= بهترین  کرج پزشک، اطفال= بهترین  کرج پزشک، جراح مغز و اعصاب= بهترین  کرج پزشک، جراح کلیه و مجاری ادرار= بهترین  کرج پزشک، دندانپزشک= بهترین  کرج پزشک، کلیه و مجاری ادرار= بهترین  کرج پزشک، آلرژی= بهترین  کرج پزشک، ارتودنسی= بهترین  کرج پزشک، بیهوشی= بهترین  کرج پزشک، پوست و مو و آمیزشی

   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ Ґ ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی   Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   () ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    Ґی ј ی یȘ   ی ی- јی Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی    Ԑ ی ј ی یȘ   ی ی- јی   Ԑ   ی ј ی یȘ   ی ی- јی      ǁ  ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی          ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی     Ԑ ی ј ی یȘ   ی ی- јی          ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی        ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی        ی ј ی یȘ   ی ی- јی    Ԑ     ی ј ی یȘ   ی ی- јی    Ԑ      ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی     Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی   Ԑ     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ  () ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی   Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  	 ی ј ی یȘ   ی ی- јی   Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ   ѐ   ی ј ی یȘ   ی ی- јی    Ԑ       ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی  Ԑ     ی ј ی یȘ   ی ی- јی          ی ј ی یȘ   ی ی- јی    Ԑ     ی ј ی یȘ   ی ی- јی  Ґ ی ј ی یȘ   ی ی- јی  Ԑ Ґ ی ј ی یȘ   ی ی- јی  Ԑ   Ґ ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ   ی ј ی یȘ   ی ی- јی  Ԑ    ی ј ی یȘ   ی ی- јی   ی ј ی یȘ   ی ی- јی  Ԑ  ی ј ی یȘ   ی ی- јی  Ԑ      ی ј ی یȘ   ی ی- јی   Ԑ     ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   _     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   ( )  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی  Ӑ  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی      ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  ѐ  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی   ( )  ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی     ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی    ی ј ی یȘ   ی ی- јی  Ӂ

ј ی ѐ  =ی  =Ԙј ی یȘ   ی ی- јی   ی= ی   Ԙј ی یȘ   ی ی- јی     ݘ  = ی   Ԙј ی یȘ   ی ی- јی   ی= ی   Ԙј ی یȘ   ی ی- јی     = ی   Ԙј ی یȘ   ی ی- јی   = ی   Ԙј ی یȘ   ی ی- јی   Ԙ= ی   Ԙј ی یȘ   ی ی- јی   ی= ی   Ԙј ی یȘ   ی ی- јی  ی= ی   Ԙј ی یȘ   ی ی- јی  Ԙ= ی   Ԙј ی یȘ   ی ی- јی   =ی ј ی یȘ   ی ی- јی ی ј ی یȘ   ی ی- јی ی ј ی یȘ   ی ی- јی   ی  ј ی یȘ   ی ی- јی  ی ǘ ј ی یȘ   ی ی- јی  یј ی یȘ   ی ی- јی ی ǘј ی یȘ   ی ی- јی  ј ی یȘ   ی ی- јی =ی ی = =ی Ϙی ی=ј ی یȘ   ی ی- јی یی =ǁیј ی یȘ   ی ی- јی ʐ= ی یی

  آمار بازدید کنندگان                       

 

 

کرج درمان اعتیاد= بهترین  کرج درمان در منزل= بهترین  کرج درمانگاه= بهترین  کرج دندانسازی= بهترین  کرج رادیولوژی= بهترین  کرج روانشناسی= بهترین  کرج ساختمان پزشکان= بهترین  کرج سرنگ، تولید= بهترین  کرج سمعک و

 

روماتولوژی= بهترین  کرج پزشک، زنان و زایمان= بهترین  کرج پزشک، طب فیزیکی و توانبخشی= بهترین  کرج پزشک، عفونی= بهترین  کرج پزشک، عمومی= بهترین  کرج پزشک، قلب و عروق= بهترین  کرج پزشک، گوارش= بهترین  کرج پزشک، گوش و حلق و بینی= بهترین  کرج پزشک داخلی، ریه= بهترین  کرج پزشک داخلی، غدد= بهترین  کرج پزشکی باروری و ناباروری= بهترین  کرج پزشکی هسته ای= بهترین  کرج ترمیم مو= بهترین  کرج تغذیه بالینی و رژیم درمانی= بهترین  کرج دارو، پخش= بهترین  کرج دارو، تولید= بهترین  کرج داروخانه= بهترین  کرج داروی گیاهی، پخش= بهترین  کرج درمان اعتیاد= بهترین  کرج درمان در منزل= بهترین  کرج درمانگاه= بهترین  کرج دندانسازی= بهترین  کرج وبلاگ سایت گفتار توان گستر =بهترین  کرج دارو، پخش= بهترین  کرج دارو، تولید= بهترین  کرج داروخانه= بهترین  کرج داروی گیاهی، پخش= بهترین  کرج درمان اعتیاد= بهترین  کرج درمان در منزل= بهترین  کرج درمانگاه= بهترین  کرج دندانسازی= بهترین  کرج  

 

 گفتار در مانی  کاردرمانی  فیزیو تراپی   شنوایی شناسی بینایی سنجی   ارتوپدی فنی   

  مجلات علمی    دانشگاه ها و دانشکده ها  کلینیکهای تخصصی   مراکز توانبخشی   

مراکز تشخیصی و  درمانی                 تجهیزات پزشکی              مراکز آموزشی خصوصی 

اطلاعات  پزشکان تهران         اطلاعات پزشکان مشهد               اطلاعات  پزشکان کرج  

اطلاعات مراکز توانبخشی و درمانی  استان مازندران

  page:  1     2      3        5     6    7      9     10    11    12      13     14     15   16    17   18    19    20     NEXT   ....

 

رادیولوژی= بهترین  کرج روانشناسی= بهترین  کرج ساختمان پزشکان= بهترین  کرج سرنگ، تولید= بهترین  کرج سمعک و شنوایی سنجی= بهترین  کرج سنجش تراکم استخوان= بهترین  کرج سونوگرافی= بهترین  کرج سی تی اسکن= بهترین  کرج طب سوزنی= بهترین  کرج عطاری= بهترین  کرج عینک، واردات و صادرات= بهترین  کرج عینک سازی= بهترین  کرج

 

 صفحه اصلی 

  درباره ما 

  تماس با ما

     نظر سنجی

 تماس با شما

   نحوه تبلیغات در سایت

  مشاوره 

  لینکهای ما

  تولیدات ما

     عضویت

  
 

 


       

 

ی ی  ј ی یȘ   ی ی- јی     ј ی یȘ   ی ی- јی    ی ی  ј ی یȘ   ی ی- јی  ǐییی Ϙ یј ی یȘ   ی ی- јی ی ј ی   ј ی یȘ   ی ی- јی  ی ی ییј ی یȘ   ی ی- јی   ی ی Ϙ

 

 


 

 

     گفتار توان گستر ѐی ј ی ی 

 

 

