Download Lecture 4: Developmental Psychopathology

Lectures 3 &4 : Developmental
Psychopathology: MR, PDD,
Autism,Aspergers and Learning
Disorders
Outline of Lecture
• Part I: Mental Retardation and Associated Syndromes
• Part II Pervasive Developmental Disorders
– Autistic Disorder
– Rett’s Syndrome
– Childhood Disintegrative Disorder
– Asperger’s Disorder
– Part III: Learning Disabilities
Part I
• Mental Retardation (MR)
• “I am Sam” (2002) (clip)
• http://www.youtube.com/watch?v=gYPCTlnW
-TA&feature=related
Mental Retardation: Diagnostic Features
• Significant subaverage IQ score (Criterion A)
• Significant Limitations in Adaptive Functioning in at least 2 skill areas
(Criterion B)
Communication
Self care
Home living
Social/interpersonal skills
Use of community resources
Self-direction
Functional academic skills
Work, leisure, health and safety
• Onset MUST occur before age 18 years (Criterion C)
Assessment of General Intellectual (IQ)
functioning
• General Intellectual functioning is defined by the
intelligence quotient (IQ or IQ equivalent) obtained
by assessment with one or more of the standardized
individually administered IQ tests (WISC-IV, Kaufman,
DAS, etc)
• Significantly subaverage IQ is defined as an IQ of
about 70 or below-approximately 2 standard
deviations below the mean with a measurement
error of approximately 5 points (e.g. WISC range of
65-75)
Mild Mental Retardation (85% of MR
population)
• IQ level (50-55 to approximately 70)
• Preschoolers typically develop social and communication skills
• Mild MR not usually distinguishable from those without MR
until after around age 5 or upon entering school; minimal
impairment in sensorimotor skills
• By late teens most individuals with MR are able to acquire
skills up to the sixth grade levels
• Minimum self-support needed; may need supervision
guidance especially under stressful conditions (e.g. financial,
social, physical, health-remember Axis IV)???
• Can usually live independently or in supervised settings
Moderate MR (10% of MR population)
• IQ level (35-40 to 50 to 55)
• Profit from vocational training, moderate supervision required
for personal care
• Benefit from training in social skills but unlikely to progress
beyond a second grade level (e.g.- I am Sam)
• Often develop peer problems dues to problems in recognition
in social conventions
• As adults unskilled and semiskilled work under supervision;
also use of sheltered workshops
• Generally adapt well with supervision and when social
support and environmental conditions are good
Severe MR (3-4% of MR population)
• IQ level: (20-25 to 35-40)
• In early childhood acquire little/no communication
• During school age years they can learn to talk and be
trained in elementary self-care
• As adults they may perform simple tasks under
closely supervised settings
• Adapt well to live in the community, group homes or
living with supportive families
• However, if they have an associated physical
handicap or other health condition they often
require specialized consistent nursing care
Profound MR (1-2% of MR population)
• IQ level: (<20 or 25)
• Most diagnosed with Profound MR have identifiable
neurological conditions
• During early childhood impairments in sensorimotor
functioning
• Optimal development occurs in highly structured
environment with constant supervision and
individualized relationships with caregivers
• Some may perform simple tasks in closely supervised
and sheltered settings.
MR Severity Unspecified
• This is coded when there is a strong presumption of
MR but person cannot be tested by standardized IQ
tests (e.g. if patient is too impaired, or uncooperative
with testing due to behavioral/emotional problems
• Sometimes in infancy and early childhood it is
difficult to yield accurate scores through IQ tests
• In general, during the younger ages it is more difficult
to assess MR except in the case of Profound MR
(Why?)
Associated Features & Disorders
• No specific personality and behavioral features are uniquely associated
with MR
• Lack of communication skills may predispose to disruptive and aggressive
behaviors that substitute for communicative language
• MR individuals may be vulnerable to exploitation by others (e.g. being
physically and sexually abused-see Glen Ridge Rape Trial (1988-1989)
• Prevalence of COMORBID mental disorders that is estimated to be 3-4
times higher than in the general population
• Diagnosis of comorbid mental disorders is often complicated by the fact
that the clinical presentation may be modified by the severity of MR and
associated handicaps
• Deficits in communication skills may result in an ability to provide and
adequate history (often in nonverbal adults, need to gestures, facial
expressions,etc to make a diagnosis of mood/anxiety disorders, etc)
Associated Features and Disorders (cont)
• The most common associated mental disorders are ADHD, Mood
Disorders, Pervasive Developmental Disorders, Stereotypic Movement
Disorder and Mental Disorders due to a General Medical Condition (e.g
Dementia due to Head Trauma)
• MR individuals due to Down syndrome may be at higher risk for
developing Dementia to the Alzheimer’s Type
• Pathological changes in the brain associated with this disorder usually
develop by the time these individuals are in their early 40’s
• Associations have been reported between specific etiological factors and
certain comorbid symptoms and mental disorders.
