1. DSM-IV-TR Criteria for Learning Disorders

2. Prevalence of Learning Disorders

3. Resiliency Factors

4. Types of Learning Disorders

5. Comorbid Conditions

6. Introduction to the Case Study

7. Possible Referral Q’s

8. Red Flags

9. Areas of Evaluation

10. Assessment Framework and Tools

11. Confirming or refuting a Learning Disorder diagnosis

12. Comprehensive Framework of Assessment

Achievement on standardized tests

SUBSTANTIALLY below that expected for age,

schooling, and intelligence

Learning problems SIGNIFICANTLY interfere with

academic achievement/activities of

daily living

If a sensory deficit is present, the learning difficulties must be in

EXCESS

EXCLUSION FACTORS: impaired vision and hearing;

mental retardation; and environmental, cultural and

economic disadvantage

More children in Canada have a learning disorder than all other types of disabilities combined

Of all the children with disabilities in Canada, more than half (59.8%) have a learning disorder

3.2% of Canadian children have a learning disorder

As children make the transition from home to school, the number diagnosed with a learning disorder grows by nearly 25%

More than half a million adults in this country live with a learning disorder

Learning disorders increased considerably between 2001 and 2006

Self-awareness Proactivity

PerseveranceGoal Setting

Presence and use of

effective social support

systems

Emotional Coping

Strategies

CR

ITER

IA A

Reading achievement falls substantially below that expected given age, intelligence, and education

CR

ITER

IA B Disturbance

significantly interferes with academic achievement/activities of daily living that require reading skills

CR

ITER

IA C

If a sensory deficit is present, the reading difficulties are in excess of those associated with the deficit

Symptoms

Problems with attention and concentration

Problems in phonological

awareness

Problems in orthographic awareness

Problems in word

awareness

Problems in semantic/syntactic

awareness

Problems in rapid

decoding

Problems in verbal

comprehension

Problems in pragmatic awareness

When you

see:

Pronounce

as:

q d or t

z m

p b

b p

ys er

a, as in bat e, as in pet

e, as in pet a, as in bat

Passage:

We pegin our qrib eq a faziliar

blace, a poqy like yours enq zine.

Iq conqains a hunqraq qrillion calls

qheq work qogaqhys py qasign.

Enq wiqhin each one of qhese zany

calls, each one qheq hes QNA,

Qhe QNA coqe is axecqly qhe

saze, a zess-broquceq rasuze.

Here is the translation:We begin our trip at a familiar place, a body like yours and mine.It contains a hundred trillion cells that work together by design.And within each one of these many cells, each one that has DNA,The DNA code is exactly the same, a mass-produced resume.

• Prevalence alone/combination with other Learning Disorders is approximately 4 out of 5 cases

Prevalence

• 60%-80% of individuals diagnosed are males

GenderFeatures

• Seldom diagnosed before the end of kindergarten/beginning of 1st grade

• May persist into adult lifeCourse

• Aggregates familially

• More prevalent among first degree biological relatives

FamilialPattern

CR

ITER

IA A

Mathematical ability falls substantially below that expected given age, intelligence, and education

CR

ITER

IA B Disturbance

significantly interferes with academic achievement/activities of daily living that require mathematical skills

CR

ITER

IA C

If a sensory deficit is present, difficulties in mathematical abilities are in excess of those associated with the deficit

Problems mastering basic

mathematical skills

Problems in understanding mathematical terminology

Problems involving perceptual/spatial

processing

Problems with attention

Problems in shifting

Problems in writingProblems in verbal

memory

Consider the two figures shown below.

What shape will result when the plane intersects the three-dimensional object?

Select shape A or B.

Follow all four instructions below to solve each of the three problems. Enter your answer into the chat box.

