Child Psychopathology

Learning DisabilityChapter 11

Learning Disability

Imagine having important needs and ideas to communicate, but being unable to express them. Perhaps feeling bombarded by sights and sounds, unable to focus your attention. Or trying to read or add but not being able to make sense of the letters or numbers.

You may not need to imagine. You may be the parent or teacher of a child experiencing academic problems, or have someone in your family diagnosed as learning disabled. Or possibly as a child you were told you had a reading problem called dyslexia or some other learning handicap.

Definitional Issues

• Broad range of definitions in various regions, provinces, and settings

• Common issue: Children do not perform up to their expected level in school

• Issues: What is the expectation? What is the level? How do we assess performance? What are the areas we are concerned about?

• Multiple aspects of intelligence: Social, musical, kinesthetic intelligences not always figure into consideration: Or are these linked? Music/Math

DSM-IV Diagnostic Criteria: Learning Disorders

• Ability as measured by tests is substantially below expected given age, intelligence, and age-appropriate education

• Achievement or activities of daily living is affected

• Not due to sensory deficit, medical condition• Kinds: Reading Disorder, Mathematics Disorder, Disorder of Written

Expression, Developmental Coordination Disorder, Expressive Language

Disorder, Phonological Disorder

Assessment issues

• Detailed assessment of achievement– WRAT-III has Reading, Arithmetic, and Spelling subtests

• Intelligence– e.g., Average IQ, but inconsistent performance such as

“peaks and valleys” in profile or VIQ>PIQ, PIQ<VIQ, or FSIQ>Achievement

• Other cognitive processes – Memory (WMS), perceptual processing (Beery),

sound/letter correspondance (TOPA), grammar/ spelling in writing

Fig. 10.6

What is “reading”? What can go wrong?

Focus attention on the printed marks and control eye movements across the page Left to right movement Recognize the sounds associated with letters Understand words and grammar Build ideas and images Compare new ideas to what you already know Store ideas in memory

Reading Disorders

• Common underlying feature is inability to distinguish or separate the sounds in spoken words or decode words from text

• Reading speed, accuracy, and/or comprehension are affected

• Reversals (bab = bad), transpositions (was = saw; plane = plaen), inversions (M/W; u/n), omissions (bread = bead; pear = pea).

• Give example of each for “nub”

Mathematics Disorder

• Difficulty in recognizing numbers and symbols, memorizing facts, aligning numbers, and abstract concepts (What is “+”; 3 vs. 8; deleting “0” from 100; $$)

• Core deficits in arithmetic calculation (2+2=3) and or mathematics reasoning abilities

• Visual perceptual and visual spatial domains (Geometry, sets, maps)

Writing Disorder

• Problems with writing, drawing, or other visual-motor tasks

• Combination of core deficits related to written output including spelling, grammar, punctuation, poor organization, poor handwriting; Specifics similar to reading

• Think of how pervasive writing is to testing within the school system

• Can computers compensate for everything

Etiology

• Reading disorders 60% heritable, thus genetic basis highly likely: autosomal dominant

• Difficult to detect neurological problem– Anoxia at birth leads to elevated risk, even when

IVH or lesion cannot be detected• Integration of skills and information ==

Metacognitive deficits, strategies• Auditory processing is important• Comorbid attentional and behavioral problems

Cycle of failure and motivation

• There is a cycle of failure, internal attributions of failure (“I am stupid”), external blame (“School is dumb”), loss of motivation to try, (“What is the point”), leading to further failure, which becomes self-fulfilling.

• Comorbid depression, anxiety, and self-esteem problems• Conflict with parents• Conflict with teachers• Peer problems can arise• Cycle must be stopped• Build on successes

Treatments and prevention

• Early identification and treatment, e.g., reading recovery, parental reading; Later, special placements

• Children are usually in regular classrooms with extra assistance either in or outside of classroom

• Direct instruction is necessary, e.g., sound-letter correspondence, steps in math problems, monitoring spelling and grammar

• Whole language vs. Code-empasis model of reading instruction. The former is good to create initial interest, but skills must be taught

• Metacognitive training: What are you doing? How long has it taken? Am you “on task”? External cues