• Example: Fragile X syndrome appears to increase the risk for ADHD; Social
Phobia, Pervasive Developmental Disorders (esp. Autism)
• Example Individuals with Prader-Willi syndrome may exhibit hyperphagia
and compulsivity
Predisposing Factors
• Etiological factors may be primarily biological or primarily
psychosocial or some combination of both
• In approximately 30-40% of individuals seen in clinical
settings, no clear etiology for MR can be determined despite
extensive evaluation efforts.
• Major Predisposing Factors Include: (DSM-IV p. 45)
–
–
–
–
–
–
Heredity
Early alterations of embryonic development
Environmental influences
Mental disorders
Pregnancy and perinatal problems
General medical conditions acquired in infancy or childhood
Specific Culture, Age, and Gender
Features
• The prevalence of MR due to known biological
factors is similar among children of upper and
lower socioeconomic classes, except that
certain etiological factors are linked to lower
socioeconomic status (e.g. lead poisoning and
premature births
• MR is more common among males, with male
to female ration of approximately 1.5:1
Prevalence and Course of MR
• Prevalence is estimated at approximately 1%
• Age, mode of onset depend on the etiology and severity of
MR; more severe MR associated with earlier recognition
• More severe MR resulting from an acquired condition,
intellectual impairment will develop more abruptly
• Course of MR is influenced by the course of underlying
general medical conditions and by environmental factors (e.g.educational and other opportunities, environmental
stimulation, and appropriateness of management(
• Individuals who had mild MR earlier in their lives manifested
by failure in academic learning tasks, may with appropriate
training and opportunities, develop good adaptive skills in
other domains and may no longer have the level of
impairment required for a diagnosis of MR
Differential Diagnosis
• No exclusion criteria, thus diagnosis should be made when the diagnostic
criteria are met, regardless of and in addition to the presence of another
disorder
• In Learning Disorders or Communication Disorders (unassociated with MR)
dev’t is in a specific area (e.g.-reading, expressive language is impaired but
there is no generalized impairment in intellectual developmental and
adaptive functioning
• In PDD there is qualitative impairment in dev’t of reciprocal social
interaction and in the dev’t of verbal and nonverbal social communication
skills
• MR often accompanies PDD
• Generally, for individuals under 18, the diagnosis of dementia is made only
when the condition is NOT characterized satisfactorily by the diagnosis of
MR alone
• Distinguish between Borderline Intellectual Functioning
Borderline Intellectual Functioning
• Forrest Gump…..