       بهترین گفتاردرمانی کرجј ی یȘ   ی ی- јی گفتار توان گستر  هوشمندј ی یȘ   ی ی- јی اسم و آدرس بهترین گفتاردرمانی کرجј ی یȘ   ی ی- јی درمان ناگویایی کودکان کرجیј ی یȘ   ی ی- јی بهترین مرکز گفتاردرمانی غرب استان تهرانј ی یȘ   ی ی- јی مطب گفتاردرمانی سیاوش عطاییј ی یȘ   ی ی- јی با سابقه ترین گفتاردرمانی کودکان       دستگاههای بیو فید بک بینایی  شنیداری= برنامه های نروفیدبک ј ی یȘ   ی ی- јی سه بعدی محرک مغزј ی یȘ   ی ی- јی بخش شنیداری - ادراکی=درمان انواع اختلالات گفتاری =ادگیری کودکان عادی= دچار تاخیر تکاملی گفتار =کودکان دچار  لکنت =فلج مغزی =کم توانی ذهنیј ی یȘ   ی ی- јی  طیف اوتیسم ј ی یȘ   ی ی- јی آماده سازی برای سنجش بدو ورود به مدرسه=جلسات درمانی دوساعتهј ی یȘ   ی ی- јی والدین همراه       =کم توانی ذهنیј ی یȘ   ی ی- јی  طیف اوتیسم ј ی یȘ   ی ی- јی آماده سازی برای سنجش بدو ورود به مدرسه=جلسات درمانی دوساعتهј ی یȘ   ی ی- јی والدین همراه کودک در جلسه  درمانیј ی یȘ   ی ی- јی جلسه درمانی شامل SIј ی یȘ   ی ی- јی تربیت شنیداری ј ی یȘ   ی ی- јی آموزش ذهنیј ی یȘ   ی ی- јی ماساژ و تحریک اندامهای گویایی =استفاده از دستگاههای بیو فیدبک =برنامه های کامپیوتری خاصј ی یȘ   ی ی- јی کودک کرجی

 


 ی ʐی ی ی Ș ییی - یی ی یȘ  ی ј یی - ǘی

ی یϐیی Ϙ ی ύ ی ʘی

 

Ϙ ύ  - ی - ی ی   ی ی (autism spectrum disorder)  ی ی

 

 

ی SI  - ی یی  - ی -  ǎ ( P.N.F) ی ی ییی - ʐی ییȘ یȘ

 

  ی یی Ϙ ی ی ј ی ی .


  با تعیین وقت قبلی     =      آدرس مطب    =    کلیک کنید

 

 

 

مطالب مرتبط

آخرین اخبار

علمی

پزشکی

ادبی

فرهنگی

سیاسی

اجتماعی

اقتصادی

ورزشی

فلسفی

مدیریت

خانواده

کامپیوتر

الکترونیک

مذهبی

روانشناسی

شیمی

طنز

سرگرمی

 

یی  :

siavashataee.com

loknatzaban.org

goftardarmani.com

vazir.org

medu-karaj.ir

siavashataee.ir

loknatshekan.ir

pff-rhs.ir

karaj-medu.ir

google-map.ir

googlegame.ir

googleimage.ir

 

 

 

 

 

 

 

 

 

  •  

 

 

 



Sensory Integration Dysfunction


Meaning of sensory integration
Sensory integration is the ability to take in information through the senses of touch, movement, smell, taste, vision, and hearing, and to combine the resulting perceptions with prior information, memories, and knowledge already stored in the brain, in order to derive coherent meaning from processing the stimuli. The mid-brain and brainstem regions of the central nervous system are early centers in the processing pathway for sensory integration. These brain regions are involved in processes including coordination, attention, arousal, and autonomic function. After sensory information passes through these centers, it is then routed to brain regions responsible for emotions, memory, and higher level cognitive functions.
Sensory integrative disorders
Vestibular processing disorders
Dyspraxia
Sensory discrimination and perception problems
Sensory modulation
Sensory modulation refers to a complex central nervous system process by which neural messages that convey information about the intensity, frequency, duration, complexity, and novelty of sensory stimuli are adjusted. Behaviorally, this is manifested in the tendency to generate responses that are appropriately graded in relation to incoming sensations, neither underreacting nor overreacting to them.
Sensory Modulation Problems
Sensory registration problems - This refers to the process by which the central nervous system attends to stimuli. This usually involves an orienting response. Sensory registration problems are characterized by failure to notice stimuli that ordinarily are salient to most people.
Sensory defensiveness - A condition characterized by overresponsivity in one or more systems.
Gravitational insecurity - A sensory modulation condition in which there is a tendency to react negatively and fearfully to movement experiences, particularly those involving a change in head position and movement backward or upward through space.
Hyposensitivities and hypersensitivities
Sensory integration disorders vary between individuals in their characteristics and intensity. Some people are so mildly afflicted, the disorder is barely noticeable, while others are so impaired they have trouble with daily functioning.
Children can be born hypersensitive or hyposensitive to varying degrees and may have trouble in one sensory modality, a few, or all of them. Hypersensitivity is also known as sensory defensiveness. Examples of hypersensitivity include feeling pain from clothing rubbing against skin, an inability to tolerate normal lighting in a room, a dislike of being touched (especially light touch) and discomfort when one looks directly into the eyes of another person.
An example of a child with hyposensitivity is one who constantly gets up and down in a classroom and is constantly seeking sensory stimulation.
In treating sensory dysfunctions, a "just right" challenge is used: giving the child just the right amount of challenge to motivate him and stimulate changes in the way the system processes sensory information but not so much as to make him shut down or go into sensory overload. The "just right" challenge is absent if the activity and the child's perception of activity do not match. In addition, deep pressure is often calming for children who have sensory dysfunctions. It is recommended that therapists use a variety of tactile materials, a quiet, subdued voice, and slow, linear movements, tailoring the approach to the child's unique sensory needs.
While occupational therapy sessions focus on increasing a child's ability to tolerate a variety of sensory experiences, both the activities and environment should be assessed for a "just right" fit with the child. Overwhelming environmental stimuli such as flickering fluorescent lighting and bothersome clothing tags should be eliminated whenever possible to increase the child's comfort and ability to engage productively. Meanwhile, the occupational therapist and parents should jointly create a "sensory diet," a term coined by occupational therapist A. Jean Ayres. The sensory diet is a schedule of daily activities that gives the child the sensory fuel his body needs to get into an organized state and stay there. According to SI theory, rather than just relying on individual treatment sessions, ensuring that a carefully designed program of sensory input throughout the day is implemented at home and at school can create profound, lasting changes in the child's nervous system.
Parents can help their child by realizing that play is an important part of their child's development. Therapy involves working with an occupational therapist and the child will engage in activities that provide vestibular, proprioceptive and tactile stimulation. Therapy is individualized to meet the child's specific needs for development. Emphasis is put on automatic sensory processes in the course of a goal-directed activity. The children are engaged in therapy as play which may include activities such as: finger painting, using Play-Doh type modeling clay, swinging, playing in bins of rice or water, climbing, etc.

