Outline – Lecture 5 [Oct. 14, 2003] Ch Outline – Lecture 5 [Oct. 14, 2003] Ch. 5: Children with Learning Disabilities Learning Disorders [LD] Definition & criteria DSM criteria Dyslexia, Dyscalculia, Dysgraphia Prevalence Cognitive, Social, & Motivation deficits Developmental course & outcome Etiology Brain abnormalities, genetic & environmental factors Assessment & Treatment Comorbid Disorders - ADHD

Chronology 1877 Kussmaul described congenital word blindness 1896 Cases of word blindness reported 1917 Hinshelwood published: “Congenital Word Blindness” 1927 Orton coins strephosymbolia 1940s Strauss & Werner work with brain-injured children 1963 Kirk uses term learning disabilities. ACLD formed 1970s Rapid expansion of the field

Generic Definition of LD A disorder in one or more of the basic psychological processes involved in understanding/using language, [spoken or written] General LD – performance lags in most academic areas Specific LD – difficulties lie in specific areas

Criteria performance is below expected grade or age level in at least one academic area or there is a discrepancy between intellectual ability and achievement level Problem: How much of a discrepancy? IQ & achievement are not independent

Common Elements of Accepted Definitions Average or above average intelligence Discrepancy between Potential &Performance Exclusion of other causes Difficulty in academic tasks Neurological dysfunction Uneven growth pattern

Learning Disorders: problems in reading, arithmetic, writing, and spelling [DSM-IV Criteria] Achievement substantially below that expected for age, IQ, and education Significant interference with academic achievement or activities of daily living If sensory deficit present, difficulties are in excess of those expected

DYSLEXIA [Disorders of Reading] [1] Deficits in language skills - phonological processing is implicated [2] Deficits in visuospatial skills - may cause reading problems for some but not central in most cases Dyslexia characterized by: - poor decoding & word recognition skills -problems with phonological processing -language difficulties -problems in short-term memory

DYSCALCULIA [Disorders of Arithmetic] [Often co-exists with reading or spelling disorders] characterized by: -deficits in computational arithmetic -deficits in fine-motor and visual-spatial abilities -deficits in nonverbal concept formation - may have age-appropriate language & auditory perceptual abilities -don’t use efficient & effective memory strategies

DYSGRAPHIA [Disorders of Writing] Appear to be 3 types: [1] deficits in language development [phonetic-analytic skills] [2] poor visuospatial and constructive skills [3] deficits in written language only [not in reading or arithmetic]

Prevalence Difficult to determine – varies with how LD is defined and with sociopolitical factors 5 to10 or 15% of school age children Boys: 3 to 5 times more than girls but can see reports of 4:1 to 10:1

Steps Involved in Learning Input – the process of recording information in the brain. Refers to how one sees, hears, or perceives the world. Term used for this central process is perception. Integration – the process of interpreting input information. Information has to be placed in right order and understood. Memory – storage of input for later retrieval. Output – achieved through through language or motor activity Malfunctions can occur at any of the steps.

Possible Underlying Cognitive Deficits Attention deficits Deficits in Language learning Deficits in listening Misperception of phonemes semantics Perceptual & perceptual-motor problems Auditory information processing Visual information processing Motor coordination Deficits in Memory, cognitive strategies May not be able to hold information in memory Metacognition problems

Effects on Social Competence Relationship problems - may be due to: Behavioural Deficits: -lower in verbal skills -deficit in motor skills -nonverbal behaviour problems Social Cognitive deficits: -less accurate in predicting appropriate emotions -less accurate in identifying emotional expressions -attribute negative bias to neutral interactions -lower in social perspective taking ability -have trouble comprehending instructions -goals for social interaction are different

Effects on Motivation Vicious cycle of academic failure & low motivation -self-perceptions [external locus of control] -problems with academic self-perceptions -more pessimistic about future performance -less personal credit for success -attribute failure to lack of ability -attribution retraining has shown some success

Effects on the Family stress resources sibling competition finding special education opportunities dealing with stigma

Developmental Course and Outcome Language disorders Receptive-Expressive: do not easily remit Expressive: children may only be delayed Reading disorders Problems tend to persist Adjustment is variable

Familial-genetic factors Brain abnormalities Etiology Familial-genetic factors Brain abnormalities hemispheric specialization structural abnormalities Environmental factors Gerald Coles [1987] ‘The Learning Mystique’ dyspedagogia

Assessment Importance of assessment identify, plan, and evaluate Formal assessments -Standardized tests e.g. IQ tests -Specific tests -processing tests [e.g. auditory, sequential] -achievement tests [e.g. math, reading] -indicate current level of achievement -highlight ability-achievement discrepancies Informal assessments e.g.teacher observations Assessment must be comprehensive in order to understand child’s deficits See Table 5-1 in text for common characteristics

Modes of Treatment Early process approaches Perceptual-motor training Visual-perception training Provide missed motor and sensory experiences Visual or visual-motor training Multisensory experiences targeting language Current Approaches [Educational] Direct instruction Behavioural approach Cognitive and cognitive-behavioural model

Common Co-Morbid Disorders Learning disabilities &ADHD are often co-morbid why? [1] LD may create an inattentive, impulsive behaviour style that is diagnosed as ADHD. [2] primary deficits of ADHD may interfere with learning to degree that LD label is warranted [3] some common biological/environmental factors can cause both [4] each has distinct biological/environmental cause but these are related [5] could build on each other

Core Characteristics of ADHD Inattention difficulty attending to relevant, ignoring irrelevant stimuli difficulty maintaining attention over time Impulsivity Difficulty inhibiting behaviour [act without thinking] Hyperactivity Excessive activity and restlessness [unable to sit still] Must appear before age 7. Must be severe and persistent. Must impair child in at least two environments