• Borderline Intellectual Functioning (p. 740 DSM) describes an
IQ range that is higher than that for MR (71-84)
• Possible to diagnose MR in individuals with 71-75 due to
measurement errors if they have significant deficits in
adaptive behavior that meet the criteria for MR
• Differentiation of Borderline Intellectual Functioning requires
careful consideration of all available information
• Note this is a V code as is coded on Axis II (see pg. 740)
Examples: Praeder Willi Syndrome &
Fragile X Syndrome
• Examples
• Prader Willi Syndrome• http://www.youtube.com/watch?v=v_YMx5H3xRA&feature=r
elated
• Fragile X Syndrome
• http://www.cnn.com/video/#/video/health/2006/08/11/forti
n.health.minute.fragile.x.affl?iref=videosearch
Part II: Pervasive Developmental
Disorders
• Pervasive Developmental Disorders are
characterized by severe and pervasive
impairment in several areas of development
– Reciprocal social interaction skills
– Communication skills
– Stereotyped behavior, interests and activities
– Includes: Autistic Disorder, Rett’s Disorder,
Childhood Disintegrative Disorder, Asperger’s
Disorder and PDD (NOS)
Autistic Disorder: Diagnostic Criteria (p. 75)
•
•
A) A total of 6 or more items from (1), (2), and (3) with at least two from (1), and one each from (2) and (3)
1) Qualitative Impairment in social interaction as manifested by at least (2) of the following
–
–
–
–
•
2) Qualititative impairments in communication as manifested by at least one of the following
–
–
–
–
•
Marked impairment in the use of multiple nonverbal behaviors such as eye to eye gaze, facial expression, body
postures, and gestures to regulate social interaction
Failure to develop peer relationships appropriate to developmental level
A lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of
showing, bringing or pointing out objects of interests
Lack of social reciprocity
Delay in or total lack of the development of spoken language (not accompanied by an attempt to compensate through
alternative modes of communication such as gesture or mime)
In individuals with adequate speech, marked impairment in the ability to initiate or sustain a conversation with others
Stereotyped and repetitive use of language or idiosyncratic language
Lack of varied spontaneous make believe play or social imitative play appropriate to developmental level
3) Restricted repetitive and stereotyped patterns of behavior, interests and activities, as manifested by at
least one of the following
–
–
–
–
Encompassing preoccupation with one or more stereotyped and restricted patterns of interests that is abnormal
either in intensity or focus
Apparently inflexible adherence to specific, nonfunctional routines or rituals
Stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole body
movements
Persistent preoccupation with parts of objects
Autistic Disorder: Diagnostic Criteria Cont.
(P. 75)
• B) Delays in Abnormal Functioning in at LEAST
one of the following areas, with onset prior to
3 years old
– 1) social interaction
– 2) language as used in social communication, or
– 3) persistent preoccupation with parts of objects
• C) The disturbance is not better accounted for
by Rett’s Disorder or Childhood Disintegrative
Disorder
•
Specific Age and Gender Related
Features
In infancy there may be a failure to cuddle;
indifference or aversion to affection or physical
contact; a lack of eye contact, facial responsiveness,
or socially directed smiles and a failure to respond to
their parents voices
• Over the course of dev’t child may become more
interested in social interaction; but have difficulty
interacting appropriately or with reciprocity
• Rates of the disorder are 4-5 times higher in males
than in females. Females with the disorder are more
likely to exhibit more severe MR
Prevalence & Course
• Estimated at least 5/10,000 with reported rates ranging from
2 to 20 cases per 10,000 individuals. However, most recent
estimates are higher some as high as 6/1000 live births
• Onset is prior to age 3
• In infancy often lack of interest in social interaction
• Follows a continuous course: In school age children and
adolescents, developmental gains in some areas are common
• Some individuals deteriorate behaviorally during adolescence,
whereas others improve
• Language skills and overall intellectual functioning are the
strongest factors related to ultimate prognosis
• Only a small percentage of individuals with the disorder go on
as adults to live and work independently
Familial Pattern
• Increased risk of Autistic disorder among
siblings of individuals with the disorder
• Approximately 5% of siblings also exhibit
conditions; rates among MZ twins very high
concordance (in some studies up to 95% or
higher)
• Also risk for various developmental difficulties
in affected siblings
Differential Diagnosis
• See Pg. 74 of DSM-IV
• Rett’s Disorder differs from Autistic disorder in its
characteristic sex ratio and pattern of deficits
• Childhood Disintegrative Disorder Has a distinctive pattern of