1. Multiply the third number in the first row by the seventh number in the third row.

2. Add this result to the fifth number in the second row.

3. Add to this total ten times the fourth number in the third row.

4. Subtract the eighth number in the first row from the result.

1 2 3 7 6 5 4 3 2

8 4 3 2 1 6 5 4 8

6 5 5 8 1 7 5 12 6

Course

Seldom diagnosed before the end of

1st grade

Usually apparent during 2nd or 3rd

grade

Prevalence

Difficult to establish

Prevalence alone is approximately one in every five cases

Symptoms

Grammatical/punctuation errors within sentences

Poor paragraph

organization

Multiple spelling errors

Excessively poor

handwriting

Prevalence

• Difficult to establish

• Rare when not associated with other Learning Disorders

Course

• Seldom diagnosed before the end of 1st

grade

• Apparent by 2nd grade

• May be seen in older children/adults

Conduct DisorderOppositional Defiant

Disorder

Attention-Deficit/Hyperactivity

Disorder

Major Depressive Disorder

Dysthymic DisorderDevelopmental

delays in language

AnxietyDevelopmental

Coordination Disorder

Nalia is a grade 3

student

Nalia’s family is of

Sudanese descent

› Adopted at 4 months

English is frequently

used in the home

Since entering Kindergarten, Nalia has

needed additional

support and instruction in all areas of

academics

Academic Referral Q’s

• What are some strategies to teach Nalia how to rhyme and sound out words?

• How can I help Nalia generate ideas for written assignments?

Cognitive Referral Q’s

• Why does it take Nalia so long to start a project?

• What are some ways to help Nalia stay on task and follow directions?

Social Emotional Referral Q’s

• How do I deal with Nalia’s impulsive and inattentive behaviours during homework time?

• How do I deal with Nalia’s occasional display of aggressive and destructive behaviour?

(Sattler & Hoge, 2006)

Family History (mental health,

learning disorder)

Pre and Postnatal

Complications

Developmental Delays (motor,

communication, etc.)

Social and Behavioural

Deficits

Previous Diagnosis

(ADHD, ODD, depression)

Average Intelligence

(Wadsworth et al., 2005; Sattler & Hoge, 2006)

Suspected alcohol consumption during

pregnancy

Unstable family life (early on)

Language delays

› Speaks both English and Dinka

Behavioural problems

Academic difficulties

› Reading, writing, math

Developmental history

Medical history

Family history

Educational history

Behavioural/social functioning

Cultural factors

(Sattler & Hoge, 2006)

Pregnancy/birth› Nutrition

› Stability

Developmental milestones

Medical HistoryHospitalizations

Previous diagnosis

Medication

(Bowen, 2005; Sattler & Hoge, 2006)

Home environment

› Attitude towards education

› Social economic status (SES)

Educational History

Early education experiences

Family verbal interaction patterns

(Hart & Risley, 2005; Lyon et al. 2001)

Behavioural functioning

› immaturity, distractibility, impulsiveness (etc.)

Social interactions

› Social skills deficits

Cultural Factors Attitude towards education

Pedagogical factors

English as a second language (ESL)

(Sattler & Hoge, 2006)

Current Level of Functioning

Health HistoryDevelopmental

History & Milestones

Personality & Temperament

Family History of Learning Problems

Cultural, Peer and other Factors

Questions

TechniquesMeasures

1. When did Nalia’s school performance become problematic?

2. What was initially observed by her parents? By her teachers?

3. What types of strategies have been put into place already? What has been tried?

4. What was Nalia’s response to any interventions and strategies attempted? Was there any noted improvement?

5. What is Nalia’s overall level of functioning in the classroom? Describe her peer relations, relations with staff and other adults.

Clarification of Referral Question

Performance range?

Exclusionary factors?

Sufficiency of Evaluation

Cognitive and achievement evaluation

Attribution of Performance

Revisit exclusionary factors

Justification for Diagnosis

Evaluation of underachievement

• Selection and implementation of intensive interventions

• Formal psycho-ed. assessment

• Implementation of modifications by teacher

• CBM

• Identification of at-risk students

Level 1

Level 2

Level 3

Level 4

Level I-A: normative deficit in academic functioning Level I-B: exclusionary factors for academicdeficit must be ruled out Level II-A: normative deficits in cognitiveabilities/processes Level II-B: exclusionary factors are ruled out for cognitive deficits Level III: establish consistency between specific cognitive deficits and areas of academic Underachievement Level IV: evidence of functional limitations in daily

activities related to the academic deficit

Level III

- consistent below-average aptitude/ability combined;

- broad abilities within the normal range

Level III

- inconsistent ability/achievement relationship;

- general ability within the normal range

Level IV

-interference with academics & functional activities?

