1. SCHOOL FAILURE

3. Etiology of School Failure

5. Why does he read SAW for WAS? Can’t he see the difference between b and d? How come she read all these words yesterday, and she can’t read them today? Will he never learn the days of the week?

6. Can’t he stop talking for 5 minutes? Why won’t he behave at school? He’s so good and he tries so hard, why can’t he learn? How could she put down the same answer to four different arithmetic problems?

7. Who is this child?

8. Generic term referring to a heterogenous group manifested as significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical skills. Disabilities are intrinsic and are presumed to be due to CNS dysfunction. Co-morbid factors (emotional, sensory, cultural, etc) not the direct cause LEARNING DISABILITIES

9. Of the basic 3 “Rs”of learning (reading, ‘riting’ and ‘rithmetic’), reading difficulty is usually easily recognized. Becomes manifest at the end of the 1st grade

10. Etiology Unknown ? Developmental alterations of CNS In early years, difficult to state whether the problem is due to neuromaturational lag or true LD Genetic factors play an important role, there is often a strong FH of LD

23. Presentation of Learning Disability in the Different Grade Levels Motor problems (especially fine motor) Sequencing difficulty Language dysfunction (including articulation) Hyperactivity/aggressiveness Kindergarten

24. Underachievement Writing Reading comprehension Behavior Decoding Behavior Early Primary Late Primary Middle school

25. Clinical Evaluation Specific attention to child’s language skills (ordinary conversation) Academic and intellectual screening tests Reading (word recognition and comprehension) Mathematics (verbal and written) Spelling (verbal and written) and writing Constructional abilities (Bender and Beery) Draw - A - Person General information, abstract reasoning, vocabulary

26. Further Assessments Psychometric testing - very important Others depend on symptomatology Language problems - Speech and language evaluation and therapy Blood tests, karyotyping, metabolic screening - no clinical value EEG- not routine, only when seizures are present or strongly suspected; Childhood Absence Epilepsy is most frequently mistaken for LD Neuroimaging - more academic than practical

27. Patient: 12-year old with learning disability Result of WISC Test: Verbal IQ 128 Performance 88 Full Scale IQ 108

28. Verbal tests Information14 Similarities15 Arithmetic 9 Vocabulary17 Comprehension13 Performance tests Picture Completion 8 Picture Arrangement10 Block Design 7 Object Assembly10 Coding 3

29. Impression Verbal IQ – superior Performance IQ – low-average Visual-perceptual, visual-sequencing, visual abstraction, visual memory, fine motor & visual motor disabilities

30. Psychosocial Problems for the Child with Learning Disabilities Emotional/Social problems Withdrawal Regression Displacement and Projection Weak Self-image

31. Prognosis Most LD improve in time Complete recovery to normality does not appear to happen Reading disabled will be able to read but slowly and laboriously (6th grade, sufficient for everyday living and even for college Spelling, writing and arithmetic deficits are rather resistant and pervasively persist

32. Treatment Educational intervention - cornerstone of treatment for LD Educational settings - Structured Private tutorial sessions Resource rooms While no single best approach or specific treatment is most specific for LD, every effort should be made to fit the needs of the child

33. Treatment Unrecognized LD, often already with emotional problems and may be more difficult to treat, counseling is a must. Explain to the child that his problems are however not his passport to completely neglect his academics.

34. Treatment Since most LD are resistant to remediation, and up until specific teaching methods are available, perhaps a good way of teaching these children is bypassing the deficits