieved September 18, 2006, from http://www.ninds.nih.gov/disorders/epilepsy/epilepsy.htm What is a Neuropsychologist? (n.d.). Retrieved September 15, 2006, from http://www.tbidoc.com/Appel2.html Wikipedia, the free encyclopedia (2006). Retrieved September 19, 2006, from http://en.wikipedia.org/wiki/Special_education Read More