PPT 7

Question 1

Prevalence of Learning Disorders

Answer 1

Prevalence of learning disorders = 15% to 25%

Question 2

Hierarchy of Cognitive Disorders
Pennington, McGrath & Peterson (2019)

Answer 2

Neurological Disorders

Developmental Disorders

Learning Disorders (LD, Autism spectrum, ID, ADHD)

Specific Learning Disabilities

Question 3

Learning Disabilities

Answer 3

Evidence supports 7 types of learning disorders

1. Speech disorder
   - Childhood apraxia of speech disorder (CAS)
   - Speech sounds disorder (SSD)
2. Language Disorders
   - Language Impairment (LI)
   - Pragmatic Language Impairment (PLI)
3. Reading Disorders
4. Mathematics Disorders
5. Attention-Deficit/Hyperactivity Disorders
6. Autism Spectrum Disorders
7. Intellectual Disability

No evidence for Written Language Disorder

Question 4

Diagnosing Learning Disabilities in the U.S.

Answer 4

1. Discrepancy Model (exclusively nomothetic)
2. Response to Intervention Approach (RTI) (largely idiographic)
3. Pattern of Strengths and Weaknesses (nomothetic and idiographic)

Question 5

Discrepancy Model

Answer 5

Significant difference between cognitive aptitude and achievement

State laws specify the required discrepancy to diagnose (a standard deviation or two or sometimes computed from a regression equation)

Question 6

Achievement Tests

Answer 6

Batteries
- Woodcock-Johnson Achievement Test IV (WJA-IV)

• Wechsler Individual Achievement Test (WIAT-IV)
• Wide Range Achievement (WRAT-5)

Focal achievement tests
- Comprehensive Test of Phonological Processing (CTOPP-)

• Nelson Denny reading test
• Gray Oral Reading Test (GORT)
• Key Math test

Question 7

Example: Colorado

Answer 7

Colorado statutes use a regression model to specify cutoff values for diagnosis (see below)

BUT now for public schools, federal law prescribes RTI

Question 8

Response to Intervention Approach (RTI)

Answer 8

School-based approach
- Classroom teachers try different interventions for a child who is falling behind in achievement to see what helps that student

• “To identify and address student academic and behavioral difficulties through effective, efficient, research-based instruction and progress monitoring in a multi-tiered intervention model”

Question 9

Assessment in RTI

Answer 9

Level 1 - Screening

Level 2 - Instruction supplements focused on non-responders to Level 1 interventions

Level 3 - Problem-solving

Level 4 - Test for Specific Learning Disorder
- Formal testing
- Dx&raquo_space; IEP
- Class accommodations, Aids in the classroom
- 504 (“suspected” SLD, less intensive)
- Determination is based on child’s response to scientific, research-based interventions

Question 10

Emerging Consensus

Answer 10

Distinguishing between ability and academic performance is arbitrary & counterproductive

RTI is a solution of trial and error (some say “waiting to fail”) that doesn’t effectively address SLDs
- Delay minimum 6 weeks at each RTI level
- High ability students with SLD are not identified
- Teachers over-burdened with added responsibilities and by the delays when some action is clearly needed
- Impact on student self-concept of continued failure
- The field of SLD assessment is transforming
- Efforts are being made to make assessment more consistent with empirical evidence
- Using tests to identify patterns of academic strengths and weaknesses is superior to the discrepancy model
- Importance of other sources of information: History and Observation to equal footing as Testing

Question 11

“Every child is like all children, like some other children, and like no other children.” (Robin Morris)

Answer 11

Like all others (species level)

Like some groups (diagnostic level)

Unlike any one else (unique)

Understanding and treating depends on group level variation. A science is not possible at the species or unique level.

Question 12

Diagnoses Are Important

Answer 12

Efficient identification and treatment

Facilitates communication

Provides access to supports

Facilitates research

Can be therapeutic in itself

Question 13

Patterns of Strengths and Weaknesses Approach to Diagnosing Specific Learning Disabilities

Answer 13

New foundation for understanding learning disabilities

Strongly grounded in and emerging from research evidence

Question 14

Diagnosing Learning Disorders: From Science to Practice (2019)
Pennington, McGrath, & Peterson

Question 15

Complicating Factors

Answer 15

Heterotypic continuity

Brain plasticity

Comorbidity

Multiple levels of consideration
- Etiology
- Brain development
- Neuropsychology
- Effects on cognitive ability

Genetic & environmental factors are bidirectional

Question 16

Heterotypic Continuity

Answer 16

The underlying impairment/disorder is continuous through life but the expression of it is different across age (I.e., symptoms manifest differently with different developmental phases/tasks)

Question 17

Plasticity of Brain Development

Answer 17

Neurodevelopment disorders are bidirectional because development is occurring throughout life and the environment also affects brain development (nutrition, experiences, etc.)

Interplay of risk factors and protective factors

Probabilistic model rather than determinative

Question 18

Comorbidity

Answer 18

“More generality than specificity in the cognitive profiles of co-morbid neurodevelopment disorders.”

Question 19

Comorbidity (cont.)

Answer 19

Comorbidity is common in neurodevelopment disorders because of shared risk and protective factors at the etiological level.

With a learning disorder, there is a 20-25% chance of also having ADHD.

With ADHD, there is a 30-70% chance of also having a learning disorder. (Everyone who has ADHD should be checked for a learning disorder – and vice versa).

With Tourette’s syndrome, ~ 60% of children also have a learning disorder.

With Conduct Disorder and Oppositional Defiant Disorder, about one third have learning disorders.

Question 20

Summary Model of Neurodevelopment Disorders (Pennington, McGrath, & Peterson)

Answer 20

1. “The etiology of complex behavioral disorders is multifactorial and involves the interaction of multiple risk and protective factors, which can be either genetic or environmental”
2. “These risk and protective factors alter the development of neural systems that mediate cognitive functions necessary for normal development, thus producing the behavioral symptoms that define these disorders.”
3. “No single etiological factor is sufficient for a disorder, and few may be necessary”
4. “Consequently, comorbidity among complex behavioral disorders is to be expected because of shared etiological and cognitive risk factors.”
5. “The liability distribution for a given disease is often continuous and quantitive, rather than being discrete and categorical, so that the threshold for having the disorder is somewhat arbitrary.”

Question 21

Holistic Approach to Diagnosis (Nomothetic and Ideographic)

Answer 21

1. Consider context (family, school, community)
2. Evaluate the full picture (including social, emotional and behavioral aspects)
3. Use multiple streams of information - HOT

Integration of:
- History
- Observation
- Tests

Question 22

History

Answer 22

Family history (Dx, difficulties in school)

Developmental, medical, and educational history

Records that are available reflecting school performance and any previous assessment results

Psychosocial history (emotional etc.)

Sleep patterns (growing evidence this is a factor)

Question 23

Observation

Answer 23

Begins with first contact

Classroom/work observation

Vicarious Observation (parents and teachers)

Testing Observations
- Cooperation and effort
- Problem solving approach
- Types of errors made

Question 24

Tests

Answer 24

Flexible battery approach
- Areas most relevant to LD
- Emotional screen

Performance validity tests are widely used (research shows judgement alone is not enough) to determine the client’s level of motivation