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Block 8 week 3 > Neuropsychological approaches to disorders of learning - Crawford > Flashcards

Neuropsychological approaches to disorders of learning - Crawford Flashcards

1
Q

What is a neuropsychologist?

A

A clinical psychologist with specialized knowledge and training in the applied science of brain behavior relationships.

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2
Q

Are licensed psychologists the only professionals outside of the school district that can administer psychological tests?

A

Yes.

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3
Q

What is the assessment process for a child neurosychologist?

A
  1. requires several meetings
  2. review of records- past testing, grades etc.
  3. parent meeting - discussion of current concerns, obtain a history, develop an assessment plan
  4. school observation
  5. 3 - two hour testing sessions - intellectual, emotional , neuropsychology tests, acedemic etc.
  6. parent feedback meeting - review testing results, make treatment recommendations
  7. written report with treatment recommendations
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4
Q

What are some neuropsychological tests?

A
  1. memory
  2. attention
  3. social cognition
  4. executive function
  5. visuospatial
  6. motor
  7. language
  8. emotional functioning
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5
Q

What is intelligence?

A

Includes abstract thought, reasoning, problem solving, acquired knowledge, and communication skills.

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6
Q

How is intelligence commonly tested?

A

Via IQ or intelligence quotient testing.

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7
Q

What are some common IQ tests?

A
  1. Wechsler intelligence scales - most common
  2. differential abilities scale
  3. Stanford-Binet intelligence scales
  4. Kaufman Assesment Battery for children
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8
Q

There are 3 types of Wechsler intelligence scales based on age. What are they?

A
  1. WAIS-V for adults
  2. WISC-V - school age children
  3. WPPSI-IV - for preschool age
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9
Q

What is the average IQ score?

A

100

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10
Q

What is an extremely high IQ score?

A

130 and above

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11
Q

What is a low average IQ score?

A

80-90

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12
Q

What IQ score might indicate a diagnosis of intellectual disability?

A

Below 70

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13
Q

How many subtests are included on the WISC-V?

A

Ten. 7 subsets are considered for Full Scale IQ. 5 subtests are considered for a General Ability Index.

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14
Q

What are the 5 indices and ten subtests included in the WISC-V?

A
  1. Verbal comprehension - includes vocabulary and similarity subtests
  2. Visual- spatial - includes block design and visual puzzle subtests
  3. Fluid reasoning - includes matrix reasoning and figure weight subtests
  4. Working memory - includes digit span and picture span subtests
  5. Processing speed - includes symbol search and coding subtests
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15
Q

What is not included on IQ tests?

A

Acedemic testing - ie. like math or spelling.

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16
Q

Kids with neurodevelopment disorders often score lower in what two indices of the IQ test?

A
  1. Working memory

2. Processing speed

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17
Q

What can be used to test the reasoning ability of kids with neurodevelopment disorders?

A

The General Ability Index. This is the IQ test without the working memory and processing speed indices.

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18
Q

What factors affect IQ scores?

A
  1. out of date test norms - i.e. Flynn Effect
  2. brief IQ screenings or group testing
  3. highly discrepant index or subtest scores may make full scale IQ invalid
  4. instruments must be normed for the individual’s sociocultural background and native language
  5. neurodevelopmental disorder can affect performance - i.e.. attention, language, motor and sensory functioning
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19
Q

What is the Flynn Effect?

A

The idea that IQ scores are increasing in the population over time.

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20
Q

What are some other factors that can affect IQ scores?

A
  1. emotional state - ie. anxiety, sadness, anger, frustration
  2. personality traits - ie. shy, outgoing
  3. physical state - ie. health, sleep, hunger
  4. testing environment - ie. location and timing
  5. motivation/effort - ie. kids might not want to take the test
  6. Skill of the examiner
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21
Q

Can IQ scores change over time in young kids?

A

Yes. For example infant test scores are virtually unrelated to intelligence at age 5.

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22
Q

When are IQ estimates considered to be stable (within 7 points)?

A

After age 5 and stability increases throughout childhood.

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23
Q

Is IQ heritable?

A

Yes.

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24
Q

What is an intellectual disability?

A

Deficit in general intellectual ability and impairment in everyday adaptive functioning (social, practical, conceptual) in comparison to peers. It is a heterogenous condition with multiple causes. Overall prevalence is approx. 1%

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25
Q

Diagnosis of an intellectual disability included what?