Conduct individual standardized testing:› Aptitude tests (e.g., WISC-IV)

› Achievement tests (e.g., WIAT-III, GORT-IV):

› Ability-achievement discrepancy analysis (predicted achievement > simple difference; sig. at p < .05; use a base rate of 10% or lower for severe LD)

› Appropriate processing measures (EVT/PPVT, CTOPP, PAL-II)

Cognitive Assessment

Achievement Measures

Appropriate Process

Measures

Ability-achievement discrepancy

analysis

Cognitive

WISC-IV

WNV

WJ-III COG

WISC IV-Integrated

NEPSY-II

(selected subtests)

Achievement

WIAT-III

WJ-ACH

PAL-II

KeyMath

EVT/PPVT

CTOPP

Psycho-social

BASC-II

Connors

BRIEF

SMALSI

WISC-IV

• Subtest and composite scores for specific cognitive domains

• Composite score that represents general intellectual functioning

WISC-IV

Integrated

• Process subtests

• Verbal and perceptual domains

WNV• Non-verbal cognitive functioning

NEPSY-II

• Attention and executive functioning

WIAT-III• reading, written expression and math

PAL-II

• Phonemic awareness, phonological and morphological processing, written expression

WJ-III

ACH

• Written expression subtests

bl sh dr st ck

the game im talking ABout is Krbys EPuic Yarn i got tHe game At rogers i got it Free becus i won A braw one of tHe reson i lick it is becus Yore a gay Made out oF yarn i beat tHe game A bay Ago My Favorit boss was megawite you Have to grab tHe boms He tHros At you some oF tHe lews you tern into a tank you can sHoot misLs At PePoL My Favorit wepon is tHe SharK you can Eat LeLy FisH i ALmost beAt tHe game. i Aolso LicK it becus its A Frby game thals A new gariter Princ FluF PuFe tHe oBect oF tHe gae is you Have to get All tHe magic Strin And Fix PLabut Poke Land you can youe yore yarn wie to

Number Concepts

• Numeration

• Algebra

• Geometry

• Measurement

• Problem Solving

Operations

• Addition and Subtraction

• Multiplication and Division

Applications

• Foundations of Problem Solving

• Applied Problem Solving

•Externalizing, Internalizing and School Problems

•Attention Problems, Hyperactivity and Learning Problems

BASC-II

• Identification and treatment planning for ADHD – all subtypes

• Identification of comorbid disorders

• (Teacher and Parent forms)

Connors

• Metacognition Index (MI)

• Behavioral Regulation Index (BRI)

• Global Executive Composite (GEC)

• (11-18 years)*

BRIEF

- Study Strategies- Listening Skills- Reading Strategies- Writing/Research Skills- Test-Taking Strategies- Organization- Time Management

Strengths

- Low Academic Motivation

- Test Anxiety

-Concentration/Attention

Difficulties

Liabilities

Learning Disorder Diagnosis

Indicated Results

DeficitsDiscrepancy

Comprehensive

framework for

assessment

A theory-based

operational definition

of LD

A straight forward

decision-making

process.

Flanagan & Mascolo, 2005

• Raymond Cattell, John Horn, and John

Carroll

› Merging of two theories of intellectual abilities

Gf-Gc theory and Carroll’s three-stratum theory

› Cattell

Fluid intelligence (Gf)

Ability to think logically and solve problems using

unfamiliar information or novel procedures

Crystallized intelligence (Gc)

Ability to use skills, knowledge and experiencee

Stratum III

General fact

• Stratum II

• Broad abilities

• Stratum I

• Narrow abilities

• Merging of the two theories of intellectual abilities

• CHC Theory

• A comprehensive and empirically supported psychometric framework for understanding the

structure of human cognitive abilities

Carroll’s Three Stratum Theory

(Flanagan & Mascolo, 2005)

CHC abilities listed at Level 1 of the operational definition of Learning

Disorder

LD area listed in IDEA definition

Grw reading Ga Gs

Basic Reading skills WIAT-III Word Reading

Reading Comprehension WIAT-III Reading Comp.

Math Calculation WIAT –III Numerical Operations

Math reasoning WIAT-III Math Reasoning (Gf, RQ)

Written Expression

(Flanagan & Mascolo, 2005)

Representation of CHC abilities on the Cognitive battery (WISC-IV) used at

Level 11-A of the operational definition of Learning Disorder

Gf Gc Gv Gsm Gs

Picture

Concepts

Similarities Block Design Digit Span Symbol

Search

Matrix

Reasoning

Vocabulary Picture

Completion

Letter-

Number

Sequencing

Coding

Arithmetic Comprehension Cancellation

Information

Word Reasoning

Standard score range Alternative description of performance

131+ Upper extreme/Normative strength

116-130 Above average/Normative strength

85-115 Average range/Normal limits

70-84 Below average/Normative weakness

≤69 Lower extreme/Normative weakness

(Flanagan &Mascolo, 2005)

Decision Based Flow Chart

(Flanagan & Mascolo, 2005)

Level 1-A academic ability analysis

Is performance within the normal limits of functioning or higher?

