1. Chapter 11 Communication and Learning Disorders
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

2. Definitions and History
Learning Disability: the general term for learning problems that occur in the absence of other obvious conditions (e.g., MR or brain damage); the term has been replaced in the DSM-IV-TR by more specific terms, learning disorders and communication disorders
Multiple Intelligence implies diverse forms of intelligence, suggesting each is as important as the others
Communication Disorder: diagnostic term; refers to difficulty in
producing speech sounds (phonological disorder)
speech fluency (stuttering)
using spoken language to communicate (expressive language disorder)
These disorders are developmentally connected to later onset of learning disorders
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

3. Definitions and History (cont.)
Learning Disorder: diagnostic term; refers to specific problems in
reading (often referred to as dyslexia)
math
writing ability
These disorders are determined by achievement test results that are lower than would be expected for one’s age, schooling, and intelligence
Learning disabilities affect how individuals of at least normal intelligence take in, retain, or express information
Learning difficulties show up in schoolwork and cause problems with a child’s ability to learn as well as other parts of life
Main characteristic of learning disorders/disabilities is not performing up to expected level in school
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

4. Definitions and History (cont.)
19th century: Franz Joseph Gall observed loss of ability to express feelings and ideas through speech in brain-injured patients despite no apparent intellectual impairment
Early observations of learning disabilities were based on known medical injuries, not intellectual deficits
1943: A. A. Straus and H. Werner: children learn in individual ways, suggesting that educational methods should be tailored to the child’s pattern of strengths and weaknesses
1960s: Modern learning disabilities movement began; domination by physicians/psychologists gave way to more input from educators, parents, and clinicians
the term “learning disabled” brought needed services, not stigma
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

5. Infants selectively attend to parental speech sounds
Language Development
Infants selectively attend to parental speech sounds
By age 1, they can recognize several words as well as say a few words to express needs and emotions
Over the next 2 years, language development increases exponentially, as does the ability to formulate complex ideas and express new concepts
Perceptual maps are formed in the brain when children hear phonemes 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
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

6. Language Development (cont.)
Phonological awareness develops by age 7, and its absence is a precursor to problems in reading and expressive language development
Language development is an indicator of general mental ability:
Although deviations may be accompanied by superior abilities in other areas of cognitive functioning, early language problems are highly predictive of subsequent communication and learning disorders and should not be ignored
Phonology: the ability to learn and store phonemes as well as the rules for combining sounds into meaningful units or words
deficits in phonological awareness (the ability to distinguish the sounds of language) are a chief reason that individuals with communication and learning disorders have problems in language-based activities
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

7. Communication Disorders
In the DSM-IV, communication disorders include:
Expressive Language Disorder
Phonological Disorder
Mixed Receptive-Expressive Disorder
Stuttering
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

8. Communication Disorders (cont.)
Expressive Language Disorder (ELD)
Characterized by deficits in expression despite normal comprehension of speech, referred to as Specific Language Impairment (SLI)
SLI occurs when a child’s language matures at least 12 months behind his/her chronological age and is not associated with another known disorder such as intellectual disability
Children with ELD often have delayed and slowed speech development, limited vocabulary, and speech marked by short sentences and simple grammatical structure
To fit diagnostic criteria, problems must be severe enough that they interfere with academic achievement or the ability to communicate in everyday social situations
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

9. Communication Disorders (cont.)
Expressive Language Disorder (cont.)
Related types of communication disorders
Mixed receptive-expressive language disorder: speaking problems are coupled with difficulty in understanding some aspects of speech (e.g., complex if-then sentences)
Phonological disorder: the developmental language problem involves articulation or sound production rather than word knowledge
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

10. Communication Disorders (cont.)
Expressive Language Disorder (cont.)
Prevalence and Course
2% to 3% of children over age 6-7 meet criteria for phonological disorder and ELD; fewer than 3% have mixed receptive-expressive disorder
communication disorders are identified twice as often in boys than girls, possibly due to boys’ behavior problems
most children acquire normal language by mid- to late adolescence; 50% fully outgrow the problems, 50% have some degree of impairment until late adolescence
associated behavior problems can add to communication problems and are risk factors for problems with relationships and education
associated with higher than normal rates of negative behaviors
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

11. Communication Disorders (cont.)
Expressive Language Disorder (cont.)
Causes
Genetics: 50-75% of children with specific language disorders have family history of learning disability; twin studies and adoption studies suggest a genetic connection
Temporal processing deficits: genetic deficit in phonological short-term memory
Brain:
Circular feedback loop in the left temporal lobe: lack of comprehension/absence of feedback reduces verbal output and interferes with development of articulation skills
Problems in connections between brain areas and less brain activity in left temporal region: phonological problems may stem from neurological deficits or deviations in posterior left-hemisphere system
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

