CO-MORBIDITY

Learning, Disabilities, ADHD, Behavioral Emotional Disorders

CO-MORBIDITY

Learning, Disabilities, ADHD, Behavioral Emotional Disorders

Disorders of Behavior- Arriving at a Disorders of Behavior- Arriving at a DefinitionDefinition

Disorders of Behavior- Arriving at a Disorders of Behavior- Arriving at a DefinitionDefinition

Normal versus Disordered Behavior

• A social construct

• What constitutes good mental health?

• Concerns of frequency, intensity, duration

• Difficult periods of childhood vs. behavior disorder

• Lack of social skills vs. behavior disorder

• Operationalizing such terms as pervasive, normal,

inappropriate, etc.

• Student's emotionalproblems vs. ability to learn. Males- in the past- propensity to rules breaking

• Behavior vs. Race and cultural bias

• Girls- internalize emotional disturbance.

• Other classifications

Normal versus Disordered Behavior

• A social construct

• What constitutes good mental health?

• Concerns of frequency, intensity, duration

• Difficult periods of childhood vs. behavior disorder

• Lack of social skills vs. behavior disorder

• Operationalizing such terms as pervasive, normal,

inappropriate, etc.

• Student's emotionalproblems vs. ability to learn. Males- in the past- propensity to rules breaking

• Behavior vs. Race and cultural bias

• Girls- internalize emotional disturbance.

• Other classifications

PhysiologicalBirth defectTBITourette’s SyndromeFetal Alcohol Syndrome, DepressionChemical and mood disorders.

EnvironmentalLearned behaviorsMental illness, etc.PTSS

Learning Disabled Students

• interact awkwardly.

• interact inappropriately in social situations.

• socially imperceptive.

Learning Disabled Students

• interact awkwardly.

• interact inappropriately in social situations.

• socially imperceptive.

ATTENTION DEFICIT HYPERACTIVE DISORDER

ATTENTION DEFICIT HYPERACTIVE DISORDER

• tend to react to others aggressively

• are generally rejected by peers

• lose the opportunity to learn social skills

• are isolated from most social situations (Westby, Cutler, 1994).

• victims of parents who are abusive or lacking effective parenting skills.

(Parker, Asher 1987).

• tend to react to others aggressively

• are generally rejected by peers

• lose the opportunity to learn social skills

• are isolated from most social situations (Westby, Cutler, 1994).

• victims of parents who are abusive or lacking effective parenting skills.

(Parker, Asher 1987).

Learning Disabilities:Typically a Disruptionin Maturational Delay

Learning Disabilities:Typically a Disruptionin Maturational Delay

• Language skills• Motor skills• Uneven performance on IQ assessment• Visual-Motor • Incomplete or mixed dominance• Social Immaturity• Genetics

• Language skills• Motor skills• Uneven performance on IQ assessment• Visual-Motor • Incomplete or mixed dominance• Social Immaturity• Genetics

At Risk for LDAt Risk for LD

Established risk:• identified through a medical diagnosis; • failure to develop, thrive; delay in language development.

Unknown etiology is the important term.Biological risk:

early medical and health history indicates increased probability for later atypical development. (HIV, premature, injury at birth (anoxia, chemical dependency at birth.)

Environmental risk: • biologically sound • early life experience are characterized by a profound lack

of stimulation- critical in the years birth to age five. Lack of cognitive stimulation in the formative years; lack of nutrition, age of mother, lack of prenatal and neonatal care.

• Child can be at risk for all three, one or two.

Established risk:• identified through a medical diagnosis; • failure to develop, thrive; delay in language development.

Unknown etiology is the important term.Biological risk:

early medical and health history indicates increased probability for later atypical development. (HIV, premature, injury at birth (anoxia, chemical dependency at birth.)

Environmental risk: • biologically sound • early life experience are characterized by a profound lack

of stimulation- critical in the years birth to age five. Lack of cognitive stimulation in the formative years; lack of nutrition, age of mother, lack of prenatal and neonatal care.

• Child can be at risk for all three, one or two.

