Learning Disabilities, ADD/ADHD, and Dyslexia

1. Learning Disabilities, ADD/ADHD, and Dyslexia Development of Young Children with Disabilities#872.514 (61)Carol Ann Heath

2. What are Learning Disabilities? • Learning disabilities are disorders that affect the ability to understand or use spoken or written language, do mathematical calculations, coordinate movements, or direct attention. Although learning disabilities occur in very young children, the disorders are usually not recognized until the child reaches school age.

3. The term "learning disability" was apparently first used and defined by Dr. Samuel Kirk (1962, cited in Streissguth, Bookstein, Sampson, & Barr, 1993, p.144). The term referred to a discrepancy between a child’s apparent capacity to learn and his or her level of achievement. A review of the LD classifications for 49 of 50 states revealed that 28 of the states included IQ/Achievement discrepancy criteria in their LD guidelines (Ibid., citing Frankenberger & Harper, 1987).

4. However, the National Joint Committee for Learning Disabilities (NJCLD) (1981; 1985) preferred a slightly different definition: • is a generic term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning abilities. These disorders are intrinsic to the individual and presumed to be due to Central Nervous System Dysfunction. Even though a learning disability may occur concomitantly with other handicapping conditions (e.g. sensory impairment, mental retardation, social, and emotional disturbance) or environmental influences (e.g. cultural differences, insufficient/inappropriate instruction, psychogenic factors) it is not the direct result of those conditions or influences.

5. The Individuals with Disabilities Education Act (United States) defines a learning disability this way: • . . .[a] disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. . . .Learning disabilities include such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia.

6. The Learning Disabilities Association of Ontario (Canada) defines LDs this way: • “Learning Disabilities” refers to a variety of disorders that affect the acquisition, retention, understanding, organization or use of verbal and/or non-verbal information. These disorders result from impairments in one or more psychological processes related to learning (a), in combination with otherwise average abilities essential for thinking and reasoning. Learning disabilities are specific not global impairments and as such are distinct from intellectual disabilities. • Learning disabilities range in severity and invariably interfere with the acquisition and use of one or more of the following important skills: oral language (e.g., listening, speaking, understanding), reading (e.g., decoding, comprehension), written language (e.g., spelling, written expression), mathematics (e.g., computation, problem solving). Learning disabilities may also cause difficulties with organizational skills, social perception and social interaction.

7. Continued • The impairments are generally life-long. However, their effects may be expressed differently over time, depending on the match between the demands of the environment and the individual’s characteristics. Some impairments may be noted during the pre-school years, while others may not become evident until much later. During the school years, learning disabilities are suggested by unexpectedly low academic achievement or achievement that is sustainable only by extremely high levels of effort and support. • Learning disabilities are due to genetic, other congenital and/or acquired neuro-biological factors. They are not caused by factors such as cultural or language differences, inadequate or inappropriate instruction, socio-economic status or lack of motivation, although any one of these and other factors may compound the impact of learning disabilities. Frequently learning disabilities co-exist with other conditions, including attentional, behavioral and emotional disorders, sensory impairments or other medical conditions.

8. A person with a learning disability has difficulty in collecting, organizing, or acting on verbal and nonverbal information. Most commonly, the person has trouble understanding or using written or spoken language. The difficulty is due to a neurological difference in brain structure or functioning.

9. The disparity between the child’s intelligence and the child’s school performance highlights the learning difficulties. • People with learning disabilities do not have low intelligence; in fact, they have average or above average intelligence. However, their academic performance, as measured by standardized tests, is below what one would expect of someone of their intelligence, age, and grade level. • A person with a learning disability may score poorly on tests, but the low scores are due to a problem with learning, not to low intelligence.

10. Problems occur in one or more of these areas: • language development and language skills (listening, speaking, reading, writing, and spelling) • social studies • mathematics • social skills • motor skills (fine motor skills, as well as coordination) • cognitive development and memory • attention and organization • test-taking

11. What are the types of learning disabilities? • Speech and language disorders • Academic disorders • Fine motor skills problems (dyspraxia) • Nonverbal Learning Disorder

12. Speech and language disorders • Difficulty producing speech sounds (developmental articulation disorder). The person might mispronounce certain letters or letter combinations. • Difficulty using spoken language to communicate (developmental expressive language disorder). The person has difficulty with verbal expression. • Difficulty understanding what other people say (developmental receptive language disorder). The person hears the words, but doesn’t process the words correctly.

13. Academic skills disorders • Reading problems (developmental reading disorder, or dyslexia). The person cannot identify different word sounds. • Writing problems (developmental writing disorder, or dysgraphia). The person has problems with handwriting or with creating sentences that make sense to others. • Arithmetic skills problems (developmental arithmetic disorder, or dyscalculia). The person has problems with calculations or with abstract mathematical concepts.

