ADHD and Learning Disorders

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ADHD and Learning Disorders

• Abnormal Behavior Problems
• Fall 03

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Attention Deficit/Hyperactivity Disorder (ADHD)

• What comes to mind when you hear ADHD?

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ADHD

• Hyperactivity
• Disorganized/forgetful
• Athletic, evolutionary advantage
• Over-diagnosed
• Not a real disorder

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ADHD Subtypes

• Not all children with ADHD are hyperactive!
• 2 clusters of symptoms Hyperactivity/Impulsivity
  and Inattention
• 3 Subtypes of ADHD
• ADHD/HI
• ADHD/IA
• ADHD/C

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ADHD Prevalence and Course

• 4 to 12
• Boysgirls 31 to 81
• 68 continue in adulthood
• Persistence of inattention
• Decline in hyperactivity/impulsivity

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Comorbidity

• ODD/CD
• Learning Disorders
• Depression
• Anxiety
• Bipolar Disorder

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Associated Features

• Academic failure/underachievement
• Peer rejection, low self-esteem
• Occupational underachievement
• Fired, job change
• Disorganized
• Smoking, drug use
• Car accidents, tickets

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A Real Disorder?

• Symptoms are atypical
• Functional impairments
• Associated features
• Symptoms can be measured reliably
• gt90 test-retest reliability
• Moderate inter-rater reliability

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Genetics and ADHD

• Meta-analytic estimate h2.73
• No single gene believed to be responsible
• Action and interaction of genes and environment
  are not well understood
• Androgenic effect among ADHD/IA boys??

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Treatment of ADHD

• Stimulants
• 90 response
• Helpful with impulsive aggression
• Not addictive if used appropriately
• MTA
• Environmental
• Parent Education
• Structured environment

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Over/Under-Diagnosed?

• Increase in diagnoses
• Disorder du jour
• Political decisions
• Community-based studies
• Treatment adherence

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Evolutionary Advantage?Better Athletes?

• Cognitive deficits
• Fidgety, impulsive
• Social deficits
• Evidence from motor studies

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Learning Disorders
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History

• Rutter and Yule (1975)
• Poor readers with low IQ had more global
  neurodevelopmental abnormalities, but better
  acquisition of reading and spelling than children
  with average ability language but with delays in
  language and speech

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Defined

• No universally accepted test or battery of tests
• Discrepancy between IQ and achievement
• Wait to fail standard
• High reliance on exclusionary criteria for
  Diagnosis

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Prevalence

• The overall prevalence of LD is estimated to be
  between 2 and 10
• Approximately 5 of children have identified LD
  in public schools

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Why increase in prevalence rates?

• Better research
• Longitudinal, focus on individual factors (e.g.
  reading)
• Not based on school diagnosis, large population
  studied
• Reading
• specific diagnostic criteria
• 5 1976 to 17 1994 having difficulties
• Increase in diagnosis among girls
• Increased awareness and understanding of
  educational, professional, social impact

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Gender Differences

• BoysgtGirls
• Among those with LD
• Females generally have a lower IQ, and perform
  more poorly in math and reading, better in
  writing
• Males tend to perform better in math

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Associated Features

• Social skills, demoralization, low self-esteem
• Dropout rate as high as 40
• Conduct
• Attention
• Internalizing symptoms
• Important predictors of classroom failure

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Associated Features

• More likely to be rejected, on-task behavior,
  off-task behavior, conduct disorders,
  distractibility, and shy/withdrawn behavior
• 8-39 comorbidity with ADHD

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Course

• Evidence for a deficit model rather than
  developmental lag
• Children identified in 3rd grade as poor readers
  in bottom 10 in 5th and 8th
• 74 of children identified in 3rd grade still
  behind at 9th
• 49 classified as poor readers in adulthood

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Genetics

• Pennington, 1995
• 40 of LD children have LD parents
• 40 of their siblings are LD

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The Mathew EffectArguments against IQ

• Cumulative effect of RD affects cognitive
  development over time
• Older students may not maintain discrepancy
• Not a 11 relation between IQ and achievement
• Specific skills (e.g. phonology) may be more
  important

