Mgmt Considerations for Children with Learning Disabilities and DCD Flashcards
The medical perspective of the definition of learning disabilities focus on
etiology or cause
Examples of a medical etiology or cause of learning disabilities
- brain injured
- minimal brain dysfunction
- psychoneurological disorder
The educational perspective of the definition of learning disabilities focus on
behavior
Examples of a behavioral cause of learning disabilities (educational perspective)
- intellectual disability
- reading/math/written expression disorder
What are the 2 perspectives of the definition of learning disabilities?
- medical
- educational
NJCLD stands for
National Joint Committee on Learning Disabilities
LD stands for
learning disability
According to the NJCLD, a learning disability is a ______________________ that refers to a ______________________ of disorders manifested by ______________________ in the _____________ and ________ of _________, ___________, __________, __________, __________, or ____________ abilities.
general term; heterogeneous group; significant difficulties; acquisition; use; listening; speaking; reading; writing; reasoning; mathematical
According to the NJCLD, learning disorders are _______________ to the individual and are presumed to be due to what?
intrinsic; CNS dysfunction
True/False: According to the NJCLD, disabling conditions or extrinsic influences may be the direct cause of a learning disability.
False
According to the IDEIA, LD is defined as a _____________ in _________________ of the basic psychological processes involved in ___________ or in _____________________, spoken or written,…
disorder; one or more; understanding; using language
According to the IDEIA, LD includes conditions such as
- perceptual disabilities
- brain injury
- minimal brain dysfunction
- dyslexia
- developmental aphasia
True/False: According to the IDEIA, LD does not include a learning problem that is primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural or economic disadvantage.
True
True/False: According to the IDEIA, LD is primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural or economic disadvantage.
False
According to the DSM–IV Classification under Developmental Disorders, learning disorders include
- reading disorder
- mathematics disorder
- disorder of written expression
According to the DSM–IV Classification under Developmental Disorders, motor skills include
developmental coordination disorder
According to the DSM–IV Classification under Developmental Disorders, communication disorders include
- expressive language disorder
- mixed receptive-expressive disorder
- phonological disorder
- stuttering
The 3 categories of disorders according to the DSM–IV Classification under Developmental Disorders:
- learning disorders
- motor skills
- communication disorder
An ICD–10 Code: Disorders of psychological development includes specific developmental disorder (SDD) of
- speech and language
- scholastic skills
- motor function
- pervasive developmental disorder
SDD stands for
Specific Developmental Disorder
A SDD of speech and language includes
acquired aphasia with epilepsy
True/False: The prevalence of LD is greater in males than females.
True
True/False: The prevalence of LD is greater in females than males.
False
Current investigation of possible causes of LD focuses more on
- pregnancy and birth
- genetic/hereditary links - across generations
- emotional/social environment influence
Pregnancy and birth causes of LD could include
- LBW
- drug/alcohol exposure
- anoxia
- preterm
- prolonged labor
Common characteristics of LD include what type of clinical presentation?
variable
Common characteristics of LD include _____________ neuropsychological symptoms that interfere with the ability to __________, __________, or _____________ information.
composite; store; process; produce
LD may result in disorders of _________, ________________, ______________, _____________________, and ___________________.
speech; spatial orientation; perception; motor coordination; activity level
What suggests different patterns of organization in children with LD?
neuroimaging
Neuroimaging suggests different patterns of ________________ in children with LD.
organization
Current subgroups of LD being explored include
- verbal learning impairments
- nonverbal learning impairments
- motor coordination deficits
- social and emotional challenges
Difficulties in verbal learning result in problems with
- reading
- acquisition of written and spoken language
- arithmetic
Difficulties in nonverbal learning result in problem with
- visual-spatial organization
- social-emotional development
- sensorimotor performance
Difficulties in motor behavior result in
developmental coordination disorder
Accompanying behavioral disorders of LD may include
- hyperactivity
- lack of attention
- poor impulse control
Concerning the concepts of hemispheric specialization, describe the organization of the left hemisphere
- more focal and precise
- facilitates accurate coding needed for speech
Concerning the concepts of hemispheric specialization, describe the organization of the right hemisphere
- more diffusely organized
- permits dissimilar information to be processed simultaneously
Concerning the concepts of hemispheric specialization, how does the left hemisphere process information?
in a sequential, linear fashion
Concerning the concepts of hemispheric specialization, which hemisphere is more proficient in analyzing details?
left
Concerning the concepts of hemispheric specialization, which hemisphere has academic responsibilities?
left
What are the academic responsibilities of the left hemisphere?