severe developmental regression in multiple areas of
functioning following at least two years of normal
development
• Asperger’s Disorder can be distinguished from Autistic
disorder by the lack of delay or deviance in early language
development. Asperger’s Disorder is NOT diagnosed if criteria
are met for Autistic disorder
• For other differential diagnoses (see p. 74)
Rett’s Disorder: Diagnostic Criteria (p.77)
• A) All of the following
– 1) apparently normal prenatal and perinatal development
– 2) apparently normal psychomotor development through the first five months
after birth
– 3) normal head circumference at birth
• B) Onset of all of the following after the period of normal development
– 1) deceleration of head growth between ages 5 and 48 months
– 2) loss of previously acquired purposeful hand skills between ages 5-30
months with the subsequent development of stereotyped hand movements
(e.g., hand wringing or hand washing)
– 3) loss of social engagement early in the course although often social
interaction develops later
– 4) appearance of poorly coordinated gait or trunk movements
– 5) severely impaired expressive and receptive language development with
severe psychomotor retardation
Rett’s Disorder Prevalence, Course and Associated Features and
Disorders
• Prevalence: Rett’s disorder is much less common than Autistic Disorder,
has been reported ONLY IN FEMALES
• Course: Pattern of developmental regression is highly distinctive; onset
prior to age 4 (usually in 1st-2nd year of life)
–
–
–
–
–
Lifelong duration
Loss of skills is persistent and progressive
Recovery is limited
Modest gains in social interaction in later childhood and adolescence
Communicative and behavioral difficulties usually remain relatively constant
throughout life
• Associated Features/Disorders
– Severe/Profound MR (Code on Axis II)
– Some increased frequency of EEG abnormalities and seizure disorder
– Data suggest that a genetic mutation is the cause of some cases in Rett’s
disorder
•
•
Childhood Disintegrative Disorder:
Diagnostic Criteria (p. 79)
A) Apparently normal development for at least the first two years after birth as manifested by
the presence of age-appropriate verbal and nonverbal communication, social relationships,
play and adaptive behavior
B) Clinically significant loss of previously acquired skills (before 10 years) in at least two of the
following areas
–
–
–
–
–
•
C) Abnormalities of functioning in at least two of the following areas
–
–
–
•
Expressive or receptive language
Social skills or adaptive behavior
Bowel or bladder control
Play
Motor skills
Qualitative impairment in social interaction (e.g. impairment in nonverbal behaviors, failure to
develop peer relationships, lack of social or emotional reciprocity
Qualitative impairments in communication (e.g., delay or lack of spoken language, inability to initiate
or sustain a conversation, stereotyped and repetitive use of language, lack of varied make believe
play
Restricted, repetitive and stereotyped patterns of behavior, interests, and activities, including motor
stereotypies and mannerisms
D) The disturbance is NOT better accounted for by another specific PDD or by Schizophrenia
•
Childhood Disintegrative Disorder:
Associated Features, Prevalence and
Associated Features and Disorders
Course
– Usually associated with severe
MR
– Increased frequency of EEG abnormalities and seizure disorders
– Occasionally observed in association with a general medical condition (Axis III)
• Prevalence-very rare and much less common than autistic disorder;
condition is likely under diagnosed
• Course
– Can only be diagnosed if the symptoms are preceded by at least 2 years of
normal development and the onset is prior to age 10
– In most cases onset is between 3-4 yrs old and may be insidious or abrupt
– Signs may include increased activity levels, irritability, and anxiety followed by
a loss of speech and other skills; child may also lose interest in the
environment
– Disorder follows a continuous course, and in the majority of cases the
duration is lifelong
– Social, communicative, and behavioral difficulties remain relatively constant
throughout life
Journal Activity: “Rainman”
• Watch the following clips from “Rainman” and
respond/reflect on some of the features he has that
are associated with Autistic Disorder or possibly
Asperger’s Disorder? How would you go about
making the proper DSM-IV Differential Diagnosis.. Is
there evidence of MR-if so what severity level and
why?
• http://www.youtube.com/watch?v=kJZQkslDBjM
• http://www.youtube.com/watch?v=vqbXPfaN_VM
• http://www.youtube.com/watch?v=AeITXkW0ITs
Autism: Prevalence and Trends
• Current Prevalence Rate: Estimated at 1016/10,000
• Prevalence for Broader PDD spectrum (excluding
Rett’s and Childhood Disintegrative Disorder is
60/10,000
• The number of students being served under the
IDEA category of Autism has risen sharply from
15,580 in 1992 to 192,643 in 2005! (US
Department of Education, 2007)
• What are the Reasons for such a huge rise in
number of students?