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A Brief Look at the Specific Disorders
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Mathematics

• Difficulty learning simple computational skills
  and numerical operations
• Math facts addition, subtraction and
  multiplication
• Operations making change, telling time, and
  understanding and using devices
• Visuo-spatial confusion
• Translation between paper and knowledge

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Mathematics

• Developmentally
• Informal- learning equivalency, magnitude,
  language, manipulation, judgment, conservation
• Formal- aspects of numbers, operations
• Abstract- concepts, going beyond mimicry

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Written Expression

• Physical aspects of writing
• Spelling
• Putting concepts on paper

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ReadingDyslexia

• Gough Simple View of Reading
• ComprehensionListening Comprehension Decoding
• CLCD

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Reading

• Dyslexia
• Decoding difficulties, intact listening
  comprehension
• Hyperlexia
• Good decoding skills, poor comprehension
• Garden Variety
• Poor decoding and comprehension

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The disabilities you can see may be easier to
deal with than the ones you cant
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Puzzles

• I O U

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Puzzles

• I O U
• I F-N N-E N-R-G

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Decoding

• O U Q-T. U R A B-U-T. S A 3-L 2 C U!
  I-L B U-R-S 4-F-R N F-R.
• I M 2 O-L 4 U.
• L! U-R O-D-S!
• N U R S-N-9. F U R B-Z, I-L 1 O-A.
  M-N-U-L S N-C-Q-R. E S N N-L-S-S. S
  N-L-S-S-T S N-2-8-F N Y-S. I F D Q-R!
• D N

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Decoding

• Why was the mans name?
• What did he think of the woman?
• What kind of Dr. was he seeing?
• What was the womans excuse?

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Comprehension

• Twas brillig, and the slithy toves  Did gyre
  and gimble in the wabeAll mimsy were the
  borogoves,  And the mome raths outgrabe.
• "Beware the Jabberwock, my son!  The jaws that
  bite, the claws that catch!Beware the Jubjub
  bird, and shun  The frumious Bandersnatch!"

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Comprehension

• He took his vorpal sword in hand  Long time the
  manxome foe he sought --So rested he by the
  Tumtum tree,  And stood awhile in thought.
• And, as in uffish thought he stood,  The
  Jabberwock, with eyes of flame,Came whiffling
  through the tulgey wood,  And burbled as it
  came!

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Comprehension

• One, two! One, two! And through and through  The
  vorpal blade went snicker-snack!He left it dead,
  and with its head  He went galumphing back.
• "And, has thou slain the Jabberwock?  Come to my
  arms, my beamish boy!O frabjous day! Callooh!
  Callay!'  He chortled in his joy.

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Comprehension

• Twas brillig, and the slithy toves  Did gyre
  and gimble in the wabeAll mimsy were the
  borogoves,  And the mome raths outgrabe.

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Comprehension

• Why was the Jabberwock killed?
• What else was there to beware of?
• What kind of tree did he rest by?

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Diagnosis

• What does the discrepancy standard boil down to?
• 1-2 standard deviations below mean
• Specific Skills assessments
• Other contributing factors
• Home and school environment, attention

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Treatment

• Megavitamins
• Colored lenses
• Special diets
• Sugar-free diets
• Body stimulation or manipulation

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Basics

• Heterogeneous disorders
• Accurate assessment
• Individual tailoring
• Basic skills, fluency, comprehension
• Research needed to help parse

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Treatment

• Remediations
• Resolving underlying difficulties
• Compensations
• Bypass the problem
• Keyboarding, changing expectations, strategies

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Treatment

• Sound-Based Strategies
• Phonics, Phonemic Awareness, Letter-sound
  relationships
• Remove the cuh sound from cart
• Whole language
• Decoding through context, emphasis is on
  comprehension and fluency

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NVLD (Non-verbal Learning Disorder)

• Not recognized by DSM
• Many have multiple etiological insults rather
  than developmental conditions
• Prevalence approximately 1-10 of LD children
• Should this be recognized as a specific disorder?