Transcript Introduction

An Introduction to
Specific Learning Difficulties in
Adults
Specific Learning Difficulties/Differences (SpLD)
Neurodevelopmental conditions that affect the individual’s abilities to
learn in normal contexts by traditional methods
Discrepancy between the individual’s general intellectual abilities and their
abilities in certain areas of learning or under certain circumstances
Distinct from global learning difficulties
SpLD arise from processing differences rather than intellectual impairment
Specific Learning Difficulties/Differences (SpLD)
Dyslexia (dyscalculia, dysgraphia)
Developmental dyspraxia/developmental coordination disorder (DCD), motor and
co-ordination difficulties
Visual and auditory processing difficulties
Attention deficit disorder with or without hyperactivity (ADD/ ADHD)
Autism/Asperger Syndrome
Tourette Syndrome/obsessive compulsive disorder (OCD)
More than one SpLD may occur or SpLD may overlap in the same person.
In adults, SpLD may be undiagnosed
Dyslexia and SpLD
Dyslexia may be the most common SpLD but may also result from, occur along
with or be misdiagnosed for one of the other conditions. Equally, other specific
learning difficulties can cause difficulties with reading writing or number skills.
Unexpected difficulties with reading and writing will be detected in school and, because
dyslexia is widely understood to affect literacy acquisition, may lead to dyslexia
assessment and diagnosis.
Other SpLD, such as dyspraxia, Asperger Syndrome or ADHD may be underrecognised because indications are less visible/less well known and conditions may
dismissed as behavioural problems.
Detection and labelling of SpLD
SpLD are “hidden” difficulties with no obvious visible signs and coping strategies and other abilities
can further mask SpLD.
Difficulties can range from mild through moderate to severe.
SpLD can be considered as a spectrum of neurodevelopmental differences
that share certain features, grade into each other and often co-occur.
Many SpLD are syndromes: detected and defined by clustering of characteristics, most of
which, in isolation, are part of ‘neurotypical’ behaviour.
Genetic links – conditions tend to run in families.
SpLD are assessed and defined by these clusters of characteristics rather than by
genetics, brain scans etc.
Diagnostic and Statistical Manual of Mental Disorders (DSM)
DSM IV: Oppositional Defiant Disorder
If a child's problem behaviors do not meet the criteria for Conduct Disorder, but involve a pattern of defiant, angry,
antagonistic, hostile, irritable, or vindictive this mental disorder of childhood may be diagnosed. These children may blame
others for their problems.
Diagnostic criteria for 313.81 Oppositional Defiant Disorder
(cautionary statement)
A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the
following are present:
(1) often loses temper
(2) often argues with adults
(3) often actively defies or refuses to comply with adults' requests or rules
(4) often deliberately annoys people
(5) often blames others for his or her mistakes or misbehavior
(6) is often touchy or easily annoyed by others
(7) is often angry and resentful
(8) is often spiteful or vindictive
Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of
comparable age and developmental level.
B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.
C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.
D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial
Personality Disorder.
Neurodiversity
SpLD conditions are considered by some to be a social construct – there is
no measure of divergence other than what’s considered to be “normal”.
They say brain differences, like body differences, should be embraced, and
argue for an acceptance of ''neurodiversity.'' AMY HARMON, New York Times: May 9,
2004
It’s possible to respect individual differences and still acknowledge that SpLD
make learning more difficult in traditional contexts.
“I’m different – the same as everybody else.”
The adult learning worker’s role is not to “cure” or change differences, but to
assist/enable learners to achieve their potential by helping overcome
barriers to learning that these conditions present.
The Bagatelle Model of SpLD
http://www.youtube.com/watch?v=41gCL4StyH0
The Bagatelle Model of SpLD
Combination of slots = a ‘syndrome’
Predisposed but not predetermined (a core
difference influenced by experience?)
Core difference being a processing difference
– holistic or sequential
Related to working memory
Same core difference with lots of overlaps
Not ‘something wrong with people’
Overlapping conditions
http://www.dystalk.com/talks/57-dyslexiadyspraxia-amp-overlapping-learning-difficulties
Short term memory
Copy down all the numbers
Short term memory
Copy down all the numbers
Dyslexia
Discrepancy between intellect and the ability to learn literacy
Difficulties with pronunciation or ‘getting the right word out
Organisation difficulties
Timekeeping and directions may be problematic
Forgetting instructions and generally poor short-term memory
Sequencing difficulties
Family history of similar difficulties
Possibly difficulties with co-ordination
Unusual learning styles or coping strategies
Low self esteem is common
Air of distraction
Dyslexia
http://www.nhs.uk/conditions/dyslexia/Pages/
Introduction.aspx
Dyscalculia
May be similar to dyslexia but with interpretation of number instead of, or as well as
reading/writing.
Note that abilities to carry out calculations may be limited by other SpLD (e.g learning
multiplication tables may be more a language task than a number task; distinguishing
between symbols requires visual perceptual skills; short term memory is needed for
mental arithmetic).
Limited research into dyscalculia.
Dysgraphia
More than simply bad handwriting – it is difficulty in automatising motor movements.
Writing skills that are substantially below those expected given the person's age,
measured intelligence, and age-appropriate education. May occur along with other
SpLD.
Little research into developmental dysgraphia.
