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Complex Learning Disabilities

Complex Learning Disabilities. Comorbidity Subdiagnostic Impairments. LIFE BELOW THE DIAGNOSTIC HORIZON Domains of unappreciated impairment. Etiology. Often genes “+” disorder Males predominate. Genetic Factors. Familial Multigenerational. Environmental Factors. Tobacco Alcohol

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Complex Learning Disabilities

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  1. Complex Learning Disabilities Comorbidity Subdiagnostic Impairments

  2. LIFE BELOW THEDIAGNOSTIC HORIZONDomains of unappreciated impairment

  3. Etiology • Often genes “+” disorder • Males predominate

  4. Genetic Factors • Familial • Multigenerational

  5. Environmental Factors • Tobacco • Alcohol • Traumatic Brain Injury • Unilateral Hearing Loss

  6. Genetics - Environment • Onset • Comorbidity • Course • Response to treatment • Outcome

  7. Learning Disabilities are an expression of the underlying physiological adaption tothe causal pathology

  8. Prevalence3-10%Diagnosis dependent rate 25% recognized Classroom – 301-3 affected

  9. Five Topics • Genes, epigenetics and responses to demands to learn • Living below the diagnostic horizon • Reading • Math and OCD • Sleep and Learning

  10. Epigenetics • Animal models • Famalial factors • Tics • Stereotypies • Handwriting • Responses

  11. Environmental Exposure • Early difficulty • Poor response to high intensity effort • Impaired persistence

  12. The Child’s Approach to Demands Genetics – exposure to stress Environment – poor stress reduction Epigenetics – poor stress tolerance

  13. Developmental Course

  14. Attention Deficit Hyperactivity Disorder % 12 10 8 6 4 2 High Hyperactivity Attention Disability 12% per year Severity & Prevalence 12% per year Low Birth 2 4 6 8 10 12 14 16 18 20 17 5

  15. Learning Disability % 8 6 4 2 High 5 – 8% per year 15 – 20% per year Severity & Prevalence Low Birth 4 9-10 13 18

  16. Distribution of Learning Disability by Age of Onset %

  17. Distribution of ADHD by Learning Disability and Age of Onset %

  18. Distribution of Learning Disability by Age Diagnosed %

  19. Distribution of ADHD by Learning Disability and Age Diagnosed %

  20. Assessment • Etiology • Course • Familial Course

  21. Reading

  22. Phonologic Errors Phonetic Spelling errors

  23. Many of the slides in this presentation are from the work of Pelli et al Nature (423) 752-756; 2003 or Wilson et al Nature (423) 696-697; 2003.

  24. By age 25 the average person has read 100,000,000 words.

  25. Efficiency Level in Reading 1 n = number of letters in word

  26. 1,000 Human 100 Energy (relative to noise) Ideal 10 1 10 Word Length (letters)

  27. 0.1 Efficiency 0.01 1 10 Word Length (letters)

  28. 5 most common 3 letter words: • The • And • Was • For • His

  29. Least frequent word “his” is encountered: • 100 times per hour • 400,000 times per decade if reading 1 hour a day

  30. Letter Recognition • All or not very well phonemena

  31. Word Effect Coin C Join J

  32. Comprehension • Decoding impairs comprehension • Comprehension improves decoding

  33. Rset Pclae Rghit Ltteer Lsat Tihng Iprmoetnt Bcuseae porbelm Raed Rscheearch Elingsh Mese Still Lteter Ervey Word wlohe

  34. Comprehension Improves Decoding Skills Aoccdrnig to rscheearch at an Elingsh uinervtisy, it deosn’t mttaer in what oredr the ltteers in a word are, the olny iprometnt tihng is that frist and lsat ltteer is at the rghit pclae. The rset can be a toatl mses and you can still raed it wouthit porbelm. This is bcuseae we do not raed ervey lteter by istlef but the word as a wlohe.

  35. Reversals are Frequent b/d p/d p/b m/w was/saw on/no

  36. Rarely 6/9 2/6 3/8

  37. Assessment • IQ • Reading rate • Standard scores • Comprehension

  38. Signs Alphabet Letter Sounds Phonics Words Careful Reading Comprehension Rapid Reading Skipping Context Context and Skipping Reading Skills Progression

  39. Successful Intervention • Early recognition • Intensive services • Skill building • Success • Avoid teasing

  40. Order of Improvement • Phonology • Phonetics • Reading speed • Spelling (last and least)

  41. Math • Cardinality • Numerosity • Ordinality

  42. Math • Reading is very difficult ( + x ) • Multiple steps • Poor tool use • Self confidence • Anxiety • Written • Oral • Can’t do “seems about right” check

  43. Common Error Patterns 4 5 8 3 + 2 + 6 - 3 - 5 6 11 11 8

  44. Math - OCD Developmental acquisition of: • Ordinality • Cardinality • Number object correspondence • 0-5 • Likelihood • Risks • Risk Perception

  45. OCD • Alterations • Intact math-skill • Deficit of inferential thinking • Application of knowledge

  46. OCD – Memory Deficits OCD can be quite complex in people with memory deficits

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