CO-MORBIDITY Learning, Disabilities, ADHD, Behavioral Emotional Disorders

Disorders of Behavior- Arriving at a Definition Normal versus Disordered Behavior A social construct What constitutes good mental health? Concerns of frequency, intensity, duration Difficult periods of childhood vs. behavior disorder Lack of social skills vs. behavior disorder Operationalizing such terms as pervasive, normal, inappropriate, etc. Student's emotional problems vs. ability to learn. Males- in the past- propensity to rules breaking Behavior vs. Race and cultural bias Girls- internalize emotional disturbance. Other classifications Normal versus Disordered Behavior A social construct What constitutes good mental health? Concerns of frequency, intensity, duration Difficult periods of childhood vs. behavior disorder Lack of social skills vs. behavior disorder Operationalizing such terms as pervasive, normal, inappropriate, etc. Student's emotional problems vs. ability to learn. Males- in the past- propensity to rules breaking Behavior vs. Race and cultural bias Girls- internalize emotional disturbance. Other classifications

Physiological Birth defect TBI Tourette’s Syndrome Fetal Alcohol Syndrome, Depression Chemical and mood disorders. Environmental Learned behaviors Mental illness, etc. PTSS

Learning Disabled Students interact awkwardly. interact inappropriately in social situations. socially imperceptive. Learning Disabled Students interact awkwardly. interact inappropriately in social situations. socially imperceptive.

ATTENTION DEFICIT HYPERACTIVE DISORDER tend to react to others aggressively are generally rejected by peers lose the opportunity to learn social skills are isolated from most social situations (Westby, Cutler, 1994). victims of parents who are abusive or lacking effective parenting skills. (Parker, Asher 1987). tend to react to others aggressively are generally rejected by peers lose the opportunity to learn social skills are isolated from most social situations (Westby, Cutler, 1994). victims of parents who are abusive or lacking effective parenting skills. (Parker, Asher 1987).

Learning Disabilities: Typically a Disruption in Maturational Delay Language skills Motor skills Uneven performance on IQ assessment Visual-Motor Incomplete or mixed dominance Social Immaturity Genetics Language skills Motor skills Uneven performance on IQ assessment Visual-Motor Incomplete or mixed dominance Social Immaturity Genetics

At Risk for LD Established risk: identified through a medical diagnosis; failure to develop, thrive; delay in language development. Unknown etiology is the important term. Biological risk: early medical and health history indicates increased probability for later atypical development. (HIV, premature, injury at birth (anoxia, chemical dependency at birth.) Environmental risk: biologically sound early life experience are characterized by a profound lack of stimulation- critical in the years birth to age five. Lack of cognitive stimulation in the formative years; lack of nutrition, age of mother, lack of prenatal and neonatal care. Child can be at risk for all three, one or two. Established risk: identified through a medical diagnosis; failure to develop, thrive; delay in language development. Unknown etiology is the important term. Biological risk: early medical and health history indicates increased probability for later atypical development. (HIV, premature, injury at birth (anoxia, chemical dependency at birth.) Environmental risk: biologically sound early life experience are characterized by a profound lack of stimulation- critical in the years birth to age five. Lack of cognitive stimulation in the formative years; lack of nutrition, age of mother, lack of prenatal and neonatal care. Child can be at risk for all three, one or two.

Children with LD and Behavior Disorders Short Attention Span Low Frustration Tolerance Insatiability- need a significant level of intensity, often bored, need new and novel activities, chronically restless, incredibly future oriented Distractibility Low self esteem Short Attention Span Low Frustration Tolerance Insatiability- need a significant level of intensity, often bored, need new and novel activities, chronically restless, incredibly future oriented Distractibility Low self esteem

Continued:Continued: Learned helplessness Hyperactivity Sequencing deficits Memory deficits Interrogoration Disinhibition Impulsivity Learned helplessness Hyperactivity Sequencing deficits Memory deficits Interrogoration Disinhibition Impulsivity

Common Elements in the Definition Common Elements in the Definitions Central Nervous System Dysfunction Uneven Growth Pattern /Psychological Processing Deficits Discrepancy Between Potential and Achievement Exclusion of Other Causes Central Nervous System Dysfunction Uneven Growth Pattern /Psychological Processing Deficits Discrepancy Between Potential and Achievement Exclusion of Other Causes

Symptoms of ADD/ADHD Severity –Symptoms more frequent and severe than other children Early onset –Symptoms must have appeared before age seven Duration –Symptoms persist for at least 6 months Severity –Symptoms more frequent and severe than other children Early onset –Symptoms must have appeared before age seven Duration –Symptoms persist for at least 6 months

Subtypes of ADHD in DSM-IV ADHD-IA ADHD-HI ADHD-C ADHD-IA ADHD-HI ADHD-C Primarily inattentive Primarily hyperactive and impulsive Combined

Implications of the Law Children with ADD/ADHD may be eligible for special education services under the category of “other health impaired” Children with ADD/ADHD may receive services under the legislation of Section 504 of the Rehabilitation Act of 1973 ADD/ADHD is listed as a specific condition under “other health impaired” Children with ADD/ADHD may be eligible for special education services under the category of “other health impaired” Children with ADD/ADHD may receive services under the legislation of Section 504 of the Rehabilitation Act of 1973 ADD/ADHD is listed as a specific condition under “other health impaired”

Increase in Disorders

Psychostimulant Medications for ADD/ADHD Ritalin Dexedrine Cylert Adderall Concerta Ritalin Dexedrine Cylert Adderall Concerta 3-5 hours Long-lasting 8 hours 8-12