Sensory integration and Autism Spectrum Disorders (ASD)
A person with autism experiences sensory perceptions differently than someone without autism.. Often, autistic brains receive too much sensory stimulation and are unable to integrate and modulate information in a neurotypical way. Each individuals experience of it will vary.
In her book, Thinking in Pictures, Temple Grandin reports the results of a survey about sensory integration in a relatively small population with autism spectrum disorders from one center:
"A survey of sensory problems in 30 adults and children was conducted by Neil Walker and Margaret Whelan from the Geneva Centre for Autism in Toronto. Eighty percent reported hypersensitivity to touch. Eighty-seven percent reported hypersensitivity to sound. Eighty-six percent had problems with vision. However, thirty percent reported taste or smell sensitivities."

Sensory Integration Dysfunction and Other Disorders
A growing number of experts, including Stanley Greenspan, M.D., Ph.D., and autism specialist Ricki Robinson, M.D., believe that sensory related disorders are frequently misdiagnosed as Attention Deficit/Hyperactivity Disorder, as well as emotional problems, aggressiveness and speech-related disorders such as Apraxia. Sensory processing, they argue, is foundational, like the roots of a tree, and gives rise to a myriad of behaviors and symptoms such as hyperactivity and speech delay. For example, a child with an under-responsive vestibular system may need extra input to his "motion sensor" in order to achieve a state of quiet alertness. To get this input, the child might fidget or run around, appearing ostensibly to be hyperactive, when in fact, he suffers from a sensory related disorder.
Sensory Integration Therapy
The main form of sensory integration therapy is a type of occupational therapy that places a child in a room specifically designed to stimulate and challenge all of the senses. During the session, the therapist works closely with the child to provide a level of sensory stimulation that the child can cope with, and encourage movement within the room. Sensory integration therapy is driven by four main principles (Schaaf 2004):
Just Right Challenge (the child must be able to successfully meet the challenges that are presented through playful activities)
Adaptive Response (the child adapts his behavior with new and useful strategies in response to the challenges presented)
Active Engagement (the child will want to participate because the activities are fun)
Child Directed (the child's preferences are used to initiate therapeutic experiences within the session).
Children with lower sensitivity (hyposensitivity) may be exposed to strong sensations such as stroking with a brush, vibrations or rubbing. Play may involve a range of materials to stimulate the senses such as play dough or finger painting.
Children with heightened sensitivity (hypersensitivity) may be exposed to peaceful activities including quiet music and gentle rocking in a softly lit room. Treats and rewards may be used to encourage children to tolerate activities they would normally avoid.

Alternative views
Not everybody agrees with the notion that hypersensitive senses is necessarily a disorder. However, sensory integration dysfunction, sometimes called sensory processing disorder, is only diagnosed when the sensory behavior interferes significantly with learning, playing, and activities of daily living (ADL). Sensory issues can be on a spectrum. Being annoyed and distracted by the sound of a noisy ventilation system or the scratchiness of a sweater is considered to be a typical sensory response. However, when a child is so strongly affected by background noise or tactile sensations that he totally withdraws, becomes hyperactive and impulsive, or lashes out as part of a primitive fight-or-flight response, the child's sensory issues are severe enough to warrant intervention.
In addition to experiencing hypersensitivity, a person can experience hyposensitivity (undersensitivity to sensory stimuli). One example of this is insensitivity to pain. A child with sensory integration dysfunction may giggle when given an injection or not even blink when receiving a second-degree burn.
There is no proof for the idea that hypersensitivity would necessarily be a result of sensory integration issues. However, there is anecdotal evidence that sensory integration therapy results in more typical sensory responses and sensory processing. For example, Temple Grandin has claimed that the deep pressure created by a cattle squeeze machine she used in her youth resulted in her being able to tolerate the affectionate hugs and touches she craved. Additionally, over 130 articles on sensory integration have been published in peer-reviewed (mostly occupational therapy) journals. The difficulties of designing double-blind research studies of sensory integration dysfunction have been addressed by Temple Grandin and others. More research is needed.
It is possible Sensory Integration Dysfunction can be misdiagnosed, just as with any other disability. Some experts claim that occupational therapists and other professionals incorrectly apply this label to individuals with attention difficulties or who simply don't put forth any effort during assessments.[citation needed] For example, a student who fails to repeat what has been said in class (due to boredom or distraction) might be referred for evaluation for sensory integration dysfunction (although many, many school teachers, therapists, and administrators are unfamiliar with sensory integration dysfunction or don't believe in it, this sometimes happens).[citation needed] The student might then be evaluated by an occupational therapist to determine why he is having difficulty focusing and attending, and perhaps also evaluated by an audiologist or a speech-language pathologist for auditory processing issues or language processing issues. As part of the auditory evaluation, the student may be asked to listen to signals coming from either side of a pair of headphones and identify where they are coming from. If the student is bored or distracted, or confused by the oral directions given, the test may be inconclusive and may not isolate what the problem is. The assessor must consider sensory and language factors in evaluating the student's performance on the test. Diagnoses based on single tests are unreliable, and integrated assessment utilizing multiple sources of information is the preferred means of diagnosis.
Similarly, a child may be mistakenly labeled "ADHD" or "ADD" because impulsivity has been observed, when actually this impulsivity is limited to sensory seeking or avoiding. A child might regularly jump out of his seat in class despite multiple warnings and threats because his poor proprioception (body awareness) causes him to fall out of his seat, and his anxiety over this potential problem causes him to avoid sitting whenever possible. If the same child is able to remain seated after being given an inflatable bumpy cushion to sit on (which gives him more sensory input), or, is able to remain seated at home or in a particular classroom but not in his main classroom, it is a sign that more evaluation is needed to determine the cause of his impulsivity. Children with FAS (Fetal Alcohol Syndrome) display many sensory integration problems.
And while the diagnosis of sensory integration dysfunction is accepted widely among occupational therapists and also educators, these professionals have been criticized for overextending a model that attempts to explain emotional and behavioral problems that could be caused by other conditions. Children who receive the diagnosis of sensory integration dysfunction should also be observed for signs of anxiety problems, ADHD, food intolerances, and behavioral disorders, as well as for autism (note that contrary to popular belief, autistic children may be social, have a sense of humor, and make eye contact). Genetic problems such as Fragile X syndrome should be looked into as well. While the DSM-IV lists sensory issues as a secondary characteristic of autism, sensory integration dysfunction is not considered to be on the autism spectrum, and a child can receive a diagnosis of sensory integration dysfunction without any comorbid conditions. However, because comorbid conditions are common with sensory integration issues, it is important to investigate whether the child has other conditions as well which make him or her reactive, "touchy", or unpredictable, and manifest in a manner similar to that characterized by occupational therapists as sensory integration dysfunction. The theory of SI points out that children learn through their senses. If a child seems to have difficulty processing sensory information, it makes sense to observe whether he or she is developmentally on track (in terms of social skills, fine motor skills, gross motor skills, language, etc.)
While the physical methods employed by occupational therapists as treatment for SID are often palliative (they make the child feel better--much as a nice massage or physical contact would make anyone feel better), it is important that children diagnosed with sensory integration dysfunction be observed closely so that any other conditions will not be overlooked. Moreover, SI therapy is not "one size fits all." According to SI theory, children with sensory integration issues have their own unique set of sensory responses that need to be addressed. What is calming and focusing for one child may be overstimulating for another, and vice versa. The child's unique set of sensory responses must be considered when designing a sensory diet.
Some adults identify themselves as having sensory integration dysfunction; that is, they report that their hypersensitivity, hyposensitivity, and related sensory processing issues, such as poor self-regulation, continue to cause significant interference in their daily lives at home, at work, and at school.
Alternatively, there is evidence to suggest that some gifted children also have an increased tendency toward hypersensitivity (e.g., finding all shirt tags unbearable), which may be correlated with their greater intellectual proclivity toward perceiving the world in unconventional ways.


