Metabolic Disorders

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Summary & Description

Metabolic disorders arise when there is a disruption in the process of metabolism. Metabolism is the process by which the body breaks down and stores food for energy. Treatment of these disorders involves dietary adjustments based on the characteristics of the specific disorder the child has. The following are a few metabolic disorders that may cause speech-language deficits:


Phenylketonuria (PKU) - a rare, inherited disorder that causes the build up of the amino acid phenylalanine (Phe), which is found in protein. This is due to a deficit in the enzyme, phenylalanine hydroxylase (PAH), which normally breaks down this amino acid.

  • Etiology - PKU is an autosomal recessive condition: Both parents must be carriers of the gene defect, and they each pass on the gene to the child.
  • Diagnosis - In the US, all infants are screened for PKU. Typically, a child with PKU will begin showing symptoms a few months after birth.
  • Classifications of Severity - Classic PKU (most severe), Moderate or Mild PKU, Benign PKU (PAH activity is low, but no dietary restrictions)
  • Prevalence - Approximately 14,500 people in US living with PKU. About 1 in 10,000 to 20,000 infants are diagnosed with PKU in the US.


Thyroid Disorders - a disorder caused by the dysfunction of the thyroid gland. Two main types: Hyperthyroidism, or an overactive thyroid, occurs when too much thyroid hormone being released into the blood. Hypothyroidism, or an underactive thyroid, occurs when not enough of the thyroid hormone is released into the blood.
  • Etiology - Low amounts of iodine in diet. Common cause of hyperthyroidism is Grave's disease, which involves antibodies stimulating the thyroid gland. Common cause of hypothyroidism is Hashimoto's thyroiditis, which involves antibodies destroying the thyroid gland.
  • Diagnosis - For hyperthyroidism, the pediatrician will perform a physical examination and run tests to determine the thyroid hormone levels in the blood. For hypothyroidism, all babies are screened at birth.
  • Signs & Symptoms - Hyperthyroidism: anxious, difficulty focusing, increased appetite without weight gain, sweating, difficulty sleeping; Hypothyroidism: sluggish, low energy level, weight gain without increased appetite, feeling cold in room temperature
  • Prevalence - Considered to be rare: 37 in 1000 school-age children


Hunter Syndrome - an incurable mucopolysaccharide disease, also called MPS II, that causes progressive damage because of the build up of mucopolysaccharides

  • Etiology - Inheritance of a defective gene that causes the malfunction or absence of the enzyme iduronate sulfatase, which is needed to break down mucopolysaccharides
  • Diagnosis - The pediatrician conducts urine, blood, and tissue sample tests to determine if there is too much mucopolysaccharides or an absence of iduronate sulfatase.
  • Classifications of Severity - Juvenile form (severe, early onset); Late form (mild)
  • Signs & Symptoms - Juvenile form: aggressive, hyperactive, severe intellectual disability, spasticity; Late form: mild to no cognitive deficiency; Symptoms for both forms includes joint stiffness, large head, and increasing deafness
  • Prevalence - about 1 in 25,000 births in the US; 1 in 100,000 to 150,000 males

Language & Learning Implications

Metabolic disorders have varying effects on language and learning. These effects depend on the type of disorder and the level of severity that the child has. Based on PKU, thyroid disorders, and Hunter syndrome, language and learning will be affected by:
  • poor memory
  • lack of self-control
  • poor visual motor skills
  • difficulty maintaining focused on a task
  • hyperactivity
  • low energy level (fatigue)
  • intellectual disability
  • behavioral disorders
  • emotional disorders

Strategies for the Classroom

To support a student with a metabolic disorder in the classroom, it is important to take into account the specific deficits that the disorder has caused. Based on PKU, thyroid disorders, and Hunter syndrome, some strategies that would be beneficial in the classroom are:


  • Break down tasks and assignments into small steps, introducing each step one at a time, to avoid overwhelming the student
  • Use a hands-on approach to learning, ensuring the material being taught is concrete and observable
  • Use visual aids (i.e. charts, graphs, pictures) to help with organization and memory
  • Provide immediate feedback
  • Introduce rewards for completing learning activities and achieving other tasks that may be difficult (e.g. staying organized)
  • Use activities that require interaction and movement to keep the student engaged and prevent distraction of other students with fidgety behavior
  • Choose a peer helper to help the student stay focused and lessen behavior that distracts the other students
  • Extended time to complete assignments and exams
  • Scheduled rest periods throughout the day
  • Allow students to have shorter days in school instead of attending for a full day


Important to remember that many difficulties associated with metabolic disorders can be lessened and/or avoided if the child is eating the proper diet and/or taking the proper medication. It is important to understand the child's dietary restrictions because this may have an affect his/her performance during the school day, as well as their overall health.