A

Diagnosis is based on both clinical assessment and standardized testing of intellectual ability.

26
Q

What 3 criteria must be met for a diagnosis of Intellectual disability?

A
  1. deficits in intellectual function confirmed by both clinical assessment and individualized, standardized, intelligence testing (ie. IQ score two standard deviations below population mean)
  2. deficits in adaptive functioning (daily living skills, communication, social skills) across multiple settings
  3. onset during the developmental period
27
Q

The level of severity of an intellectual disability depends on what?

A

Defined on the basis of adaptive function deficits.

28
Q

What is a learning disability?

A

Difficulty with learning and academic skills (ie. reading, math, writing) that is not attributable to intellectual ability.

29
Q

Do learning disorders thought to have a biological origin?

A

Yes.

30
Q

What affect do learning disorders have on the brain?

A

They affect the brain’s ability to perceive or process verbal or non-verbal information efficiently and accurately.

31
Q

What is the prevalence of learning disorders?

A

In all academic domains - 5-15%. Learning disorders are more common in males than females - 2-3:1 and they also commonly co-occur with other disorders.

32
Q

What is a Specific Leading disorder?

A

Indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties:

  1. Inaccurate or slow & effortful word reading
  2. Difficulty understanding what is read
  3. Difficulty with spelling
  4. Difficulty with written expression
  5. Difficulty with mastering number sense, number facts, calculations and/or mathematical reasoning
33
Q

What are some other criteria for Specific learning disorder?

A
  1. The affected academic skills are substantially & quantifiably below those expected for age & cause significant impairment in academic or occupational performance.
  2. The learning difficulties begin during school age, but may not fully manifest until later.
  3. The learning difficulties are not better accounted for by intellectual disability, uncorrected visual or auditory acuity, other mental or neurological disorder, psychosocial adversity, lack of proficiency in language of instruction, or inadequate educational instruction.
34
Q

According to the Individuals with disabilities education improvement act, what is a learning disability?

A
  1. Disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations.
  2. Child does not make sufficient progress in meeting grade-level standards . . .when using a process based on the child’s response to research-based intervention (RTI); or
  3. Child exhibits a pattern of strengths and weaknesses in performance, achievement, or both, relative to age, grade-level standards, or intellectual development.
35
Q

What is the response to intervention model?

A

This is an intervention applied to an apparent learning disability. The thought is that if it is not a true learning disability but is do to other reasons then the child may respond to intervention. The problem is that it may cause a delay in diagnosis and services for those who truly have a learning disability.

36
Q

Describe the response to intervention model.

A
  1. Primary goal: Improve academic and behavioral outcomes for all students by eliminating discrepancies between actual and expected performance
  2. A multi-tiered instructional approach that focuses on preventing problems first, and then brings increasingly intense interventions to students who don’t respond
37
Q

The response to intervention model follows a Three Tier system, describe this.

A

Tier 1 - most students are in this category (80%), involves core instructional interventions for all students, in all settings and is preventive and proactive in preventing problems.
Tier 2 - about 15% of students are at risk and need more intervention than Tier 1 and are moved up. Involves targeted group interventions, is a rapid response system and is highly efficient.
Tier 3 - Only about 5% of students need to move up to Tier 3. Involves intensive, individual interventions, is assessment based with high intensity procedures and is of a longer duration.
If students are not successfully helped in Tier 3 then they are recommended for assessment of possible learning disability diagnosis.

38
Q

What is the most common learning disorder?

A

Dyslexia, prevalence is about 9%.

39
Q

What is dyslexia?

A

A deficit in phonological processing - the ability to process information related to the sound structures of language. For example these patients have a hard time remembering what sound is associated with which symbol/letter.

40
Q

What are some other criteria of dyslexia?

A
  1. reading fluency is below expectations
  2. exhibit poor spelling abilities
  3. have associated problems with rote memory like memorizing math facts and state capitols
  4. have difficulty with learning a foreign language
41
Q

Do dyslexic patients have a hard time with the visualizing of words?

A

No, dyslexia is not associated with problems in the visual system.

42
Q

What are the recommended interventions for dyslexia?

A
  1. Intensive reading remediation that incorporates explicit, semantic phonics-based instruction.
  2. Improvement of reading fluency (rate and accuracy),
    guided oral repetitive reading and speed drills
  3. sight word list practice
  4. Programs used should conform to the theoretical guidelines outlined by the National Reading Panel
  5. Encourage reading for pleasure
43
Q

What types of accommodations are recommended for dyslexic students?

