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Neuropsychological Aspects of Learning Disabilities

Neuropsychological Aspects of Learning Disabilities. Responsiveness-to-Intervention Symposium December 4-5, 2003 • Kansas City, Missouri

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Neuropsychological Aspects of Learning Disabilities

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  1. Neuropsychological Aspects of Learning Disabilities Responsiveness-to-Intervention Symposium December 4-5, 2003 • Kansas City, Missouri The National Research Center on Learning Disabilities, a collaborative project of staff at Vanderbilt University and the University of Kansas, sponsored this two-day symposium focusing on responsiveness-to-intervention (RTI) issues. The symposium was made possible by the support of the U.S. Department of Education Office of Special Education Programs. Renee Bradley, Project Officer. Opinions expressed herein are those of the authors and do not necessarily represent the position of the U.S. Department of Education. When citing materials presented during the symposium, please use the following: “Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.” Margaret Semrud-Clikeman, Ph.D. University of Texas at Austin

  2. Definitions of LD • Minimal brain dysfunction • Word Blindness • Dyslexia • Learning disabilities • Popular after P.L. 94-142 • Suggested include • Intrinsic to individual • Due to central nervous system dysfunction Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  3. Learning disabilities • Include difficulty with mathematics, written language, expressive/receptive language, listening comprehension • The brain naturally learns language • The child must be taught reading--it is not a natural skill. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  4. Comorbidity Issues • Reading disabilities comorbid with ADHD in 20-50% of the LD population • We found comorbidity between mathematics and ADHD in approximately 30% of the LD population and 75% of the ADHD population Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  5. Comorbidity Issues • Also found a significant overlap between difficulties with written language expression and ADHD • Problems with planning and organization of written material was found to be more predictive of difficulty for these children than reading deficits. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  6. Brain Imaging and LD • Information processed differently for children with LD • Fluent adult readers utilize the frontal region more than beginning readers • The left frontal region becomes more active over development • Fluent child readers utilize this area more than nonfluent readers. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  7. Brain Imaging and LD • Nonfluent readers show more activity in the parietal and occipital regions • Also more activity noted in the right hemisphere for nonfluent readers • Fluent and adult readers utilize the left hemisphere more for reading. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  8. Brain Imaging and LD • There is a change from posterior systems in early reading (visual-perceptual processes) to frontal systems • The progression from simple letter and word calling to comprehension requires the maturation of these pathways from back to front. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  9. Brain Imaging and LD • As child improves in reading, the activation changes from diffuse to more organized. • This change has been found with improvements in reading and language skills as well as better auditory processing ability. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  10. Neuropsychology and LD • The most predictive measures for response to intervention have been found to be attentional ability, language processing, and auditory processing. • These skills have been found to be more important that verbal IQ or the verbal IQ achievement discrepancy. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  11. Neuropsychological Components in LD • Additional evaluation of the following abilities is strongly recommended in children with learning problems: • Auditory processing/phonemic awareness Attention • Working memory • Executive functions (metacognition) • Processing speed Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  12. Auditory Processing Requires • the ability to discriminate sounds • To segment words into sounds • To produce rhyming words • Looks at not just the ability to hear individual sounds but to supply missing sounds to incomplete words Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  13. Speed of Information Processing • This skill has been found to be related to ability as well as to learning skills • The rate of decoding of words is more predictive of learning problems in older children than the ability to decode words • Reading that is effortful is generally not fluent. • Children who are slower at naming words and nonwords showed poorer reading ability. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  14. Listening Comprehension • Is mediated by the same cognitive processes are reading comprehension only through the auditory modality • Is a direct measure of the child’s ability to understand and process language • Assists with determining whether the reading difficulty is due to decoding or comprehension deficits Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  15. Working Memory • Is the ability to hold information in mind while performing a mental operation • Appears important in the ability to hold sounds and words in mind as well as content while reading a passage. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  16. Working Memory • Also been linked to the ability to organize a task’s temporal aspect. • The prefrontal cortex is linked to memory systems that allow the child to access previously learned material • Difficulties are related to problems with decoding and math facts and processing becomes effortful and slow. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  17. Executive Functions • Are the “how” something is accomplished not just the “what” • Important for the child to evaluate his/her performance and to self-correct • Involved with the ability to inhibit responding to irrelevant material. • Help select what is important to remember or to encode Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  18. Executive Functions • Anterior Cingulate has been hypothesized to be part of an attentional “executive system • Coordinates activity across attentional systems • Interactions with prefrontal areas may enlist support of working memory networks Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  19. Executive Functions • When children are directly taught to evaluate their progress, their performance improves. • Worked with 36 children in 3-5 grade who were experiencing difficulty with work completion. • Small group sessions were used to teach metacognitive techniques. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  20. Executive Functions • Improvement noted in work completion as well as accuracy • Children were identified as having attentional difficulties but not as LD or ADHD. • Use of frequent feedback, individualized programs and support assisted child. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  21. Attention • “Everyone knows what attention is. It is the taking possession of the mind, in clear and vivid form, of one out of what seem several simultaneously possible objects or trains of thought. Focalization, concentration of consciousness are of its essence. It implies withdrawal from some things in order to deal effectively with others” (Wm. James) Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  22. Attention • In order for something to be learned, it has to be attended. • Attention has been found to play an important role in reading and reading comprehension • Children with ADHD tend to have more difficulty with comprehension than with decoding. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  23. Remediation • Definitional difficulties make it problematic to study children with LD across locations • Neurologically the child lays down neural connections that once formed may be difficult to reteach. • May be windows of time when child is most receptive to remediation. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  24. Shaywitz studies • Found that poor readers who compensated for difficulties through remediation used different brain areas than those who did not compensate. • The main difference was in verbal ability (language) and the school level of advantage. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  25. What happens if delay services? • When children were provided with the “usual” interventions, little improvement was seen. • Assessment is needed prior to the child progressing to the third tier. • Understanding of neuropsychological processes in reading (and math) is important in the “screening” done in the first two tiers. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  26. Screening • The development of appropriate screening instruments is crucial • Need to incorporate measures of speed of information processing, working memory, and attention as well as the mechanics of reading. • Training for such assessment is crucial Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  27. Where do we go now? • University teacher training programs need to: • Provide training in brain processes underlying reading skills • Provide training in evaluation of these skills • Provide training in appropriate interventions beyond the “usual” practice Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  28. Conclusions • Exciting time for learning and teaching • However, must provide needed support to these teachers if the tier system to work • Need Master teachers and psychologists to provide additional support and to consult when a child is not responding Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  29. Conclusions • Must provide appropriate training at the university and practicum levels. • Continued research is needed as to the appropriateness of various techniques to individual problems • Also need continuing research into the long-term effects of intervention as well as early identification. Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

  30. Finally • Learning to read is hard work--for dyslexics is very hard work • For teachers of children with learning problems, instruction is very hard work. More support is needed for these teachers in order for success to be realized (Berninger, 2003) Semrud-Clikeman, M. (2003, December). Neuropsychological aspects of learning disabilities. Paper presented at the National Research Center on Learning Disabilities Responsiveness-to-Intervention Symposium, Kansas City, MO.

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