Semantics
Semantics is the aspect of language function that relates to understanding the meanings of words, phrases and sentences, and using words appropriately when we speak. Children with semantic difficulties have a very hard time understanding the meaning of words and sentences.
This is sometimes apparent from their unusual responses when they are told to do something, and sometimes it is revealed by the questions they ask, and the things they say about words. There is an example here of 12 year old Nerida's interpretation of the word "acquire". In the example, she was unable to detect from the context that she was being asked what "acquire", rather than "a choir" meant.
People with semantic processing difficulties have particular trouble with abstract words like 'curious' or 'vague', words that relate to feelings and emotions such as 'embarrassed' and 'anxious', and words that refer to status (for instance 'expert' or 'authority') or degree (for example, 'essential' or 'approximate').
They have difficulty with idioms, sayings and slang expressions, often taking them literally or interpreting them oddly. For example, when asked if he enjoyed spending time with his friends, a 14 year old with semantic processing problems replied, "I don't see how you can spend time, and I certainly don't see how you could enjoy it because spending time is not something you can do. You can only actually spend money".
Another difficulty children with semantic problems experience is that they may not be able to identify the key point or topic in a sentence, and because of this may suddenly change the subject, very obscurely, apparently thinking they are on the same subject. Here is another real example from a girl aged eleven. Question: "Could you get the book off the shelf and give it to me?" Reply: "The Gulf Stream warms the coast-line"

NOTE: CLOSE QUESTIONING REVEALED THAT THE OBSCURE CONNECTION HERE WAS THE CONTINENTAL SHELF, AND THE GULF STREAM. HER RESPONSE WAS RELATED TO HER DEEP INTEREST IN MARINE BIOLOGY AND OCEAN CURRENTS.

Pragmatics
Pragmatics is the area of language function that embraces the use of language in social contexts (knowing what to say, how to say it, and when to say it - and how to "be" with other people).
Children with pragmatic difficulties have great trouble using language socially in ways that are appropriate or typical of children of their age. They often do not understand that we take turns to talk, and they will "talk over the top of you" at times, or, at other times respond to what you say with inappropriate silences, or in a voice that is too quiet. They may interrupt excessively and talk irrelevantly or about things the listener shows no interest in. Their communicative behaviour often appears rude and inconsiderate.
They often do not assume prior knowledge. So for example, one boy explained to me in minute detail how to wash a car, wrongly assuming that I needed (and wanted) the information and that I had never washed a car.
On the other hand, they may assume prior knowledge that the listener could not possibly have, and launch into a long disquisition without describing in sufficient detail the participants, location and general background of their story.
They can go on far too long telling stories, and include so much detail that the listener becomes disinterested.


Pragmatics skills include:
knowing that you have to answer when a question has been asked;

being able to participate in a conversation by taking it in turns with the other speaker;

the ability to notice and respond to the non-verbal aspects of language (reacting appropriately to the other person's body language and 'mood', as well as their words);

awareness that you have to introduce a topic of conversation in order for the listener to fully understand;

knowing which words or what sort of sentence-type to use when initiating a conversation or responding to something someone has said;

the ability to maintain a topic (or change topic appropriately, or 'interrupt' politely);

the ability to maintain appropriate eye-contact (not too much staring, and not too much looking away) during a conversation; and

the ability to distinguish how to talk and behave towards different communicative partners (formal with some, informal with others).

Go here to see how pragmatic skills fit with other aspects of language development.


Semantic-Pragmatic Language Disorder
Children with SPLD (called semantic-pragmatic disorder (SPD) in some literature) have a language disorder that affects both semantic processing and the pragmatics of language use. Some authorities see SPLD as part of the autism spectrum of disorders while others see it purely as a language disorder.
I once said to a twelve year old with semantic and pragmatic difficulties "Tell me all about yourself." He responded, perfectly seriously, with "It will take a very long time", and made an immediate start!
Although isolated examples like the ones here can appear quite amusing and even endearing, these difficulties with word comprehension and social aptitude can be extremely embarrassing, upsetting, confusing and frustrating for the child with SPLD, and can give rise to teasing and criticism of the child.
Family, peers, teachers and other adults need to apply great sensitivity to guiding the young person with SPLD. Understanding the nature of the disorder is helpful in this regard.

Assessment
Speech-Language Pathology treatment is planned on the basis of a formal language assessment, interviews with the client and their caregivers and clinical observations.
It is always necessary to determine whether the client has:
isolated semantic processing difficulties OR
isolated difficulties with the pragmatics of language use OR
a combination of the two OR
semantic pragmatic language disorder (SPLD) OR
SPLD in combination with another communication disorder that is NOT in the autism spectrum, for example, developmental apraxia of speech OR
SPLD in combination with another disorder in the autism spectrum, for example, Asperger's Syndrome OR
SPLD in combination with another disorder that is NOT in the autism spectrum, e.g., Attention Deficit Hyperactivity Disorder (ADHD).
The diagnosis of isolated semantic difficulties, isolated pragmatic difficulties and combinations of the two is "routine" for many paediatric SLPs. The diagnosis of SPLD can be difficult, lengthy and indeterminate, often involving several professionals in addition to the speech-language pathologist (family physician, paediatrician, audiologist, clinical psychologist, occupational therapist, etc). There are many children with semantic and pragmatic difficulties who don't quite "fit" into a definite diagnostic category.

Intervention
Clinical management of any communication disorder is geared to the unique needs and capacities of the particular client in their particular setting. Children with semantic difficulties, or pragmatic difficulties, or a combination of the two, or SPLD are no exception.

Tips and tricks
There are no "tips and tricks". There is no "therapy cookbook". Rather, there are evidence-based therapy procedures and techniques that must be geared to the individual needs of the particular client. Having said that, Working with Pragmatics ISBN 0 86388 168 8 is recommended.


Links
Auditory Processing Disorders
Article by Caroline Bowen
Auditory Processing Disorders (a-p-d) Listserv
Professional discussion
Autism, Asperger's syndrome and semantic-pragmatic disorder: Where are the boundaries?
Article by D.V.M. Bishop. British Journal of Disorders of Communication 24, 107-121 (1989) The College of Speech Therapists, London
Belonging: Creating Community in the Classroom
Mona Halaby's highly acclaimed (by teachers) book!

