Learning disabilities Julie Dockrell Conceptualising learning difficulties

Aims Consider alternative conceptualisations of learning difficulties Focus on language learning difficulties Consider the impact of co-occuring difficulties in the social-emotional domain Examine how studies of children with language difficulties can support theory and conceptualisation Writing as the example Focus on key experimental studies

Workshop Examine how the complexity of language problems impacts on decisions about assessment and intervention

Familiarisation session To ask questions about developmental disorders Challenges current wisdom Per favore domande se qualcosa non sia chiaro o non sei d’accordo

Neurodevelopmental disorders Neurotypical Neurodiversity Neurodivergent No valid scientific evidence Premised on the categorisation of disorders Vast majority done a behavioural not neurological bases

Specific V. general neurodevelopmental disorders but even here we have a tremendous reaction range SOME BACKGROUND General learning disabilities/ difficulties level of intellectual development is significantly below average (as assessed by an intelligence test) perform less well than age matched peers on a range of intellectual tasks. 'slow learners', and in more severe cases ‘intellectual disability'. Some of these neurodevelopmental disorders can be traced to specific genetic factors – Down syndrome Specific intellectual development is normal but have specific difficulty with some particular task performance profile gap between their level of achievement in their area of specific difficulty and their levels of achievement in other areas of cognitive functioning …discrepancy between achievement and their aptitude UK- specific learning difficulty/ USA learning disability Attempts to identify genetic factors but no clear success Check they know what a reaction range is.

Primary diagnostic model DSM-5™ (American Psychiatric Association, 2013) Specific learning disorder – developmental disorder that begins by school-age, although it may not be recognized until later - involves ongoing problems learning key academic skills, including reading, writing and math Communication Disorders – independent of modality (oral, written, sign) Language Disorder and Mixed Receptive-Expressive Language Disorder (LD), Social (Pragmatic) Communication Disorder (SCD), Speech sound disorder (SSD) Childhood onset fluency disorder (stuttering)

A learning disability (LD)   A learning disability (LD) affects the brain's ability to receive, process, store and respond to information. The term learning disability is used to describe the seeming unexplained difficulty a person of at least average intelligence has in acquiring basic academic skills. These skills are essential for success at school and work, and for coping with life in general. LD is not a single disorder.

History of the term Samuel Kirk 1962 coined term learning disabilities “ a retardation, disorder or delayed development in one or more of the processes of speech, language, reading, spelling, writing or arithmetic resulting from a possible cerebral dysfunction and not from a mental retardation, sensory deprivation or cultural or instructural factors” Kirk 1963 LD discrepancy between a child’s achievement and ability to learn Amalgam of disabilities all grouped under a single label

Validity rarely examined! Assumptions Validity rarely examined! Child internal Cognitively determined Based on Information Processing Perspective with an emphasis on subskill breakdowns/faults Discrepancy between learning potential and achievement Exclusion of cultural, educational, environmental and economic factors or other disabilities FACTORS Age determined Context determined Heterogeneous group CRITICAL

Some caveats No objective way to assess putative brain dysfunction + new studies suggest interaction between environment (including instruction) and brain circuitry IQ scores reflect a gross estimate of current general cognitive functioning should not be used as a measure of learning potential (Thorndike, 1963) Discrepancy means implementing the wait to fail model! Interaction is the key

Neural systems supporting reading may not be fixed, but develop if challenged. Image of a 10-year-old with severe reading disabilities before and after 60 hours of intensive instruction, during which the child rose into the average range in word-reading ability. The “before” image captures a brain exhibiting the standard activity pattern of children with reading disabilities. The “after” image shows increased activity in the left hemisphere, a pattern common to nonimpaired readers From F=G. Reid Lyon and J. Fletcher

Focus is learning What impacts on learning Child Task general (processing) or specific structures (phonology) Task task analysis to identify key components writing reading Environment (particularly vulnerable) Bronfenbrenner’s analyses

Over time

Primary language problem? Problems in the acquisition and development of oral language. Language difficulties without any obvious aetiological causes e.g. hearing Range of different terms used to describe these children - often reflecting theoretical background Estimated 10% of pupils in Year 1 (age 6) Majority will be in mainstream classes More prevalent in lower SES & EAL pop (Dockrell et al, 2014) Specific language impairment Meet Seb The children and their difficulties have been described in a variety of ways. This confusion is reflected in the variety of terms that have been used to describe the children. These include as developmental aphasia, specific language impairment, and developmental disorders of language. This list is not all inclusive and more recently new terms have been added to describe particular types of problem. New, more specific, descriptions have begun to emerge, including specific grammatical language impairment or word-finding difficulties. Unfortunately, little consensus exists about the appropriate terminology. In this chapter we use the term specific speech and language difficulty to describe children who have primary 2

SPECIFIC CRITERIA used in the past 'specific developmental disorders of speech and language' ICD 10 'developmental language disorder'. DSM IV The criteria to make these specific diagnoses centred on three issues: Performance on a language test below the child's chronological age A discrepancy between the child's language skills and their non-verbal abilities Language abilities that cannot be attributed to any other cause the norm itself is not easy to characterize. There is considerable diversity in the rate at which children acquire language, especially in the pre-school period. Thus, there is no exact point that divides normal development from that which should cause concern. 3

Many challenges What is a discrepancy? When is performance below expectation? Which aspect of language?

Language disorders Language disorders ? Language learning disabilities Specific language impairment Range of other terms Terminological confusion Professional challenges Lack of specificity in looking at co-morbidity Causal models

Developmental language Disorder (Catalise project) Bishop, D. V. M., Snowling, M. J., Thompson, P. A., Greenhalgh, T., & Consortium, C. (2016). CATALISE: A Multinational and Multidisciplinary Delphi Consensus Study. Identifying Language Impairments in Children. Plos One, 11(7). doi:10.1371/journal.pone.0158753