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Transcript
Learning Disorder and ADHD
Assessment in University
Counseling Center
Sara Rieder Bennett, Ph.D.
Licensed Psychologist, Counseling & Testing Center, The University of Akron
President, Ohio College Testing Association
1
Objectives
• Provide overview of psychological assessment, diagnosis,
and interpretive reports for common academic
disabilities
• Diagnostic categories and associated features
• Specific Learning Disorders
• ADHD
•
•
•
•
Practices in psychological assessment
Standard batteries at UA CTC
Factors affecting test performance
Recommendations and accommodations
2
Specific Learning Disorder Diagnoses
• Difficulties learning and using academic skills, as indicated by the
presence of at least one symptom persisting for at least 6 months
despite provision of interventions that target those abilities
• Symptoms include inaccurate or slow and effortful word reading;
reading comprehension difficulties; difficulties with spelling;
difficulties with written expression; difficulties mastering number
sense, number facts, or calculation; difficulties with mathematical
reasoning).
• Identify by specific impairment and mild, moderate, or severe
severity.
• Neurobiological disorder affecting information processing – input,
processing, storage, expression, output
• Typically “hidden disabilities”
• Prevalence across diagnoses of 5-15%, and adults around 4%.
3
SLD with Impairment in Reading (315.00)
• 4% prevalence in school aged kids in U.S.
• Basic skill is below age norm and aptitude – decoding, fluency,
letter-word recognition, phonemic analysis, comprehension.
• Processing deficits may include - speech/language delays;
auditory processing; phonological awareness; phonemic
awareness; phonics; lexical retrieval; ST auditory memory;
verbal fluency; visual memory and processing speed
• Specify if Word Reading Accuracy, Reading Rate or Fluency,
Reading Comprehension.
• “Dyslexia” refers specifically to problems with accurate or
fluent word recognition, poor decoding, or poor spelling
abilities.
SLD with Impairment in Written Expression (315.2)
• Prevalence difficult to identify
• Basic skill below age norm and aptitude – composition,
grammar, punctuation, organization, handwriting,
spelling
• Processing deficits – dyspraxia; R/L confusion;
phonological processing; phoneme-grapheme
relationships; lexical retrieval; auditory working memory;
visual motor integration, sequencing, memory,
processing, and planning
• Specify if Spelling Accuracy, Grammar and Punctuation
Accuracy, Clarity or Organization of Written Expression.
• May be referred to as “Dysgraphia”
SLD with Impairment in Math (315.1)
• 1% of school age children in US
• Basic skill below age and aptitude – recognizing numbers and
symbols, understanding math concepts, sequencing…not math
anxiety, self-efficacy, training
• Usually present by 5-6th grade due to increased complexity of
classes
• Processing deficits – motor skills, VMI, visual-spatial organization,
tactile perceptual tasks, attention to visual detail, sequential
processing, mental flexibility, LT memory (storage and retrieval)
• Specify if Number Sense, Memorization of Arithmetic Facts,
Accurate or Fluent Calculation, Accurate Math Reasoning.
• “Dyscalculia” is alternative term referring to pattern of problems
processing numerical information, learning arithmetic facts, and
performing accurate or fluent calculations.
Common Characteristics across LDs
Developmental Delays
• Learning to speak
• Fine motor skills
• Following directions or
routines
• Coordination
• Usually family history or
developmental trauma
like TBI as causal factors
Reading Problems
• Trouble learning ABCs
• Rhyming words
• Connecting letters to
sounds
• Errors when reading
aloud
• Frequent pauses when
reading
• Avoid reading aloud or
independently
Common Characteristics across LDs
Writing Problems
•
•
•
•
•
•
Sloppy handwriting
Hold pencils awkwardly
Persistent spelling errors
Letter reversals
Confusion of basic words
Spell same word
differently throughout
one piece of writing
Other Cognitive Problems
• Work slowly/impaired
processing speed
• Memory impairments
• Too little or much attention
to details
• Difficulty with abstract
concepts
• Struggle with summarizing
information or answering
open ended questions
Common Social Characteristics in LD
• Misunderstand social rules of conversation, language,
facial expressions
• Frequent pauses/stammering in conversation
• Trouble understanding jokes, comics, sarcasm
• Seen as socially awkward or immature
• Few friends, isolated, and likely experienced bullying or
ridicule
• Seen as liars – poor recall of events; intentional hiding of
perceived failures
• Difficulty adjusting to new settings
Common Emotional Characteristics
• Low self-esteem/efficacy, insecure, thwarted
potential
• Difficulty managing stress and usually under high
stress
• Frustration, feel defeated, angry
• Anxiety, depression
• See self as lazy or unmotivated…or perfectionistic
• Family discord
Impact of Learning Disorders
• Affects access and performance in school, work, daily
routines, family life, social context
• 35% drop out of high school – 2x general population
• 13% attend college within 2 years of HS – ¼ that of
general population rate
• Fewer attend graduate school or plan to attend
• 43% at or below poverty level
• 48% out of workforce or unemployed
Attention-Deficit /
Hyperactivity Disorders
• 3-7% of school age children
• 50-80% continue to have symptoms in adulthood and most
have comorbid conditions
• Youth with ADHD underreport symptoms, while other college
students overreport
• 50% of variance in objective testing is due to effort and
cooperation
• Assessment is not about the presence of a critical number of
symptoms, but their strength:
• Chronicity
• Pervasiveness
• Stability
DSM-5 ADHD
A.
