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Learning Disorders

VIEWS: 7 PAGES: 47

									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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