Specific Learning Disorder PDF

Dr. Will Chien Associate Professor Acknowledge Dr Cynthia Lai and Mr Johnny Lam for the powerpoint slides 1  After the lecture, you will be able to: ◦ List the three subtypes of SpLD u...

Dr. Will Chien Associate Professor Acknowledge Dr Cynthia Lai and Mr Johnny Lam for the powerpoint slides 1  After the lecture, you will be able to: ◦ List the three subtypes of SpLD under DSM-V ◦ Identify the clinical features of people with the three subtypes of SpLD ◦ Describe the features of assessment tool in making diagnosis ◦ Describe the five hypotheses of SpLD ◦ Give examples of deficits of people with SpLD in daily living ◦ Start to think about what the role of occupational therapist is in management of people with SpLD 2  A neurodevelopmental disorder with a biological origin ◦ Basis for abnormalities at a cognitive level  Associated with behavioral signs  The biological origin includes an interaction of genetic, epigenetic, / & environmental factors Likely to pass to next generation; siblings (APA, 2013)  Neuroanatomical abnormalities ◦ Migration of cells at gestation period ◦ https://www.biorxiv.org/content/10.1101/780874v1.full 3  Persistent difficulties learning keystone academic skills neurodevelopmental :  Onset during the years of formal schooling (i.e. developmental period)  Disrupt normal pattern of learning academic skills  Performance of affected academic skills is well below average for age ◦ Children: Interference to school performance ◦ Adults: Avoidance of activity requiring academic skills 4 Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition  There are 4 diagnostic criteria for specific learning disorder  The 4 diagnostic criteria are to be met based on a clinical synthesis of the individual’s history (developmental, medical, family, educational), school reports, and psychoeducational assessment  Difficulties learning and using academic skills, as indicated by the presence of at least one of the following symptoms that have persisted for at least 6 months, despite the provision of interventions that target those difficulties: 1. Inaccurate or slow and effortful word reading (e.g., reads single words aloud incorrectly or slowly and hesitantly, frequently guesses words, has difficulty sounding out words). 2. Difficulty understanding the meaning of what is read (e.g., may read text accurately but not understand the sequence, relationships, inferences, or deeper meanings of what is read). 3. Difficulties with spelling (e.g., may add, omit, or substitute vowels or consonants). 4. Difficulties with written expression (e.g., makes multiple grammatical or punctuation errors within sentences; employs poor paragraph organization; written expression of ideas lacks clarity). 5. Difficulties mastering number sense, number facts, or calculation (e.g., has poor understanding of numbers, their magnitude, and relationships; counts on fingers to add single-digit numbers instead of recalling the math fact as peers do; gets lost in the midst of arithmetic computation and may switch procedures). 6. Difficulties with mathematical reasoning (e.g., has severe difficulty applying mathematical concepts, facts, or procedures to solve quantitative problems).  The affected academic skills are substantially and quantifiably below those expected for the individual’s chronological age, and cause significant interference with academic or occupational performance, or with activities of daily living, as confirmed by individually administered standardized achievement measures and comprehensive clinical assessment.  For individuals age 17 years and older, a documented history of impairing learning difficulties may be substituted for the standardized assessment.  usually referral @P2  The learning difficulties begin during school-age years but may not become fully manifest until the demands for those affected academic skills exceed the individual’s limited capacities (e.g., as in timed tests, reading or writing lengthy complex reports for a tight deadline, excessively heavy academic loads).  The learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual or auditory acuity, other mental or neurological disorders, psychosocial adversity, lack of proficiency in the language of academic instruction, or inadequate educational instruction. Some components fall apart -> difficulty in reading 1. Specific learning disorder with impairment in reading includes possible deficits in:  Word reading accuracy  Reading rate or fluency  Reading comprehension DSM-5 diagnostic code 315.00.  Note: Dyslexia is an alternative term used to refer to a pattern of learning difficulties characterized by problems with accurate or fluent word recognition, poor decoding and poor spelling abilities. 2. Specific learning disorder with impairment in written expression includes possible deficits in:  Spelling accuracy  Grammar and punctuation accuracy  Clarity or organization of written expression DSM-5 diagnostic code 315.2. 3. Specific learning disorder with impairment in mathematics includes possible deficits in:  Number sense (quantities / concepts like more and less)  Memorization of arithmetic facts (addition, subtraction, multiplication, and division)  Accurate or fluent calculation  Accurate math reasoning DSM-5 diagnostic code 315.1.  Note: Dyscalculia is an alternative term used to refer to a pattern of learning difficulties characterized by problems numerical information, learning arithmetic facts, and performing accurate or fluent calculations. http://psychcentral.com/disorders/specific-learning-disorder/ 13  Mild: Some difficulties learning skills in one or two academic domains, but of mild enough severity that the individual may be able to compensate or function well when provided with appropriate accommodations or support services, especially during the school years.  Moderate: Marked difficulties learning skills in one or more academic domains, so that the individual is unlikely to become proficient without some intervals of intensive and specialized teaching during the school years. Some accommodations or supportive services at least part of the day at school, in the workplace, or at home may be needed to complete activities accurately and efficiently. 14  Usually combined with other diagnosis  Severe: Severe difficulties learning skills, affecting several academic domains, so that the individual is unlikely to learn those skills without ongoing intensive individualized and specialized teaching for most of the school years. Even with an array of appropriate accommodations or services at home, at school, or in the workplace, the individual may not be able to complete all activities efficiently. 15 International Statistical Classification of Diseases and Related Health Problems - Eleventh Revision 16 6A03.0 Developmental learning disorder with impairment in reading significant and persistent difficulties in learning academic skills related to reading, such as word reading accuracy, reading fluency, A and reading comprehension. The individual’s performance in reading is markedly below what would be expected for chronological age and level of intellectual B functioning and results in significant impairment in the individual’s academic or occupational functioning. Not due to a disorder of intellectual development, sensory impairment (vision or hearing), neurological disorder, lack of availability of D education, lack of proficiency in the language of academic instruction, or psychosocial adversity. C school year XCILD in DSM5 17 6A03.1 Developmental learning disorder with impairment in written expression significant and persistent difficulties in learning academic skills related to writing, such as spelling accuracy, grammar and punctuation accuracy, and organization and coherence of ideas in writing. The individual’s performance in written expression is markedly below what would be expected for chronological age and level of intellectual functioning and results in significant impairment in the individual’s academic or occupational functioning. Not due to a disorder of intellectual development, sensory impairment (vision or hearing), a neurological or motor disorder, lack of availability of education, lack of proficiency in the language of academic instruction, or psychosocial adversity. 