Neurodevelopmental Disorders: Lecture 3: Specific Learning Disorder

1. Difficulties learning/using academic skills, despite interventions, indicated by on of the following symptoms (which has persisted for at least 6 months):
a. inaccurate/slow/effortful word reading
b. difficulties understanding the meaning of what is read
c. difficulties with spelling
d. difficulties with written expression
e. difficulties mastering number sense, number facts, or calculations
f. difficulties with mathematical reasoning (applying mathematical thinking)

2. Affected academic skills are below what is expected for individual's chronological age, interfere with academic/occupational performance, or daily living activities, as documented by a standardized assessment (17 years and older can sub assessment with documented history of impairment.

3. Learning difficulties begin during school-age but may not manifest until academic demands outweigh ability/capacity.

4. Learning difficulties are not better accounted for by intellectual disabilities, uncorrected visual/auditory acuity, mental/neurological disorders, psychosocial adversity, lack of language knowledge, lack of adequate instruction.

The four criteria are determined based on clinical review of medical, family, educational and developmental history. School reports and psychoeducational reports are reviewed.

Specify all academic domains ans subskills impaired. If more than one domain is impaired , code and specify: Specific learning Disorder
1. with impairment in reading: accuracy/fluency/comprehension
2. with impairment in written expression: spelling/grammar and punctuation/organization and clarity of written expression
3. with impairment in mathematics: number sense/memorization of arithmetic facts/math reasoning

Dyslexia is an alternate term referring to patterns of reading difficulties with: word recognition, decoding, spelling abilities. If specifiers include other difficulties, they must also be included.

Dyscalculia is an alternative term referring to a pattern of mathematical difficulties with: numerical info, arithmetic facts, calculations. If specifiers include other difficulties, they must also me included.

Specify current severity:

Mild- some difficulties learning skills in one or two academic domains- may be able to function well with accommodations.

Moderate- Marked difficulties learning skills in one or more academic domains in which individual cannot become proficient without intense intervals of specialization- some accommodations/support services throughout the day.

Severe- Severe difficulties learning skills affecting several academic domains; individual is unable of learn those skills without intensive individualized support throughout school years, even with support- individual may not be successful.

+Neurodevelopmental disorder with biological origin ( interactions of genetic, epigenetic, environmental with brain's ability to process information)

+ (core feature) Persistent difficulties learning keystone academic skills with onset during formal schooling

+Keystone academic skills include: reading of single words accurately/fluently, reading comp., written expression/spelling, arithmetic calculations, and mathematical reasoning.

+ SLD disrupts learning, not just a consequence of inadequate edu.

+ Dyslexia (difficulty mapping letters with sounds- to read printed words) is the most common manifestations of SLD.

+ (core feature) Learning difficulties are persistent (restricted progress in learning)- not transitory

+ Manifested difficulties are observable, attained clinically, through school reports, or through assessments.

+ Performance of affected skill is below average for the individual's age.

+ Indicator (especially in adults): Avoidance of activities which require skill.

+ (core feature) Learning difficulties are apparent in early school years for most individuals (later is possible as learning demands increase)

+++Comprehensive assessment required: clinical,educational,assessments, observations...

1. SLD are not related to intellectual disabilities, global developmental delay, hearing/vision, or neurological/motor. + SLD affects learning in individuals who otherwise reflect normal intellectual abilities; even individuals considered gifted.

2. SDL can not be attributed to external factors (economic disadvantage or lack of education.

3. SLD cannot be attributed to neurological/motor/vision/hearing disorders.

4. SLD may be restricted to one academic domain or even one skill (ex: reading single words).

+(Invariably) proceeded in preschool years by delays in attention, language, and motor
+Uneven abilities are common: (example)Above average drawing, design and spacial with effortful/poor reading and writing skills/comprehension
+Cognitive processing deficits may co-occur but are not required for diagnostic assessment
+Increased risk for ideation and suicide attempts
+ No known biological markers

+SLD across the academic domains of reading, writing and mathmatics is 5-15%among school age children. Among adults: 4%

+Onset, recognition, and diagnosis of SLD usually occurs during elementary school years when children are required to read, write, spell and learn mathematics.
+Precursors such as language delays, difficulty rhyming, counting, and with fine motor skills are common before formal schooling.
+ Precursors may also be behavioral
+SLD is lifelong- persist until adulthood
++but the expressions are variable (may change with age), depending on demands of the environment, severity, range of disabilities, availability of services

Preschool: Lack of interest in nursery rhymes or language games/trouble remembering letters, numbers, days of the week/failure to recognize letters in name or to count.