Precursors of Learning Disabilities- Difficulties in any of the following: Communication/oral language Phonological awareness Rapid naming skills Knowledge of the alphabet Visual-motor skills Fine- and gross-motor skills Attending abilities Social skills Communication/oral language Phonological awareness Rapid naming skills Knowledge of the alphabet Visual-motor skills Fine- and gross-motor skills Attending abilities Social skills

Age Span of Learning Disabilities Population Preschool children Elementary-age children Secondary students Adults Preschool children Elementary-age children Secondary students Adults

Ages that Children with LD Are Identified

Composition of Students with Disabilities

Left-Right Brain Processing Left BrainRight Brain AnalyticalSynthesizes Verbal StrengthsVisual (spatial imagery LinearSimultaneous SequentialHolistic “Sees” parts, pieces“Sees” whole, gestalt Precise & accurateMakes sense of all the parts Detail orientedInterpretation of non verbal cues Step by step learner Organization Ambiguity Open ended questions Left BrainRight Brain AnalyticalSynthesizes Verbal StrengthsVisual (spatial imagery LinearSimultaneous SequentialHolistic “Sees” parts, pieces“Sees” whole, gestalt Precise & accurateMakes sense of all the parts Detail orientedInterpretation of non verbal cues Step by step learner Organization Ambiguity Open ended questions

Nonverbal Learning Disabilities Characteristics –Poor social perception –High verbal intelligence –Early reading achievement –More evident in adolescents and adults Different than academic, language and cognitive disabilities Asperger’s (?)Syndrome Video Characteristics –Poor social perception –High verbal intelligence –Early reading achievement –More evident in adolescents and adults Different than academic, language and cognitive disabilities Asperger’s (?)Syndrome Video

Indicators of Social Disabilities Poor social perception Lack of judgment Lack of sensitivity to others Difficulty making friends Problems with family relations Social problems in school Undiagnosed Syndromes Poor social perception Lack of judgment Lack of sensitivity to others Difficulty making friends Problems with family relations Social problems in school Undiagnosed Syndromes

Difficulties in Reading Students may: Have difficulty with one or more subject areas. Have limited mastery of concepts. Have limited fund of information. Have limited expressive and receptive vocabulary. Display limited knowledge of word meanings. Do not understand special multiple meanings of words. Read significantly below level of text. Difficulties in Reading Students may: Have difficulty with one or more subject areas. Have limited mastery of concepts. Have limited fund of information. Have limited expressive and receptive vocabulary. Display limited knowledge of word meanings. Do not understand special multiple meanings of words. Read significantly below level of text. Verbal Linguistic Learning Disabilities

Content Area Reading Technical Vocabulary- in the content areas carries the conceptual load. Students may: Have difficulty with one or more subject areas. Have limited mastery of area concepts. Do not understand technical words. Do not understand special uses of non technical words. Display limited knowledge of word meanings. Read significantly below level of text. Content Area Reading Technical Vocabulary- in the content areas carries the conceptual load. Students may: Have difficulty with one or more subject areas. Have limited mastery of area concepts. Do not understand technical words. Do not understand special uses of non technical words. Display limited knowledge of word meanings. Read significantly below level of text.

Causes: Weak listening speaking and sight vocabulary. Weak contextual analysis skills. Inability to apply same word in different contexts. Causes: Weak listening speaking and sight vocabulary. Weak contextual analysis skills. Inability to apply same word in different contexts.

Dyslexia and the Brain Broca's area Expressive language Wernicke's area Receptive language. Posterior reading system. There are three neural pathways for reading: the parietal-temporal and frontal-(slower, analytical, used by beginning readers) the occipital-temporal (word form, experienced readers).

Sally Shaywitz, MD Recent Brain Research Sally Shaywitz, MD At left, non-impaired readers activate neural systems that are mostly in the back of the left side of the brain (shaded areas); at right, dyslexic readers under activate these reading systems in the back of the brain and tend to over activate frontal areas. In addition to their greater reliance on Broca's area, dyslexics are also using other auxiliary systems for reading, ones located on the right side as well as in the front of the brain. This is evidenced by the activation of right hemisphere parts of the brain. (Dyslexics and slow readers often sub-vocalize. The physical aspect to their reading is an attempt to compensate for the disruption in the back of the brain.) At left, non-impaired readers activate neural systems that are mostly in the back of the left side of the brain (shaded areas); at right, dyslexic readers under activate these reading systems in the back of the brain and tend to over activate frontal areas. In addition to their greater reliance on Broca's area, dyslexics are also using other auxiliary systems for reading, ones located on the right side as well as in the front of the brain. This is evidenced by the activation of right hemisphere parts of the brain. (Dyslexics and slow readers often sub-vocalize. The physical aspect to their reading is an attempt to compensate for the disruption in the back of the brain.)

An Information-Processing Model of Learning

Difficulties in Mathematics Sense of Body Image Visual-motor & Visual Perceptual Abilities Spatial Relations Memory Abilities Sense of Body Image Visual-motor & Visual Perceptual Abilities Spatial Relations Memory Abilities

Progressing from Concrete to Abstract Concrete Level- Use Real Objects Representational Level- Use Graphic Symbols Abstract Level- Use Numbers Concrete Level- Use Real Objects Representational Level- Use Graphic Symbols Abstract Level- Use Numbers

Information Processing Problems in Mathematics Attention Visual-spatial Processing Auditory Processing Memory & Retrieval Motor Problems Non Verbal LD Attention Visual-spatial Processing Auditory Processing Memory & Retrieval Motor Problems Non Verbal LD