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1 Lee Reynolds, MD Child & Adolescent Psychiatrist 4KidHelp Center for Child & Adolescent Psychiatry 6513 Frank Ave NW North Canton, OH (330)

2 What it feels like to have a LD Illustrate the size of the problem Briefly describe the most common LDs Discuss general solutions Explain Special Education law 2

3 Low Achievement in one or more skills Significantly less than class average Significantly less than child s potential Not explained by any social, religious, cultural, economic or other emotional issues Auditory: may be bothered by different frequencies of sound; may consistently misunderstand what is being said Cognitive: may acquire new skills slowly; may have difficulties following directions, especially multiple directions Motor: may have problems with fine motor skills, such as holding a pencil; may have poor coordination; not good in sports Memory: may be able to learn information presented in one way, but not in another; may have difficulties memorizing 3

4 Organization: may have difficulties following a schedule or being on time; may have trouble learning about time Social: may have difficulties with social skills; may misinterpret non verbal social cues; may experience social isolation Attention: may have short attention span or be impulsive; may be easily distracted; may experience stress on extended mental effort 4 10% of all students have LD 80% of LD students are boys 2.5 Million children are currently diagnosed with LD The number of school age children identified with LD has decreased in the last 10 years Close to ½ of all secondary students with LD perform more than 3 grade levels below their enrolled grade in essential academic skills 22% of LD students drop out of high school compared with 8% of general students Two thirds (66%) of high school graduates with learning disabilities were rated not qualified to enter a four year college, compared to 37% of non disabled graduates 4

5 Economic disadvantage Environmental factors Cultural or differences Poor parenting 5

6 We believe that LDs occur because of damage to underlying nerves Genetics Find out on both sides of the family if anyone struggled with school, and if so in what area. Ask if anything helped. Childhood Development Exposure to lead or heavy metals Significant fever of the brain or seizures Malnourishment Neglect Physical abuse with brain damage Exposure in the Womb Placental bleeding, tobacco use, or cocaine use which deprives baby of oxygen Alcohol use which malforms certain body organs Lack of oxygen at birth Umbilical cord around neck Prolonged labor where umbilical cord gets trapped between mother s pelvis & baby 6

7 Dyslexic Example Control Example Left Anterior Left Anterior The dyslexic subject has large activation in the left anterior region of the brain. This kind of difference is specific to the phonological task. (Data from the University of Washington Learning Disability Center) Normal Brain Mental Retardation Autism (Pervasive Developmental Disorder) Learning Disability 7

8 Sparse Profuse Pruned connections connections connections 8

9 Dyslexia Dyscalculia Disorders of Communication (Language) Phonological Disorders Disorder of Written Expression Dysgraphia Executive Skills Problems Non Verbal Learning Disorder Silent reading/reading aloud Writing/spelling Learning languages/math Expressing what is known and understood Having to re do school work at home Having no time off since everything takes longer Dropping out 9

10 Feeling dumb, stupid, embarrassed, frustrated, anxious, lonely, isolated Being called stupid, lazy; being put down by teachers, friends, and even parents Feeling nobody understands Feeling need of help Fearing rejection & failure Always having to cover up, act a role Lack of basic skills Lack of social skills It s never cured, It never goes away Having to cover up Never feeling adequate Low expectations Jobs don t last 10

11 Dyslexia: difficulties processing language; difficulties with reading Dyscalculia: difficulties with math concepts and numerical operations; difficulty learning to count by 2 s, 3 s, 4 s Dysgraphia: difficulties with handwriting; written expression Dyspraxia: difficulties with motor coordination; fine motor skills Auditory Processing Disorder: difficulties interpreting auditory information; may impact both language development and reading Nonverbal Learning Disorder: difficulties with nonverbal cues; social skill deficits; visual spatial difficulties Visual Processing Disorder: difficulties interpreting visual information; difficulties with copying Attention Deficit Hyperactivity Disorder: difficulties with concentration and focus; impulsivity 11

