Teaching Disciplines


It is not unusual for young children with Spina Bifida and Hydrocephalus to be easily distracted. They seem hyperactive and are often referred to as having 'poor concentration'. As they become older, they are more inclined to demonstrate reduced alertness and arousal, thereby gaining a reputation for passivity, laziness and/or a lack of interest and motivation. For many, it is difficult to sustain attention for the time that a task might require.

Some students struggle to identify the most salient aspect of a task, and when there is no obvious objective for them to focus on, their concentration will lapse. Tiredness, difficulty with understanding, or the child's attempts to block out general classroom or school noise can also result in a student seeming inattentive or restless.

The student with Spina Bifida and Hydrocephalus will often:

  • Benefit from one on one teaching; single activities; sitting close to the front, near the teacher and away from the flow of activity.
  • Find the interspacing of high demand work periods with more relaxing activities easier to handle.
  • Be helped by reminders of where their focus should be.
  • Learn to communicate more effectively if redirected when their conversation wanders or becomes repetitive
  • Better attend to subject matter that they perceive to be of interest or relevance.
  • Respond well to some form of explanation about the problematic nature of her/his behaviour. It is possible that they do not properly understand what it means to concentrate, focus, pay attention etc. Furthermore, such terms may hold negative connotations for the student if they have learned to associate them with reprimand.
  • Appreciate some help in learning to recognise a lapse in concentration. This may involve a quiet word or a secret signal.

Perceptual and Motor Ability

Most students with Spina Bifida and Hydrocephalus have problems with perceptual and motor ability. Perceptual problems include understanding pictures (particularly detailed and photocopied illustrations), discerning between different shapes, recognising and reproducing symbols, figure/ground discrimination, and spatial judgements (ie size, space, distance and direction, and concepts including up/down, over/under, in/out, above/below etc).

Motor problems involve impaired dexterity of the hands and arms and cause the student to have difficulty with pens, pencils, rulers, scissors and other manipulative equipment. Left and mixed handedness is more common, and students show a tendency toward delay in choosing a dominant hand.

Impaired perceptual and motor ability results in clumsiness and slow and untidy handwriting is also common. This is often a source of distress for the student, particularly if they notice that peers seem to manage. The student may fall behind in work and find it difficult to complete written tasks in a given time. One possible solution may be the introduction of a keyboard.

Perceptual and motor problems are also likely to impede the student's ability to manage map work, drawing, interpret detailed diagrams and handle equipment. This becomes more of an issue as the student progresses to higher levels of subjects such as geography, science, maths, physics etc.

The student with Spina Bifida and Hydrocephalus will often:

  • When young, enjoy practicing drawing letters and numerals in the air, on the blackboard, in sand etc.
  • Appreciate the occasional head start so that work is finished alongside peers.
  • Require an alternative medium in which to present material eg audio tapes,computers, posters, verbally.
  • Find books with prominent lines easier to write in.
  • Require some special equipment eg sloping desks, pen and pencil grips and chubby pens.


Although students with Spina Bifida and Hydrocephalus often have large vocabularies and appear to have no trouble understanding single words, many have problems formulating language for written work and conversation. Communication may seem nonsensical at times and there are students who will not be able to demonstrate understanding of the stream of words that they have used.

Difficulty in connecting sentences, or relating a sentence back to the original thought may be apparent, particularly in speaking exercises and written work. For some students, making relevant comment about what somebody else has said can pose a problem. Students who have slow thinking and comprehension speed should be encouraged to take time to formulate an answer rather than respond impulsively. Finally, the student with Spina Bifida and Hydrocephalus may have difficulty discerning what is or is not relevant or important. Therefore large amounts of high level information should be minimised.

The student with Spina Bifida and Hydrocephalus will often:

  • When young, need instructions given one at a time, small amounts of information, and time to think about answers.
  • Need to feel secure in the amount of time that they have to formulate an answer, tell a story, share information etc.
  • Be most successful in answering when given prompts and additional information.
  • Need to have work monitored for understanding and relevance.
  • Need to be asked a few questions to ensure a thorough understanding of the work set, especially in higher grades.
  • Be assisted by knowing who to approach regarding queries, concerns etc.
  • Better absorb main themes and key points if they are highlighted eg underlined in passages, emphasised by the teacher as they speak, discussed by the class etc.
  • Be most successful if comprehension activities relate to personal experience, hobbies, or special interests.
  • Glean understanding from personally chosen materials eg magazines, a car manual, a brochure.
  • On occasion need simplified texts and references or alternative presentations eg a video instead of a novel.


Some students with Spina Bifida and Hydrocephalus have poor short-term memory. However, it is more common for them to have problems with storage and retrieval of information. Whether or not the student understands a concept, and how relevant or interesting it is, are factors that can make a difference to the student's capacity for recall.