- recognizing words
- comprehending material read
- performing mathematical calculations
- processing and producing language
Concerning the concepts of hemispheric specialization, the right hemisphere is advantageous for __________________ and ____________________.
spatial processing; visual perception
Concerning the concepts of hemispheric specialization, how does the right hemisphere process input?
in a more wholistic manner
Concerning the concepts of hemispheric specialization, how does the right hemisphere “grasp” information?
grasps the overall organization or “gestalt” of a pattern
Concerning the concepts of hemispheric specialization, which hemisphere has functional responsibilities?
right
What are the functional responsibilities of the right hemisphere?
- synthesizes nonverbal stimuli
- recognizes and interprets facial expressions
- contributes to math reasoning and judgment
Examples of nonverbal stimuli include
- environmental sounds
- voice intonations
Verbal learning impairments include
- dyslexia
- dyscalculia
- dysgraphia
Nonverbal learning disabilities include
- visual-spatial organization
- sensorimotor integration
- social-emotional learning disorders
Examples of dyslexia include
- visual-spatial
- audiophonic
- mixed
Examples of dyscalculia include
- decoding
- copying
- sequencing
- interpreting
Examples of dysgraphia include
- penmanship
- linguistic
- combination
Specific motor impairments include
developmental coordination disorder
Behavior disorders due to social/emotional challenges include
- ADD
- ADHD
- anxiety
- conduct disorder
- frustration
3 parts of developmental coordination disorder
- “clumsy” child
- developmental apraxia
- developmental clumsiness
DCD stands for
developmental coordination disorder
DSM-IV-TR Criterion A for DCD
marked impairment in development of motor coordination
DSM-IV-TR Criterion B for DCD
impairment that significantly interferes with academic achievement or ADL
DSM-IV-TR Criterion C for DCD
not resulting from medical condition
DSM-IV-TR Criterion D for DCD
not consistent with intellectual disabilities (if present)
True/False: The incidence of DCD is greater in males than females
True
True/False: The incidence of DCD is greater in females than males
False
List the functional limitations associated with DCD
- poor performance on academic task
- reduced performance of ADL’s
- problems with participating in age appropriate leisure activities
- behavior problems
- psychosocial problems
Pathophysiology of DCD
- no known cause
- multifactorial
Regarding the pathophysiology of DCD, what are the homogeneous clinical signs?
There are none except for delay in age appropriate motor development
Regarding the pathophysiology of DCD, describe movement time.
consistently demonstrate slower movement time, regardless of type of task
Regarding the pathophysiology of DCD, describe the subtypes.
currently being defined
Regarding the pathophysiology of DCD, describe the correlation
ex-post facto correlation with prematurity
Regarding the pathophysiology of DCD, describe the possible cellular level cause.
neurotransmitter and receptor level rather than specific region of the brain
Regarding the pathophysiology of DCD, there are possible ________________________ deficits. This relates to __________________.
multisensory processing; sensory integration disorder
Regarding the pathophysiology of DCD, there is a possible link with ________________________, __________________________, and _________________________________.
