Specific Learning Disorder (SpLD) Overview

Specific Learning Disorder (SpLD) Overview

• SpLD is a neurodevelopmental disorder with a biological origin.
• It involves cognitive abnormalities, and is linked to behavioral signs
• Genetic, epigenetic, and environmental factors interact to cause SpLD.
• The disorder can be passed to subsequent generations (e.g., siblings).
• SpLD comes with neuroanatomical abnormalities, frequently related to cell migration during gestation.

Learning Objectives

• Students will be able to identify the three subtypes of SpLD under DSM-V.
• Students will be able to point out the clinical characteristics of each SpLD subtype.
• Students will be able to describe SpLD assessment tools for diagnosis.
• Students will be able to summarize the five hypotheses about SpLD.
• Students will be able to give examples demonstrating how SpLD affects daily living.
• Students will start to think about the role of an occupational therapist in SpLD management.

Essential Features of SpLD

• Individuals with SpLD experience persistent difficulties learning core academic skills.
• The difficulties start during the formal schooling years.
• Academic performance is well below average for the individual's age.
• In children, SpLD can affect school performance. In adults, it can lead to avoidance of activities requiring academic skills.

DSM-5 Criteria of SpLD

• Four diagnostic criteria must be met to diagnose SpLD.
• The diagnosis is based on a clinical synthesis of the individual's history (developmental, medical, family, educational), school reports, and psychoeducational assessments.
• Criterion A: individuals with SpLD experience persistent difficulties learning using academic skills for at least six months, despite interventions aimed at improving skills.
• Criterion B: Affected academic skills are significantly below expected levels for the individual's chronological age.
• Criterion C: Learning difficulties begin during the school-age years.
• Criterion D: Learning difficulties cannot be explained by other conditions.

DSM-5 Criteria of SpLD (Specific Examples)

• Difficulty with reading words (i.e., reading single words aloud incorrectly, slowly; guessing words frequently; difficulty sounding out).
• Understanding the meanings of what is read.
• Difficulties with spelling (substituting, omitting, or adding vowels/consonants).
• Difficulties with written expression (multiple grammatical/punctuation errors within sentences, poor paragraph organization, poor idea clarity).
• Difficulty with math (number sense, magnitude, and relationships; counting fingers to perform math, lost in computation, wrong arithmetic procedures).
• Difficulty with mathematical reasoning.

Criterion B

• Affected academic skills are substantially below expected levels for the individual's age, and directly interferes with academic/occupational performance and/or daily living activities.
• It's confirmed by standardized achievement measures and comprehensive clinical assessments.

Criterion C

• Learning difficulties start during school age and may only become fully obvious when academic demands exceed available learning capacities.

Criterion D

• SpLD is not caused by intellectual disabilities, uncorrected visual/auditory impairments, other mental/neurological conditions, psychosocial adversity, lack of proficiency in language of academic instruction, or inadequate educational instruction

Types of SpLD

• Reading: Impairment in word reading accuracy, reading rate/fluency, and reading comprehension.
• Written Expression: Spelling accuracy, grammar/punctuation accuracy, and clarity/organization of written expression.
• Mathematics: Number sense, memorizing/calculating math facts, fluent calculation, and mathematical reasoning

Common Assessment Tools in Hong Kong (HKT-P(II)/HKT-JS-II)

• Hong Kong Test
• Wechsler Individual Achievement Test (WIAT-III)
• Woodcock-Johnson tests

Role of Occupational Therapists in SpLD

• OTs do not make diagnoses.
• OTs provide supplementary information about underlying problems (e.g., attention, working memory, information processing speed, organization, visual/auditory perception).
• OTs also provide supplementary information on related functions, e.g., visual-motor control, ocular-motor control, fine motor skills, and sensory processing.

Common Assessment Tools for OTs

• Smart Handwriting Analysis and Recognition Platform (SHARP)
• Computerized Handwriting Speed Test System (CHSTS-II)
• Copying Speed Test for Secondary School Students (CST-HK)
• Beery-Buktenica Visual Motor Integration (VMI-6)
• Developmental Test of Visual Perception (DTVP-3)
• Motor-Free Visual Perception Test (MVPT-4)
• Developmental Eye Movement Test (DEM)
• Grooved Pegboard Test

Hypotheses of SpLD

• (1) Phonological Deficit: Underlying difficulty decoding words and linking sounds to letters/representation.
• (2) Automatization Deficit: Challenge automating cognitive/motor skills.
• (3) Cerebellar Deficit: Problems with coordination and automaticity affecting various tasks.
• (4) Magnocellular Deficit: Processing visual/auditory information inadequately and struggling to perform reading accurately.
• (5) Executive Function Deficits: Demonstrating many neurocognitive deficits, not limited to phonology.

Prevalence

• SpLD affects 5-15% of people across reading, writing, and mathematics domains.
• SpLD has high heritability.

Special Issue: Chinese word

• Specific language differences between Chinese and English reading and writing in children with SpLD

Dyslexia: Specific Characteristics

• Normal intelligence.
• Deficits in nervous system aspects.
• Impaired multiple cognitive abilities, not just single aspects, e.g. long-term memory, working memory, sequencing, organization.
• Specific deficits identified often include phonological retrieval and orthographic awareness.

Management of SpLD

• Multidisciplinary approach, including psychologists, pediatricians, speech therapists, occupational therapy, physical therapy, social workers and school staff.
• Comprehensive assessment is crucial.
• Skills training and accommodation are key to improving learning.
• Educational resources and support are extremely important.

Example Strategies

• Use multimodal strategies to teach complex mathematical steps.

This quiz provides an overview of Specific Learning Disorders (SpLD), focusing on their neurodevelopmental origins, subtypes, and assessment tools. Students will learn to identify characteristics of SpLD and the role of occupational therapy in its management. Test your knowledge about the complexities and implications of SpLD.