A
  1. Extended time testing
  2. Relaxed grading for spelling errors
  3. Not required to read out loud or write on board
  4. Assistive Technologies
  5. Foreign language waiver
  6. Use of spell checkers & calculators
  7. Help with tasks that require rote memorization
  8. Reduced course load
44
Q

What is Specific math disorder or Dyscalculia?

A

A specific learning disorder characterized by poor math achievement. It is highly co-morbid with other learning disabilities and also ADHD.

45
Q

What is the treatment for Specific math disorder?

A
  1. Rule out other causes!!
  2. there are no real effective treatments except for treating co-morbid conditions
  3. math remediation and improving numerical concepts may help
46
Q

Describe some characteristics of executive functions.

A
  1. A set of cognitive abilities that control and regulate other abilities and behaviors.
  2. Include the ability to initiate and stop actions (e.g., impulse control), to monitor and change behavior as needed, regulate attention and emotions, organize materials and information, as well as to plan future behavior when faced with novel tasks and situations.
  3. Executive functions allow us to anticipate outcomes and adapt to changing situations.
  4. Deficits in executive functioning are observed in a number of neurodevelopment disorders.
47
Q

What is the core deficit in ADHD?

A

Executive function deficits.

48
Q

What is ADHD?

A

Persistent pattern of inattention and or hyperactivity-impulsivity (or mixed) that interferes with functioning and or development.

49
Q

What it the prevalence of ADHD?

A

About 5% in children. Males are twice as likely as females to have it. It is highly comorbid with other disorders.

50
Q

Does prevalence of ADHD have a biological basis?

A

Yes, it is highly heritable and is correlated with prenatal exposure to drugs, alcohol, nicotine and other toxins.

51
Q

Is the predominately hyperactive-impulsive subtype of ADHD is more common in older or younger kids?

A

Younger.

52
Q

What is the most prevalent heritable childhood neurodevelopment disorder?

A

Autism.

53
Q

What are some examples of disorders that are commonly co-morbid with ADHD?

A
  1. depression
  2. anxiety
  3. learning disorder
  4. autism
  5. disruptive behavior disorders
54
Q

What are some more criteria for ADHD?

A

Two Domains:

  1. Inattention: off task behavior, lacking persistence, difficulty with sustaining focus, disorganized
  2. Hyperactivity-Impulsivity: excessive motor activity, talkativeness, restlessness, acting without thinking, difficulty with delaying gratification
  3. Three Subtypes: Combined, Predominantly Inattentive, Predominantly Hyperactive/Impulsive
  4. Symptoms must be present before age 12
  5. Symptoms must be present in 2 or more settings
55
Q

Is ADHD a diagnosis of exclusion?

A

Yes. The symptoms must not be better explained by other conditions.

56
Q

What are some other disorders where problems with attention are observed?

A
  1. anxiety
  2. depression
  3. learning disabilities
  4. language disorder
  5. medical diagnoses
  6. substance abuse
  7. attachment disorder
  8. PTSD
  9. giftedness
  10. bipolar disorder
  11. health and sleep are also potential causes of inattention
57
Q

Describe some results of the NIMH study of ADHD treatment.

A
  1. Combined treatment (medication + behavioral treatment) and medication alone were both significantly superior to intensive behavioral treatments & routine community care.
  2. In other areas of functioning (e.g., anxiety symptoms, academic performance, parent-child relations, & social skills), combination treatment was superior to routine community care, whereas medication alone or behavioral treatment alone were not.
  3. The children in the combination treatment also ended up taking lower doses of medication
58
Q

What are some standard meds used to treat ADHD?

A
  1. stimulants - ie. Ritalin, 75-90% of kids show improvement

2. Non-stimulants - ie. Strattera

59
Q

What is the MOA of Ritalin?

A

It is a dopamine reuptake inhibitor. It does not work in all kids.

60
Q

What is the MOA of Strattera?

A

It is a NE reuptake inhibitor.

61
Q

What are some other modalities used in treating ADHD?

A
  1. parent training
  2. behavioral classroom interventions such as increased structure, help with organization and time management
  3. working memory training - ie. Cogmed, does not work unless you are consistent in the training

Block 8 week 3 (9 decks)

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