Transcript Learning Disabilities - גילה קדוש דדון | חינוך

Definitions
Learning
Disabilities
•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
AD(H)D
DSM-IV ADHD ICD-10 HKD
Symptoms
Pervasiveness
Either or both of following:
At least six of nine inattentive
symptoms
At least six of nine
hyperactive or
impulsive symptoms
All of following:
At least six of eight
inattentive symptoms
At least three of five
hyperactive symptoms
At least one of four impulsive
symptoms
Some impairment from
symptoms is
present in more than one
setting
Criteria are met for more than
one setting
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).
Diagnosis
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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)
Growing up with Learning
Disability
Developmental Tasks:
In childhood:
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learning to behave carefully
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cooperate with adults and peers
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communicate effectively
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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:
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Continue Studying
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Find a meaningful job.
• managing a household and finances,
• managing work while nurturing relationships,
• parenting and sustaining partnerships.
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)
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).
Social aspects
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ADHD children tend to have poor peer relationships and are often
rejected by their peers
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Social encounters of students with ADHD are characterized by
rough play compared to typical students.
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Aggression appears to be a solid characteristic for this group of
children. (Zentall, 2005).
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Married adults with ADHD reported poorer overall marital
adjustment and more family dysfunction than control adults.
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 codiagnosis of conduct
disorder than the ADHD-H
subtype.
Psychological variables
Ego 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).
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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.
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Therefore, Self Efficacy influences academic achievements.
(Bandura)
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High school students with LD tended to have lower scholastic selfefficacy than students without LD.
Motivation
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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.
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).
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
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.
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.
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
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.
Peers
• LD children and adolescents are
often lonely and tend to have poor
peer relationships and are often
rejected by their peers.
Treatment Models
• Medications
• Family Intervention
• School Intervention: Academic, Peer
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
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.
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.
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.
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
Integrative Dynamic
Intervention
• Constitutional Treatment :
Medical, Academic, Social
• Holistic, systemic attitude: child,
family, school, friends.
References