1. ADHD and Learning Disorders
Abnormal Behavior Problems
Fall 03

2. Attention Deficit/Hyperactivity Disorder (ADHD)
What comes to mind when you hear ADHD?

3. ADHD Hyperactivity Disorganized/forgetful
Athletic, evolutionary advantage
Over-diagnosed
Not a real disorder

4. ADHD Subtypes Not all children with ADHD are hyperactive!
2 clusters of symptoms: Hyperactivity/Impulsivity and Inattention
3 Subtypes of ADHD
ADHD/HI
ADHD/IA
ADHD/C

5. ADHD Prevalence and Course
4% to 12%
Boys:girls 3:1 to 8:1
68% continue in adulthood
Persistence of inattention
Decline in hyperactivity/impulsivity

6. Comorbidity ODD/CD Learning Disorders Depression Anxiety
Bipolar Disorder

7. Associated Features Academic failure/underachievement
Peer rejection, low self-esteem
Occupational underachievement
Fired, job change
Disorganized
Smoking, drug use
Car accidents, tickets

8. A Real Disorder? Symptoms are atypical
Functional impairments
Associated features
Symptoms can be measured reliably
>90% test-retest reliability
Moderate inter-rater reliability

9. Genetics and ADHD Meta-analytic estimate h2=.73
No single gene believed to be responsible
Action and interaction of genes and environment are not well understood
Androgenic effect among ADHD/IA boys??

10. Treatment of ADHD Stimulants Environmental 90% response
Helpful with impulsive aggression
Not addictive if used appropriately
MTA
Environmental
Parent Education
Structured environment

11. Over/Under-Diagnosed?
Increase in diagnoses
Disorder du jour
Political decisions
Community-based studies
Treatment adherence

12. Evolutionary Advantage? Better Athletes?
Cognitive deficits
Fidgety, impulsive
Social deficits
Evidence from motor studies

13. Learning Disorders

14. History Rutter and Yule (1975)
Poor readers with low IQ had more global neurodevelopmental abnormalities, but better acquisition of reading and spelling than children with average ability language but with delays in language and speech
Good evidence for specific difficulties

15. Defined No universally accepted test or battery of tests
Discrepancy between IQ and achievement
“Wait to fail” standard
High reliance on exclusionary criteria for Diagnosis
Different prevalence rates
Disagreement as to what is LD for research
establishment of valid prevalence rates
Educational political implications
Child will have already experienced failure, loss of SE, etc
Longer they go without TX more difficult to remediate
Fall behind in “world Knowledge” etc
Overly broad label
7 areas to cover, would be to ambiguous to cover all at once

16. Prevalence
The overall prevalence of LD is estimated to be between 2 and 10%
Approximately 5% of children have identified LD in public schools

18. Why increase in prevalence rates?
Better research
Longitudinal, focus on individual factors (e.g. reading)
Not based on school diagnosis, large population studied
Reading
specific diagnostic criteria
5% 1976 to 17% 1994 having difficulties
Increase in diagnosis among girls
Increased awareness and understanding of educational, professional, social impact
Phonological difficulties, non-fluent single word reading

19. Gender Differences Boys>Girls Among those with LD:
Females generally have a lower IQ, and perform more poorly in math and reading, better in writing
Males tend to perform better in math

20. Associated Features Social skills, demoralization, low self-esteem
Dropout rate as high as 40%
Conduct
Attention
Internalizing symptoms
Important predictors of classroom failure

21. Associated Features
More likely to be rejected, on-task behavior, off-task behavior, conduct disorders, distractibility, and shy/withdrawn behavior
8-39% comorbidity with ADHD

22. Course Evidence for a deficit model rather than developmental lag
Children identified in 3rd grade as poor readers in bottom 10% in 5th and 8th
74% of children identified in 3rd grade still behind at 9th
49% classified as poor readers in adulthood