B.
C.
D.
E.
Persistent pattern of inattention and/or hyperactivity-impulsivity:
1.
Inattention – Six or more symptoms inconsistent with developmental level, for
at least six months, with impairments (Five symptoms if 17 or older)
2.
Hyperactivity and Impulsivity – Six or more symptoms inconsistent with
developmental level, for at least six months, with impairments (Five symptoms
if 17 or older)
Symptoms were present prior to age 12
Present in two or more settings
Interferes with or reduces quality of social, academic, occupational functioning
Rule outs
314.01 Combined Presentation
314.00 Predominantly Inattentive Presentation
314.01 Predominantly Hyperactive/Impulsive Presentation
- In partial remission (less than full criteria for 6 months, still impaired)
- Mild, Moderate, Severe
314.01 Other Specific Attention-Deficit/Hyperactivity Disorder
314.01 Unspecified Attention-Deficit/Hyperactivity Disorder
Attention or Executive Functioning
Deficit Disorder?
• Barkley (1993, 94) and just about everyone since then:
• ADHD is not a deficit in attention, but in the ability to inhibit
behavior and delay a response to immediate events.
• Contingency-shaped sustained attention versus Goal-directed
persistence
• ADHD is multifaceted impairments in executive functioning:
• Working memory, inhibition, self-monitoring, emotional control,
organization, planning, initiating (all subtypes according to
metaanalysis in 2004)
• Processing speed (C, IA; not H/I)
Psych Assessment Models for LD
• Discrepancy Approach: 1-2 standard deviation
discrepancy between achievement and expectations
for age, education, and IQ
• Cutoff Approach: use of normed cutoff scores
• Ipsative Approach: intra-individual discrepancies
(not norm based)
• Inter-Individual Ability/Cognitive Approach: skills in
normative weakness range for general population
and confirmed through convergent data sources
• Across all, attend to rule-outs, exclusionary criteria,
and explanatory criteria
• LD usually impaired WMI and PSI
Integrated Method of Psychological
Assessment
•
•
•
•
Observational Data
Background Information
Research-Based Evidence
Quantitative Data – an aid to judgment, not a substitute
• No specific battery exists for LD or ADHD but ethical
assessment of either includes investigation of
cognitive, language, behavioral, affective, and
achievement performance
(Gregg, 2009)
Counseling Center Batteries
• All batteries: Clinical Interview and CCAPS-62, SDS, Review of
records, Assessment Screener Questionnaire, WAIS-IV
• LD: WJ-IV Tests of Achievement, psych measures (e.g. PAI) and
collateral interviews as needed
• ADHD:
• Student: Barkley Adult ADHD Rating Scale-IV (Current and
Childhood), Barkley Functional Impairment Scale, PAI, PRIME-MD
Patient Health Questionnaire, Semi-Structured Interview for
Adult ADHD
• Parent/Guardian completes: BAARS-IV (Current and Childhood),
BFIS, Interview for Adult ADHD
• If needed, WJ-IV Tests of Achievement, WMS-IV, Validity Indicator
Profile
17
Considerations
• Intelligence Hereditary Indexes are around .50
• Intelligence Scores influenced by:
•
•
•
•
•
•
•
•
•
Culture, language, opportunities, interests/curiosity
School attendance and quality of schooling
Family environment
Environmental toxins
Motivation, Persistence
Anxiety, obsessiveness, ability to tolerate ambiguity
Concentration/Attention, distractibility and distractions
Sleep, diet, medications etc.
Bias of examiner
• Gender Differences tend to be minimal and specific
• Race/ethnicity – African Americans, Latino(a)s, Native Americans
lower than Asian Americans and European Americans (~9 points)
18
Recommendations and/or Accommodations
• Reports culminate in treatment planning and feedback session with
student, with recommendations including meeting with OA to identify
accommodations if diagnosis and impairments
• Accommodations can include Adaptive Study Strategies Program,
adaptive technology, alternative media format, classroom,
equipment, internship/co-op, recording lectures, note-taker, priority
registration, sign language, testing
• Recommendations: personal, educational, career counseling;
academic support services on campus; community resources; online
resources (e.g. Pomodoro, Khan Academy); physician referral; speech
pathology; rehabilitation, occupational therapy