Unit 3 - Learning Disability

Question 1

definition

Answer 1

“A disorder in one or more of the basic psychological processes involved in understanding or in using spoken or written language, which may manifest itself in an imperfect ability to listen, think, speak, read, write, or do mathematical calculation”

Question 2

learning disability includes …

Answer 2

dyslexia (reading), arithmetic (dyscalculia), spelling, written expression, or handwriting (dysgraphia), and in the understanding and/or use of verbal communication (dysphasia, dysnomia) and non-verbal communication.

Question 3

learning disability excludes …

Answer 3

that are the result of visual, hearing, or motor disabilities, mental handicap, or environmental, cultural, or economic disadvantage.

Question 4

DSM-IV

Answer 4

Average to above average intelligence but failure to learn/work up to potential

Skills (as measured by a standard achievement test) are are“substantially below” the child’s ability as measured by IQ

Question 5

DSM-IV example

Answer 5

David had an IQ of 120
(1 standard deviation above average)

David is struggling in reading and score below average on reading tests

Question 6

DSM-V

Answer 6

considers LD to be a type of Neurodevelopmental Disorder

Early signs of may appear in preschool
Cross-cultural and chronic condition
LD is the clinical (medical) diagnosis
“learning disabilities” as defined in the education system may be different
**those with the DSM-V clinical diagnosis would be expected to meet the educational definition

Question 7

Is LD a clinical diagnosis?

Answer 7

LD is a clinical (medical) diagnosis that is not necessarily synonymous with ‘learning disabilities’ as identified within the
education system: that is, not all children with learning disabilities/difficulties identified by the school system would meet a DSM-­V clinical diagnosis of LD. By contrast, those with a DSM-­V diagnosis of LD would be expected to meet the educational definition.

Question 8

DSM-V 2 major changes

Answer 8

1) one overarching category of LD with ‘specifiers’ to characterize the specific manifestations of learning difficulties at the
time of assessment in three major academic domains
2) elimination of the IQ-­achievement discrepancy requirement and its replacement with four criteria, all of which must be met.

Question 9

Criterion A

Answer 9

refers to the key characteristics of LD (symptoms of learning difficulties that have persisted for at least 6 months despite the provision of extra help or targeted instruction). 
 Difficulty with reading and/or writing
 Problems with math skills
 Difficulty remembering
 Problems paying attention
 Difficulty following directions
 Poor coordination
 Difficulty with concepts related to time
 Problems staying organized

Question 10

Criterion B

Answer 10

refers to measurement of those characteristics (the affected academic skills are substantially and quantifiably below those expected for age and cause impairment in academic, occupational activities, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment).

Question 11

Criterion C

Answer 11

refers to age at onset of problems (during the school-­age years, although may not fully manifest until young adulthood in some individuals)

Question 12

Criterion D

Answer 12

specifies which disorders (Intellectual Disabilities, uncorrected auditory or visual acuity problems, other mental or neurological disorders) or adverse conditions (psychosocial adversity, lack of proficiency in the language of instruction, inadequate instruction) must be ruled out before a diagnosis of LD can be confirmed.

Question 13

Incidence

Answer 13

• 4-5% of school age population
• Includes ~2 million children
• Diagnosis usually made by 6-8 years of age
• Affects more males in 4:1 ratio of males to females
• *Studies now suggest the actual ratio of males to females is closer to 1:1.

Question 14

Etiology

Answer 14

• Genetics: it has been hypothesized since the early 1900’s that learning disabilities may have a genetic base.
• Studies of identical twins have found that more than half of reading impairments are a consequence of inheritance.
• The recurrence rate of reading disability in susceptible families has been found to be 35%-45% suggesting a single gene may be involved.
• It is suspected that a major gene locus for reading disability has been identified in a small region on the short arm chromosome #6.

Question 15

executive function impairments

Answer 15

Executive function and self-regulation skills are the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully.

Question 16

working memory

Answer 16

governs our ability to retain and manipulate distinct pieces of information over short periods of time

Question 17

mental flexibility

Answer 17

helps us to sustain or shift attention in response to different demands or to apply different rules in different settings

Question 18

self-control

Answer 18

enables us to set priorities and resist impulsive actions or responses

Question 19

memory impairments

Answer 19

poor ability to listen, remember, and repeat auditory stimuli. This is essential for learning to read

Question 20

ADHD

Answer 20

~1/3 of children with learning disabilities also have a dual diagnosis of ADHD

Question 21

social skill impairments

Answer 21

children may be socially isolated, have few friends, and choose not to participate in social activities

Question 22

emotional and behavioral disorders

Answer 22

the children’s’ external experiences with failure can lead to withdrawal, depression, poor self-esteem, and conduct disorders. More than 1/3 of children with learning disabilities receive a failing grade in 1 or more, 40% of children with a learning disability dropout of school

Question 23

specific reading disability (dyslexia)

Answer 23

a defect in the processing and interpretation of written words.

• Reading is slow, labored, and inaccurate with poor comprehension.
• inability to understand word boundaries and how to analyze and manipulate syllables in words.

