Learning Disabilities

1. Learning Disabilities Definitions IQ Stand alone According to WHO: IQ + Social Functioning and age at onset Administrative Definition: Those who attend learning disability services Educational approach: A disorder in one of the basic psychological processes that is manifested in low ability in language and math

2. AD(H)D

3. Prevalence • Attention-Deficit/Hyperactivity Disorder (ADHD) is the current diagnostic label for one of the most prevalent neurobiological/developmental disorders of childhood (American Psychiatric Association, 2000) • Current estimation is that ADHD affects 8–12% of children worldwide (Faraone, Sergeant, Gillberg, Biederman, 2003). Seven percent of American children between ages 6 and 11 have been diagnosed with ADHD; approximately 75% of these children are boys (CDC Report, 2002).

4. Diagnosis • A diagnosis should be made based on the individual's clinical history of abnormality and impairment. An evaluation for AD(H)D will often include assessment of intellectual, academic, social and emotional functioning. Medical examination is also important to rule out infrequent, but possible, causes of AD(H)D-like symptoms. The diagnostic process must also include gathering data from others who interact on a routine basis with the individual being evaluated (Grosenbach et al., 2000). Critique • ADHD diagnosis is a likely outcome of any presentation to a doctor with officially logged problems of conduct in school. Therefore if there were no schools, ADHD could hardly be a condition at all. Mchoul & Rapley (2005) • Parents may experience a kind of relief in response to the diagnosis considering ADHD as a condition with an easy cure for it. • A deficit-based description of their child. • Parents and child lose the ability to have effectiveness over problems. • The child’s behavior and experiences are predicted, defined, and attended but the end result of this often is the idea that kids with ADHD somehow have to settle for less in life. (Nylund, 2005)

6. Growing up with Learning Disability Developmental Tasks: In childhood: • learning to behave carefully • cooperate with adults and peers • communicate effectively • Read and write In adolescence: • manage time, • organize longer term tasks, • consider long-term consequences of immediate actions, • deal with burgeoning sexuality, • learn to negotiate increasingly complex relationships, • learn to recreate the “scaffolding” provided by parents and other adults during childhood so that they can function independently. Adulthood: • Continue Studying • Find a meaningful job. • managing a household and finances, • managing work while nurturing relationships, • parenting and sustaining partnerships.

7. Cognitive Aspects Executive functioning is impaired in ADHD: • 1. Activation: organizing, prioritizing, and activating for tasks; • 2. Focus: focusing, sustaining focus, and shifting focus or attention; • 3. Effort: regulating alertness, sustaining effort, and processing speed; • 4. Emotion: managing frustration and modulating emotion; • 5. Memory: using working memory and accessing recall; • 6. Action: monitoring and self-regulating action. Current approach emphasize the importance of cognitive impairments of the brain’s self-management system - executive functions – in ADHD children. This central element is ignored by the DSM definition (Brown, 2005)

8. Emotional aspects • There is evidence that learning-disabled children experience difficulties in emotional development: loneliness and signs of maladjustment. • Two major affective disturbances: distress and anxiety and low-level chronic depression: feelings of sadness, loss, confusion, helplessness, anxious anticipation of failure and humiliation, incompetence, inadequacy, damage and rigidity (Cohen, 1985).

9. Social aspects • ADHD children tend to have poor peer relationships and are often rejected by their peers • Social encounters of students with ADHD are characterized by rough play compared to typical students. • Aggression appears to be a solid characteristic for this group of children. (Zentall, 2005). • Married adults with ADHD reported poorer overall marital adjustment and more family dysfunction than control adults.

10. Behavioural aspects • Attention problems and sometimes also hyperactive behaviour, as well as more aggressive and antisocial behavior • However, ADHD-I group (and LD group) are better able to inhibit responses and exhibit behavior that is less problematic and less likely to have a co- diagnosis of conduct disorder than the ADHD-H subtype.