Kindergarten: Unable to recognize and write letters, their own name, make up spelling, difficulty understanding syllables and rhyming words, difficulty connecting letters to sounds.

School-age: Marked difficulty learning letter sounds correspondence, word decoding, spelling, math and reading aloud is difficult.

Adolescents: May have mastered word decoding, yet reading is effortful, reading comprehension and written expression may be a problem.

Adults and adolescents may avoid work or leisurely tasks which involve reading/writing/math tasks.

+Environmental- Low birth weight, prenatal nicotine
+ Genetic and physiological- appears to aggregate in families

+Occur across cultures but manifest differently depending on the culture's use of symbols, writing, and numbers.
+ Second language learners need to have their native language development taken into account

More common in males in females

+ Lower academic attainment, higher rates of high school drop outs, lower rates of post secondary education, high levels of psychological distress, poorer mental health, higher unemployment, lower income

+Normal variations in academic attainment-distinguished due to external factors (poor education, instruction)
+Intellectual disability (SLD differs because the learning deficits occur in conjunction with normal learning)
+Learning difficulties due to neurological or sensory disorders
+Neurocognitive disorders(Findings based on neurological exams, which are not necessary for SLD)
+Attention-deficit/hyperactivity disorder (AD/HD does not always reflect difficulty in learning)
+Psychotic disorders (with these disorders there is a decline in functional domains)

+Commonly co-occurs with neurodevelopmental disorders and/or other mental disorders- often making diagnoses of SLD more difficult.

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or affect; to failure or initiate or respond to social interactions.
2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye contact and body language or deficits in understanding and use of gestures; to a total lack of facial expressions and nonverbal communication.
3. Deficits in developing, maintaining, and understanding relationships, ranging, for example, from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing imaginative play or in making friends; to absence of interest in peers.

severity is based on social communication impairments and restricted, repetitive patterns

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor stereotypes, lining up toys or flipping objects, echolalia, idiosyncratic phrases).
2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns of verbal or nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid thinking patterns, greeting rituals, need to take same route or eat same food everyday).
3. Highly restricted, fixed interests that are abnormal in intensity or focus (e.g., strong attachment to or preoccupation with unusual objects, excessively circumscribed or perseverative interests).
4. Hyper - or hypo activity to sensory input or unusual interest in sensory aspects of the environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

1. Severity is based on social communication impairments and restricted, repetitive patterns of behavior.
2. Symptoms must be present in the early developmental period (but may not become fully manifest until social demands exceed limited capacities, or may be masked by learned strategies later in life).
3. Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
4. These disturbances are not better explained by intellectual disability or global developmental delay. Intellectual disability and autism spectrum frequently co-occur; to make cormorbid diagnosis of autism spectrum disorder and intellectual disability, social communication should be below that expected for general developmental level.

1. with or without accompanying intellectual impairment
2. with or without accompanying language impairment
3. associated with a known medical or genetic condition or environmental factor
4. associated with another neurodevelopmental, mental, or behavioral disorder
5. with catatonia

Pervasive Developmental Disorders (PDD) were done away with. The specific terminology of the artificial distinctions were tossed and a spectrum of disorders in terms of functionality is now termed Autism Spectrum Disorder (ASD).

1. children vary in intellectual impairments; many will show language impairment.
2. average or high intelligence will still be uneven in their skills and capacities
3. there is a gap between intelligence and what they can do with it.
4. autism is comorbid with anxiety and depression and may also be cataonia as well.
5. onset is between 12 and 24 months
6. it is not progressive (does not get worse with time)
7. first indication is lack of interest in social interaction
8. early onset has a worse prognosis than late onset
9. large genetic component as high as 90%
10. still not certain if there are gene markers for autism
11. people's genetic make-up is too complex to make a one to one relationship.

1. males are 4 times more likely than females to be autistic.
2. when a female is diagnosed, they are more likely to have intellectual impairments
3. this suggests females have better social skills than males to mask the presence of autism