12. Communication Disorders (cont.)
Expressive Language Disorder (cont.)
Causes (cont.)
Middle ear infections (otitis media) in first year of life may cause ELD in some children
Home environment: except in cases of extreme neglect or abuse, parental speech and language stimulation may affect the pace and range of language development, but not the specific impairments that characterize disorders
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

13. Communication Disorders
Expressive Language Disorder (cont.)
Treatment
Communication disorders usually self-correct by age 6
Strategies for parents to stimulate language development
Specialized preschools: combination of computer- and teacher-assisted instruction
Work on existing strengths
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

14. Communication Disorders (cont.)
Stuttering: The repeated and prolonged pronunciation of certain syllables that interferes with communication; normal for children to go through period of nonfluency
Prevalence and Course
gradual onset between ages 2 and 7, peak at age 5; about 3% of children
affects males about 3 times more often than females
80% of those who stutter before age 5 stop after a year or so in school
Causes and Treatment
Genetic factors: Heritability accounts for 71% of variance in causes; the remaining 29% is environmental
abnormal development of the left hemisphere
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

15. Communication Disorders (cont.)
Stuttering (cont.)
Causes and Treatment (cont.)
Treatment, if necessary, may include
speaking more slowly to child, using short/simple sentences, removing pressure
contingency management procedures using positive consequences for fluency and negative consequences for stuttering
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

16. Learning disorders: reading, mathematics, writing
To meet DSM criteria, performance in reading, mathematics, and/or written expression must be substantially below what would be expected for someone of the same age, schooling, and intelligence, and must also significantly interfere with academic achievement or daily living
“Substantially below”: a discrepancy of more than 2 standard deviations between the IQ findings and the actual achievement test findings
Learning disorders: reading, mathematics, writing
The different learning disorders overlap and build on the same brain functions, so people can have more than one form of learning disorder
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

17. Learning Disorders (cont.)
Reading Disorder
Most common underlying feature is inability to distinguish or separate sounds in spoken words
Often involves difficulty learning basic sight words, such as: the, what, laugh, said
Often 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); although these errors are common in young children
Core deficits in reading disorders are in decoding-- breaking a word into parts rapidly enough to read the whole word--coupled with problems reading single, small words
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

18. Learning Disorders (cont.)
Mathematics Disorder
Difficulty in recognizing numbers and symbols, memorizing facts, aligning numbers, and understanding abstract concepts
May have problems in comprehending abstract concepts or in visual-spatial ability
Core deficits in arithmetic calculation and/or mathematics reasoning abilities
Underlying neuropsychological processes are believed to be underdeveloped or impaired
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

19. Learning Disorders (cont.)
Writing Disorder:
Writing disorders are often associated with problems with eye/hand coordination (which leads to poor handwriting), despite normal gross motor development
Children with writing disorders typically produce shorter, less interesting, and poorly organized essays, and are less likely to review spelling, punctuation, and grammar to increase clarity
spelling errors/poor handwriting that don’t interfere with daily activities/academic pursuits do not qualify for a writing disorder diagnosis
Commonly found in combination with/signal other learning disorder with underlying core deficits in language and neuropsychological development
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

20. Learning Disorders (cont.)
Prevalence and Course
Estimates: 2-10% of the population, depending on definition/ measurement; figures may be underestimated
Reading disorder (dyslexia): estimated range is 5-17% of school-aged children
Reading difficulties may be part of reading abilities continuum, not discrete phenomenon; using this criterion, 20% (10 million) of children in the U.S. would be diagnosed
Mathematics disorder: estimated at about 20% of children with learning disorders (about 1% of school-age children); if based on tests scores, a conservative estimate would be 5-6%
Becomes apparent during second or third grade
Writing disorder: rare by itself; due to overlap with reading/math disorders, may affect at least 10% of school-age children
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

21. Learning Disorders (cont.)
Prevalence and Course (cont.)
Cultural, Class, and Gender Variations
Social and cultural factors less relevant to learning disorders than other types of cognitive/behavioral problems
The disorders reflect an interaction between child’s inherent abilities and resources/opportunities available
when learning to read, some teaching approaches neglect specific sound-symbol relationships inherent in dialects of children from diverse ethnic backgrounds
More common in males (60-80% of all children diagnosed), likely reflecting referral bias due to comorbid behavior problems; epidemiological estimates show equal representation for boys and girls
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