Conversational characteristics of children with semantic-pragmatic disorder 2: What features lead to a judgement of inappropriacy?
Article by D.V.M. Bishop & C. Adams. British Journal of Disorders of Communication, 24, 241-263 (1989) The College of Speech Therapists, London
Information sheet
by Dr Jane Shields, The National Autistic Society
Jeers and Tears: Teasing and Communication Disorders
Judith Maginnis Kuster
PBS: Social and Emotional Growth from Age 3 to 4 PBS
"The significance of social and emotional development is seen in every area of a child's life. A child will have a strong foundation for later development if he or she can manage personal feelings, understand others' feelings and needs, and interact positively with others. Differences in social and emotional development result from a child's inborn temperament, cultural influences, disabilities, behaviors modeled by adults, the level of security felt in a child's relationships with adults, and the opportunities provided for social interaction..."
Pragmatics, Socially Speaking and Pragmatic language tips on the ASHA web site
Questioning the validity of the semantic pragmatic syndrome diagnosis
ABSTRACT "The classification of developmental language disorders has recently witnessed the birth of a subsyndrome, semantic-pragmatic syndrome, used to describe the case of children with specific language and communication impairments. However, there are striking similarities between children with semantic-pragmatic syndrome and those with high-functioning autism on a communicative, behavioural and cognitive level. This article questions the validity of semantic-pragmatic syndrome as a diagnostic concept distinct from high-functioning autism and, consequently, its use as a clinical entity."
Sematic Pragmatic Disorder Forum (on Denise Vignola's site)
"Welcome to the Semantic-Pragmatic Disorder Forum. Share your thoughts, experiences and questions on SPD. A special welcome to SPD adults who wish to share their experience with us!"

Semantic-Pragmatic Disorder Web Page
Denise Vignola's useful collection of links and articles has been constructed from the perspective of a parent of a young child with APD, and also from that of an adult with the same issues.
Social Thinking
"Michelle Garcia Winner, MA CCC is a speech and language pathologist who addresses the educational and life-planning needs of people who live on the autism spectrum. She specializes in social thinking and perspective-taking therapy and education for professionals, educators, and children, adults, and their families with high-end autism spectrum disorders..."
Tele-collaboration - Social Communication
The Social Communication Web site from the University of Washington, Department of Speech and Hearing Sciences is designed to provide caregivers and professionals with a deeper understanding of social communication problems exhibited by school age children, and ways to assess these problems.
The Parameters of Pragmatics
from Anne Neville's Masters dissertation, The role of unestablished referent in the conversations of young communicatively impaired children. The author's CV.

What is semantic pragmatic disorder? by Julia Muggleton
Published by the Surrey Branch of National Autistic Society in the UK.
Young people with communication disorders
Article by Caroline Bowen: "For students with communication disorders, high school and university can feel like an interminable ordeal. But when supplied with appropriate information, insight, resources and time, and input from parents when necessary, teachers can provide structure, support, encouragement and an exciting learning environment for them..."




Semantic Pragmatic Disorder
(A paper prepared by Heathlands Language Unit staff for parents and teachers involved in the care of children with Semantic-Pragmatic Difficulties)
Editors note: Apparently, the author of this article is: Margo Sharp from the Heathlands School, 56 Parkside, London SW19 5NJ. (England) Tel 0181 947 7373. The former Heathlands school moved out of London a few years ago and underwent a name change in the process. It is now Heathermount School, Devenish Road, Ascot, Berks, SL5 9PG, UK Tel 0134 4875101.
Updated 10/2002: Margo Sharp is currently not based at the Heathermount School. Latest known contact information: eMail -- MARY.RICHARDS@bhamchildrens.wmids.nhs.uk * Telephone 0121 243 2000.



