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ADHD and Learning Disorders Abnormal Behavior Problems Fall 03 Attention Deficit/Hyperactivity Disorder (ADHD) What comes to mind when you hear ADHD? ADHD Hyperactivity Disorganized/forgetful Athletic, evolutionary advantage Over-diagnosed Not a real disorder 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 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 Comorbidity ODD/CD Learning Disorders Depression Anxiety Bipolar Disorder Associated Features Academic failure/underachievement Peer rejection, low self-esteem Occupational underachievement Fired, job change Disorganized Smoking, drug use Car accidents, tickets A Real Disorder? Symptoms are atypical Functional impairments Associated features Symptoms can be measured reliably >90% test-retest reliability Moderate inter-rater reliability 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?? Treatment of ADHD Stimulants 90% response Helpful with impulsive aggression Not addictive if used appropriately MTA Environmental Parent Education Structured environment Over/Under-Diagnosed? Increase in diagnoses Disorder du jour Political decisions Community-based studies Treatment adherence Evolutionary Advantage? Better Athletes? Cognitive deficits Fidgety, impulsive Social deficits Evidence from motor studies Learning Disorders 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 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 Prevalence The overall prevalence of LD is estimated to be between 2 and 10% Approximately 5% of children have identified LD in public schools 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 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 Associated Features Social skills, demoralization, low self- esteem Dropout rate as high as 40% Conduct Attention Internalizing symptoms Important predictors of classroom failure 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 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 Genetics Pennington, 1995 40% of LD children have LD parents 40% of their siblings are LD 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 A Brief Look at the Specific Disorders 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 Mathematics Developmentally Informal- learning equivalency, magnitude, language, manipulation, judgment, conservation Formal- aspects of numbers, operations Abstract- concepts, going beyond mimicry Written Expression Physical aspects of writing Spelling Putting concepts on paper Reading Dyslexia Gough Simple View of Reading: Comprehension=Listening Comprehension * Decoding C=LC*D Reading Dyslexia Decoding difficulties, intact listening comprehension Hyperlexia Good decoding skills, poor comprehension “Garden Variety” Poor decoding and comprehension “The disabilities you can see may be easier to deal with than the ones you can’t” Puzzles IOU Puzzles I O U I F-N N-E N-R-G 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 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? 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!" 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! 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. Comprehension `Twas brillig, and the slithy toves Did gyre and gimble in the wabe; All mimsy were the borogoves, And the mome raths outgrabe. Comprehension Why was the Jabberwock killed? What else was there to beware of? What kind of tree did he rest by? 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 Treatment Megavitamins Colored lenses Special diets Sugar-free diets Body stimulation or manipulation Basics Heterogeneous disorders Accurate assessment Individual tailoring Basic skills, fluency, comprehension Research needed to help parse Treatment Remediations Resolving underlying difficulties Compensations Bypass the problem Keyboarding, changing expectations, strategies Treatment Sound-Based Strategies Phonics, Phonemic Awareness, Letter-sound relationships Remove the “cuh” sound from cart Whole language Decoding through context, emphasis is on comprehension and fluency 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?
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