14. What are the signs of LD? • average or above average intelligence (as measured by the IQ score) • significant delay in academic achievement • severe information processing deficits • uneven pattern of cognitive development throughout life • a disparity between measured intellectual potential (IQ score) and actual academic achievement • the learning disability persists despite instruction in standard classroom situations

15. Discrepancy Model • The discrepancy model has dominated the school system for many years, there has been substantial criticism of this approach (e.g., Aaron, 1995, Flanagan and Mascolo, 2005) among researchers. • Does not predict the effectiveness of treatment. • Low academic achievers who do not have a discrepancy with IQ (i.e. their IQ scores are also low) appear to benefit from treatment just as much as low academic achievers who do have a discrepancy with IQ.

16. Responsiveness to Intervention • Children who are having difficulties in school are identified early - in their first or second year after starting school. • They receive additional assistance such as participating in a reading remediation program. • The response to this intervention determines whether they are designated as having a learning disability. • Sternberg (1999) has argued that early remediation can greatly reduce the number of children meeting diagnostic criteria for learning disabilities. He suggested that the focus on learning disabilities and the provision of accommodations in school fails to acknowledge that people have a range of strengths and weaknesses and places undue emphasis on academics by insisting that people should be propped up in this arena and not in music or sports.

17. What can help? • The most common intervention for learning disabilities is special education. • Trained educators may perform a diagnostic educational evaluation assessing the child's academic and intellectual potential and level of academic performance. • Basic approach is to teach learning skills by building on the child's abilities and strengths while correcting and compensating for disabilities and weaknesses. • Other professionals such as speech and language therapists also may be involved. • Some medications may be effective in helping the child learn by enhancing attention and concentration. • Psychological therapies may also be used.

18. What is the prognosis? • Learning disabilities can be lifelong conditions. • In some people, several overlapping learning problems may be diagnosed. • Other people may have a single, isolated learning problem that has little impact on their lives.

19. What causes a learning disability? • Abnormal brain structure or function causes learning disabilities. However, poor performance in school can be due to other factors. For example: • If no one at home talks to a child and helps the child to learn how to interact with the world, the child will be delayed in social or intellectual development. • If parents or teachers have a personal style at odds with the child’s style (such as a highly structured, visually organized adult and an energetic, kinesthetic child who learns by doing, not by seeing), the mismatch may appear to be a learning disability in the child.

20. What brings about the different brain structure or function? • Neurological abnormalities in the brain can result from: • genetics • factors before birth or during delivery • factors in early childhood • brain trauma or tumors

21. Genetics • A person can inherit abnormal brain structure or function. Although a person may have inherited a learning disability, the environment can still make a difference.

22. Factors before birth or during delivery • The uterine environment is very important for healthy brain development in the fetus. Negative influences on brain development in utero and at birth are: • the mother’s drug-use, alcohol-use, or smoking during pregnancy • physical problems during pregnancy or delivery (e.g., measles, oxygen deprivation) • very low birth weight; extremely low birth weight • premature birth • birth trauma or distress • the mother’s poor nutrition

23. Factors in early childhood • Several factors in early childhood can contribute : • neonatal seizures • a poor learning environment due to a parent’s own learning disability • developmental trauma ( such as abuse, isolation or neglect in infancy) • toxins in the environment (such as cadmium, lead, or mercury) • chemotherapy treatment for childhood cancer • central nervous system infections • chronic illnesses such as diabetes or asthma • poor nutrition

24. Terminology and classification • Some of them are as follows (codes provided are ICD-10 and DSM-IV, respectively.) • (F80.0-F80.2/315.31) Dysphasia/aphasia - Speech and language disorders • difficulty producing speech sounds (articulation disorder) • difficulty putting ideas into spoken form (expressive disorder) • difficulty perceiving or understanding what other people say (receptive disorder)

25. (F81.0/315.02) Dyslexia - the general term for a disability in the area of reading. • difficulty in phonetic mapping, where sufferers have difficulty with matching various orthographic representations to specific sounds • Some claim that dyslexia involves a difficulty with spatial orientation, which is stereotyped in the confusion of the letters b and d, as well as other pairs. In its most severe form, b, d, p and q, all distinguished primarily by orientation in handwriting, look identical to the dyslexic. However, there is no scientific evidence that dyslexia, or other learning difficulties, are related to vision or can be alleviated with visual exercises or colored glasses.[1] • Some claim that dyslexia involves a difficulty with sequential ordering, such that a person can see a combination of letters but not perceive them in the correct order. However, as with spatial orientation, there is no scientific evidence that dyslexia involves a visual problem.[1]

26. (F81.1/315.2) Dysgraphia - the general term for a disability in the area of physical writing. It is usually linked to problems with visual-motor integration or fine motor skills.

