Kk&s Ch.39 Learning Ds

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Learning disorders affect at least ? percent of school-age children

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5%

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The most recent revised version of the DSM-IV (DSM-IV-TR) includes four diagnostic categories of learning disorders:

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reading disorder,
mathematics disorder,
disorder of written expression, and learning disorder not otherwise specified

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Children with a learning disorder, such as reading disorder, for example, can be identified in two different ways:

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children who read poorly compared with most other children of the same age and

children whose achievement in reading is significantly lower than their overall IQ would predict

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Learning disorders are associated with higher than average risk of a variety of comorbid disorders, including

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attention-deficit/hyperactivity disorder (ADHD),
communication disorders,
conduct disorders, and
depressive disorders

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Reading disorders are present in approximately ? percent of children and adolescents with learning disorders

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75%

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Reading disorder and gender?

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Three to four times as many boys as girls are reported to have reading disability in clinically referred samples.
Careful epidemiological studies have found closer to equal rates of reading disorder among boys and girls. Boys with reading disorder may be referred for evaluation more often than girls because of frequently associated behavior problems.

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Reading ds prevalence?

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2 to 8%

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Children with reading disorder are at higher than average risk for , particularly older children and adolescents

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attentional problems, disruptive behavior disorders, and depressive disorders

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Data suggest that up to 25 percent of children with reading disorder also have ?

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ADHD

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Conversely, it is estimated that between ?percent of children diagnosed with ADHD have a learning disorder

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15 and 30

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etiology of reading ds?

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genetic
deficiency in processing sounds of spoken language.
That is, children who struggle with reading have a deficit in phonological processing skills.
These children cannot identify effectively the parts of words that denote specific sounds, which leads to grave difficulty in recognizing and sounding out words

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Given that reading disorder is essentially a ? deficit, the ? brain has been hypothesized to be the anatomical site of the dysfunction.

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Given that reading disorder is essentially a language deficit, the left brain has been hypothesized to be the anatomical site of the dysfunction.

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Reading Ds: Several research studies using magnetic resonance imaging (MRI) studies have suggested

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that the planum temporale in the left brain shows less asymmetry than the same site in the right brain in children with both language and learning disorders.

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Studies indicate that ? percent of first-degree relatives of children with reading disorder also have some reading disability.

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35 to 40

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Several recent studies have suggested that phonological awareness (i.e., the ability to decode sounds and sound out words) is linked to chromosome.

Furthermore, the ability to identify single words has been linked to chromosome

recent research study identified a locus on chromosome ? as a strong influence on single word reading and phoneme awarenes

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6

15

18

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False hypotheses of reading ds?

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visual-motor problems
allergies
cerebellar-vistibular system problem
left handedness

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Research in the fields of cognitive neuroscience and neuropsychology supports the hypothesis that ? and ? memory, rather than ? or ?, are areas of weakness for children with reading disorder

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Research in the fields of cognitive neuroscience and neuropsychology supports the hypothesis that encoding processes and working memory, rather than attention or long-term memory, are areas of weakness for children with reading disorder

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Is reading ds associated with prenatal infection exposure?

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One recent study found an association between dyslexia and birth in the months of May, June, and July, which suggests that prenatal exposure to a maternal infectious illness, such as influenza, in the winter months may contribute to reading disorder.

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Known risk factors for reading ds?

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preg and perinatal complications; low birthweight, prematurity,

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A higher than average incidence of reading disorder occurs among children of normal intelligence who have ?, and ? children exhibit a slightly increased incidence of reading disorder

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cerebral palsy
epileptic

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Is malnourishment a risk for LD?

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Children who were malnourished for long periods during early childhood are at increased risk of subaverage performance in many cognitive areas, including reading

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LD reading ds Characteristic diagnostic features include

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difficulty recalling, evoking, and sequencing printed letters and words;
processing sophisticated grammatical constructions;
and making inferences

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Clinically, a child may be first identified with a reading disorder after

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becoming demoralized or exhibiting symptoms of depression related to being unable to succeed in school.