Autism: Associated Features
• Mental Retardation (MR)
– Rate of MR in autism is around 70%
• Seizures
– Age of appearance of seizures is BIMODAL, peaks in
early childhood and another in adolescence
• Greater proportion of affected males (4:1 ratio)
• Comorbidity with other genetic syndromes
– Fragile X Syndrome
– Tuberous Sclerosis
Autism: Etiology-Genetics
• Genetics
– Twin studies: MEDIAN concordance rate is about
60% for MZ twins; in some studies up to 90%
– Chromosome 15 & Chromosome 7 most
commonly affected
– Reviews of genome wide scans have revealed at
least one positive genetic linkage on almost every
chromosome
Autism Etiology: Neurological
Correlates
• Unusual serotonin levels and synthesis patterns
• Unusual brain size and growth patterns
– Autistic children tend to go through a prior of accelerated
head and brain growth soon after birth, which subsides
before 24 mos/unusually large brain size
– Once completed, this period is followed by a time of
unusually slow brain growth relative to same age nonautistic peers so that by adolescence average overall brain
volume is not substantially different
• Cerebellum abnormalities
• Amygdala abnormalities
Diagnosis and Assessment of Autism
• Most children with autistic disorder will be identified before they reach
school age; higher functioning (e.g-Aspergers may be later)
• Comprehensive Assessment is required to be eligible to receive special
education services under the classification of “Autistic” Assessments
usually include many but not necessarily all of the following tests
–
–
–
–
–
–
–
–
–
–
Psychological
Genetic
Audiological
Speech/language
Occupational Therapy (O/T) evaluation
Physical Therapy (P/T) evaluation
Educational
Adaptive Functioning
Psychiatric
Neurological/Neurodevelopmental
Diagnostic Tools for School Psychologists when
assessing for Autism
•
•
•
•
•
Standardized Intelligence Tests
Standardized educational Tests (in some cases)
Adaptive Functioning Measures
Social/Emotional Functioning; Social History
Specialized Assessment Tools
– The Autism Diagnostic Interview Revised (ADI-R; Rutter, Le Conteour,
& Lord, 2003)
• administered in semistructured interviews to parents/caregivers
– The Autism Diagnostic Observation Schedule (ADOS; Lord, Rutter,
DiLavore & Risi, 1999)
• Standardized behavioral observation and coding system
– Both are considered the "The Gold Standard "consistent with DSM-IVTR criteria; maximum diagnostic utility is obtained when both scales
are used together
Autistic Disorder: Diagnostic Criteria
(DSM-IV-TR- P. 75)
A) A total of 6 (or more) items from (1), (2) and (3) with at least 2 from
(1) and one each from (2) and (3)
• (1) Qualitative impairment in social interaction as manifested by at
least 2 symptoms (see pg. 75) (e.g.- lack of eye contact, lack of
social initiation, lack of social or emotional reciprocity
• (2) Qualitative impairments in communication (e.g.-lack of speech,
inadequate speech, stereotyped or repetitive speed, lack or varied,
spontaneous/imitative play)
• (3) Restricted repetitive and stereotyped patterns of behavior,
interests and activities (e.g.- preoccupation with abnormal patterns,
inflexibility, adherence to rigid routines, stereotyped and repetitive
motor mannerisms, persistent preoccupation with parts of objects
Autistic Disorder: Diagnostic Criteria
(DSM-IV-TR- P. 75)-cont
• Delays in abnormal functioning in at least one
of the following areas with onset prior to age
3
– 1) social interaction
– 2) language as used in social communication
– 3) persistent preoccupation with parts of objects
• The disturbance is not better accounted for by
Rett’s Disorder or Childhood Disintegrative
Disorder
Aspergers Syndrome: A Special Case
• “Rainman” (1989)
• http://www.youtube.com/watch?v=AeITXkW0
ITs&feature=related
• “Mozart and the Whale” (2006)
• http://www.youtube.com/watch?v=qlOMimp
9KDY
Diagnostic Criteria (DSM-IV-TR) P. 84
• A) Qualitative impairment in social interaction (see p. 84)-need at
least 2
• B) Restricted repetitive and stereotyped patterns of behavior,
interests and activities (see p. 84)-need at least 1
• C) Disturbance causes clinically significant impairment in social,
occupational, or other important areas of functioning
• D) No clinically significant general delay in language (e.g. single
words used by 2 years old, communicative phrases used by 3 yrs)
• E) No clinically significant delay in cognitive development, or in the
development of age-appropriate self-help skills, adaptive behavior
(other than in social interaction) and in curiosity about the
environment in childhood
• F) Criteria are NOT met for another specific Pervasive