kinesthetic perception; visual-spatial processing; multisensory integration deficits
Gross motor characteristics of DCD
- Diminished core strength and postural control
- Delayed balance reactions
- Often falling, tripping & bumping into things (acquiring more than the usual # of bruises)
- Slower rate of motor performance (despite
practice & repetition) - Delayed acquisition of motor milestones
- Poor anticipation (inability to use past performance to prepare for subsequent tasks)
- Reduced quality of running and ball skills
- Difficulty learning bilateral tasks (e.g. riding bike, catching a ball, jumping rope)
- Hesitance/avoidance of novel complex skills
- Reduced safety awareness
- Lack of smooth body transition/turning (e.g. playground slide; on/off playground equipment)
- More sedentary lifestyle; more solitary play
- Reduced safety awareness
- Lack of smooth body transition/turning (e.g. playground slide; on/off playground equipment)
- More sedentary lifestyle; more solitary play
- Tendency not to follow game rules
- Avoidance of team sports
Fine motor characteristics of DCD
- Diminished wrist/hand strength
- Maladaptive or immature grasp pattern
- Excess or inadequate pressure
- Poor refinement of small motor movements (Lack precision when manipulating objects)
- Drops / breaks items frequently
- Delayed dressing skills (buttons, zippers, laces)
- Trouble managing eating utensils or tools (scooping/piercing/scissors/pencils/hole punch)
- Laborious & often illegible writing
- Impaired drawing ability (Wobbly lines, innacurate junctures, coloring in lines)
- Decreased ability completing art projects
- Difficulty with constructive / manupulative play (e.g. Tinker toys/ legos/ blocks)
- Associated difficulty with articulation deficits
Visual motor characteristic of DCD
- Difficulty with visually guided motor actions (Hand/eye; eye/foot)
- Hesitancy or decreased safety on stairs
- Inaccuracy due to timing of kick/ hit/ catch skill
- Poor judgement of spatial relationships (e.g. difficulty with hopscotch / 4-square)
- Difficulty with spatial planning (e.g. puzzles / building models/ constructional toys)
- Labored writing/ spacing/ irregular letters
Self-care characteristics of DCD
- Slowness to develop independence in ADL
- Overreliance on parental assistance with self care
- Clothes improperly donned (backward/crooked)
- Problems cutting nails; applying makeup; hair style
- Problems blowing nose / applying band-aid
- Difficulty applying toothpaste on toothbrush
- Messy eater; spills often; doesn’t recognize food on face
- Difficulty pouring from a container
- Problems opening lunch box, unwrapping
sandwich, opening containers - Problems peeling fruit (Challenges sequencing cutting utensil task while holding fruit without squeezing too tight)
- Trouble packing a bag, backpack or suitcase
- Difficulty sequencing daily routines
Social and emotional characteristics of DCD
- Often emotionally immature
- May act out / become class clown
- Can appear fiercely competitive (Hates to lose, complains rules are unfair)
- Can be self-deprecating / calls self “stupid”
- Often easily frustrated
- May feel depressed / incompetent
- Has difficulty making and maintaining friendships
- Plays alone
- Has feelings of low self-worth, poor self-esteem
- Perceived by others as lazy, overprotected
- Behavior often described as immature
- Adolescents have fewer social past-times / hobbies
- Problems persist into adulthood
Describe some of the problems of DCD that persist into adulthood
- Adults are often under-/un-employed
- Alcohol abuse more frequent
- Live with parents longer / marriage delayed (or never happens)
Assessment Considerations for DCD
- Postural Control and Gross Motor Performance
- Fine motor performance
- Praxis and motor planning
- Performance difficulties related to physical fitness
Regarding assessment considerations for DCD, what should be considered with the postural and gross motor performance?
– muscle tone & strength
– compensatory fixing patterns
– muscle “feel” (mushy, soft, hyperextensible)
– integration of primitive reflexes - asymmetries
– righting, equilibrium, vestibular function
Regarding assessment considerations for DCD, what should be considered with the fine motor performance?
- FM skills vs FM movements
- eye-hand coordination and handwriting
FM stands for
fine motor
Things to look for related to FM skills vs FM movements
- proximal control & distal movements
- wrist stability, development of hand arches, separation of 2 sides of the hand
What should be looked at when assessing wrist stability, development of hand arches, and separation of 2 sides of the hand?
- translation
- shift
- rotation
Regarding wrist stability, development of hand arches, and separation of 2 sides of the hand, define translation.
finger movement to move objects into and out of the palm of the hand
Regarding wrist stability, development of hand arches, and separation of 2 sides of the hand, define shift.
alternation of pattern of thumb & 1st finger
Regarding wrist stability, development of hand arches, and separation of 2 sides of the hand, define rotation.
turning an object within the hand
Things to look for related to eye-hand coordination and handwriting
- diadochokinesis, sequential finger/thumb touch,
stererognosis - standardized tools (e.g. Peabody)
Things to look for related to Praxis and motor planning
– the ability to carry out a new or unusual motor act, when there is potentially adequate cognitive and motor skill to do so.