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DSM criteria for Reading Ds

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1. Reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, is substantially below that expected given the person's chronological age, measured intelligence, and age-appropriate education.
2. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require reading skills.
3. If a sensory deficit is present, the reading difficulties are in excess of those usually associated with it.

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Children who have reading disorder can usually be identified by the age of ?

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7 years (second grade).

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Children with reading disorder make many errors in their oral reading. The errors are characterized by .

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omissions,
additions, and
distortions of words

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Describe clinical features of reading ds

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The child's reading speed is slow, often with minimal comprehension.
Associated problems include language difficulties, exhibited often as impaired sound discrimination and difficulty in sequencing words properly. A child with disorders may start a word either in the middle or at the end of a printed or written sentence. At times, because of a poorly established left-right tracking sequence, such children transpose letters to be read. Failures in both memory recall and sustained elicitation result in poor recall of letter names and sounds.

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People with reading ds:
copying ability
spelling?

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Most children with reading disorder have an age-appropriate ability to copy from a written or printed text, but nearly all spell poorly.

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Tx to boost reading skills?

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To boost his fluency in reading and reading comprehension, the clinical team recommended the use of repeated reading, reading along with audio taped (unabridged) versions of his favorite books, use of graphic organizers to facilitate reading for comprehension, and further participation in the summer camp reading program

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Diagnositic tests used for reading ds?

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The reading subtests of the Woodcock-Johnson Psycho-Educational Battery-Revised, and the Peabody Individual Achievement Test-Revised are useful in identifying reading disability

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What grade is reading disorder hard to hide?

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Many children with reading disorder gain some knowledge of printed language during their first 2 years in grade school, even without any remedial assistance. By the end of the first grade, many children with reading disorder, in fact, have learned how to read a few words; however, by the time a child with a reading disorder reaches the third grade, keeping up with classmates is exceedingly difficult without remedial educational intervention.

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DDX of reading ds?

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expressive language disorder, disorder of written expression, and ADHD
MR
Hearing and visual impairment

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ADHD vs reading ds difference?

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A recent study indicates that children with reading disorder consistently present difficulties with linguistic abilities, whereas children with ADHD do not.
Children with reading disorder who do not qualify for a diagnosis of ADHD, however, were shown to have some overlapping deficits in the area of cognitive inhibition such that they perform impulsively on continuous performance tasks

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Reading DS: Visual perceptual deficits occur in ? percent of cases.

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only about 10

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Describe reading ds tx?

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Most current remediation strategies for children with reading disorder are characterized by direct instruction of the various components of reading that focus a child's attention to the connections between speech sounds and spelling
specific word study with text reading practice
teaching the child to make accurate associations between letters and sounds
After individual letter-sound associations have been mastered, remediation can target larger components of reading such as syllables and words
small, structured reading groups that offer individual attention and make it easier for a child to ask for help.

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core deficits in reading disorders are related to

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difficulty recognizing and remembering the associations between letters and sounds.

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Reading instruction programs such as the Orton Gillingham and Direct Instructional System for Teaching and Remediation (DISTAR) approaches begin by

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concentrating on individual letters and sounds, advance to the mastery of simple phonetic units, and then blend these units into words and sentences

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Other reading remediation programs, such as the Merill program, and the Science Research Associates, Inc. (SRA) Basic Reading Program, begin by

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introducing whole words first and then teach children how to break them down and recognize the sounds of the syllables and the individual letters in the word

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the Bridge Reading Program uses?

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Another approach teaches children with reading disorders to recognize whole words through the use of visual aids and bypasses the sounding-out process

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The Fernald method uses a

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multisensory approach that combines teaching whole words with a tracing technique so that the child has kinesthetic stimulation while learning to read the words.

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Tx reading ds?

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tx comborb,
parental counselling
social skills

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Why include social skills teaching in reading disordeR?