22. Learning Disorders (cont.)
Prevalence and Course (cont.)
Cultural, Class, and Gender Variations (cont.)
Development: Daily experience of being labeled and unable to keep up can cause children to withdraw or become angry and noncompliant
75% of children with reading disorder in elementary school continue to have problems in high school and young adulthood
Learning disorders are risk factor for internalizing problems such as anxiety and mood disorders, and externalizing behaviors such as ADHD
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

23. Learning Disorders (cont.)
Prevalence and Course (cont.)
Cultural, Class, and Gender Variations (cont.)
Psychological and Social Adjustment:
These students feel less support from parents, teachers, peers
More likely to drop out of school
More difficult to manage: behavior problems are about 3 times higher than the norm by age 8
Co-occurring problems across ages: CD, ODD, ADHD, and major depressive disorder
About 75% have significant deficits in social skills
The child can be an emotional burden for family members
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

24. Learning Disorders (cont.)
Prevalence and Course (cont.)
Cultural, Class, and Gender Variations (cont.)
Adult Outcomes:
May continue into adulthood because of inadequate recognition and services, although problems may be disguised
Many, however, excel in nonacademic subjects
Men with learning disorders perceive lower level of social support
Women with learning disorders have more adjustment problems and face greater risk of sexual assault and related forms of abuse
Opportunities that increase resilience can help overcome the problems
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

25. Learning Disorders (cont.)
Causes
Difficulties bringing information from various brain regions together to integrate and understand information
Genetic and Constitutional Factors: Heritability accounts for about 60% of variance in reading disorders
Inherit subtle brain dysfunction (e.g., chromosome 6)
Neurobiological Factors: Reading and language-based problems associated with cellular abnormalities in brain’s left hemisphere, especially in the planum temporale
Lower activation of inferiori frontal, parieto-temporal, and occipito-temporal gyri, which are responsible for understanding phonemes, analyzing words, and automatically detecting words
Problems with neurological processing of phonology
Behavioral/physiological abnormalities processing visual information
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

26. Causes of Learning Disorders (cont.)
Causes (cont.)
Neurobiological Factors (cont.)
Non-verbal learning disabilities may result from deficits in right hemisphere brain functioning, and have been linked to prenatal and early childhood disease and trauma
Social and Psychological Factors
Co-occurring emotional disturbances and other signs of poor adaptive ability
overlap between dyslexia and ADHD ranges from 30-70%
reading disorder associated with deficits in phonological awareness; ADHD has effects on cognitive functioning, especially rote verbal learning and memory
some children with learning disorders show symptoms similar to ADHD: inattention, restlessness, hyperactivity
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

27. Learning Disorders (cont.)
Prevention and Treatment
Despite strong biological underpinnings, interventions rely primarily on educational and psychosocial methods
At present, no biological treatments exist for speech, language, and academic disabilities
stimulant medications are only temporary treatments for problems with attention, concentration, and impulsivity
Issues of identification are important because of the brief window of opportunity for successful treatment
Prevention involves training children in phonological awareness activities at an early age
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

28. Learning Disorders (cont.)
Prevention and Treatment (cont.)
The Inclusion Movement: Integrate children with special needs into the regular classroom (began during the 1950s)
Individuals with Disabilities Education Improvement Act (IDEA) in U.S., provincial Educational Acts in Canada
2002: No Child Left Behind
Currently almost 14% of school-age children in the US. receive some level of support through special education; students with specific learning disabilities account for about 4.5%
Response to Intervention (RTI) models: identify and assess children and provide tiered instruction as needed
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

29. Learning Disorders (cont.)
Prevention and Treatment (cont.)
Instructional Methods
Direct instruction is often best for children with LDs: a straightforward approach to teaching based on the premise that to improve a skill, the instructional activities have to approximate those of the skill being taught
Early interventions must address phonological and verbal abilities
Effective reading instruction focuses on phonemic awareness/decoding skills, fluency in word recognition, construction of meaning, vocabulary, spelling, and writing
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning

30. Learning Disorders (cont.)
Treatment and Prevention (cont.)
Behavioral strategies focus on a simple, gradual approach providing a set of verbal rules that can be written out and reapplied, and teaching children to generalize new information to different situations;
behavioral principles of learning are used to teach systematically
used in conjunction with complete program of direct instruction in a cumulative, highly structured and repetitive manner
Cognitive-behavioral approaches teach children to monitor their own thought processes and emphasize the use of strategies such as self-monitoring, self-assessment, self-recording, and self-management of reinforcement
Computer-assisted learning techniques can help children to distinguish sounds and improve language understanding
Mash/Wolfe Abnormal Child Psychology, 4th edition © 2009 Cengage Learning