Lecture 3: Learning disorders

Question 1

After this lecture students:
* Know why response to intervention (RTI) is important related to diagnosis and prevention of learning disorders
* Have knowledge of the RTI Three-tier model
* Have knowledge of the difference between primary developmental dyscalculia (DD) and secondary dyscalculia
* Know the defining features of developmental dyslexia and dyscalculia
* Have knowledge of the components of dyslexia treatment
* Recognize the social-emotional consequences of learning disorders and how this needs to be treated

Answer 1

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Question 2

Specific Learning Disorder info

Answer 2

(Learning disorders are within neurodevelopmental disorders)

• Prevalence: 5-15% (average worldwide)
• From discrepancy (between level of general abilities and specific learning abilities) to Response to Intervention

Reading disorders: (fully or partially) compromised abilities:
* Word reading accuracy
* Reading rate or accuracy (so it is possible that they read at the same rate, but make a lot of mistakes. or the other way around)
* Reading comprehension (this is not a part of dyslexia!! this is about insight in the story (begrijpend lezen) -> als kids met dyslexia een verhaal horen oplezen begrijpen ze het wel, alleen wanneer ze het zelf lezen)

Question 3

dyslexia in dsm 5

Answer 3

• Persistency of symptoms for at least 6 months, despite specific interventions
• Impairment of single or more abilities, negative effects on school achievement
• Onset in school-age, even if disorder could manifest later (high IQ compensates in primary school, then it could maybe be seen in high school)

two main diagnostic criteria:
1. response to intervention: 3 tiers of intervention (personalized and individualized support for students struggling to learn)
-> so when the kid does not respond to these, we can start to think of interventions.
2. reading and spelling must be substantially and quantifiably below expected level, based on age and influencing academic achievements.
- impairment cut off: 1.5 SD below expected mean
- age of onset: manifestations can change during life, and life long condition
- generally discovered during first years of schooling

Question 4

exclusion criteria for dyslexia

Answer 4

• intellectual disability
• inadequate instruction (didactic deprivation)
• insufficient linguistic proficiency in language used for instruction
• sensory problems (needing glasses)!

Question 5

cross-modal integration

Answer 5

phonological processing <-> letter-speech sound integration -> reading and spelling

Question 6

core deficits in dyslexia

Answer 6

-> Core deficit in dyslexia: disturbance in cross-modal integration of letters and speech sounds, resulting in obstruction of fluent reading

after treatment, the letter-sound connection will become accurate, but automation of cross-modal integration will nót

Question 7

why can dyslectic children also have math problems

Answer 7

dyslexia is a problem of automaticity, which is also important in math

Question 8

children with dyslexia really have to practice a lot, everyday, both at school and at home, even during holidays! otherwas it will decay again

Answer 8

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Question 9

dus wat gebeurt er bij typical readers, en wat doen we bij interventies voor dyslexie

Answer 9

• typical reader: sound (auditory) <-> letter (visual) (automatic, quick, integrated)
• sound <-> sound-symbol (visual) <-> letter (visual)

sound-symbol: visual signs for different word parts (klinker, medeklinker, stomme klank) and you teach them to read words like that

Question 10

intervention together

Answer 10

• Phonological awareness: connection between graphemes and speech sound representations
• Reading fluency: word and text reading -> practicing reading out loud and together (attractive texts to the child, only for 10 minutes, for it to remain somewhat fun because they usually do not like to read. they need support and rewards!)
• Symbols for speech sound categories

Question 11

3 diagnostic elements for at risk children for a specific learning disorder (response to intervention)

Answer 11

1. Screening tests: are the basic prereading skills present
2. Family history of reading/language difficulties (very heritable!)
3. Intervention based on tiered system

Question 12

children are usually motivated, so when parents/teachers say the child is not motivated, there is usually something else going on:

Answer 12

bullying, failing to learn, etc

Question 13

3-Tier model of remedial intervention for learning disorders:

Answer 13

• Tier 1: trained classroom teachers
• Tier 2: additional 1-1 instruction or small groups
• Tier 3: special education classroom (specialized and individualized)

Most common of a variety of multi-tiered models currently in use. Aims at early identification of at-risk children

Question 14

prevalentie kinderen die responden op de tiers

Answer 14

tier 1: 80-90%
tier 2: 5-10% will require this level
tier 3: 1-5% need this, children will go to this when they get a diagnosis