Question 24

dyslexia causes

Answer 24

The normal pathways for reading involve the visual cortex and Wernicke’s area

Functional neuroimaging studies have found 1) decreased activation of the left temporal-parietal cortex and superior temporal during rhyme detection, tests of phonological awareness, and semantic processing. 2) dysfunction of the central visual processing 3) abnormalities of the thalamus - important for attention and planning

Question 25

specific writing disability (dysgraphia)

Answer 25

difficulty in processing and reporting information in written form.

1) the inability to manipulate a pen and paper
2) an inability to express oneself on paper

Question 26

specific math disability (dyscalculia)

Answer 26

difficulty with arithmetic functions with an inability to perform basic math operations (ie. addition, subtraction, multiplication, division).

Question 27

secondary learning problem (excluded) - chronic illnesses

Answer 27

an increased in learning problems has been described in children with juvenile diabetes, AIDS, cancer, and chronic kidney and liver disease. Learning difficulties may be due to a combination of biomechanical disturbance, excessive school absences, or depression

Question 28

secondary learning problem (excluded) - acute disorders

Answer 28

This could include meningitis, encephalitis, and traumatic brain injury (TBI). TBI is the most common cause of behavior and learning problems in children due to resulting temporary or permanent neurological impairments.

Question 29

secondary learning problem (excluded) - psychosocial influences

Answer 29

This includes environmental influences that can affect a child’s school performance.
• A child from a home with many family problems or abuse
• A child who is hungry or sleep deprived
**Improvements in the child’s environment typically results in improved school performance

Question 30

Assessment of cognitive function

Answer 30

IQ (Intelligence Quotient) testing using the WISC-III (Wechsler Intelligence Scale for Children - 3rd Edition), and the K-ABC (Kaufmann Assessment Battery for Children)

Question 31

Assessment of academic areas

Answer 31

oral expression, listening comprehension, written expression, basic reading skills, reading comprehension, mathematical calculation, and mathematical reasoning

Question 32

Complete medical, behavioral, education, and social history

Answer 32

try to rule out other physical or emotional disorders

Question 33

re-testing

Answer 33

*Federal legislation requires psycho-educational testing be repeated every 3 years. Annual re-testing in academic subjects helps determine progress and effectiveness of interventions.

Question 34

input disorders

Answer 34

• visual perceptual impairments (figure ground, distance perception, spacial relations)
• auditory perceptual impairments (auditory figure ground/lag)
• other: tactile, proprioceptive, vestibular

Question 35

integration disorders

Answer 35

Processing the information after it is taken in and registered by the brain. Can the child make sense of the information? Can the information be cataloged and sequenced? Can the information be matched to previously learned information?
• Sequencing
• Abstraction
• Memory (retrieval, short and long term) - working memory

Question 36

output disorders

Answer 36

Making a motor response after the information is processed. This is done in many ways, by words, or muscle activity through postural adjustment, gesturing, writing, drawing.
• Language –.verbal and non-verbal communication
• Gross Motor – smooth coordinated response vs. appearing clumsy with poor coordination
• Fine Motor – refined hand skills and smoothness to movement vs. poor coordination and dysmetria

Question 37

tx - medication

Answer 37

Learning disabilities cannot be “cured”. Certain medications have been shown to be affective for certain associated impairments that affect learning. This includes problems with attention or emotional problems. Medication can only be effective with a good educational program for a child with a diagnosed learning disability.

Question 38

tx - social skills training

Answer 38

Encourage positive self esteem and development of social skills by participation in extracurricular activities or by participation in special classroom/school jobs.

Question 39

tx - counseling

Answer 39

This may help a child and the family deal better with the child’s underlying psychological issues, especially if the child is having difficulty with discipline or behavior in the classroom/home.

Question 40

school based treatment for dyslexia

Answer 40

Special reading programs
Implementation before the 3rd grade demonstrates the best results
Encourage good study and organizational habits
Individualized instruction
Curriculum adjustments
Orton-Gillingham Approach

Question 41

school based treatment for dysgraphia

Answer 41

• Alternative writing devices - computer word processing (typing or voice recognition), tape recorder
• Use of immediate feedback and correction of student work to limit repeated errors
• Journal writing
• Use of open ended sentences - draw on student’s prior knowledge
• Encourage good study skills and organization of writing materials

Question 42

school based treatment for dyscalculia

Answer 42

• Teaching practical applications - use of money, grocery shopping, banking, cooking
• Use of systematic and corrective feedback throughout the math process so errors are not repeated.
• Use of calculators?

Question 43

school based strategies to help with associated problems

Answer 43

• Child should be seated near teacher/instructor in classes or labs - this maximizes chances of seeing and hearing what is being said and done by teacher, improves intake of information.
• Teacher should check with child to assure directions are correctly understood and that the child understands what is expected of him/her.
• Make sure testing environment is free of distractions
• Provide additional time for tests, especially those requiring reading and writing skills.
• Child should have access to note-taking or note-copying services - this will assure child has a complete set of school notes for all homework assignments and reduce pressure to both listen and write during all class subjects.
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