27. (F81.2-3/315.1) Dyscalculia - the general term for a disability in the area of math. • Dyspraxia - the general term for a disability with co-ordination and movement.

28. Accommodations involve multi-modal and appropriately tailored teaching and compensatory strategies/tools such as: • special seating assignments • alternative or modified assignments • modified testing procedures • electronic spellers and dictionaries • word processors • talking calculators • audio books • Text-to-Speech (TTS) Software • note-takers • readers • proofreader

29. What else can look like a learning disability? • ADHD • sensory integration dysfunction (DSI, or SI) (see below) • hearing deficits • vision problems • attachment disruption • emotional trauma • anxiety • depression • a home environment that is not conducive to learning • a mismatch between a child’s personal learning style and the expectations of the child’s parents and/or teachers

30. How is sensory integration dysfunction (DSI or SI) related to learning disabilities? • Sensory integration dysfunction (DSI or SI) can look like a learning disability, but it isn’t. DSI is a neurologically based disorder, like ADHD and learning disabilities. A child with DSI has an inability to organize sensory input for use in daily living, which includes school, play, and family life. The child has either a hyposensitivity or a hypersensitivity to sensory input, such as an overreaction to the feel of clothing or to the texture of food. DSI is similar to ADHD in that it impacts learning, but is not a learning disability. DSI overlaps with ADHD in symptoms of inattention and restlessness.

31. Is ADHD a learning disability? • This question is an important, but confusing, one because many individuals with ADHD also have one or more learning disabilities, and individuals with learning disabilities sometimes also have ADHD. Each condition has a separate diagnosis and treatment.

32. An individual with ADHD may struggle with learning, but he or she can often learn adequately once successfully treated for the ADHD. A person can have ADHD but not learning disabilities or have learning disabilities without having ADHD. The conditions can co-occur known as co-morbidity. • Someone with a learning disability is affected in only one or a few areas. However, people with ADHD are often affected in all areas.

33. What is ADD/ADHD • ADD = Attention Deficit Disorder • ADHD = Attention Deficit Hyperactivity Disorder • Predominantly Inattentive type • Predominantly Hyperactive and Impulsive type • Combined type

34. Attention Deficit Hyperactivity Disorder (ADHD) • Condition that becomes apparent in some children in the preschool and early school years. It is hard for these children to control their behavior and/or pay attention. • It is estimated that between 3 and 5 percent of children have ADHD, or approximately 2 million children in the United States. • This means that in a classroom of 25 to 30 children, it is likely that at least one will have ADHD.

35. ADHD was first described by Dr. Heinrich Hoffman in 1845. • "The Story of Fidgety Philip" was an accurate description of a little boy who had attention deficit hyperactivity disorder. • It was not until 1902 that Sir George F. Still published a series of lectures to the Royal College of Physicians in England in which he described a group of impulsive children with significant behavioral problems, caused by a genetic dysfunction and not by poor child rearing—children who today would be easily recognized as having ADHD.1

36. Symptoms of ADHD • Appear over the course of many months, often with the symptoms of impulsiveness and hyperactivity preceding those of inattention, which may not emerge for a year or more. • Different symptoms may appear in different settings, depending on the demands the situation may pose for the child's self-control. A child who "can't sit still" or is otherwise disruptive will be noticeable in school, but the inattentive daydreamer may be overlooked. The impulsive child who acts before thinking may be considered just a "discipline problem," while the child who is passive or sluggish may be viewed as merely unmotivated. Yet both may have different types of ADHD.

37. Diagnostic and Statistical Manual of Mental Disorders2 (DSM-IV-TR), • Three patterns of behavior that indicate ADHD. People with ADHD may show several signs of being consistently inattentive. They may have a pattern of being hyperactive and impulsive far more than others of their age. • May show all three types of behavior. This means that there are three subtypes of ADHD recognized by professionals. • predominantly hyperactive-impulsive type (that does not show significant inattention); • predominantly inattentive type (that does not show significant hyperactive-impulsive behavior) sometimes called ADD—an outdated term for this entire disorder; • combined type (that displays both inattentive and hyperactive-impulsive symptoms).

38. Hyperactive children • Seem to be "on the go" or constantly in motion. They dash around touching or playing with whatever is in sight, or talk incessantly. Sitting still at dinner or during a school lesson or story can be a difficult task. They squirm and fidget in their seats or roam around the room. Or they may wiggle their feet, touch everything, or noisily tap their pencil. • Hyperactive teenagers or adults may feel internally restless. They often report needing to stay busy and may try to do several things at once.

