Communication and Learning Disorders

1. 7 Communication and Learning Disorders

2. Definitions and History • Learning disability: learning problems that occur in the absence of other obvious conditions • The term has been replaced in the DSM-5 by more specific terms, communication disorders and learning disorders • Affects how individuals of at least normal intelligence take in, retain, or express information

3. Categories of Communication Disorders • Language disorder • Speech sound disorder • Childhood-onset fluency disorder • Social (pragmatic) communication disorder

4. Specific Learning Disorder • Co-occurring problems in: • Reading • Math • Written expression • Determined by achievement test results that are lower than would be expected for one’s age, schooling, and intellectual ability

5. Language Development • Infants selectively attend to parental speech sounds • By age 1, a child can recognize several words as well as say a few words to express needs and emotions • Over the next two years, language development increases exponentially along with the ability to formulate complex ideas and express new concepts

6. Language Development (cont’d.) • Perceptual maps are formed in the brain when children hear phonemes (basic sounds) repetitively • By 6 months - infants differentiate their own language from other languages • By age 1 - the map is complete and infants have lost the ability to discriminate sounds not important to their own language

7. Phonological Awareness • Language development • Early language problems are highly predictive of subsequent communication and learning disorders and should not be ignored • Phonology • Deficits in phonology are a chief reason that individuals develop communication and learning disorders • About 80% of children can use phonemes properly by the age of 7

8. Phonological Awareness (cont’d.) • Phonological awareness • Broad construct that includes recognition of the relationship that exists between sounds and letters • Detection of rhyme and alliteration • Awareness that sounds can be manipulated within syllables

9. Communication Disorders • Diagnostic subcategories in the DSM-5 • Language disorder • Speech sound disorder • Childhood-onset fluency disorder • Social communication disorder

10. Language Disorder (LD) • Characterized by deficits in expression despite normal comprehension of speech • LD occurs when a child’s language matures at least 12 months behind his or her chronological age • Children with LD often have: • Delayed/slowed speech development; limited vocabulary; and speech marked by short sentences and simple grammatical structure

11. Diagnostic Criteria for Language Disorder

12. Diagnostic Criteria for Language Disorder (cont’d.)

13. Language Disorder (cont’d.) • Linguistic abilities vary significantly among those with LD • Children with LD may have difficulty understanding particular types of words or statements • Speech sound disorder – difficulty with articulation or sound production

14. Prevalence and Course of Language Disorder • Language disorder affects 7% of younger school-age children • Communication disorders are identified twice as often in boys than girls • Most children acquire normal language by adolescence • 50% fully outgrow the problems • LD is associated with higher-than-normal rates of negative behaviors

15. Causes of Language Disorder • Genetics • Temporal processing deficits • Brain • Circular feedback loop in the left temporal lobe • Problems in connections between brain areas and less brain activity in left temporal region

16. Areas of the brain involved in language functions

17. Other Causes of Language Disorder • Recurrent middle ear infections (otitis media) in first year of life may lead to speech and language delays • Home environment • It is unlikely that communication disorders are caused by parents • Except in cases of extreme neglect and abuse

18. Treatment of Language Disorder • LD and other similar communication disorders usually self-correct by age 6 and may not require intervention • Strategies for parents to stimulate language development • Enroll child in a specialized preschool • Using a combination of computer- and teacher-assisted instruction to teach early academic skills • Build on the child’s existing strengths

19. Childhood-Onset Fluency Disorder • The repeated and prolonged pronunciation of certain syllables that interferes with communication • Prevalence and course • Gradual onset between ages 2 and 7; peaks at age 5 • About 3% of children are affected • Affects males about three times more often than females • 80% of those who stutter before age 5 stop after a year in school

20. Causes and Treatment of Childhood-Onset Fluency Disorder • Genetic factors account for 70% of variance in causes • Environmental factors account for remaining influences • Possible treatments • Parental changes - speak to the child slowly in short sentences • Contingency management procedures • Habit reversal procedures

21. Social (Pragmatic) Communication Disorder • New addition to DSM-5 • Persistent difficulties in pragmatics (social use of language and communication)

22. Diagnostic Criteria of Social Communication Disorder

23. Diagnostic Criteria of Social Communication Disorder (cont’d.)

24. Specific Learning Disorder • A discrepancy of more than two standard deviations between the IQ findings and the actual achievement test findings in a child • Learning disorders include reading, mathematics, and writing • The different learning disorders overlap and build on the same brain functions • A person can have more than one form of learning disorder

25. SLD With Impairment in Reading • Most common underlying feature is the inability to distinguish or separate sounds in spoken words • Involves difficulty learning basic sight words, such as: the, who, what, laugh, said