18 6A03.2 Developmental learning disorder with impairment in mathematics significant and persistent difficulties in learning academic skills related to mathematics or arithmetic, such as number sense, memorization of number facts, accurate calculation, fluent calculation, and accurate mathematic reasoning. The individual’s performance in mathematics or arithmetic is markedly below what would be expected for chronological or developmental age and level of intellectual functioning and results in significant impairment in the individual’s academic or occupational functioning. NOT due to a disorder of intellectual development, sensory impairment (vision or hearing), a neurological disorder, lack of availability of education, lack of proficiency in the language of academic instruction, or psychosocial adversity. 19  Across domains of reading, writing, and mathematics ◦ 5%-15%  Remarks: ◦ High heritability (APA, 2013) 20 http://www.edb.go v.hk/attachment/e n/edu- system/special/res ources/serc/downl oad/spld_e.pdf (EDB, 2015) 21 22  Mainly conducted by Psychologist (XXX OT)  「香港⼩學⽣讀寫障礙測驗—第⼆版」 [2007年出版]* (The Hong Kong Test of Specific Learning Difficulties in Reading and Writing for Primary School Students—Second Edition) [HKT- P(II)]  Literacy (Word Reading, One-minute Reading, Word Dictation) 中文讀字 、 中文默字 、⼀分鐘讀字  Digit Rapid Naming 快速命名  Phonological Awareness 語⾳意識  Phonological Memory 語⾳記憶  Orthographic Knowledge 字型結構  Visual Perceptual Skills 視覺認知能⼒  …By Psychologist 23  「香港初中學⽣讀寫障礙測驗—第⼆版」 [2012年出 版]* (The Hong Kong Test of Specific Learning Difficulties in Reading and Writing for Junior Secondary School Students—Second Edition) (HKT-JS-II) Mainly conducted by Psychologist (XXX OT)  Literacy (Word Reading, One-minute Reading, Word Dictation, Ten- minute writing, Reading Comprehension) 中文讀字 、 中文默字 、⼀分鐘讀字、 ⼗分鐘寫作、 閱讀理解  Digit Rapid Naming 快速命名  Phonological Memory 語⾳記憶  Orthographic Knowledge 字型結構  Morphological Awareness 詞素意識  …By Psychologist 24  Wechsler Individual Achievement Test – Third Edition (WIAT-III)  Woodcock Johnson III normative update tests of achievement  …By Psychologist 25  Not to make diagnosis  Can provide supplementary information about underlying problems, e.g. ◦ Attention ◦ Working memory ◦ Information processing speed ◦ Organization ◦ Visual and auditory perceptual abilities  Can provide supplementary information about performance in related functions, e.g. ◦ Visual motor control ◦ Ocular motor control ◦ Fine motor skills ◦ Sensory processing 26  Smart Handwriting Analysis and Recognition Platform (SHARP) ◦ https://scholars.cityu.edu.hk/en/projects/trial-smart-handwriting-analysis-and- recognition-platform-sharp(a35cab8c-66d1-4fc3-bf16-cafdde86eeea).html  Computerized handwriting speed test system (CHSTS-II) for all secondary school students with handwriting difficulties in Hong Kong ◦ http://www2.rs.polyu.edu.hk/cecili/res_grants.html ◦ https://link.springer.com/content/pdf/10.1007/s10803-018-3580-3.pdf  Copying Speed Test for Hong Kong Secondary Students (CST-HK) ◦ https://hkota.org.hk/images/data/Poster%20of%20Workshop%20Certification%20of%20CST %20for%20HK%20Secondary%20Students%20_17-0029.pdf 27  Beery-Buktenica Visual Motor Integration (BEERY™ VMI-6) ◦ https://www.pearsonclinical.com/therapy/products/100000663/the-beery-buktenica- developmental-test-of-visual-motor-integration-6th-edition-beery-vmi.html  Developmental Test of Visual Perception (DTVP-3) ◦ https://www.pearsonclinical.co.uk/AlliedHealth/PaediatricAssessments/PerceptualFineMoto rDevelopment/dtvp-3/developmental-test-of-visual-perception-third-edition.aspx  Motor-Free Visual Perception Test (MVPT-4) ◦ https://www.wpspublish.com/store/p/3303/mvpt-4-motor-free-visual-perception-test-4  Developmental Eye Movement™ Test (DEM™) ◦ https://www.bernell.com/product/DEM/Visual_Non-Visual  Grooved Pegboard Test ◦ http://lafayetteevaluation.com/products/grooved-pegboard 28 29  A prevalence explanation of cause of reading difficulties (dyslexia)  Stems from the evidence that ◦ Performance poorly in tests which measure ability in decoding nonsense words using conventional phonological rules ◦ High correlation between difficulties in connecting the sounds of language to letters and reading delay in children  Intervention strategy ◦ Training