Question 15

tier 1 in details

Answer 15

• assessment and possible modification fo language program
• in a targeted classroom
• teacher must: address the individual needs of all children, including children experiencing early literacy difficulties

Question 16

tier 2 in details

Answer 16

• for children whose literacy difficulties are not resolved by appropriate adjustment to the classroom instructional programme
• intervention in a small group

Question 17

tier 3 in detail

Answer 17

• or children who continue to perform below their peers on measures of literacy development, despite secondary intervention
• more intensive intervention (fewer children in a group, daily 1-to-1 tutoring)

Question 18

all three strategies rely on:

Answer 18

continuous monitoring of student progress as the basis for determining eligibility for a given tier of remedial intervention

Question 19

diagnostic classification is deferred (uitgesteld), pending the outcomes from the different levels of intervention

Answer 19

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Question 20

which is better for diagnosis; iq or rti

Answer 20

rti

Question 21

• One semester of tutoring (Instruction): majority who qualified as disabled reader based on discrepancy criterion reach average scores
• Some require 2 semesters tutoring
• Others: when still below average (so after 2 semesters!) => Are these Dyslexic readers?
• Knowledge at that time or reading difficulties?
• At entrance of kindergarten almost all atypically achieving children identified as at-risk for long term reading difficulties in first grade were:

Answer 21

• Lacking in emergent literacy skills (knowledge of the Alphabet, phonological awareness)
• Exposed to a less than optimal language arts program in kindergarten

So “differential diagnosis” needed: other causes such as bad education need to be excluded

Question 22

causes early reading difficulties

Answer 22

• Causes of early reading difficulties in most beginning readers: primarily experiential and instructional deficits
• Most reading difficulties not caused by basic deficits in reading-related cognitive abilities

Question 23

Response to remedial intervention (RTI): proves to be a more effective and more valid approach to identifying reading disabled children than IQ-achievement discrepancy approach

Answer 23

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Question 24

2 important false diagnostics (wat zijn het en wat zijn de gevolgen?)

Answer 24

1) false positives:
- unduely tax school resources that may be needed for tier 2 and 3
- life long diagnosis: difficult to undiagnose
- possible effects on self-esteem, leading to a self fulfilling prophecy
- effect on the child-teacher interaction

2) false negatives deprive at risk students of the early intervention they need to become reasonably competent readers
- low self esteem when difficulties reading and writing remain
- lower school level
- effect on child-teacher and child-parent interactions

Question 25

social-emotional problems related to dyslexia

Answer 25

- 1/4 sleeping problems - 20% fear of failure - lower self esteem - negative interactions with parents and teachers - 3x more often feelings of anger, distraction, sadness/loneliness, social isolation

Question 26

dyscalculia

Answer 26

* limitations in mathematical understanding: deficit in number sense (bv. mental number line) due to poor approximate number system * in activities that involve problem solving or retrieving mathematical information (number facts)

Question 27

prevalence dyscalculia

Answer 27

3-6%

Question 28

dyscalculia in research

Answer 28

understudied and cognitive causes are poorly understood

Question 29

two types of developmental dyscalculia

Answer 29

* Primary DD: impaired ability to acquire mathematical skills * Secondary DD: math deficits caused by external factors (poor teaching, low socio-economic status, or other developmental disorders as ADHD)

Question 30

defining features of developmental dyscalculia

Answer 30

- Core difficulty: Impaired ability to process numerical magnitudes (e.g., understanding how many items are in a set), which affects the development of arithmetic skills. - Arithmetic fact retrieval: Children with DD often struggle to memorize and recall basic math facts. Instead of retrieving answers automatically, they rely on slow, effortful strategies (like counting). - Problem-solving: They tend to use immature or inefficient strategies that are labor-intensive and less effective. - Cognitive factors: While it's unclear how much general cognitive skills (like working memory or attention) contribute, primary DD seems to occur independently of working memory issues. - Early deficits matter: Some children show specific difficulties at early stages (e.g., number sense or digit understanding), which can disrupt the development of more advanced math skills later on. - Changing profiles: Because difficulties can shift or evolve, it’s important to track persistent deficits over time when diagnosing DD—not just rely on a snapshot. - Possible root cause – Access Deficit Hypothesis: Suggests that DD may stem from an impaired ability to link symbolic numbers (like Arabic digits) to their underlying numerical meaning. This implies the core understanding of quantity is intact, but the connection to symbols is disrupted.