Children with LD and Behavior DisordersChildren with LD and Behavior DisordersChildren with LD and Behavior DisordersChildren with LD and Behavior Disorders

• Short Attention Span

• Low Frustration Tolerance

• Insatiability- need a significant level of intensity, often bored, need new and novel activities, chronically restless, incredibly future oriented

• Distractibility

• Low self esteem

• Short Attention Span

• Low Frustration Tolerance

• Insatiability- need a significant level of intensity, often bored, need new and novel activities, chronically restless, incredibly future oriented

• Distractibility

• Low self esteem

Continued:Continued:Continued:Continued:• Learned helplessness

• Hyperactivity

• Sequencing deficits

• Memory deficits

• Interrogoration

• Disinhibition

• Impulsivity

• Learned helplessness

• Hyperactivity

• Sequencing deficits

• Memory deficits

• Interrogoration

• Disinhibition

• Impulsivity

Common Elements in the DefinitionCommon Elements in the Definitions

Common Elements in the DefinitionCommon Elements in the Definitions

• Central Nervous System Dysfunction• Uneven Growth Pattern /Psychological Processing

Deficits• Discrepancy Between Potential and Achievement• Exclusion of Other Causes

• Central Nervous System Dysfunction• Uneven Growth Pattern /Psychological Processing

Deficits• Discrepancy Between Potential and Achievement• Exclusion of Other Causes

Symptoms of ADD/ADHDSymptoms of ADD/ADHD

• Severity– Symptoms more frequent and severe than

other children

• Early onset– Symptoms must have appeared before

age seven

• Duration– Symptoms persist for at least 6 months

• Severity– Symptoms more frequent and severe than

other children

• Early onset– Symptoms must have appeared before

age seven

• Duration– Symptoms persist for at least 6 months

Subtypes of ADHD in DSM-IVSubtypes of ADHD in DSM-IV

• ADHD-IA

• ADHD-HI

• ADHD-C

• ADHD-IA

• ADHD-HI

• ADHD-C

• Primarily inattentive• Primarily• hyperactive and impulsive

• Combined

Implications of the LawImplications of the Law

• Children with ADD/ADHD may be eligible for special education services under the category of “other health impaired”

• Children with ADD/ADHD may receive services under the legislation of Section 504 of the Rehabilitation Act of 1973

• ADD/ADHD is listed as a specific condition under “other health impaired”

• Children with ADD/ADHD may be eligible for special education services under the category of “other health impaired”

• Children with ADD/ADHD may receive services under the legislation of Section 504 of the Rehabilitation Act of 1973

• ADD/ADHD is listed as a specific condition under “other health impaired”

Increase in DisordersIncrease in Disorders

Psychostimulant Medications for ADD/ADHDPsychostimulant Medications for ADD/ADHD

• Ritalin• Dexedrine• Cylert

• Adderall

• Concerta

• Ritalin• Dexedrine• Cylert

• Adderall

• Concerta

• 3-5 hours• 3-5 hours• Long-lasting

• 8 hours

• 8-12

Precursors of Learning Disabilities-Difficulties in any of the following:Precursors of Learning Disabilities-Difficulties in any of the following:

• Communication/oral language• Phonological awareness• Rapid naming skills• Knowledge of the alphabet• Visual-motor skills• Fine- and gross-motor skills• Attending abilities• Social skills

• Communication/oral language• Phonological awareness• Rapid naming skills• Knowledge of the alphabet• Visual-motor skills• Fine- and gross-motor skills• Attending abilities• Social skills

Age Span of Learning Disabilities PopulationAge Span of Learning Disabilities Population

• Preschool children

• Elementary-age children

• Secondary students

• Adults

• Preschool children

• Elementary-age children

• Secondary students

• Adults

Ages that Children with LD Are IdentifiedAges that Children with LD Are Identified

Composition of Students with Disabilities

Composition of Students with Disabilities

Left-Right Brain ProcessingLeft-Right Brain ProcessingLeft Brain Right Brain

Analytical Synthesizes

Verbal Strengths Visual (spatial imageryLinear SimultaneousSequential Holistic“Sees” parts, pieces “Sees” whole, gestaltPrecise & accurate Makes sense of all the

partsDetail oriented Interpretation of

non verbal cuesStep by step learner

Organization Ambiguity

Open ended questions

Left Brain Right BrainAnalytical Synthesizes

Verbal Strengths Visual (spatial imageryLinear SimultaneousSequential Holistic“Sees” parts, pieces “Sees” whole, gestaltPrecise & accurate Makes sense of all the

partsDetail oriented Interpretation of

non verbal cuesStep by step learner

Organization Ambiguity

Open ended questions

Nonverbal Learning DisabilitiesNonverbal Learning Disabilities• Characteristics

– Poor social perception– High verbal intelligence– Early reading achievement– More evident in adolescents and adults

• Different than academic, language and cognitive disabilities

• Asperger’s (?)Syndrome

• Video

• Characteristics– Poor social perception– High verbal intelligence– Early reading achievement– More evident in adolescents and adults