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Approximately 75 percent of children with learning disorders can be differentiated from comparison samples by lower measures of social competence. It is important, therefore, to include social skills improvement as a therapeutic component of a treatment program for children with reading disorders.

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Poor achievement in four groups of skills have been identified in mathematics disorder:

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1. linguistic skills (those related to understanding mathematical terms and converting written problems into mathematical symbols),

2. perceptual skills (the ability to recognize and understand symbols and order clusters of numbers),

3. mathematical skills (basic addition, subtraction, multiplication, division, and following sequencing of basic operations), and

4. attentional skills (copying figures correctly and observing operational symbols correctly).

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Mathematics disorder alone is estimated to occur in about ? percent of school-age children, that is, approximately 1 of every ?children with learning disorder

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Mathematics disorder alone is estimated to occur in about 1 percent of school-age children, that is, approximately 1 of every 5 children with learning disorder

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Mathematics ds and gender?

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Mathematics disorder may occur with greater frequency in girls

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Epidemiological studies have indicated that up to ? percent of school-age children have some difficulty with mathematics.

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6

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Mathematics ds comorb?

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Mathematics disorder is commonly found comorbid with reading disorder and disorder of written expression. Children with mathematics disorder may also be at higher risk for expressive language disorder, mixed receptive-expressive language disorder, and developmental coordination disorder.

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Mathematics disorder etiology?

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Mathematics disorder, as with other learning disorders, is probably at least partly caused by genetic factors.

An early theory proposed a neurological deficit in the right cerebral hemisphere, particularly in the occipital lobe areas .. but not pan out

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Compared with reading, arithmetic abilities seem to depend (less, more) on the amount and quality of instruction

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more

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Most children with mathematics disorder can be detected during the ? grades in elementary schoo

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second and third

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DSM Criteria for Mathemtics Ds?

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1. Mathematical ability, as measured by individually administered standardized tests, is substantially below that expected given the person's chronological age, measured intelligence, and age-appropriate education.
2. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require mathematical ability.
3. If a sensory deficit is present, the difficulties in mathematical ability are in excess of those usually associated with it.

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Tx for Math Ds

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increased activity especially word problems
use computer games

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Disorder of written expression is characterized by

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writing skills that are significantly below the expected level for a child's age and intellectual capacity.

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? are among the most common difficulties for a child with a writing disorder

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Spelling errors

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Spelling mistakes are most often phonetic errors; that is, an

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erroneous spelling that sounds like the correct spelling. Examples of common types of spelling errors are fone for phone, or beleeve for believe

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Recommendations for Disorder of written expression

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Recommendations included the following: psychoeducation (primarily bibliotherapy), the need for educational accommodations (e.g., provision of additional time for test taking and written assignments, specific educational intervention to facilitate written expression and to teach note taking, and use of specific computer software to support written composition and spelling), and counseling or psychotherapy should his depressive episodes continue or worsen.

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DSM Criteria for Disorder of Written Expression?

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1. Writing skills, as measured by individually administered standardized tests (or functional assessments of writing skills), are substantially below those expected given the person's chronological age, measured intelligence, and age-appropriate education.
2. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living that require the composition of written texts (e.g., writing grammatically correct sentences and organized paragraphs).
3. If a sensory deficit is present, the difficulties in writing skills are in excess of those usually associated with it.

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Tx of Ds of Written Expression

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Remedial treatment for writing disorder includes direct practice in spelling and sentence writing as well as a review of grammatical rules. Intensive and continuous administration of individually tailored, one-on-one expressive and creative writing therapy appears to effect favorable outcome. Teachers in some special schools devote as much as 2 hours a day to such writing instruction. The effectiveness of a writing intervention largely depends on an optimal relationship between the child and the writing specialist.

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Learning Ds NOS criteria

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This category is for disorders in learning that do not meet criteria for any specific learning disorder. This category might include problems in all three areas (reading, mathematics, written expression) that together significantly interfere with academic achievement even though performance on tests measuring each individual skill is not substantially below that expected given the person's chronological age, measured intelligence, and age-appropriate education.