12 A word meaning difficulty with language or difficulty with words, from the Greek morphemes dys and lex Synonymous with Reading Disorder in most contexts We used to think: That dyslexia meant seeing things backwards That left handedness predicted dyslexia That we couldn t diagnose dyslexia until after first grade was completed 24 12

13 WHAT IS PHONOLOGICAL AWARENESS? The ability to identify, think about and manipulate the individual sounds (Phonemes) in word. Problems with reading comprehension correlates with phonemic awareness 13

14 COMPREHENSION FLUENCY AUDITORY / SOUNDING OUT VISUAL / SIGHT WORDS LANGUAGE / VOCABULARY GRAMMAR NORMAL READER COMPREHENSION FLUENCY AUDITORY AUDITORY / / / SOUNDING SOUNDING OUT OUT OUT VISUAL / SIGHT WORDS LANGUAGE / VOCABULARY GRAMMAR DYSLEXIA 14

15 Failure to understand that words come apart Inability to learn to associate letters with sounds Omitting parts of words when reading Reading errors that show no connection to the sounds of the letters The inability to read common one syllable words or to sound out even the simplest of words Very slow progress in acquiring reading skills Oral reading filled with substitutions, omissions, and mispronunciations Reading that is very slow and tiring A struggle to retrieve words: It was on the tip of my tongue Finding it really hard to write by hand neat writing is very difficult Finding it difficult to copy things accurately off the board Having difficulty writing down what they think 15

16 17 % of children have difficulty learning to read Girls are just as likely to be affected as boys According to the National Institutes of Health (NICHD Branch) 31 About 20% of all children have significant difficulty learning to read, but the prevalence figure varies according to the instruction available to K 3 students. When instruction is optimal, all but about 5% can be brought into the average range in reading

17 Trouble segmenting and blending sounds Poor letter sound recall Poor application of phonics Inconsistent memory for words & lists Mispronouncing words Inability to spell phonetically 33 Phonic decoding is a struggle Inconsistent word recognition Poor spelling, dysphonetic Over reliance on context and guessing Trouble learning new words (spoken) Confusion about other symbols 34 17

18 Poor spelling, poor punctuation Reverts to manuscript from cursive Organization of writing is difficult Decodes laboriously, skips unknown words Avoids reading, vocabulary declines 35 Slow reading, loses the meaning Persistent phonological weaknesses, less obvious Poor spelling and writing Confusions of similar words Does better with structured, explicit teaching of language 36 18

19 Trouble with foreign language study Writing and spelling problems persist Reading is slow and labored, can t sustain Longer writing assignments very difficult Can cope when given extra time, study strategies, and structured language teaching 37 He learns the word while listening to the story... Read To Your Child...Then your child can more easily sound out the word if it is part of his listening and speaking vocabulary

20 Whole class reading instruction core, comprehensive SB reading program small groups 10% 3 5 times/week, groups of 4 6; measure response to instruction most severe problems; intensive daily instruction; possible SPED 39 Reading grade level Low Risk on Early Screening With intensive instructional intervention Research- based core but no extra instructional intervention No intervention 1 At Risk on Early Screening Grade level corresponding to age 20

21 Central Auditory Processing Expressive Language Receptive Language 21

22 Mispronouncing syllables or whole words Voice disorder, including abnormal pits, loudness or voice quality Fluency disorder, pauses, hesitations, repetitions Stutter Reluctance to speak Work closely with speech therapist Minimize the pressure to perform verbally and reduce student s anxiety Use nonverbal listening skills such as eye contact and facial expressions Let the student finish talking Don t finish the student s sentences Do not allow other students to make fun of the student Provide positive feedback for all communication efforts 22

23 Be patient Speak in short words and sentences Reinforce communication with hand signs and facial/body expressions Have child practice telegraphing main thought initially think of communication as a Christmas Tree 45 23

24 Dyscalculia refers to a wide range of lifelong learning disabilities involving math. There is no single type of math disability. Dyscalculia can vary from person to person. It can affect people differently at different stages of life. Visual spatial difficulties, which result in a person having trouble processing what the eye sees Language processing difficulties, which result in a person having trouble processing and making sense of what the ear hears 24