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Tools for the SLP

When deciding the tools and techniques to implement in the therapy setting, it is important to consider the characteristics of the specific metabolic disorder the child has. Below are links to tools and techniques that address some deficits exhibited by children with metabolic disorders that can be used in conjunction with speech-language tasks:


Executive Functioning Activities

https://www.pinterest.com/pin/37717715605442143/


Addressing Inattention, Impulsiveness, Hyperactivity in Therapy Sessions http://www.smartspeechtherapy.com/in-case-you-missed-it-how-to-successfully-address-clients-inattention-impulsivity-and-hyperactivity-in-therapy-sessions/


Material Ideas for Intellectual Disabilities https://www.pinterest.com/pin/204913851768892589/


Using AAC Devices with Students with Intellectual Disabilities

http://praacticalaac.org/video/aac-for-students-with-intellectual-disabilities-basic-strategies-for-immediate-results/


Calming Hyperactivity

http://www.livestrong.com/article/86634-calm-hyperactive-child/


Teaching Self-Control with Bubbles

http://notjustcute.com/2012/09/28/teaching-social-skills-with-bubble-lessons/

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Resources and Links

Children Living with Inherited Metabolic Disorders - provides research funding and support for families with children with inherited metabolic disorders


Children's PKU Network - provides education and assistance for families affected by PKU


National MPS Society - supports those affected by MPS diseases through research, advocacy, and awareness


National Organization for Rare Disorders - provides education, advocacy, research, and service to identify, treat, and cure rare disorders


http://www.nlm.nih.gov/medlineplus/metabolicdisorders.html#cat5 - information provided by NIH U.S. National Library of Medicine regarding metabolic disorders, with list of specific disorders and links to more information

References

About pku (2014). Retrieved from http://www.npkua.org/Education/AboutPKU.aspx


About thyroid function and disorders (2015). Retrieved from http://www.chop.edu/conditions-diseases/pediatric-thyroid-disorders/about#.VUIScqLD_IV


Causes of speech and language disorders (2014). Retrieved from http://www.chihealthstelizabeth.com/index.php?option=com_content&task=view&id=294


Chronic fatigue syndrome (CFS) (2015). Retrieved from http://www.cdc.gov/cfs/pediatric/factsheets/Education-Professionals.html


Dowshen, S. (2012). Thyroid disorders. Retrieved from http://kidshealth.org/kid/health_problems/glandshoromones/thyroid.html#


Endocrine and immune system conditions: Thyroid problems (2015). Retrieved from http://www.seattlechildrens.org/medical-conditions/endocrine-immune-system-conditions/thyroid-problems/


Metabolic disorders (2015). Retrieved from http://www.nlm.nih.gov/medlineplus/metabolicdisorders.html#cat5


Moltz, K. (2015). Common signs of thyroid disease in children. Retrieved from http://www.childrensdmc.org/?id=2382&sid=1


Pediatric thyroid disease (2012). Retrieved from https://www.surgery4children.com/diagnoses-and-treatment/neck/305-thyroid-disease-in-children


Phenylketonuria (2012). Retrieved from http://ghr.nlm.nih.gov/condition/phenylketonuria


Reynolds, T., Zupanick, C. E., & Dombeck, M. (2013). Effective teaching methods for people with intellectual disabilities. Retrieved from https://www.mentalhelp.net/articles/effective-teaching-methods-for-people-with-intellectual-disabilities/


Staff, Mayo Clinic (2012). Diseases and conditions: Hunters syndrome. Retrieved from http://www.mayoclinic.org/diseases-conditions/hunter-syndrome/basics/definition/con-20026538


Staff, Mayo Clinic (2014). Phenylketonuria (PKU). Retrieved from http://www.mayoclinic.org/diseases-conditions/phenylketonuria/basics/definition/con-20026275


Wright, J. (2015). School-wide strategies for managing...hyperactivity. Retrieved from http://www.interventioncentral.org/behavioral-interventions/challenging-students/school-wide-strategies-managing-hyperactivity