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Types of LD Most common: Word Level
Reading LD (“dyslexia”) Others: reading comprehension,
reading fluency, math, written expression
Some would include: language problems, “slow learners,” mild intellectual disability
Word Level Reading Disability
Common: 5-10% of total population, largest single group of students in special education
Almost 2/5 of all children identified for special education in the US
Problem with decoding words
Underlying deficit: Phonological Awareness
Reading requires awareness:1. Words break down into sounds2. Represented by letters
Phonological awareness = The ability to recognize, hear the difference between, and manipulate the sounds of your language
“Ha, ha, Biff. Guess What? After we go to the drugstore and the post office, I’m going to the vet’s to get tutored.”
LD traditionally not diagnosed until early elementary age, but deficits in phonological awareness are present much earlier
3 yrs
4 yrs
5 yrs
6 yrs+
Spontaneous rhymes
Identifies rhymes
Segments syllables
Blends syllables
Generate rhymes, blend and segment phonemes
Delete phonemes, manipulate phonemes and syllables
Phonological awareness allows for accurate reading decoding
Later steps:- Fluent, automatic reading- Reading comprehension- Spelling
“Sophia” - Pattern in late elementary school
* decodes familiar words accurately
* guesses at unfamiliar words* slow reading fluency* weak comprehension* poor speller
What causes LD? Biological Factors
› LD is genetic - Runs in families 50-80% of variance explained by genetic
factors› LD in brain-based – differences in neural
activation
Environmental Factors› Exposure to print materials, rich language› Instructional factors
Prevention is Possible
Risk characteristics present in
Kindergarten and G1 (and earlier) Letter sound knowledge, phonological
awareness, oral language development Assess all children and INTERVENE- first
in the classroom and then through supplemental instruction
Intervention
Examples: Orton-Gillingham Wilson Lindamood-Bell Phonographix
Look to the Florida Center for Reading Research:http://www.fcrr.org/
Reading Programs Must Include:
• Phonemic Awareness
• Phonics
• Fluency
• Vocabulary
• Comprehension
What matters most?- Direct instruction in decoding using phonological rules- Intensity, duration, frequency
- Teacher training
Over 90% of children reading below the 15th percentile at the beginning of first grade read at or above grade level by the end of the first grade with appropriate intervention.
Fifteen minutes of instruction in the alphabetic code as part of a standard kindergarten curriculum led to significant gains in phonological analysis skills
Even at the Preschool Level…
Phonological activities:› Rhyming (nursery rhymes, rhyming
stories)› Segmentation (breaking sentences into
words, investigating word length)› Syllables (clapping and dancing to syllabic
rhythms)› Phonemes in words (initial sound vs. rime)
Interactive reading: Pause, ask questions, expand and elaborate
Students Need to Know Teachers Need to Teach
Phonological Awareness rhyme, alliteration; deletion; segmentation
Alphabetic Principle letter-sound patterns (phonics) with correlated text
Orthographic Awareness spelling; writing conventions
Comprehension Strategies
main idea; inferencing; study skills
Inclusion
Inclusion by default – very young children not yet identified but at risk
Older students: › Usually have history of limited success in
general education› Does it make sense to continue to educate
them in general settings?
Research on Inclusion for LD
Mixed results Inclusion
› Best for mild LD› Associated with better social/emotional?
Some studies show better outcomes for combination general ed/ resource pull-out
Unproven “Treatments”
Vision training/ eye exercises Tinted lenses or filters Special visual-motor exercises to
“develop the cerebellum” Vitamins or herbal remedies Chiropractic manipulations Biofeedback
Attention Disorders
“Marcus”
Impulsive, acts without thinking, gets hurt a lot, always “into things,” risky behaviors
Described as “busy” his whole life; “even in the womb!” – “on the go”
Curious, often off-task, quickly bored
ADHD Symptoms
Attention Deficit/ Hyperactivity Disorder:1. Inattention2. Overactivity3. Impulsivity
Three Subtypes
ADHD, Predominantly Hyperactive/ Impulsive Subtype
ADHD, Predominantly Inattentive Subtype
ADHD, Combined Subtype
Hyperactive/ Impulsive Subtype Fidgets, squirms Leaves seat Runs about or
climbs excessively Difficulty playing
quietly “On the go" or
"driven by a motor;" Talks excessively.
Blurts out Difficulty awaiting
turn Interrupts or
intrudes on others
Inattentive Subtype
Fails to give close attention to details, makes careless mistakes
Difficulty sustaining attention
Does not seem to listen
Does not follow through/ fails to finish
Difficulty organizing tasks and activities
Trouble with sustained mental effort (schoolwork, homework)
Loses things Easily distracted Forgetful
Combined Subtype
Six hyperactive/ impulsive and six inattentive symptoms
7% of children have ADHD› 4% of children 4-8 yrs old
Increase from 1997-2006 Boys more likely to be diagnosed than
girls Rates vary from place to place Similar rates in Caucasian (7.6%) and
African-American kids (7.4%); but Hispanic (5.1%)
Comorbidity is common
Clinical Symptoms of ADHD
Beyond the traditional triad of “not paying attention”, “not thinking before he acts” and “running all over the house constantly”...