23. Genetics Pennington, 1995 40% of LD children have LD parents
40% of their siblings are LD

24. The “Mathew Effect” Arguments against IQ
Cumulative effect of RD affects cognitive development over time
Older students may not maintain discrepancy
Not a 1:1 relation between IQ and achievement
Specific skills (e.g. phonology) may be more important

26. A Brief Look at the Specific Disorders

27. Mathematics
Difficulty learning simple computational skills and numerical operations
Math facts: addition, subtraction and multiplication
Operations: making change, telling time, and understanding and using devices
Visuo-spatial confusion
Translation between paper and knowledge

28. Mathematics Developmentally
Informal- learning equivalency, magnitude, language, manipulation, judgment, conservation
Formal- aspects of numbers, operations
Abstract- concepts, going beyond mimicry

29. Written Expression Physical aspects of writing Spelling
Putting concepts on paper

30. Reading Dyslexia Gough Simple View of Reading:
Comprehension=Listening Comprehension * Decoding
C=LC*D

31. Reading Dyslexia Hyperlexia “Garden Variety”
Decoding difficulties, intact listening comprehension
Hyperlexia
Good decoding skills, poor comprehension
“Garden Variety”
Poor decoding and comprehension

32. “The disabilities you can see may be easier to deal with than the ones you can’t”

33. Puzzles
I O U

34. Puzzles
I O U
I F-N N-E N-R-G

35. Decoding O U Q-T. U R A B-U-T. S A 3-L 2 C U! I-L B U-R-S 4-F-R N F-R.
I M 2 O-L 4 U.
L! U-R O-D-S!
N U R S-N-9. F U R B-Z, I-L 1 O-A. M-N-U-L S N-C-Q-R. E S N N-L-S-S. S N-L-S-S-T S N-2-8-F N Y-S. I F D Q-R!
D N

36. Decoding Why was the man’s name? What did he think of the woman?
What kind of Dr. was he seeing?
What was the woman’s excuse?

37. Comprehension
`Twas brillig, and the slithy toves   Did gyre and gimble in the wabe: All mimsy were the borogoves,   And the mome raths outgrabe.
"Beware the Jabberwock, my son!   The jaws that bite, the claws that catch! Beware the Jubjub bird, and shun   The frumious Bandersnatch!"

38. Comprehension
He took his vorpal sword in hand:   Long time the manxome foe he sought -- So rested he by the Tumtum tree,   And stood awhile in thought.
And, as in uffish thought he stood,   The Jabberwock, with eyes of flame, Came whiffling through the tulgey wood,   And burbled as it came!

39. Comprehension
One, two! One, two! And through and through   The vorpal blade went snicker-snack! He left it dead, and with its head   He went galumphing back.
"And, has thou slain the Jabberwock?   Come to my arms, my beamish boy! O frabjous day! Callooh! Callay!'   He chortled in his joy.

40. Comprehension
`Twas brillig, and the slithy toves   Did gyre and gimble in the wabe; All mimsy were the borogoves,   And the mome raths outgrabe.

41. Comprehension Why was the Jabberwock killed?
What else was there to beware of?
What kind of tree did he rest by?

42. Diagnosis What does the discrepancy standard boil down to?
1-2 standard deviations below mean
Specific Skills assessments
Other contributing factors
Home and school environment, attention

43. Treatment Megavitamins Colored lenses Special diets Sugar-free diets
Body stimulation or manipulation

44. Basics Heterogeneous disorders Basic skills, fluency, comprehension
Accurate assessment
Individual tailoring
Basic skills, fluency, comprehension
Research needed to help parse

45. Treatment Remediations Compensations Resolving underlying difficulties
Bypass the problem
Keyboarding, changing expectations, strategies

46. Treatment Sound-Based Strategies Whole language
Phonics, Phonemic Awareness, Letter-sound relationships
Remove the “cuh” sound from cart
Whole language
Decoding through context, emphasis is on comprehension and fluency

47. NVLD (Non-verbal Learning Disorder)
Not recognized by DSM
Many have multiple etiological insults rather than developmental conditions
Prevalence approximately 1-10% of LD children
Should this be recognized as a specific disorder?