Question 31

neural markers

Answer 31

* Intraparietal sulcus IPS = key brain region involved in processing of numerical magnitude representation * Evidence of atypical brain activation (no distance effect) during nonsymbolic (dus patronen etc, symbolic is 5/five) numerical comparison task * Reduced activation of IPS during mental arithmetic Developmental dysfunction of IPS in DD associated with basic number processing & phenotypic expression of impaired arithmetic skills

Question 32

the difference in countries

Answer 32

depends on the transparency of the language!!! very nontransparent languages: different pronounciation

Question 33

treatment of dyscalculia

Answer 33

- Neuroscientific research helps identify core cognitive processes that need support in children with DD. - Examples of targeted interventions: Graphogame and The Number Race—games designed to improve number comparison skills by requiring children to compare sets of objects. - These tools have been effective in enhancing number-comparison abilities, a foundational math skill. - Limitations: These interventions do not generalize to broader skills like counting or arithmetic. Children tend to only improve in the specific skill trained by the program. - More research is needed to design structured interventions that promote this progression effectively. A better understanding of how foundational skills (like number comparison) scaffold into higher-level math abilities (like arithmetic).

Question 34

general advicees for teachers

Answer 34

- Stepwise introduction of every new arithmetic domain: Material operation Perceptual operation Verbal operation Mental operation - Take into account memory capacity/load - Teach the child only one strategy to solve a math problem - Use strategy cards with intermediate steps - Demonstrate first - do it together – child solves task - Ask the child to verbalize the math strategy (give positive feedback) - Use calculation tools: always use the same at home and at school - Use memory tools like scrap paper, Nmes tables card, etc. - MathsoPware, for example Rekentuin.nl

Question 35

so the needs of children with dyscalculia

Answer 35

* Stepwise instruction for every math domain * Memory support to minimize memory load * Specific, hands-on material for arithmetic operations * Learn one strategy per math problem * Strengthening sense of autonomy and competence by adaptive arithmetic (many math problems correctly solved) * Use of math software to enhance cognitive and social-emotional well-being

Question 36

pygmalion effect

Answer 36

= self-fulfilling prophecy our actions towards others -> impact others -> cause others actions -> reinforce beliefs about ourselfs -> which influence our actions

Question 37

pygmalion effect in learning disorders

Answer 37

* weak link between global self-perceptions and literacy deficit or dyslexia * has a large impact on academic self-concept: is very dependent on the environmental response to their emotions. then the child makes this their own self-worth, and experiences shame and guilt for not achieving their expectations. they use internalizing or externalizing behavior as a coping style. attributional style: internal locus of control is affected, they get passive, they think they need the other to be able to perform surface approach (slamming doors) vs. deep approach (listening, what does he need, what is going on, what are they worrying about) low expectations and negative attitudes from teachers * risk: self-fulfilling prophecy

Question 38

treatment of dyscalculia is much more difficult than treatment of dyslexia, and way less research available. the most effective treatment, just as with dyslexia, is early diagnosis:

Answer 38

the earlier the child gets a diagnosis, the earlier they can learn tools to adapt a new learning process, and the more likely they are to avoid learning delays, self-esteem problems and more serious disorders

Question 39

What does a child with a learning disorder need to psycho-social adjustment and positive self-image

Answer 39

* Close relationships * Social support * Knowledge about their difficulties * Recognition of their success in other areas

Question 40

A Swedish study showed that

Answer 40

* Inclusive schooling improved attitudes and understanding of dyslexia May lead students to: * Make fewer peer comparisons * Focus more on own progress * With positive self-attitudes as a result

Question 41

learning disorders and social-emotional interventions

Answer 41

* Psychoeducation, not only learning disorder but also social-emotional effects (positive attitude towards literacy and highlighting strengths) * CBT (child and parents/teacher) next to LD therapy * Structural consultation with parents and school: working together * Helping the teacher and parents to understand the child’s struggle, but also to help them with their struggle! * Enhancing Locus of Control of child, parents & teachers * Inclusive schooling (also: country wide policy)