… We see… › Disorganization› Can’t remember 3-step instructions› Can’t track time› Poor planning› Not checking his/ her work› Difficulty accepting other strategies,
getting stuck› Overemotional› Desk/ bookbag/ room a disaster
Also known as…
Executive Dysfunction
Your executive function skills are like…
The "conductor of the orchestra"
The “CEO of the corporation” The “general of the army”
ADHD and Executive Dysfunction in the Young Child
3 year olds – normally impulsive, limited attention
* only 10% might have ADHD
4 year olds – problems more likely to be persistent
ADHD Preschoolers:› Challenging to parent and to teach› Impulsivity or Weaknesses in Behavioral
Inhibition often most striking Acts without thinking “Leaps before she looks” Can’t stop Can’t self-regulate (including emotions)
Result…* More temper tantrums* Higher parental stress* Disruptive in groups
* More likely to be expelled from preschools* More likely to be behind in academic readiness
By early elementary school…
More likely to repeat Kindergarten At major risk for academic failure;
inconsistent performance Disorganization and poor planning Poor working memory Social rejection
Problems with getting started on tasks, organization, planning, self-monitoring, and holding information in mind emerge
What causes executive dysfunction in ADHD?
Neurobiological disorder› Prefrontal cortex/ frontal networks
Genes / Heredity- runs in families› Dopamine-related genes
Other risk factors?
Prefrontal/ frontal areas important in attention and self-regulation
Evidence for under-activity in frontal networks in ADHD
Genetics of ADHD
ADHD clearly has a strong genetic component› Heritability .65-.90
Converging evidence related to genes that affect dopamine communication in the brain
Management of Pediatric ADHD
Multimodal Treatment Medication (stimulant or non-) Psychosocial
Parent training Social skills training Coaching/ EF tutoring
School-based
Unproven “Treatments”
Special diets – limiting or eliminating sugar, preservatives, artificial flavors/ colors, etc› Sugar does not cause hyperactivity
Mega doses of vitamins (can be dangerous)
Treatments targeting “inner ear system”
Chiropractic manipulation Vision therapy
The jury is still out…
Not yet enough evidence for or against: Omega fatty acid, glyconutritional
supplementation, regular multivitamins (within RDA), and herbals
Neurofeedback Computer-based training of attention/
working memory
Busting the Myths about ADHD
Myth #1: ADHD is not a “real” disorder
Myth #2: ADHD only affects kids
Myth #3: ADHD is overdiagnosed
Myth #4: Children are being over-medicated
Myth #5: Poor parenting causes ADHD
Myth #6: Minority children are over-diagnosed with ADHD
ADHD and Special Education
Estimate 50% qualify under IDEA› LD, OHI or other categories
Majority of identified students in OHI and ED group have ADHD
Of special education students with ADHD, majority (63%) are in general education settings most of the time
Classroom Accommodations for ADHD
Most commonly used:› Strategic seating› Behavior modification techniques› Extended time› Modified assignments› Testing accommodations
Daily Report Card
Has best research support of any classroom intervention› List target behaviors (e.g., raise hand
before speaking)› Specific criteria for meeting target (< 3
violations)› Teacher records progress on DRC, gives
feedback/ praise› DRC goes home – link to rewards
Direct teaching of executive skills?
Research evidence for preschool / K curriculum that directly teaches executive function skills (Tools of the Mind)› Improves self-regulation, also classroom
management and academic readiness gains
› Used successfully with range of special needs learners in inclusion model
Tips and Tricks Classroom Strategies That Work
Ideal Classrooms for Children with ASD
Highly Structured
Consistent routine every day Roadmaps for daily activities
› Visual schedules Preparation and support for transitions
› Advance warning› Develop transition rituals› Provide additional support for transitions
Classroom/Teacher Qualities
Highly structured approach to teaching Teachers who are interpersonally
flexible Collaborative with parents to meet
children’s needs Positive, non-punitive behavior
management system
Curriculum-based Social Instruction
Generic social skills training for whole classroom› Cooperation skills› Helping skills
Social Initiation› Asking questions› Verbal negotiation
Teacher modeling and reinforcement of social initiation
Components of Social Instruction
Cooperative learning groups with high level of teacher attention› Increased academic engagement› Better academic performance
Social activities that appeal to all children
Physically structure classroom to promote interaction – place child with ASD near a high status who is likely to initiate
Components of Social Instruction
Promote peer interaction Create opportunities for cooperation
and negotiation› Supported group work› Sharing of resources
Teaching about differences
Normalize unusual behaviors Reduce stigma for children with special
needs Research suggests early education
promotes more acceptance as children age
Provide opportunities for children with special needs to show their strengths
Learning Disabilities
In early education› Phonological awareness training works to
prevent LD› Interactive reading builds literacy and
comprehension skills More intense intervention
› Look to the research: Florida Center on Reading Research www.fcrr.org
› Increase teacher training
Accommodate LD in the inclusion classroom› Multimodal presentations› Prompting and cuing to elicit correct
responses› Make the abstract concrete› Allow alternative response modes› Increase access to written word
ADHD
Planned physical movement Structure the unstructured Proximity control Strategic seating Break tasks and directions into smaller
steps Provide choices
Behavior modification› Whole class› Contingency contracts› Daily Behavior Report Card
Catch them being good Planned ignoring
Components of Inclusion Models•School level support•Access to specialists•Address attitudes toward inclusion•Components of an inclusion classroom
School Level Support
Administrative support› Mentoring› Training› Ongoing support and encouragement
Identify at-risk situations outside of class› Lunch› Recess› Transition› Before-after school
Specialists
Educational Specialists Developmental Specialists Autism Experts Speech-Language Pathologists Occupational Therapists
Attitudes toward inclusion
Positive, open mindedness is important Teachers with positive, optimistic
attitudes disseminate that to students› Behavior management problems predict
attitudes Parents are quite variable about
inclusion
Ferraioli and Harris, 2010, Journal of Contemporary Psychotherapy
Vaccines and Autism
Numerous population based study have found no link between autism and any vaccine
http://www.cdc.gov/ncbddd/autism/documents/vaccine_studies.pdf