39. Impulsive children • Unable to curb their immediate reactions or think before they act. They will often blurt out inappropriate comments, display their emotions without restraint, and act without regard for the later consequences of their conduct. Their impulsivity may make it hard for them to wait for things they want or to take their turn in games. They may grab a toy from another child or hit when they're upset. • As teenagers or adults, they may impulsively choose to do things that have an immediate but small payoff rather than engage in activities that may take more effort yet provide much greater but delayed rewards.

40. Signs of hyperactivity-impulsivity are: • Feeling restless, often fidgeting with hands or feet, or squirming while seated • Running, climbing, or leaving a seat in situations where sitting or quiet behavior is expected • Blurting out answers before hearing the whole question • Having difficulty waiting in line or taking turns.

41. Inattention • Children who are inattentive have a hard time keeping their minds on any one thing and may get bored with a task after only a few minutes. If they are doing something they really enjoy, they have no trouble paying attention. But focusing deliberate, conscious attention to organizing and completing a task or learning something new is difficult. • Homework is particularly hard for these children. They will forget to write down an assignment, or leave it at school. They will forget to bring a book home, or bring the wrong one. The homework, if finally finished, is full of errors and erasures. Homework is often accompanied by frustration for both parent and child.

42. DSM-IV-TR gives these signs of inattention: • Often becoming easily distracted by irrelevant sights and sounds • Often failing to pay attention to details and making careless mistakes • Rarely following instructions carefully and completely losing or forgetting things like toys, or pencils, books, and tools needed for a task • Often skipping from one uncompleted activity to another.

43. Causes of ADHD-like behavior are the following: • A sudden change in the child's life—the death of a parent or grandparent; parents' divorce; a parent's job loss • Undetected seizures, such as in petit mal or temporal lobe seizures • A middle ear infection that causes intermittent hearing problems • Medical disorders that may affect brain functioning • Underachievement caused by learning disability • Anxiety or depression.

44. Environmental Agents • Studies have shown a possible correlation between the use of cigarettes and alcohol during pregnancy and risk for ADHD in the offspring of that pregnancy. As a precaution, it is best during pregnancy to refrain from both cigarette and alcohol use. • Another environmental agent that may be associated with a higher risk of ADHD is high levels of lead in the bodies of young preschool children. Since lead is no longer allowed in paint and is usually found only in older buildings, exposure to toxic levels is not as prevalent as it once was. Children who live in old buildings in which lead still exists in the plumbing or in lead paint that has been painted over may be at risk.

45. Brain Injury • One early theory was that attention disorders were caused by brain injury. • Some children who have suffered accidents leading to brain injury may show some signs of behavior similar to that of ADHD, but only a small percentage of children with ADHD have been found to have suffered a traumatic brain injury.

46. Food Additives and Sugar • It has been suggested that attention disorders are caused by refined sugar or food additives, or that symptoms of ADHD are exacerbated by sugar or food additives. • In 1982, the National Institutes of Health held a scientific consensus conference to discuss this issue. It was found that diet restrictions helped about 5 percent of children with ADHD, mostly young children who had food allergies.3 • A more recent study on the effect of sugar on children, using sugar one day and a sugar substitute on alternate days, without parents, staff, or children knowing which substance was being used, showed no significant effects of the sugar on behavior or learning.4 • In another study, children whose mothers felt they were sugar-sensitive were given aspartame as a substitute for sugar. Half the mothers were told their children were given sugar, half that their children were given aspartame. The mothers who thought their children had received sugar rated them as more hyperactive than the other children and were more critical of their behavior.5

47. Genetics • Attention disorders often run in families, so there are likely to be genetic influences. Studies indicate that 25 percent of the close relatives in the families of ADHD children also have ADHD, whereas the rate is about 5 percent in the general population.6 Many studies of twins now show that a strong genetic influence exists in the disorder.7 • Researchers continue to study the genetic contribution to ADHD and to identify the genes that cause a person to be susceptible to ADHD. Since its inception in 1999, the Attention-Deficit Hyperactivity Disorder Molecular Genetics Network has served as a way for researchers to share findings regarding possible genetic influences on ADHD.8

48. Disorders that Sometimes Accompany ADHD • Learning Disabilities • Tourette Syndrome • Oppositional Defiant Disorder • Conduct Disorder • Anxiety and Depression • Bipolar Disorder

49. Facts to Remember About Medication for ADHD • Medications for ADHD help many children focus and be more successful at school, home, and play. Avoiding negative experiences now may actually help prevent addictions and other emotional problems later. • About 80 percent of children who need medication for ADHD still need it as teenagers. Over 50 percent need medication as adults.

50. Intervention Approaches • Psychotherapy • Behavioral therapy (BT) • Social skills training • Support groups • Parenting skills training