HISTORY
Semantic-Pragmatic Disorder was originally defined in the literature on Language Disorder in 1983, by Rapin and Allen, although at that time it was classified as a syndrome. They referred to a group of children who presented with mild Autistic features and specific semantic pragmatic language problems.
In babyhood, parents often described them as model babies or by contrast babies who seemed to cry too much. Many of these children babbled little or very late and went on using 'jargon' speech much longer than other children of the same age. Their first words were late and learning language was a hard slog. Some had other speech disorders too. Problems were usually first identified between 18 months and 2 years when the child had few if any real words.
Many parents wondered if their children were deaf at first because they did not appear to respond to speech. Assessment found that most children had good hearing, although some did have otitis media and had grommets fitted to ensure maximum hearing.
The problem usually proved to be one of listening and processing the meaning of language instead. Many of the children ignored their names early on but would hear the telephone or the door bell and even respond to the rustle of a sweet paper. Early on in their lives, Semantic-Pragmatic Disordered children were found to have comprehension problems finding it difficult to follow instructions which were not part of the normal routine. Comprehension problems usually improved or responded well to speech therapy so that by the age of four years, many of the children appeared to be functioning superficially, very well.
By the time these children reached school, staff and parents were aware that there was something "different" about them, but they couldn't quite put their finger on it. Sometimes the children would appear to follow very little conversation,while at other times they could give a detailed explanation of an event. Later on in school they were often good at maths, science, and computers but had great difficulty in writing a coherent sentence or playing with other children. They were also unable to share and take turns. They could appear aggressive, selfish, bossy, over confident, shy or withdrawn. Many, therefore, were singled out as behaviour problems and subjected to behavioural regimes which did not always work and left the child confused about what he was supposed to be doing. As one 6 year old Semantic-Pragmatic Disordered child said to his mother, "I don't want to be naughty".
Current Thinking
Today we have a better understanding of the Disorder. We know that Semantic-Pragmatic Disordered children have many more problems than just speaking and understanding words, so we call it a communication disorder rather than a language disorder. We think that the difficulty for children with S.P.D. may be in the way they process information. Children with S.P.D. find it more difficult to extract the central meaning or the saliency of an event. They tend to focus on detail instead; for example the sort of child who finds the duck hidden in the picture but fails to grasp the situation or story in the picture or the child who points out the spot on your face before saying 'hello'.
Extracting information from around us is something we do all the time. We are always looking for similarities and differences so that we can understand and anticipate. Children who find it difficult to extract any kind of meaning will find it even more difficult to generalise and grasp the meaning of new situations. They will therefore cling on to keeping events the same and predictable. Maintaining sameness, by following routines slavishly, insisting on eating certain foods or wearing particular articles of clothing or developing obsessional interests are all characteristics of children with S.P.D. Because these children have difficulty extracting meaning both aurally and visually, the more stimulating the environment becomes the more difficult they find extracting information. Because people have minds which allow them to behave independently they are much less predictable and more difficult to understand than objects or machines. Children with S.P.D. are often more sociable with friends at home or in a formal 1:1 assessment situation than in a busy classroom. Carers may be puzzled by the apparent discrepancy.
Listening and Understanding Language
Because children with S.P.D. find it difficult to focus their listening, they are easily distracted by noises outside the classroom or someone talking on the other side of the room. They may butt in on conversations which have nothing to do with them. They are often described by staff as inattentive or impulsive. They may find loud noise in the classroom distressing and may comment on this. Sometimes when children with S.P.D. are trying very hard to concentrate they may not hear speech at all and ignore general instructions in the classroom while they are trying to work. Many class teachers say they sometimes have to stand in front of their children with S.P.D. or touch them before they respond.
Although many children with S.P.D.do very well; sometimes way above their age level on formal language assessments, this does not mean that they do not have comprehension difficulties. What it does mean is that our methods of testing are not tapping the right areas, or the ones we are using are not standardised yet.
Their difficulties in understanding language are usually fairly subtle by the time they are 5. Children with S.P.D. can often respond to long instructions like, "put the blue pen under the big book", because the objects are there, because it is here and now in time, and because bright children with S.P.D. usually have very little difficulty in understanding visible concepts like size, shape and colour and can be well ahead of their peers. The other very important point is, this kind of language does not require knowledge about the person giving the instruction.
Children with S.P.D. would find comments and questions like "Where did you come from then?, What are you doing later?" "That was very clever of you!", much more difficult. This language requires more than listening and understanding words. You need to understand what the speaker was thinking and intending. You need to understand non literal expressions and time concepts too.
S.P.D. children's understanding usually breaks down in a busy classroom when the teacher starts to chat, tell jokes, or makes a few sarcastic remarks. Children with S.P.D. often feel very uncomfortable at this point because they take everything literally. If other children become aware of this, they can learn to tease and take advantage.
Because children with S.P.D. have difficulty in understanding what other people are thinking when they are talking, they cannot understand when people are lying or deceiving them. Many parents of children with S.P.D. have reported to us that their children have had their lunches taken off them or parted with pocket money and returned home unable to give a clear account of what happened.
Talking
As well as subtle comprehension problems children with S.P.D. have difficulties with talking too. These are not always picked up by parents or staff because so often they chat fluently. It is the particular way in which they use language which identifies them as a group. That is, they have specific Pragmatic Difficulties
Children with S.P.D. have a different style of learning language, they seem to learn more by memorising than knowing what the individual words really mean; so they cannot use language with the same range and flexibility as other children. Children with S.P.D. remember whole chunks of adult phrases and because they are not sure which bits are more important than others they learn everything accurately including the intonation and the accent of the speaker! Sometimes you can hear yourself talking. All in all they seem to say a lot more than they really understand. Some children with S.P.D. use a flat or 'sing-songy' voice when they are echoing other people's language.
Children with S.P.D. often remember to use this echoed language appropriately so they can sound very grown up which contrasts dramatically with their social immaturity. However, when you ask them to give you an account of an event or discuss a picture story which they have not rehearsed, you find them groping for original words and the whole account is very disjointed. One mum described how her son of 5 would tell everyone off in his class including the teacher using her words but could never explain what he had done at school or ask the teacher for help.
When you analyze the content of an S.P.D. child's speech, you find a disappropriate amount of echoed social phrases and very little about how people feel or think. S.P.D. children's delayed social development means that they do not make distinctions between people. Adults, children, teachers and parents are treated the same so when Adam said "don't talk to me like that" to a visitor, he was understandably thought to be very rude, when in fact he was simply repeating what had been said to him. S.P.D. children's inappropriate or immature use of language can be very embarrassing. They say things like, "why has that lady got such a big nose", or they give the family secret away to the very person you had intended it to be kept from. It is easy to see why adults find children with S.P.D. so exasperating at times.
Problems with talking really show up at a conversational level for children with S.P.D. First of all their delayed social development means that like younger children, they are much more interested in themselves than other people so they tend to choose topics about themselves, their family or their special interests. Because they have insufficient understanding of their conversational partner, they tend not to understand that she might not be interested in their latest obsession and because the S.P.D. child has no idea what is pertinent in his story and what is not, when he is able to describe past events, he tends to give an over detailed account and fails to read the signals of boredom in his listener. He may, on the other hand believe that his listening partner shares his thoughts exactly. He thus assumes common knowledge and fails to put his partner sufficiently in the picture and requests for information may bring one word answers only.
On top of these problems so far described, the S.P.D. child may misunderstand what his conversation partner intended so he may give rather bizarre answers or he may, if he is skilful enough, change the topic and gear it back to what he understands and keep talking just to shut his partner out. Conversation can take on very strange meanings, if you are not aware of the S.P.D. child's difficulty.
Understanding how others think
Some S.P.D children become skilled at talking about pictures or sequences of pictures but you find them only able to give you the bare facts. Their inability to describe people's thoughts and intentions within the picture mean they cannot be creative or abstract in their account or they cannot infer or make sensible predictions. They cling to the observable features of the picture without dealing with the implied underlying meaning.
The S.P.D. child's difficulty in seeing the world through other people's eyes or understanding that other people think differently from himself, is often described as a child who does not have a 'theory of mind'
There has been a lot of research recently into when children develop a 'theory of mind'. Researchers have used false belief stories and deception tasks (which tests the child's ability to understand that people who do not share the same knowledge will behave differently) to determine when children develop this skill. Researchers think that four year olds have quite good understanding of minds but that children on the Autistic Continuum * find this more difficult.
Most 'core' Autistic children never acquire a complex theory of mind where as S.P.D. do seem to but later than other skills at the same developmental stage. This lack of social 'nous' above all else makes life difficult for the S.P.D. child. They find it difficult to make friends with children of their own age and tend to gravitate towards younger or much older children unless of course there are other children with S.P.D.in the class - when they seem to be attracted to each other like magnets. We think that children with S.P.D. need to spend time together so they can feel on a par with each other and not constantly at the mercy of more sophisticated peers.
We think teachers should explain to other children, in simple terms, why it is the S.P.D. child cannot conform and to keep an eye on his vulnerability both inside and outside of the classroom.
Creative Play
Researchers have also suggested that the difficulty children with S.P.D. have in playing creatively and in mentalising has a common cognitive origin. The ability to separate ones own thinking from that of another person may start at birth and develop through simple turntaking and shared attention games. Even breast feeding, humpty dumpty or peek-a-boo requires turntaking and mentalising.
At about 18 months, children take a leap forward in their mentalising, they are able to think even more abstractly and they can switch from abstract to concrete thinking very easily. For example, they can pretend a toy cup is a telephone, but they also understand that the toy cup is a cup.
Toddlers' teddies take on extra meanings when they become people who are taken to bed, fed and even used to fight childrens battles for them. Three year olds know how to switch from pretend to reality and develop story lines with their friends when they say, "let's pretend you are .....".
Children with S.P.D., on the other hand, find this kind of abstract thinking much more difficult. This makes their play less creative so that a tower of bricks is always a tower of bricks until someone else tells him otherwise. Children with S.P.D. tend to flit from toy to toy or play repetitively. They show more interest in real activities like water, motor play, operating machines, tidying up and stacking toys. Many children with S.P.D. understand representation i.e. that a toy cup stands for a real cup and they will often perform the appropriate action on the toy. They are not however pretending. The child who is really pretending is taking on the role of someone else and using their persona to develop a story line.