Developmental Disorder
Course and Prognosis
• Continuous and lifelong disorder
• In school age children, good verbal abilities mask
other symptoms (social dysfunction
• In adolescence, interest in forming social
relationships may increase but may lack
understanding of conventional rules/reciprocity,
etc
• Often abnormal expression of sexualized
behavior may be present (e.g.-excessive and
inappropriate staring, touching, inappropriate
comments)
Aspergers Syndrome: Prevalence and
Trends
• 5 times more common in males
• Prognosis is significantly better than in Autistic
Disorder and most adults are capable of
employment and personal independence
Associated Features
• In contrast to Autistic Disorder, MR is usually Not
present in Aspersers, occasionally mild MR
• Variability in cognitive functioning
– Strengths in verbal ability (vocabulary, rote memory)
– Weaknesses in nonverbal areas (visual-motor, visual spatial
skills)
• Comorbidity of ADHD diagnosis; symptoms of
overactivity and inattention
• Depressive Disorders also common especially in
adolescence
• Obsessive Compulsive Disorder and features also often
present
Interventions for Autism & Aspergers
• Multidisciplinary approach when planning psychological
and educational interventions for individuals with Autism
and Aspergers
• Generally, a behavioral approach has been recommended
when setting therapy/counseling goals
• Goals are different depending on
–
–
–
–
–
–
Levels of cognitive functioning
Levels of social functioning
Levels of adaptive functioning
Individual’s other co-existing psychological and medical history
Family dynamics
Social context
Behavioral Interventions
• Applied Behavioral Analysis
– 1:1 intensive
– Pivotal Response Training
– Incidental Teaching
• Positive Behavior Support
– Strength based approach
• DRO (Differential Reinforcement for Other Behaviors)
– Reinforcing alternative behaviors- ex) if student constantly kicks his
desk; he is given positive reinforcement when he engages in sitting
appropriately
• Behavioral Interventions-often developed using a combination of
FBA (Functional Behavioral Assessment) and subsequently
developing a BIP (Behavior Intervention Plan)
• These interventions are not limited to Aspergers and Autism and
can be applied to many different disorders.
Therapeutic Interventions
• Limited success with individual therapy that
involves verbal communication in low functioning
Autistics
• In higher functioning students (e.g-Aspergers)
social skills groups, individual training in social
skills; anger management are useful (CBT
approach mainly used)
• Family therapy/counseling often a necessary
component to help parents, siblings deal with
and follow through with school-based
interventions
Psychopharmacology Interventions
• Used to treat associated features and syndromes (but
caution b/c of side effects)
– Stimulants (ADHD and features of hyperactivity and
inattention (e.g. Ritalin, Concerta, Adderrall)
– SSRI’s (Prozac, Zoloft, etc) to help with repetitive
behaviors, resistance to change, anxiety and OCD type
behavior
– Atypical Antipsychotics (Risperidal, Olanzapine) to help
with aggression, self-injury, severe tantrums, property
destruction
– Lamictal and Depakote-two mood stabilizers have often
been successful in treating seizures and associated mood
disorders in those with Aspergers/Autism
Journal Activity
• Watch the following clips from the movie “Rainman” (1989)
• http://www.youtube.com/watch?v=RW1qHA5Hqwc
• http://www.youtube.com/watch?v=vqbXPfaN_VM&feature=r
elated
• http://www.youtube.com/watch?v=kJZQkslDBjM
Identify some of the features you observe which resemble
Aspergers/Autism and/or other associated conditions
discussed
– Reflect on the challenges that Raymond’s brother had to
deal with when working with him….and how he coped with
the everyday life of “Rainman”
Part III: Learning Disabilities
• Diagnostic Features
– Diagnosed when person’s achievement on an
individually administered, standardized tests in
reading, math, or written expression is substantially
below that for age, schooling and level of intelligence
– Learning problems significantly interfere with
academic achievement or activities of daily living
requiring these skills
– What is “substantially below”-usually 2 standard
deviations, higher IQ, with much lower achievement
in one or more specific academic areas (sometimes
1.5 SD difference is used)
Risk Factors for Development of
Learning Disabilities
• Family History of Learning and or Psychiatric
Disorders
• Poverty
• Low SES
• Minority groups are over-represented;
especially those with limited English
proficiency; why?
• Other risk factors???