Dyspraxia (Developmental Coordination Disorder)
Poor gross motor coordination: clumsiness, poor balance/posture; floppy joints
Accident prone – falling over, bumping into things
Poor fine motor coordination: handwriting difficulties, poor grasp and manipulation
Visual tracking may be a problem in reading
Hypersensitivity to touch, taste, temperature etc
Time management, organisation and directional difficulties
Poor short term/working memory; forgetful, easily distracted
May be messy
http://www.youtube.com/watch?v=1tvrWH4EJmw
http://www.youtube.com/watch?v=say3psC9fp0
ADHD (HD and ADD)
Behavioural disorders with childhood onset – usually before the age of 7 but onset
at puberty is also recognised.
HD
Individuals display at least 6 features of hyperactivity and impulsivity including
fidgeting, tapping, restlessness, excessive talking, interrupting others.
ADD
Individuals display at least 6 features of inattention, including difficulties in finishing
tasks, listening, giving attention to details; makes careless mistakes; may be
forgetful and easily distracted.
ADHD
6 or more symptoms of inattention and 6 or more symptoms of hyperactivityimpulsivity
Symptoms need to be present for 6 months or more and need to be present in 2 or
more settings (e.g. home and school).
http://www.youtube.com/watch?v=SMikx-vjgKc
http://www.youtube.com/watch?v=WcVTiV47Gf8
Visual and visual processing difficulties
Might be seen as SpLD because they can make learning more difficult and yet are
unrelated to intellect, education or social factors.
Standard eye examinations are not designed to check for reading efficiency.
What is seen is processed into meaning in the brain and it is possible to have excellent
eyesight but still have difficulties with perception of reading material.
Efficient reading and reading comfort requires an amount of stamina in the visual
system to sustain functions over time: processes may function adequately for the
purposes of an eye examination but may fatigue too quickly for continuous reading.
Problems in the vision system can have serious effects on reading, literacy and
learning in general.
http://www.youtube.com/watch?v=uMXQAr6oP-o
Auditory processing difficulties
Auditory processing is the process of changing sound into meaning – which takes place in
the brain rather than in the ear.
Not a hearing impairment and may not be detected in a standard hearing test
Can cause difficulties in understanding what is being said
Can cause difficulties in relating sounds to written language and can result in literacy
difficulties.
Can be mistakenly diagnosed as other SpLD conditions
Is often associated with dyslexia
It is relatively unusual for an adult to have a positive diagnosis for auditory
processing difficulty and therefore it’s important that those working with adults with
literacy difficulties are aware of indications.
http://www.youtube.com/watch?v=5xQE2qMVt5M
Auditory processing difficulties
difficulties in distinguishing between similar phonic sounds (auditory discrimination)
problems recognising words in noisy environments
missing pieces of spoken information
easily distracted by noise
difficulties in following sequences of oral information
problems with locating the direction of sounds
difficulty interpreting degraded sounds
taking longer to process oral information
difficulties with writing while listening
poor memory for sounds and oral information
poor attention with oral information
history of childhood ear infections (glue ear)
asking for information to be repeated and generally poor listening skills
Autism/the autistic spectrum:
(Autism/Asperger Syndrome/Pervasive Developmental Disorder – Not Otherwise
Specified – PDD-NOS )
Triad of impairments:
1 of social interaction (relationships)
2 of communication (verbal/non-verbal)
3 of imagination (restricted interests and repetitive behaviour)
Autism: early language impairment/Asperger’s: no early language impairment
By definition, those with Asperger Syndrome have normal or above normal intellect, however,
assessing intelligence in those with autism is problematic by standard IQ measures estimates of low intellect in those with autism vary so much as to be unhelpful (25%-75%
Dawson M, Mottron L, Gernsbacher MA (2008))
Scatter skills; highly focused on interests and details;
difficulties with generalisation, literal interpretations;
disinterest in areas that don’t affect the individual directly.
stress in social situations; lack of social skills/difficulty with social “rules” and norms;
non-verbal communication (eye contact; body language cues).
Theory of mind – empathy http://www.youtube.com/watch?v=QjkTQtggLH4
Robyn http://www.nhs.uk/Conditions/Autistic-spectrumdisorder/Pages/Robynsstory.aspx
Dave http://www.youtube.com/watch?v=WAfWfsop1e0
Tourette Syndrome and Obsessive Compulsive Disorder (OCD)
Both are characterised by repetitive behaviour.
Tourette’s is a tic disorder while OCD is an anxiety disorder (they may occur
together)
Tourette’s is characterised by recurring involuntary tics (motor and/or vocal) that
have no purpose. Tics are “suppressible but irresistible”
Repetitive behaviour in OCD is disabling but purposeful.
Obsessive thoughts cause the anxiety (such as fear of germs) compulsive
behaviour (such as washing) relieves the anxiety. The OCD sufferer will be aware
that the behaviour is unreasonable (otherwise the behaviour would be psychotic).
OCD may be treated by Cognitive Behavioural Therapy (CBT).
What is Tourette's? http://www.youtube.com/watch?v=hNSHLOI_aU&feature=related
Summary
SpLD co-occur, overlap and share so many common features that labelling, based on
behaviour is difficult – the labels themselves may be artificial.
Even within specific labelled conditions, degree of difficulty and profile of problem areas
will vary between individuals.
Many adults with SpLD will never have had an assessment or diagnosis for any
condition, but may have difficulties achieving their potential in learning or workplace
because of unrecognised processing differences.
It is therefore better to work with the individual’s needs and abilities, making
adjustments for problem areas rather than looking for a single approach to work with a
labelled condition.
Adjustments will need to account for working memory difficulties, organisational and
coordination difficulties, learning preferences, learning or work environment issues and
physical issues such as stamina and fatigue.