Many bright children with S.P.D. try to solve the mystery of pretence by copying other peoples' pretence or copying parents actions in the same detailed way they copy their speech. Some children with S.P.D. copy exerts from t.v. programmes exactly, and some people actually think children with S.P.D. are being creative when in fact they are simply copying in detail. We call this kind of play functional play. This inability to separate pretence from reality can pose problems for some children watching t.v. Although most children with S.P.D. prefer cartoon programmes, many, as they mature, enjoy films too. We would suggest that as far as possible you limit access to programmes which contain violence and that you explain what is real and what is not.
This inability to be creative is usually extended to drawing skills too. Many children with S.P.D. are late acquiring representational drawing skills. Many have to be taught how to draw a face and they can only repeat it in a particular way. Some children with S.P.D. will only copy draw and some will only draw objects related to their obsessional interests. One child we knew would only draw pyramids, another drew horses. Very few, except the most able, can draw a picture story which is not the same each time.
Motor Difficulties
Some children with S.P.D. have fine motor difficulties. They find handwriting very difficult. They often need specialised help in making the correct letter shapes.
Some children with S.P.D. have mild gross motor difficulties too, not always noticed early on except they are sometimes described as walking with an 'odd gait'. They are late riding bikes, find gym work difficult and take little interest in rule based games like football. Perceptual difficulties too can interfere with performance on practical skills, e.g. the sort of child who tells you how to prepare a 3 course meal but cannot put the beans on the toast.
Memory Skills
Many bright children with S.P.D. have exceptional memory skills which compensate for their communication problems. Many have a detailed memory for past events which other members of the family have long forgotten. Most have a detailed memory for social phrases as mentioned. Many have a memory for routes and can direct parents long distances by car! Some have an excellent memory for reading, others remember tunes.
Academic Performance
In the classroom, academic performance, tends to be patchy. First of all, the S.P.D. child's egocentricity means that he can only understand topic work from his own perspective. Refusing to do work may signal the work has no meaning for him and may suggest to the teacher and parents that they need to supplement classwork with more concrete shared experience. Children with S.P.D. often have excellent number concepts and teachers and parents are puzzled by the child's slowness in grasping how to do 'sums'. It seems they find the abstract symbols of adding = and subtracting - rather meaningless unless they are allowed to make their own. Later on, they often fail to understand the value of money or tell analogue time - unless of course either one happens to be an obsessional interest.
We think these difficulties can be remediated if addressed early on. Children with S.P.D. usually manage fairly well during infant classes and it is often not until junior level, when help has not been available that obstacles seem to be met. At Junior level, the major problems are handwriting and creative writing.
We would suggest that if handwriting is still unintelligible at nine years, there is little point in persisting with further handwriting practise and that it may be more sensible to encourage development of written skills through the use of word processors.
Creative writing, rather like pretend play, is something which may remain inflexible. Many children with S.P.D. find it easier to regurgitate their own experiences or retell stories. One child we know is so accomplished at memorising stories and interweaving them into new ones that he has actually won prizes for creative writing!
Some children with S.P.D. learn to read very early but not necessarily with understanding. We call this hyperlexia. Other children find reading and writing a hard slog and we call this dyslexia. As yet we cannot predict which children will fall into which group.
S.P.D. is therefore a complex disorder not yet fully understood. Except we now know that most of the problems experienced by these children have something to do with abstract thinking and mentalising; but just like any group of children, they are all different. They have their individual personality and their individual abilities, which means they have individual needs.
School Placements
Some children have moderate learning difficulties on top of their S.P.D. problems and do best in special schools, but many children are brighter than average and can do very well in mainstream education; particularly if they have the support of a helper or spend time in a language unit or a language school. We think that as our understanding of the disorder improves then we shall be able to provide an educational environment which best meets their needs.
For bright children with S.P.D., we think that the most important question is, "What is it that makes the S.P.D. child unique?" He has a different style of learning which is equally valid but it does necessitate a special understanding and a different approach. If we are to maintain his self esteem and reduce his anxiety to levels that allow him to learn, then we should perhaps start from the premise of what can this child do, rather than what can't he do.
With a clear understanding of his skills and his needs, our expectations should become more realistic and our interventions less punitive. The S.P.D. child may not show embarrassment when he has violated a class social rule but he will feel a failure if he is saturated with labels of 'naughty', 'silly' and 'no common sense'. He simply needs to know what is acceptable and what is unacceptable.
Bright children with S.P.D. are usually very quick at picking up rules if they are spelt out and will stick to them much more slavishly than the rest of the class. The secret of good teaching is perhaps to anticipate when these rules may need revision. Children with S.P.D. often perform best in small, orderly 'old fashioned' styled classrooms.
Growing Up
We haven't followed any of language unit children with S.P.D. into adulthood yet, but we do know that the children whose problems have been identified early and whose behaviour and communication problems have been recognised as part of the learning disorder tend to integrate best at least up to senior level. Some children have managed the transition to senior school well and one we expect to go to university. Other children however bright would simply be too vulnerable to cope socially at comprehensive school even though much of the academic work would be within their scope. We hope that in time some specialist facility may be offered locally at senior school for those who need it.
What we are sure of at this stage, is that children with S.P.D. do have problems recognising what is sociably acceptable and unacceptable and that they should not be educated with children whose primary diagnosis is E.D.B (Emotional Disturbed Behaviour). We believe that S.P.D. children's behaviour problems escalate in the presence of conduct disorders.
We have also found that some children with S.P.D. who find it difficult to cope in a busy mainstream class are out performed by similar children in special school, particularly if there is high Speech Therapy input and if the school has a genuine interest in developing a service for children with Semantic Pragmatic Difficulties.
Echoed speech, comprehension problems and refusal to co-operate are all behaviours minimized in the appropriate setting.
Children with S.P.D. will probably benefit most from an adapted curriculum where teachers and speech therapists work alongside each other to provide an integrated academic and communication programme.
Children with S.P.D. often do well if they spend time with children who are equally or less socially sophisticated than themselves. They need social peers as well as intellectual ones. Children who will encourage or insist on interaction rather than children who ignore.
Children with S.P.D. need extra talking practice, not less. With help, children with S.P.D. will overcome most of their language comprehension problems but if their conversation is to be timely and appropriate they need to 'know' who their conversational partner is.
* Autistic Continuum
This phrase refers to all children who share the same specific cognitive deficit resulting in problems with sociability, language and pretence. At the severe end of the continuum, we have children labelled as Autistic, Core Autistic or Classically Autistic.
At the other end of the continuum, we have children with milder problems who may have diagnostic labels of Semantic-Pragmatic Disorder or Autistic Spectrum Disorders
Autistic Spectrum Disorders
This recently adopted phrase refers to children who fall some way between normality and Autism but outside Core Autism. Labels like Atypical Autism, Aspergers Syndrome, or Semantic-Pragmatic disorder are often used and they all describe similar communication difficulties to a greater or lesser degree. All children on the Autistic Continuum including those with Core Autism have Semantic-Pragmatic difficulties with language and they should all be viewed in the context of Autism. That is they share the same triad of difficulties, with sociability, pretence and language.
Children with S.P.D. are the group who are sociably the most able but who have much more difficulty early on at least learning basic language skills. but whose difficulties we suspect in adulthood will blur into the realms of mild eccentricity.
Children with Aspergers Syndrome tend to have more problems with socialising than children with Semantic Pragmatic Disorder but are generally earlier fluent speakers. There seems to be a pay off between early comprehension skills and sociability. As children mature, it is often difficult to specify what label best fits. Many children improve dramatically and diagnostic labels can change.
Labelling or not
There is an argument, at least in the early years, particularly for more able children, to use less specific diagnostic labels like Autism and simply to describe children who may well improve dramatically in the pre-school years as falling within the 'Autistic Continuum' or as having an Autistic Spectrum Disorder.
Specific labels, however, can be useful, at the school stage of development both for research and for planning resources. There is clearly an enormous difference between a child with severe learning difficulties and Autism and a child of superior intelligence with a Semantic-Pragmatic Disorder. When we are describing children on the Autistic Continuum, we must also be clear in our own minds about whether we are simply describing levels of sociability or whether we are also describing more generalised learning difficulty. The two do not necessarily go hand in hand.
As a rule of thumb, however, children with Semantic Pragmatic Disorders as a group have less generalised learning difficulties than Autistic Children.
Origins of Semantic-Pragmatic Difficulty
We now think there is a family link between these Autistic Spectrum Disorders. We have sometimes found that having identified one child on the Autistic Continuum, another child in the family has been found to have milder communication problems too, particularly if they are male.
Parents ask why? Well as you have probably deduced, the evidence is now pointing to a disorder which is genetic in origin. Autistic Spectrum Disorders are sometimes associated with other genetic disorders like Fragile X Syndrome, Retts Syndrome and Tuberousclerosis.
We think the problem is much more complex than one parent passing on a problem. Just like two hearing parents can produce a profoundly deaf child, we think that two healthy parents can produce a child with a communication disorder.
Some parents of children with S.P.D. describe eccentric relatives or others with psychiatric illness, but this is by no means always the case. We still have much to learn about genes and inheritance. What we cay say is, boys are much more likely to have communication problems than girls : something in the ratio of 6:1.
Some parents describe difficult birth history's and wonder if brain damage at birth could have been responsible. Well it is possible, but unlikely that a brain injury could be so specific. We think that in the majority of cases, the genetic make up of the child makes him more vulnerable at birth.
If the same partners are contemplating extending their families after discovering they have a child with Autism and Semantic-Pragmatic Difficulties, we would recommend they sought Genetic counselling first.
Prognosis
Semantic-Pragmatic Disorder is not an illness like Diabetes. It is a developmental disorder which improves with age. Rates of progress are probably dependent on overall intelligence and the support of carers. At centres like Heathlands, carers hope to maximise on such improvement by providing support and guidance throughout childhood.
Until about 10 years ago, we were only able to recognise the most handicapped children with Autism. Children were either Autistic or they were not Autistic. this meant that many able children on the continuum with very mild and specific learning difficulties were excluded from a diagnosis and subsequent help. Many were dismissed as eccentric or language disordered or as having behaviour problems, leaving parents with much unresolved guilt.
Today we have extended the boundaries to include those children with only mild social difficulties, some of whom may be able to extend their special interest and abilities to out perform their peers in mainstream.
The gloomy picture of Autism and Mental Handicap once painted is not something that necessarily follows. If you are a parent and you have been given this article to read, you should feel reasonably optimistic.