to improve phonological ability ◦ Support difficultyto connecting written (voice)' cat'> cat 30 (Nicolson, & Fawcett, 2008) 31   A cognitive theory of dyslexia based on deficits in automaticity, encompassing skills in both cognitive and motor domains See the word -> autonomatically link with the meaning -> understand and interpret the information 32  Problem of people with dyslexia ◦ Difficulty in making their skills automatic ◦ Then use conscious compensation (consciously concentrating) to perform at normal levels  Intervention strategy ◦ Ensuring consistency of exposition with rapid and appropriate feedback to foster skill automatization 33 V dys = poor performance of dual task 34  Cerebellar Deficit Hypothesis ◦ Previously not well accepted: as cerebellum seems not linked to language ◦ New concepts accepting importance of the role of cerebellum in cognitive skills involving language  Research findings on cerebellar activation in reading and verbal working memory  Intervention strategy ◦ Activation of region of interest 35  “To perform task without thinking” -> writing can be messy, irregular word size  Coordination and automaticity  Internalization of speech  Vestibulor-ocular reflex – for Eye fixation during reading  Mental rotation – for spatial operation 36  Magnocellular Deficit Hypothesis 37  I Unable to keep up with a visual information in a fluent way  Transmit visual/auditory information quickly  register Tiger comes danger “Large animal – attend left” rapid eye coordination The dog ran across the yard. w/ dyslexia: The ran dog across the yard the. may c the control motion ↳business - words clearly high-contrast depth but struggle to move their eyes to the - perception next word, disorganised due to X keep up w/ visual -> quick reaction magnocellular pathway -> put a lot of consciousness to reorganise the disorganised part -> need more time 38  Magnocellular Visual Pathway ◦ Dyslexics needed a greater contrast/ movement on e.g. different colours visual stimulations ◦ Facilitate orthographic processing ◦ Remarks: controversial in alphabetic dyslexia CAR ⾞ # 39  Magnocellular Auditory Pathway ◦ Track sound frequency & amplitude change ◦ Facilitate rapid auditory processing ◦ Such as /ba/ and /ga/ 40 41  Executive Function Deficits Hypothesis ◦ Multiple neurocognitive deficits and not solely related to a phonological system dysfunction in dyslexia 42  Recent research showed children with dyslexia has deficits in several EF domains ◦ Verbal categorical and phonological fluency ◦ Visual-spatial and auditory attention ◦ Spoonerism (exchange of initial sound)  e.g. Ring Kichard the Third  e.g. Is the bean dizzy? ◦ Verbal and visual short-term memory ◦ Verbal working memory (Varvara et al., 2014) 43 Specific learning disorder with impairment in reading (Dyslexia) 44  Normal intelligence  Associated with deficits in nervous system  Not deficit in a single aspect but deficit in multiple cognitive abilities ◦ E.g. long term memory, working memory, sequencing, organization, information processing speed  Commonly found deficits in HK students ◦ 語⾳檢索 (phonological retrieval) ◦ 字形結構意識 (orthographic awareness) Extended reading, please visit http://www.psychology.hku.hk/hksld/ 45 CAT Mosquito 貓 蚊 Any difference between English and Chinese reading or writing http://dyslexiahelp.umich.edu/latest/dyslexia-in-chinese 46 47 Learn more in depth, next semester in RS3430 48  Multidisciplinary ◦ Psychologist, pediatrician, speech therapy, occupational therapy, physiotherapy, social worker, teacher, (school system, policy)…  Assessment & skills training  Strategies & accommodation  Resources 49  As key team member in management of people with SpLD  Work closely with other disciplines  Conduct assessment and training (e.g. SI, executive function, fine motor, visual motor, ocular motor, pre-writing or handwriting)  Conduct educational talk/seminar/workshop for teacher and parents  Offer recommendation to school or parents (e.g. environmental accommodation, task adaptation)  Design and develop assessment and training tools 50  Use Multimodal Strategies To Teach Multistep Division in maths learning http://dyslexia.yale.edu/Edu_mathbreakdown.html 51