11. Psychological variablesEgo Strengths - Self Perception and Self Efficacy • A child’s self-concept goes through a major transition at the age of 8 or 9 years. • Many children with LD display a poor academic self-concept. • The concept of self-esteem or self-perception is probably internalized during the same developmental phase as when ADHD is generally diagnosed and treated (Bussing et al., 2000).

12. Self efficacy is a concept representing acquired beliefs through socialization experiences on self-perception. It influences one’s beliefs about one’s ability to successfully perform specific tasks in specific situations. • Therefore, Self Efficacy influences academic achievements. (Bandura) • High school students with LD tended to have lower scholastic self-efficacy than students without LD.

13. Motivation • Motivation plays a salient role in students’ achievement and adaptiveness at school • Students with LD have lower scores in academic self-regulation and are less motivated for on-task performance, especially reading comprehension and arithmetic tasks • Classroom environments that have a focus on mastery are the most appropriate ones for the education of students with and without LD.

14. Coping mechanisms • The cognitive deficits ADD and ADHD individuals may place them in a condition of limited resources to cope with stressful life events. • They lack planful problem-solving, cognitive reframing and taking the perspective of others (Young, 2000) • They use maladaptive coping strategies: confrontative, escape-avoidance and less planful problem-solving (Young, 2005).

15. Surrounding Circles -Parents • Increased caretaking demands, decreased parenting esteem and satisfaction and decreased sense of volition or choice, play a critical role in the development course of ADHD and its long-term outcomes. • Parental well being and coping competence, household financial and emotional climate, and the quality of marital relations. • ADHD children tend to have poor relations with their parents and have a higher rate of family conflict

16. The experience of the parent of the ADHD child • Influence on parenting perceptions and the quality of family life. • Mothers of children with AD(H)D: stress, depression, isolation. • Mothers experience blame for their sons’ behaviors. • Getting an accurate diagnosis and relevant treatment for their children’s difficulties is one of the biggest obstacles facing mothers. • Positive: thinking, faith, familial cohesion.

17. Sisters and Brothers • ‘Outlasting disruption' and stress • ADHD and siblings make social comparisons in order to determine how they should behave. • Non-disabled siblings: some copied and wanted to be like their older brother or sister; others wanted their disabled brother or sister to be like themselves; some copied their parents.

18. School • ADHD is essentially a school-based disorder. • Educators play an important role through early identification and intervention. • Teacher’s knowledge about ADHD is deficient

19. Parents and Professionals • Stressful relationships between parents of ADHD children and school teachers, psychologists and physicians. • Professionals are judgmental of parents. • Elementary school teachers perceive ADHD as being the result of poor parenting. • Gaps of knowledge and perception between parents and professionals.

20. Peers • LD children and adolescents are often lonely and tend to have poor peer relationships and are often rejected by their peers.

21. Treatment Models • Medications • Family Intervention • School Intervention: Academic, Peer

22. Medication Treatment • Extensive use of stimulant medication, about 85% of all children • Ritalin, Concerta (Methylphenidate ) • Pros: behavioral changes: less classroom disruption and negative social behavior, more compliance • Cons: 30% of children do not respond positively. • Side effects: insomnia, appetite loss, overdose

23. Family Intervention • Parenting programs: modifying parenting behaviors: consistency, follow-through, behavior management. • Self care programs: behavior modification, coping, diet, religious practices, OTC medication; in this order. • Parent-Child Interaction Therapy.

24. School intervention • Behavioral management in the classroom: directed at the teachers • Praise, planned ignoring, effective commands, time out, daily report card (DRC) • Proven to be very effective - when implemented.

25. Academic Interventions • A strong correlation between ADHD and academic underachievement. • Intervention: modification of academic instructions or materials to improve behavior and achievement. • Task & instructional modifications, peer tutoring, computer assisted, strategy training.

26. Peer interventions • Social Skills Training – social openness • Communication, Cooperation, Participation • SST works well with aggressive and antisocial, less with LD and ADHD • Combined training: Parents and Social skills, is most effective

27. Integrative Dynamic Intervention • Constitutional Treatment : Medical, Academic, Social • Holistic, systemic attitude: child, family, school, friends.

28. References