Reading Disorders (Diagnostic Criteria)
• A) Reading achievement as measured by individually
administered standardized tests of reading accuracy or
comprehension, is substantially below that expected
given the person’s chronological age, measured
intelligence, and age-appropriate education
• B) Disturbance in Criterion A significantly interfered
with academic achievement or activities of daily living
that require reading skills
• C) If a sensory deficit is present, the reading difficulties
are in excess of those usually associated with it
Dyslexia
• Oral reading is characterized by distortions,
substitutions, or omissions
• Both oral and silent reading are characterized
in slowness and errors in comprehension
Mathematics Disorders: Diagnostic
Criteria
• A) Mathematical ability, as measured by individually
administered standardized tests, is substantially below
that expected given the person’s chronological age,
measured intelligence and age-appropriate education
• B) The disturbance in Criterion A significantly interferes
with academic achievement or activities of daily living
that require mathematical ability
• C) If a sensory deficit is present, the difficulties in
mathematical ability are in excess of those usually
associated with it.
Mathematics Disorders: Skill
Impairments
• “linguistic” skills- (understanding or naming
mathematical terms, operations, or concepts or
decoding written problems into mathematical symbols
• “perceptual skills”-(e.g., recognizing or reading
numerical symbols or arithmetic signs, and clustering
objects into groups)
• “attention skills” (e.g., copying numbers or figures
correctly, remembering to add in “carried” numbers,
and observing operational signs)
• “mathematical” skills (e.g., following sequences of
mathematical steps, counting objects and learning
multiplication tables
Disorder of Written Expression
• A) Writing skills, as measured by individually
administered standardized tests (or functional
assessments of writing skills) are substantially below
those expected given the person’s chronological age,
measured IQ, and age-appropriate education
• B) Disturbance in Criterion A significantly interferes
with academic achievement or activities of daily living
that require the composition of written texts (e.g.,
writing grammatically correct sentences and organized
paragraphs)
• C) If a sensory deficit is present, difficulties in writing
skills are in excess of those usually associated with it
Features Associated with Learning
Disabilities
•
•
•
•
•
•
•
•
ADHD
High intelligence
Depression, anxiety
Low self-esteem
Conduct disorder
Substance abuse
Juvenile delinquency
School refusal/school phobia
Some Famous “Dyslexics”
http://www.dyslexia.com/famous.htm
Academic Interventions
• Should be specifically tailored to the student’s
individual cognitive/academic strengths and
weaknesses
• Goals and objectives are required to be reviewed
and revised annually for students with IEP’s
• Common Academic Interventions
– Wilson Reading; Orton Gillingham
– Classroom interventions (extended time, directions
read aloud; use of calculator, scribe to write
assignments, tape recorder, etc)
Therapeutic Interventions
• Address students perception of his/her learning disability and the
“stigma” of being in the “low class”-intervene appropriately
• If associated psychological/emotional problems treat these with
counseling (group/individual)
• Social skills groups very effective as students with learning
disabilities sometimes have difficulties reading and
interpreting/responding to social cues
• As students enter adolescence and young adulthood help them to
recognize their individual strengths, improve self-esteem and guide
towards an appropriate career path
• Many of the most gifted individuals have had learning disabilities
(e.g. Einstein, Churchill, Whoopi Goldberg, Magic Johnson, Bill
Cosby to name a few…..)
Family Based Interventions
• Family should be involved in all aspects of interventions, from initial
classification, IEP development, etc
• School psychologist is often the primary liaison with parents and
will help family by discussing how the student learns differently and
what they may be able to do at home to help student with
academic and social problems.
• Help family to identify and reinforce the student’s strengths as
many students with LD have low self-esteem which may be
exacerbated by unsupportive or derogatory remarks such as “you
are so dumb, I was an honor’s student, you are just lazy”) to name a
few
• Encourage parents to speak to their children using positive
language and reinforce achievements/improvements in academic
functioning on a consistent basis.
Psychopharmalogical Interventions
• Used to help with associated psychological
disorders; no “pill to cure dyslexia, etc.”
• ADHD-stimulant medications
• SSRI’s and other Antidepressants to help with
depression and anxiety
• Other medications dependent on student’s
medical and psychiatric needs
Journal Activity B: “It’s all Greek to
Me!”
• Read the short article handed to you and
answer the questions on the worksheet using
your non-dominant hand. If you are a lefty
right with your right hand, if you are righty
• Respond with how you felt while trying to
figure out the answers to the questions on the
worksheet: List the feelings that come to your
mind….