1. Communication and Learning Disorders7
Communication and Learning Disorders

2. Definitions and History
Learning disability: learning problems that occur in the absence of other obvious conditions
The term has been replaced in the DSM-5 by more specific terms, communication disorders and learning disorders
Affects how individuals of at least normal intelligence take in, retain, or express information

3. Categories of Communication Disorders
Language disorder
Speech sound disorder
Childhood-onset fluency disorder
Social (pragmatic) communication disorder

4. Specific Learning Disorder
Co-occurring problems in:
Reading
Math
Written expression
Determined by achievement test results that are lower than would be expected for one’s age, schooling, and intellectual ability

5. Language Development
Infants selectively attend to parental speech sounds
By age 1, a child can recognize several words as well as say a few words to express needs and emotions
Over the next two years, language development increases exponentially along with the ability to formulate complex ideas and express new concepts

6. Language Development (cont’d.)
Perceptual maps are formed in the brain when children hear phonemes (basic sounds) repetitively
By 6 months - infants differentiate their own language from other languages
By age 1 - the map is complete and infants have lost the ability to discriminate sounds not important to their own language

7. Phonological Awareness
Language development
Early language problems are highly predictive of subsequent communication and learning disorders and should not be ignored
Phonology
Deficits in phonology are a chief reason that individuals develop communication and learning disorders
About 80% of children can use phonemes properly by the age of 7

8. Phonological Awareness (cont’d.)
Broad construct that includes recognition of the relationship that exists between sounds and letters
Detection of rhyme and alliteration
Awareness that sounds can be manipulated within syllables

9. Communication Disorders
Diagnostic subcategories in the DSM-5
Language disorder
Speech sound disorder
Childhood-onset fluency disorder
Social communication disorder

10. Language Disorder (LD)
Characterized by deficits in expression despite normal comprehension of speech
LD occurs when a child’s language matures at least 12 months behind his or her chronological age
Children with LD often have:
Delayed/slowed speech development; limited vocabulary; and speech marked by short sentences and simple grammatical structure

11. Diagnostic Criteria for Language Disorder
Table 7.1 Diagnostic Criteria for Language Disorder
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association.

12. Diagnostic Criteria for Language Disorder (cont’d.)
Table 7.1 Diagnostic Criteria for Language Disorder
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. American Psychiatric Association.

13. Language Disorder (cont’d.)
Linguistic abilities vary significantly among those with LD
Children with LD may have difficulty understanding particular types of words or statements
Speech sound disorder – difficulty with articulation or sound production

14. Prevalence and Course of Language Disorder
Language disorder affects 7% of younger school-age children
Communication disorders are identified twice as often in boys than girls
Most children acquire normal language by adolescence
50% fully outgrow the problems
LD is associated with higher-than-normal rates of negative behaviors

15. Causes of Language Disorder
Genetics
Temporal processing deficits
Brain
Circular feedback loop in the left temporal lobe
Problems in connections between brain areas and less brain activity in left temporal region

16. Areas of the brain involved in language functions
Figure 7.1 Areas of the brain involved in language functions
Source: From Plotnik/Kouyoumdjian. Introduction to Psychology, 9E. © 2011 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission.

17. Other Causes of Language Disorder
Recurrent middle ear infections (otitis media) in first year of life may lead to speech and language delays
Home environment
It is unlikely that communication disorders are caused by parents
Except in cases of extreme neglect and abuse

18. Treatment of Language Disorder
LD and other similar communication disorders usually self-correct by age 6 and may not require intervention
Strategies for parents to stimulate language development
Enroll child in a specialized preschool
Using a combination of computer- and teacher- assisted instruction to teach early academic skills
Build on the child’s existing strengths

19. Childhood-Onset Fluency Disorder
The repeated and prolonged pronunciation of certain syllables that interferes with communication
Prevalence and course
Gradual onset between ages 2 and 7; peaks at age 5
About 3% of children are affected
Affects males about three times more often than females
80% of those who stutter before age 5 stop after a year in school

20. Causes and Treatment of Childhood-Onset Fluency Disorder
Genetic factors account for 70% of variance in causes
Environmental factors account for remaining influences
Possible treatments
Parental changes - speak to the child slowly in short sentences
Contingency management procedures
Habit reversal procedures

21. Social (Pragmatic) Communication Disorder
New addition to DSM-5
Persistent difficulties in pragmatics (social use of language and communication)

22. Diagnostic Criteria of Social Communication Disorder
Table 7.3 Diagnostic Criteria for Social Communication Disorder
Source: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American
Psychiatric Association.

23. Diagnostic Criteria of Social Communication Disorder (cont’d.)
Table 7.3 Diagnostic Criteria for Social Communication Disorder
Source: Diagnostic and Statistical Manual of Mental Disorders, 5th ed. American
Psychiatric Association.

24. Specific Learning Disorder
A discrepancy of more than two standard deviations between the IQ findings and the actual achievement test findings in a child
Learning disorders include reading, mathematics, and writing
The different learning disorders overlap and build on the same brain functions
A person can have more than one form of learning disorder

25. SLD With Impairment in Reading
Most common underlying feature is the inability to distinguish or separate sounds in spoken words
Involves difficulty learning basic sight words, such as: the, who, what, laugh, said

26. SLD With Impairment in Reading (cont’d.)
Errors in reversals (b/d, p/q), transpositions (was/saw, scared/sacred.), inversions (m/w, u/n), and omissions (place for palace, section for selection)
These errors are common in young children
Core deficits in reading disorders are in decoding rapidly enough to read the whole word – coupled with problems reading single, small words

27. SLD with Impairment in Written Expression
Writing disorders are often associated with problems with eye/hand coordination
Leads to poor handwriting
Children with writing disorders:
Produce shorter, less interesting, and poorly organized essays
Are less likely to review spelling, punctuation, and grammar to increase clarity

28. Impairment with Written Expression Example
Figure 7.3 Top: Drawings produced by Carlos when asked to copy a triangle, a circle, and a square. Bottom: Examples of a triangle, circle, and square from a typically developing 7-year-old-boy.
Source: Based on authors’ case materials.

