ADHD and Learning Disorders

1. ADHD and Learning Disorders Abnormal Behavior Problems Fall 03

2. Attention Deficit/Hyperactivity Disorder (ADHD) • What comes to mind when you hear ADHD?

3. ADHD • Hyperactivity • Disorganized/forgetful • Athletic, evolutionary advantage • Over-diagnosed • Not a real disorder

4. 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

5. 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

6. Comorbidity • ODD/CD • Learning Disorders • Depression • Anxiety • Bipolar Disorder

7. Associated Features • Academic failure/underachievement • Peer rejection, low self-esteem • Occupational underachievement • Fired, job change • Disorganized • Smoking, drug use • Car accidents, tickets

8. A Real Disorder? • Symptoms are atypical • Functional impairments • Associated features • Symptoms can be measured reliably • >90% test-retest reliability • Moderate inter-rater reliability

9. 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??

10. Treatment of ADHD • Stimulants • 90% response • Helpful with impulsive aggression • Not addictive if used appropriately • MTA • Environmental • Parent Education • Structured environment

11. Over/Under-Diagnosed? • Increase in diagnoses • Disorder du jour • Political decisions • Community-based studies • Treatment adherence

12. Evolutionary Advantage?Better Athletes? • Cognitive deficits • Fidgety, impulsive • Social deficits • Evidence from motor studies

13. Learning Disorders

14. 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

15. 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

16. Prevalence • The overall prevalence of LD is estimated to be between 2 and 10% • Approximately 5% of children have identified LD in public schools

18. 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

19. 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

20. Associated Features • Social skills, demoralization, low self-esteem • Dropout rate as high as 40% • Conduct • Attention • Internalizing symptoms • Important predictors of classroom failure

21. 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

22. 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

23. Genetics • Pennington, 1995 • 40% of LD children have LD parents • 40% of their siblings are LD

24. 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

26. A Brief Look at the Specific Disorders

27. 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

28. Mathematics • Developmentally • Informal- learning equivalency, magnitude, language, manipulation, judgment, conservation • Formal- aspects of numbers, operations • Abstract- concepts, going beyond mimicry

29. Written Expression • Physical aspects of writing • Spelling • Putting concepts on paper

30. ReadingDyslexia • Gough Simple View of Reading: • Comprehension=Listening Comprehension * Decoding • C=LC*D

31. Reading • Dyslexia • Decoding difficulties, intact listening comprehension • Hyperlexia • Good decoding skills, poor comprehension • “Garden Variety” • Poor decoding and comprehension

32. “The disabilities you can see may be easier to deal with than the ones you can’t”

33. Puzzles • I O U

34. Puzzles • I O U • I F-N N-E N-R-G

35. 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

36. 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?

37. 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!"

38. 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!

39. 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.

40. Comprehension • `Twas brillig, and the slithy toves  Did gyre and gimble in the wabe;All mimsy were the borogoves,  And the mome raths outgrabe.

41. Comprehension • Why was the Jabberwock killed? • What else was there to beware of? • What kind of tree did he rest by?

42. 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

43. Treatment • Megavitamins • Colored lenses • Special diets • Sugar-free diets • Body stimulation or manipulation

44. Basics • Heterogeneous disorders • Accurate assessment • Individual tailoring • Basic skills, fluency, comprehension • Research needed to help parse

45. Treatment • Remediations • Resolving underlying difficulties • Compensations • Bypass the problem • Keyboarding, changing expectations, strategies

46. 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

47. 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?