– Motor planning deficits create difficulty performing in, acting on the environment
Describe how motor planning deficits create difficulty performing in, acting on the environment
- inability to figure out new activities
- disorganized approach
- poor anticipation of his/her actions
- difficulty with peer interactions
- frustration
Things to look for related to performance difficulties related to physical fitness
– Problems with games / athletic activities
– Often demonstrate below average measures of
physical fitness
Individuals with DCD often demonstrate below average measures of physical fitness in what areas?
- Strength
- Muscular endurance
- Flexibility
- Cardiorespiratory endurance (as reflected by tests of aerobic/ anaerobic capacity)
Gubbay Test of Motor Proficiency
- Standardized for children 8 – 12 yrs of age
- 8 tests – inexpensive / easily created with readily available equipment
- Targets skills challenging for children with DCD
DCD associated impairments of body structure and function
- soft signs
- poor visual perception
- joint laxity
- poor spatial organization
- poor sequencing
- inadequate information processing
- poor feedback
- poor short- and long- term memory
- poor visual memory
DCD activity limitations
- Awkward gait
- Delayed GM / FM with poor motor quality
- Delayed oral-motor skills
- Low self esteem
- Distractibility
- Dependent self help
- limited participation in PE
- poor written communication
- poor language skills
- reduced social interaction
- depression
- low academic work
Soft signs include
- poor strength
- poor coordination
- jerky movements
DCD Participation Restrictions
- Limited indoor and outdoor play with peers
- Strained child-parent relationship
- Social isolation
- Limited vocational success
- Design of objects such as tamper-proof packaging / tying shoes/ poor written communication/ PE
2 types of treatment of children with learning disabilities who also have motor deficits
- Indirect
- Direct
Describe indirect treatment of children with learning disabilities who also have motor deficits
- perceptual
- perceptual-motor skills
- psycholinguistic abilities
- integration of subcortical function to improve specific skills
Examples of indirect treatment techniques
- SI
- NDT
- PNF
Describe direct treatment of children with learning disabilities who also have motor deficits
- specific cognitive and adaptive skills
- teach to the child’s strengths
- compensate for weaknesses
What type of model is a direct model?
educational
Examples of direct treatment techniques
- motor skill training
- monitoring physical fitness
Supportive Treatment Practices
- Include other children for peer support
- Cooperative rather than competitive activities
- Incorporate rhythmic activities
- Use age-appropriate skills
- Look for other developmental co-morbidities like LD, ADHD, etc
5 areas of function for the PT in the educational environment as identified by Kaslish & Presseller:
– Screening and evaluation – Program planning – Delivery of treatment activities – Providing consultation services – In-service training
What are the subcortical structures that Ayres emphasizes?
- brainstem
- thalamus
- vestibular
Types of SI dysfunction
– vestibular-proprioceptive discrimination
– somatodyspraxia
– tactile defensiveness & gravitational insecurity
– visuomotor & visual construction
– auditory-language
What does vestibular-proprioceptive discrimination influence and what does this result in?
postural-ocular movements and bilateral integration and sequencing; results in hypo- / hyper- reactivity to movement
Somatodyspraxia includes what?
poor tactile & proprioceptive discrimination
What types of concerns do auditory-language SI dysfunctions cause?
praxis concerns
Praxis concerns are caused by SI dysfunctions of what type?
auditory-language
Poor tactile & proprioceptive discrimination are caused by SI dysfunctions of what type?
somatodyspraxia
Hypo-/hyper- reactivity to movement is caused by SI dysfunctions of what type?
vestibular-proprioceptive discrimination
What percentage of children with LD have motor coordination or visuomotor problems?
90%
By definition, DCD is not related to
- muscle pathology
- peripheral sensory abnormality
- CNS disorder that causes spasticity, athetosis, or ataxia
What type of tone is DCD often associated with?
mild-moderate hypotonia
Describe the timing associated with those who have DCD
poor
Describe the force of production associated with those who have DCD
poor
Apraxia is associated with what type of brain lesion?
- lesions in anterior half of the periventricular white & frontal lobe