29. SLD With Impairment in Mathematics
Difficulty in recognizing numbers and symbols, memorizing facts, aligning numbers, and understanding abstract concepts
May include problems in comprehending abstract concepts or in visual-spatial ability
Involves core deficits in arithmetic calculation and/or mathematics reasoning abilities

30. Example of SLD With Impairment in Mathematics
Figure 11.2 Errors in math computation by a 10-year-old girl with a mathematics disorder
Source: From Learning Disabilities by H. G. Taylor, 1988, p In E. J. Mash and L. G. Terdal (Eds.) Behavioral Assessment of Childhood Disorders, 2nd ed. Copyright © 1988 The Guilford Press. Reprinted by permission.

31. Prevalence and Course of SLDs
Estimates: 2-10% of the population
SLD with reading impairment
5-17% of school-aged children
Reading difficulties may be part of reading abilities continuum, rather than a discrete phenomenon

32. Prevalence and Course of SLDs (cont’d.)
SLD with impairment in mathematics
20% of children with learning disorders (1% of school-age children)
SLD with impairment in written expression
Rare by itself
Overlap with reading and math disorders
May affect 10% of school-age children

33. Cultural, Class, and Gender Variations in SLDs
Social and cultural factors are less relevant to LDs than other types of cognitive and behavioral problems
The disorders reflect an interaction between a child’s inherent abilities and resources/opportunities available
When learning to read, some teaching approaches neglect specific ethnic sound-symbol relationships
SLDs are more common in males

34. Development of SLDs
Daily experience of being labeled and unable to keep up can cause children to withdraw or become angry and noncompliant
Three-fourths of children with a reading disorder in elementary school continue to have problems in high school and young adulthood

35. Psychological and Social Adjustment
Students with reading disorders feel less support from parents, teachers, and peers
Difficulty in managing a child with SLD
Behavior problems are about three times higher than the norm by age 8
Co-occurring problems across ages: CD, ODD, and ADHD
About three of every four students have significant deficits in social skills

36. Percentage of Behavior Problems Among Children With and Without SLDs
Figure 7.4 Percentage of clinically significant behavior problems among children with and without learning disorders, at 4 years and 8 years of age.
Source: Data from Benasich et al., 1993
Photo credits: © iStockphoto.com/Rhienna Cutler; © iStockphoto.com/Jack Hollingsworth

37. Adult Outcomes of SLDs
May continue into adulthood because of inadequate recognition and services
Many excel in nonacademic subjects
Men with learning disorders perceive lower levels of social support
Women with learning disorders have more adjustment problems and face greater risk of sexual assault and related forms of abuse

38. Causes of SLDs
Difficulties bringing information from various brain regions together to integrate and understand information
Recent findings suggest two distinguishable types of reading disorder
Children who are persistently poor readers
Children who are accuracy-improved
Heritability accounts for 60% of variance in reading disorders

39. Neurobiological Causes of SLDs
Reading and language-based problems are associated with cellular abnormalities in the brain’s left hemisphere
This part of the brain is responsible for understanding phonemes, analyzing words, and automatically detecting words

40. Neurobiological Causes of SLDs (cont’d.)
Behavioral and physiological abnormalities in the processing of visual information
Non-verbal learning disabilities are associated with deficits in right- hemisphere brain functioning

41. How the Brain Processes Speech
Figure 7.5 How the brain processes speech.
Source: From Plotnik/Kouyoumdjian. Introduction to Psychology, 9E. © 2011 Wadsworth, a part of Cengage Learning, Inc. Reproduced by permission.

42. Social and Psychological Causes of SLDs
Co-occurring emotional disturbances and other signs of poor adaptive ability
The overlap between dyslexia and ADHD ranges from 30-70%
Reading disorder is associated with deficits in phonological awareness
ADHD has effects on cognitive functioning, especially in rote verbal learning and memory
Some children with learning disorders show symptoms similar to ADHD

43. Prevention and Treatment
Interventions rely primarily on educational and psychosocial methods
No biological treatments exist
Issues of identification are important
There is a brief window of opportunity for successful treatment
Prevention involves training children in phonological awareness activities at an early age

44. The Inclusion Movement
Integrate children with special needs into the regular classroom
Individuals with Disabilities Education Improvement Act (IDEA) in U.S. and provincial Educational Acts in Canada
No Child Left Behind (2002)
14% of school-age children in the U.S. receive some level of support through special education

45. Instructional Methods
Direct instruction is best for children with LDs
Early interventions must address phonological and verbal abilities
Effective reading instruction focuses on:
Phonemic awareness and phonemic decoding skills, fluency in word recognition, construction of meaning, vocabulary, spelling, and writing

46. Behavioral and Cognitive Treatments
Behavioral principles of learning are used to teach systematically
Used in conjunction with complete program of direct instruction
Cognitive-behavioral approaches
Teach children to monitor their own thought processes
Emphasize strategies such as self-monitoring, self-assessment, self-recording, and self- management of reinforcement

47. Computer-Assisted Learning
Provides more academic engagement and achievement than traditional pencil-and- paper-methods
Compute programs slow down grammatical sounds allowing young children to process them more slowly and carefully