• Different than academic, language and cognitive disabilities

• Asperger’s (?)Syndrome

• Video

Indicators of Social DisabilitiesIndicators of Social Disabilities

• Poor social perception

• Lack of judgment

• Lack of sensitivity to others

• Difficulty making friends

• Problems with family relations

• Social problems in school

Undiagnosed Syndromes

• Poor social perception

• Lack of judgment

• Lack of sensitivity to others

• Difficulty making friends

• Problems with family relations

• Social problems in school

Undiagnosed Syndromes

Difficulties in Reading

Students may:

• Have difficulty with one or more subject areas.• Have limited mastery of concepts.• Have limited fund of information.• Have limited expressive and receptive vocabulary.• Display limited knowledge of word

meanings.• Do not understand special multiple meanings of

words.• Read significantly below level of text.

Difficulties in Reading

Students may:

• Have difficulty with one or more subject areas.• Have limited mastery of concepts.• Have limited fund of information.• Have limited expressive and receptive vocabulary.• Display limited knowledge of word

meanings.• Do not understand special multiple meanings of

words.• Read significantly below level of text.

Verbal Linguistic Learning Disabilities

Content Area Reading

Technical Vocabulary- in the content areas carries the conceptual load.

Students may:

Have difficulty with one or more subject areas.

Have limited mastery of area concepts.

Do not understand technical words.

Do not understand special uses of non technical words.

Display limited knowledge of word meanings.

Read significantly below level of text.

Content Area Reading

Technical Vocabulary- in the content areas carries the conceptual load.

Students may:

Have difficulty with one or more subject areas.

Have limited mastery of area concepts.

Do not understand technical words.

Do not understand special uses of non technical words.

Display limited knowledge of word meanings.

Read significantly below level of text.

Causes:

• Weak listening speaking and sight vocabulary.• Weak contextual analysis skills.• Inability to apply same word in different contexts.

Causes:

• Weak listening speaking and sight vocabulary.• Weak contextual analysis skills.• Inability to apply same word in different contexts.

Dyslexia and the BrainDyslexia and the Brain

Broca's areaExpressive language

Wernicke's areaReceptive language.

Posterior reading system.

There are three neural pathways for reading:

•the parietal-temporal and frontal-(slower, analytical, used by beginning readers)•the occipital-temporal (word form, experienced readers).

Recent Brain ResearchSally Shaywitz, MDSally Shaywitz, MD

Recent Brain ResearchSally Shaywitz, MDSally Shaywitz, MD

• At left, non-impaired readers activate neural systems that are

mostly in the back of the left side of the brain (shaded areas); at right, dyslexic readers under activate these reading systems

in the back of the brain and tend to over activate frontal areas.

• In addition to their greater reliance on Broca's area,

dyslexics are also using other auxiliary systems for reading,

ones located on the right side as well as in the front of the brain.

• This is evidenced by the activation of right hemisphere parts of the brain. (Dyslexics and slow readers often sub-

vocalize. The physical aspect to their reading is an attempt to

compensate for the disruption in the back of the brain.)

• At left, non-impaired readers activate neural systems that are

mostly in the back of the left side of the brain (shaded areas); at right, dyslexic readers under activate these reading systems

in the back of the brain and tend to over activate frontal areas.

• In addition to their greater reliance on Broca's area,

dyslexics are also using other auxiliary systems for reading,

ones located on the right side as well as in the front of the brain.

• This is evidenced by the activation of right hemisphere parts of the brain. (Dyslexics and slow readers often sub-

vocalize. The physical aspect to their reading is an attempt to

compensate for the disruption in the back of the brain.)

An Information-Processing Model of Learning

An Information-Processing Model of Learning

Difficulties in Mathematics Difficulties in Mathematics

• Sense of Body Image

• Visual-motor & Visual Perceptual Abilities

• Spatial Relations

• Memory Abilities

• Sense of Body Image

• Visual-motor & Visual Perceptual Abilities

• Spatial Relations

• Memory Abilities

Progressing from Concrete to AbstractProgressing from

Concrete to Abstract

•Concrete Level- Use Real Objects

•Representational Level- Use Graphic Symbols

•Abstract Level- Use Numbers

•Concrete Level- Use Real Objects

•Representational Level- Use Graphic Symbols

•Abstract Level- Use Numbers

Information Processing Problems in MathematicsInformation Processing Problems in Mathematics

•Attention•Visual-spatial Processing•Auditory Processing•Memory & Retrieval•Motor Problems•Non Verbal LD

•Attention•Visual-spatial Processing•Auditory Processing•Memory & Retrieval•Motor Problems•Non Verbal LD