Chapter 11 Communication and Learning Disorders

1. Chapter 11Communication and Learning Disorders

2. Definitions • Learning Disability: a general non-diagnostic term for communication and learning problems that cannot be attributed to other obvious conditions • Communication Disorder: a diagnostic terms that refers to problems producing speech sounds or with speech fluency, using spoken language to communicate, or understanding what other people say • Learning Disorder: a diagnostic terms that refers to specific problems in reading, math, or writing ability, as determined by achievement test results that are lower than would be expected for one’s age, schooling, and intelligence

3. Language Development • Infants selectively attend to parental speech sounds • By age 1, they can recognize several words as well as say a few words to express needs and emotions • Perceptual maps are formed in the brain when children hear phonemes repetitively; by age 1 the map is complete and infants have lost the ability to discriminate sounds not important to their own language

4. Language Development (cont.) • Phonological awareness develops by age 7, and its absence is a precursor to problems in reading and expressive language development • Language development is an indicator of general mental ability- early language problems are highly predictive of subsequent communication and learning disorders

5. Communication Disorders • In the DSM-IV, communication disorders include: • Expressive Language Disorder • Phonological Disorder • Mixed Receptive-Expressive Disorder • Stuttering

6. Expressive Language Disorder • Characterized by deficits in expression despite normal comprehension of speech • To fit diagnostic criteria, problems must be severe enough that they interfere with academic achievement or the ability to communicate in everyday social situations • Children with ELD often have delayed and slowed speech development, limited vocabulary, and speech marked by short sentences and simple grammatical structure

7. Expressive Language Disorder (cont.) • Differential Diagnosis • if problems are coupled with difficulty understanding some aspects of speech, child may meet the criteria for a mixed receptive-expressive language disorder • when the problem is one of articulation or sound production, rather than word knowledge, child may meet the criteria for a phonological disorder

8. Expressive Language Disorder (cont.) • Prevalence and Course • 2% to 3% of children • most children acquire normal language by mid- to late adolescence • early communication disorders linked to the later onset of learning disorders • associated with higher than normal rates of negative behaviors • only slightly more common in boys, although this may reflect a referral bias due to their higher rates of behavior problems

9. Expressive Language Disorder (cont.) • Causes • family and twin studies suggest language processes are heritable • deficits in phonological awareness related to problems in brain functioning within the posterior left hemisphere • recurrent middle ear infections in first year of life may cause ELD in some children • parental speech and language stimulation may affect the pace and range of language development, but not the specific impairments that characterize disorders

10. Expressive Language Disorder (cont.) • Treatment of children with communication disorders is often unnecessary, since many of these problems are self-correcting soon after school entry

11. Stuttering • Repeated and prolonged pronunciation of certain syllables that interferes with communication • Gradual onset between ages 2 and 7, peak at age 5 • Affects males about 3 times more often than females • Heritability accounts for 71% of variance in causes • Most likely associated with abnormal development of the left hemisphere • Treatment, if necessary (80% no longer stutter after about the first year of school), may include speaking slower to child, removing pressure, and regulated breathing method

12. Learning Disorders • In order to meet DSM criteria, performance in reading, mathematics, and/or written expression must be below what would be expected for someone of the same age, schooling, and intelligence, and must also significantly interfere with academic achievement or daily living • The different learning disorders overlap and build on the same brain functions, hence people can have more than one form of learning disorder

13. Learning Disorders (cont.) • Reading Disorder • most common underlying feature is inability to distinguish or separate sounds in spoken words • often a difficulty learning basic sight words, such as: the, what, laugh, said • often errors in reversals (b/d, p/q), transpositions (was/saw, scared/sacred), inversions (m/w, u/n), and omissions (place for palace, section for selection) • core deficits in reading disorders are in decoding- breaking a word into parts rapidly enough to read the whole word- coupled with problems reading single, small words

14. Learning Disorders (cont.) • Mathematics Disorder • difficulty in recognizing numbers and symbols, memorizing facts, aligning numbers, and understanding abstract concepts • may have problems in visual-spatial ability • core deficits in arithmetic calculation and/or mathematics reasoning abilities • underlying neuropsychological processes are believed to be underdeveloped or impaired

15. Figure 11.2 An example of a calculation error that shows errors suggesting spatial difficulties and directional confusion.

16. Learning Disorders (cont.) • Writing Disorder: • children with writing disorders typically produce shorter, less interesting, and poorly organized essays, and are less likely to review spelling, punctuation, and grammar • often associated with problems with eye/hand coordination (which leads to poor handwriting), despite normal gross motor development • commonly found in combination with a learning disorder in reading or mathematics

17. Figure 11.3 Top: Drawings produced by Carlos when asked to copy a triangle, a circle, and a square. Bottom: Examples of a triangle, circle and square from a normally developing 7-year-old boy.

18. Figure 11.3 Top: Drawings produced by Carlos when asked to copy a triangle, a circle, and a square. Bottom: Examples of a triangle, circle and square from a normally developing 7-year-old boy.

19. Prevalence of Learning Disorders • Estimates range from 2% to 10% of the population • Reading disorders most common (and overlap considerably with math and writing disorders), followed by mathematics disorders, and then writing disorders (rare when not associated with another LD) • More common in males (most likely reflecting a referral bias due to comorbid behavior problems) • Social and cultural factors may affect how children with LDs are identified and diagnosed

20. Course of Learning Disorders • Many children with LDs are at risk for social and psychological problems, including poor academic self-concept, depression, behavior problems, social skills deficits, and dropping out of school • LDs often life-long, although in adulthood individuals may excel in areas not related to their difficulties • In the long-run, women with LDs have more adjustment problems, especially with respect to relationships

21. Figure 11.4 Percentage of clinically significant behavior problems among children with and without learning disorders, at 4 years and 8 years of age. Data from Benasich et al., 1993.

22. Causes of Learning Disorders • Most likely cause is genetic-based neurological problem • Most LDs stem from difficulties bringing together information from different brain regions into “convergence zones” where it is integrated and understood • Reading and language-based problems appear to be associated with cellular abnormalities in brain’s left hemisphere, especially in the planum temporale

23. Causes of Learning Disorders (cont.) • Children with learning problems have been found to have an immature form of EEG activation, and lower activation in primarily the left hemisphere of the brain has been found in children with dyslexia • Language-based LDs may be associated with “timing” deficits at the level of the nervous system, resulting in problems in visual and auditory discrimination • Non-verbal learning disabilities may result from deficits in right hemisphere brain functioning, and have been linked to prenatal and early childhood disease and trauma

24. Figure 11.6 A biobehavioral systems model.

25. Treatment and Prevention of LDs • Early identification and treatment leads to better outcomes • The Regular Education Initiatives places students with LDs in general classrooms with both general and special teachers • Direct instruction is often best for children with LDs- a straightforward approach to teaching based on the premise that to improve a skill, the instructional activities have to approximate those of the skill being taught

26. Treatment and Prevention (cont.) • Behavioral strategies focus on slowing down the presentation of material, breaking learning into manageable steps, making learning highly structured, and employing reinforcement and practice opportunities • Cognitive-behavioral approaches teach children to monitor their own thought processes and emphasize the use of strategies such as self-monitoring, self-assessment, self-recording, and self-management of reinforcement • Computer-assisted learning techniques can help children to distinguish sounds and improve language understanding