See also
Weak central coherence theory
Fetal alcohol syndrome
References
Case-Smith, Jane. (2005) Occupational Therapy for Children. 5th Edn. Elesevier Mosby: St. Louis, MO. ISBN 032302873X
Biel, Lindsey and Peske, Nancy. (2005) Raising A Sensory Smart Child. Penguin: New York. ISBN 014303488X
Schaaf, R.C., and L.J. Miller. 2005. "Occupational therapy using a sensory integrative approach for children with developmental disabilities", Ment. Retard. Dev. Disabil. Res. Rev. 11(2):143-148.

External links
Sensory Processing Disorder Resource Center - Online resources for tips, educational articles, products, symptom checklists, and explanations about SPD
spdresources.com - 'author of Parenting a Child with Sensory Processing Disorder'
SensorySmarts.com-Lindsey Biel, OTR/L
Incredible Horizons: S.I.D.
Sensory Nation
Autism.org - 'Sensory Integration', Cindy Hatch-Rasmussen, MA, OTR/L
Genetic.org - 'Sensory Integrative Dysfunction', Linda C. Stephens, MS, OTR/L, FAOTA
Quirky Kids - 'Quirky Kids: Understanding and helping your child who doesn't fit in - when to worry and when not to worry', Perri Klass, M.D., and Eileen Costello, M.D.
SensoryInt.com - Sensory Integration International
AdultSID.com - E-mail list for adults with Sensory Integration Dysfunction
The SPD Network - Resources for the Sensory Processing Disorder community
Healing Thresholds - Summaries of the latest research on sensory integration therapy and autism
The Autism Acceptance Project - contains information from autistic people regarding their sensory and experiential issues
Parenting Kids with Sensory Processing Disorder (SPD)
The Highly Sensitive Person
Highly Sensitive People
SuperSensitive Person
Sensory Sensitivity
Sensory Integration Therapy as an Autism intervention


دسترسی به قسمت مشاوره

 

1   2    3     4   5    6     7      8     9     10   11    12    13     14    15     16   17    18   19    20.......next



 

 

    آخرین نوشته ها

 

    


      ϐ

       یэی ی یی (AIT)

       ی یی ی ی یی ی ј

        ی ی ی ی یی ݘ ی ی ی ی ی

        

         ی ی ی ی ی ی ی . ی ی  ی

       ی ی

       ی ی (autism spectrum disorder) 60 ی ی یی ی ی . 10% ی ی

       ی ی یی ی (autism spectrum disorder) .  

       Ϙ ی

      یӘی Ԙی ی ی ی ی ی ی ی Ϙ ی .

       ی ی ی ی یی ی ی یی ی ی ی

       ی јی ی Ϙ ی ی یی ی یی ی ی ی یی

      

       ی ی ی Ԑ -

     ȍ ʝ ʝ ی ی ی Ϙ ی یی. ی ǎ ی ی ی՝ ی ی

     روشهاي اصلاح و درمان (stuttering)

      -

     ی

      Ԑ , ˜

     زنان در دوران ميانسالي بيشتر دچار استرس مي‌شوند

     Dramatically Reduces Stuttering

     يكي از راه هاي درمان شب ادراري ، درمان با بازتاب هاي شرطي است ، اما تا چه حد عاقلانه خواهد بود كه ما

     عجله نکنید یه این بچه خودش بزرگ بشه درست میشه این بچه فقط تاخیر داره

 


 

  •  قسمتی از آنچه می توانید در این پایگاه اطلاع رسانی مشاهده کنید :  

     


           مواردی ما می توانیم  به یاری شما بشتابیم :

    •    آخرین تحقیقات و یافته ها

    •    آخرین محصولات توانپزشکی در رفع مشکلات شما

    •    ارائه برنامه های درمانی  توانبخشی  و  مشاوره

    •    ارائه نرم افزارهای گفتاردرمانی - بیوفیدبک تراپی (stuttering) بصورت خانگی و کلینیکی - ارائه نرم افزارهای آموزشی  از پیش دبستان تا راهنمایی و بالاتر مطابق نیازهای فردی افراد - ارائه نرم افزارهای آموزشی 

    •    معرفی درمانگران و متخصصین

    •    معرفی مراکز درمانی به وجود شما  نیاز دارند .

    •    مشاوره در مورد مشکلات کودک شما .

       

     

  •  

         

     

     

       

     

         
       

     

         
       

     

     

     

       

    ی ی ی ی ی ی
     

       
       

                                                                                                   

       
     

                           برگشت به صفحه قبلی                                       برگشت به صفحه اصلی                                           صفحه بعدی