Child Psychopathology

Learning Disability

Chapter 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

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

LD: 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

Learning Disorders: 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-emphasis 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

How do learning disorders effect peer relations?

• The term “children with learning disorders” refers broadly to children who are not performing at age expected academic level.

• It is estimated that 75% of children with learning disorders have some kind of social deficit.

• Children often experience rejection and are victimized by peers. This can lead to loneliness and possibly depression. Peer relations are vital to a child’s development

Social Deficits

• Reduced social and communicative competence

• Fewer initiated social interactions

• Less cooperative

• Less tactful in social situations

• Less developed concept of conflict

Social Deficits

• Adjustment difficulties

• Immaturities

• Difficulty distinguishing subtle cues

• Difficulty processing facial expressions and other social information

• If children with learning disorders are rejected by peers then they do not get the opportunity to practice social interactions.

• Friendships give these children a medium to learn skills and develop

Bullying and Rejection

• bullying can be direct (name calling) or indirect (gossiping)

• bullying may increase the child’s experience of emotional and social problems

• isolation only limits their opportunities to learn and practice skills

Bullying and Rejection

• Approximately 30% of children with learning disorders are rejected by peers in comparison to 8-16% of normal achieving children

• Learning disorders are often associated as a deficit of the individual and they are seen as abnormal which will reduce social acceptance.

• Children are often left vulnerable due to their complete lack of social networks and are also at risk for being victims of bullying and violence

Types of Peer Relationships

• More negative nominations than normal achieving peers

• Peer relationships are less stable

• More relationships with younger peers

• More friends who also have learning disorders

• Boys with learning disorders are more likely to have friends outside of school

Implications

• Children are at a much greater risk for experiencing loneliness and possibly depression and anxiety

• Children with learning disorders have a lower sense of coherence and a lower self esteem than their peers

• At least one friend is an important provider of social support and learning and reduces loneliness