25 Is seen as this: For individuals with visual spatial troubles, it may be hard to visualize patterns or different parts of a math problem. Language processing problems can make it hard for a person to get a grasp of the vocabulary of math. Without the proper vocabulary and a clear understanding of what the words represent, it is difficult to build on math knowledge. When basic math facts are not mastered earlier, teens and adults with dyscalculia may have trouble moving on to more advanced math applications. 25

26 Difficulty learning to count Trouble recognizing printed numbers Difficulty tying together the idea of a number (4) and how it exists in the world (4 horses, 4 cars, 4 children) Poor memory for numbers Trouble organizing things in a logical way putting round objects in one place and square ones in another Trouble learning math facts (addition, subtraction, multiplication, division) Difficulty developing math problem solving skills Poor long term memory for math functions Not familiar with math vocabulary Difficulty measuring things Avoiding games that require strateg 26

27 Difficulty estimating costs like groceries bills Difficulty learning math concepts beyond the basic math facts Poor ability to budget or balance a checkbook Trouble with concepts of time, such as sticking to a schedule or approximating time Trouble with mental math Difficulty finding different approaches to one problem yscalculia Work extra hard to "visualize" math problems. Maybe even draw yourself a picture to help understand the problem. Take extra time to look at any visual information that may be provided (picture, chart, graph, etc.). Read the problem out loud and listen very carefully. This allows you to use your auditory skills (which may be a strength). Ask to see an example. Ask for or try to think of a real life situation that would involve this type of problem. Do math problems on graph paper to keep the numbers in line. Ask for uncluttered worksheets so that you are not overwhelmed by too much visual information. Spend extra time memorizing math facts. Use rhythm or music to help memorize 27

28 56 28

29 Special Education (SPED): Accommodations and modifications to curriculum to help child with learning problems be successful in school. Multifactored Evaluation (MFE): Federally mandated process to determine special education eligibility under IDEA Individualized Education Plan (IEP): Federally mandated document with specifies educational goals, objectives and plan for meeting these

30 In the Individuals with Disabilities in Education Act, called IDEA, Congress stated that one purpose of the law is to ensure that all children with disabilities have available to them a free appropriate public education that emphasizes special education and related services designed to meet their unique needs and prepare them for further education, employment and independent living. (Section 1400(d)(1)(A)) (1975, ammended in 1997 & 2004) 59 Attempts to meet child s needs within existing classroom setup by being creative with normal resources School representative(s) meet with parent to discuss problem(s) & develop strategies to try After strategies are tried meeting occurs with parent to review success or failure of these strategies If failure, school can consider moving to a 504 or IEP, or to leave things as they are Parent can always write a letter again, requesting a special education evaluation 60 30

31 Attempts to meet child s needs within existing classroom setup by being creative with normal resources School representative(s) meet with parent to discuss problem(s) & develop strategies to try After strategies are tried meeting occurs with parent to review success or failure of these strategies If failure, school can consider moving to a 504 or IEP, or to leave things as they are Parent can always write a letter again, requesting a special education evaluation 61 How parents often feel during an IEP 62 31

32

33 Allow more time to complete assignments Adjust length of assignments Modify pace of instruction Use peer tutors Provide outline of lectures Use visual aids Use advance organizers Highlight texts and worksheets Tape lectures Adjust reading levels of materials Use specialized curricular materials 65 Modifying the Presentation of Material Modifying the Environment Modifying Time Demands Modifying the Materials 66 33

34 New language in IDEA: a local educational agency may use a process that determines if the child responds to scientific, research based intervention as a part of the evaluation procedures. Sec. 614(b)6B The language of IDEA 2004 does not specifically use the term responsiveness to intervention (RTI). In the special education research literature, the process mentioned in this language is generally considered as referring to responsiveness to intervention (RTI). RTI is not mandated (e.g.,... a local agency may use a process... )

35 35

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