26. SLD With Impairment in Reading (cont’d.) • 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) • These errors are common in young children • Core deficits in reading disorders are in decoding rapidly enough to read the whole word – coupled with problems reading single, small words

27. SLD with Impairment in Written Expression • Writing disorders are often associated with problems with eye/hand coordination • Leads to poor handwriting • Children with writing disorders: • Produce shorter, less interesting, and poorly organized essays • Are less likely to review spelling, punctuation, and grammar to increase clarity

28. Impairment with Written Expression Example

29. SLD With Impairment in Mathematics • Difficulty in recognizing numbers and symbols, memorizing facts, aligning numbers, and understanding abstract concepts • May include problems in comprehending abstract concepts or in visual-spatial ability • Involves core deficits in arithmetic calculation and/or mathematics reasoning abilities

30. Example of SLD With Impairment in Mathematics

31. Prevalence and Course of SLDs • Estimates: 2-10% of the population • SLD with reading impairment • 5-17% of school-aged children • Reading difficulties may be part of reading abilities continuum, rather than a discrete phenomenon

32. Prevalence and Course of SLDs (cont’d.) • SLD with impairment in mathematics • 20% of children with learning disorders (1% of school-age children) • SLD with impairment in written expression • Rare by itself • Overlap with reading and math disorders • May affect 10% of school-age children

33. Cultural, Class, and Gender Variations in SLDs • Social and cultural factors are less relevant to LDs than other types of cognitive and behavioral problems • The disorders reflect an interaction between a child’s inherent abilities and resources/opportunities available • When learning to read, some teaching approaches neglect specific ethnic sound-symbol relationships • SLDs are more common in males

34. Development of SLDs • Daily experience of being labeled and unable to keep up can cause children to withdraw or become angry and noncompliant • Three-fourths of children with a reading disorder in elementary school continue to have problems in high school and young adulthood

35. Psychological and Social Adjustment • Students with reading disorders feel less support from parents, teachers, and peers • Difficulty in managing a child with SLD • Behavior problems are about three times higher than the norm by age 8 • Co-occurring problems across ages: CD, ODD, and ADHD • About three of every four students have significant deficits in social skills

36. Percentage of Behavior Problems Among Children With and Without SLDs

37. Adult Outcomes of SLDs • May continue into adulthood because of inadequate recognition and services • Many excel in nonacademic subjects • Men with learning disorders perceive lower levels of social support • Women with learning disorders have more adjustment problems and face greater risk of sexual assault and related forms of abuse

38. Causes of SLDs • Difficulties bringing information from various brain regions together to integrate and understand information • Recent findings suggest two distinguishable types of reading disorder • Children who are persistently poor readers • Children who are accuracy-improved • Heritability accounts for 60% of variance in reading disorders

39. Neurobiological Causes of SLDs • Reading and language-based problems are associated with cellular abnormalities in the brain’s left hemisphere • This part of the brain is responsible for understanding phonemes, analyzing words, and automatically detecting words

40. Neurobiological Causes of SLDs (cont’d.) • Behavioral and physiological abnormalities in the processing of visual information • Non-verbal learning disabilities are associated with deficits in right-hemisphere brain functioning

41. How the Brain Processes Speech

42. Social and Psychological Causes of SLDs • Co-occurring emotional disturbances and other signs of poor adaptive ability • The overlap between dyslexia and ADHD ranges from 30-70% • Reading disorder is associated with deficits in phonological awareness • ADHD has effects on cognitive functioning, especially in rote verbal learning and memory • Some children with learning disorders show symptoms similar to ADHD

43. Prevention and Treatment • Interventions rely primarily on educational and psychosocial methods • No biological treatments exist • Issues of identification are important • There is a brief window of opportunity for successful treatment • Prevention involves training children in phonological awareness activities at an early age

44. The Inclusion Movement • Integrate children with special needs into the regular classroom • Individuals with Disabilities Education Improvement Act (IDEA) in U.S. and provincial Educational Acts in Canada • No Child Left Behind (2002) • 14% of school-age children in the U.S. receive some level of support through special education

45. Instructional Methods • Direct instruction is best for children with LDs • Early interventions must address phonological and verbal abilities • Effective reading instruction focuses on: • Phonemic awareness and phonemic decoding skills, fluency in word recognition, construction of meaning, vocabulary, spelling, and writing

46. Behavioral and Cognitive Treatments • Behavioral principles of learning are used to teach systematically • Used in conjunction with complete program of direct instruction • Cognitive-behavioral approaches • Teach children to monitor their own thought processes • Emphasize strategies such as self-monitoring, self-assessment, self-recording, and self-management of reinforcement

47. Computer-Assisted Learning • Provides more academic engagement and achievement than traditional pencil-and-paper-methods • Compute programs slow down grammatical sounds allowing young children to process them more slowly and carefully