Visual memory is often weak. Associated difficulties include copying, especially off the blackboard, finding a spot on the page after having glanced away for a moment, and sequencing. Auditory retention is generally better. Therefore, use of speech ie talking to oneself, audio tapes, and rhythm may be useful.

The student with Spina Bifida and Hydrocephalus will often:

  • Be more likely to remember if rituals, routines and repetition are applied to learning experiences. They may also be assisted by a calendar, timetable, written notes and lists, a journal or a diary.
  • Reinforce processes if they talk to themselves through activities.
  • Benefit from word association.
  • Remember key points if they are assisted in working out what they are and what they mean etc.

Problem Solving and Decision Making


Due to the physical nature of their disability children with Spina Bifida and Hydrocephalus do not experience as many interactions with the environment as do other children. Consequently learning with regard to requests and expectations is limited, which means that many do not understand how their behaviour affects their environment. A student who does not understand cause and effect has reduced power in terms of the impact that they will have.

Further, generating and maintaining a plan will be problematic. For example, the student may find it difficult to define the essence of the problem, generate strategies for resolution, choose a solution, initiate action, or alter their approach when necessary.

Many students with Spina Bifida and Hydrocephalus are ineffective at generalising, and transferring problem solving experience from one situation to another.

The student with Spina Bifida and Hydrocephalus will often:

  • Establish a 'can do' approach to problem solving if they are given the opportunity to practice and succeed.
  • Benefit from an array of options rather than a right/wrong, good/bad choice.
  • Gain a better understanding of cause and effect through brainstorming and the implementation of solutions, particularly if they are relevant and of interest.
  • Need the opportunity to generalise problem solving strategies. Significant prompting will help with the transfer of solutions from one situation to another.

Planning and Organisation

Spina Bifida and Hydrocephalus associated difficulties with planning and organisation stem from an impaired ability to know when and where to start. Some students manifest this in their day to day tasks while others struggle predominantly in novel or unstructured situations. As students become older and independence becomes more significant, many have trouble organising themselves well enough to meet extra demands. This can look like laziness and inactivity. However, it is better seen as a signal for extra support and empathy.

The student with Spina Bifida and Hydrocephalus will often:

  • Be helped by colour coded books and equipment. The younger student, could use one colour for everything including books, reading folder, pencil case, bag etc. so that their possessions are easily recognised. The older student who is expected to be more responsible could colour code according to subjects. For example, maths books/folders and associated equipment could be covered or labelled in red and corresponding red stickers in diaries indicate to the student collect red items and go to maths.
  • Be able to keep notes in order and good condition using lightweight folders that come with plastic sleeves. Alternatively, the student may prefer one large folder with separate compartments so that all subjects are kept in one place.
  • Appreciate a clearly visible timetable. For the younger student it may be pictorial and on the wall. For the older student it could go on the back of a book, a door, inside a locker, or on a desk.
  • Be more organised if they are encouraged to use a diary.
  • Need ample practice at constructing plans.
  • Be more inclined to initiate action if they are prompted in a way that motivates self prompting.
  • Submit work that is more detailed if permitted on occasion, to hand up a dot point plan rather than a complete assignment.
  • Appreciate the opportunity to submit draft copies for review to teachers for larger assignments. These may be as detailed as much as is necessary to support the student in presenting an assignment of peer quality.
  • Be helped by the introduction of essay maps as a formula for writing. The student who requires substantial prompting can hand in an essay map full of detail while another student uses it for planning, or in lieu of a first draft.


Maths is the most common academic deficit for students with Spina Bifida and Hydrocephalus, probably because it involves all of the previously mentioned abilities ie attention, perceptual and motor ability, comprehension; memory, problem solving and decision making and planning and organisation.

The student must not be allowed to accept that they 'can't do numbers'. Rather, with constant reward and encouragement, tasks that are broken into several small steps, and opportunities to practice that aren't too long, the student can learn to manage basic concepts. Some students develop rote memorisation of facts and procedures. However, translating mathematical concepts to concrete examples requires significant understanding. Therefore learning must be centred around consolidating pre-skills in order to facilitate understanding.

Maths pre-skills include:

  • The ability to follow sequential direction.
  • Spatial orientation; recognising the relative position of a number in order to know its value ie 60 as opposed to 6 and the ability to judge left from right which affects concepts of place values, fractions, integers, geometry, trigonometry and all concepts after that.
  • The ability to discern emerging patterns in incoming information.
  • Visualisation; the ability to hold data in the mind's eye and manipulate it ie working memory.
  • The ability to estimate; to know what to expect in an answer.
  • Deductive thinking; the ability to go from the general to the specific.
  • Inductive thinking; the ability to go from the specific to the general case.