Level 1-B Evaluation of exclusionary factors

Can performance be primarily attributed to other factors

Level 11-A: Cognitive analysis-Measurement of abilities/processes and learning efficiency

Is performance within the normal limits of functioning or higher

No

No

Yes

Yes

Yes

WIAT-III scores

Reading Composite -1st percentile

Math Composite- 1st percentile

Written Language 3rd percentile

Nalia likes school, attends regularly.

No concerns regarding being sad, anxious, nervous- some behavioural problems at home. Mild difficulties with attention and impulsivity VMI-5 –average range

WISC-IV

VCI-10th percentile

PRI -73rd percentile

WMI- 34th percentile

PSI -23rd percentile

No

Level II B: Re-evaluation of exclusionary factors

Can performance be primarily attributed to other factors?

Level III: Integrated ability analysis- evaluation of underachievement.

Below average aptitude achievement consistency and other broad abilities within the normal limits of functioning or higher

Or

Ability-achievement discrepancy and general ability within the normal limits of functioning or higher

Level IV: Evaluation of interference with functioning

Do the identified deficits significantly interfere with academic achievement or other daily activities requiring these skills (e.g. Reading, writing, math) ?

No

Yes

Yes

No

(Flanagan & Mascolo, 2005)

Learning Disorder

Yes

Nalia’s Learning

Disorder profile

Questions?

Comments?

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.

Bowen, J. M. (2005). Classroom interventions for students with traumatic brain injuries. Preventing School Failure, 49, 34-41.

Flanagan, D. P., & Mascolo, J. T. (2005) Psychoeducational assessment and learning disability diagnosis. In D. P. Flanagan & P. L. Harrison (Eds.), Contemporary intellectual assessment: Theories, tests, and issues(2nd ed., pp.521-544). New York, NY: Guilford Press.

Goldberg, R.J., Higgins, E.L., Raskind, M.H., & Herman, K.L. (2003). Predictors of success in individuals with learning disabilities: A qualitative analysis of a 20-year longitudinal study. Learning Disabilities Research & Practice, 18, 222-236.

Hart, B., & Risley, T. (1995). Meaningful differences in the everyday experiences of young American children. Baltimore: Paul H. Brookes

Lyon, G.R., Fletcher, J.M., Fuchs, L.S., & Chhabra, V. (2006). Learning disabilities. In E. J. Mash and R. A. Barkley (Eds.), Treatment of Childhood Disorders (3rd ed., pp. 512-591). New York: Guilford Press.

Mash, E.J., & Barkley, R.A. (Eds.) 2006. Treatment of Childhood Disorders. (3rd Ed.) Guilford Press: New York, NY.

Sattler, J. M., & Hoge, R. D. (2006). Assessment of children: behavioral, social, and clinical foundations (5th

ed.). La Mesa, CA: Jerome M. Sattler, Publisher, Inc.

Sattler, J. M., & Hoge, R. D. (2008). Assessment of children: cognitive foundations (5th ed.). La Mesa, CA: Jerome M. Sattler, Publisher, Inc.

Statistics Canada. (2006). Participation and activity limitation survey. Retrieved October 18, 2011 from Statistics Canada: http://www.statcan.gc.ca/dailyquotidien/071203/dq071203a-eng.htm

Wadsworth, S. J., & DeFries, J. C (2005). Genetic etiology of reading difficulties in boys and girls. Twin Research and Human Genetics, 8, 594-601. doi: 10.1375/twin.8.6.594

Weschler, D. (2003). Weschler intelligence scale for children. (4th Ed.) San Antonio, TX: The Psychological Corporation.

Weschler, D. (2004). Weschler integrated intelligence scale for children. San Antonio, TX: The Psychological Corporation.

Weschler, D. & Naglieri, J.A. (2006). Weschler nonverbal scale of ability: interpretive and technical manual. San Antonio, TX: The Psychological Corporation.

Weschler, D. (2010). Weschler individual achievement test. San Antonio, TX: The Psychological Corporation.