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Learning Disorders

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The term "learning disorder" emerged in the 1960s. Ld's Involve significant diffs. in acquisition and use of listening,speaking, reading, writing, reasoning, math abilities or soc. skills.
They are presumed to be due to ______ dysfunction.
The term "learning disorder" emerged in the 1960s. Ld's Involve significant diffs. in acquisition and use of listening,speaking, reading, writing, reasoning, math abilities or soc. skills. They are presumed to be due to CNS dysfunction. LD's may co-occur with other d/o’s or complex environmental influences, but THEY ARE NOT THE DIRECT RESULT OF THESE OTHER DISORDERS OR ENVIRONMENTAL INFLUENCES.
In essence a learning disorder is determined by a ________ discrepancy between an “ought” score (i.e., ______ such as IQ), and “is” score (i.e. _________, such as an academic performance score).
In essence a learning disorder is determined by a significant discrepancy between an “ought” score (i.e., ABILITY, such as IQ), and “is” score (i.e. ACHIEVEMENT, such as an academic performance score).
There is no consensus about what constitutes a significant ______/________ discrepancy.
There is no consensus about what constitutes a significant ABILITY/ACHIEVEMENT discrepancy.
LDs may be due to many factors, including g________, pre- or perinatal ______, other congenital factors, and early brain ______. Remember that they are not exclusively due to _________ factors (e.g. available education).
LDs may be due to many factors, including genetics, pre- or perinatal injury, other congenital factors, and early brain injury. Remember that they are not exclusively due to environmental factors (e.g. available education).
LD studies: _______’s BEAM studies showed bilateral abnormalities in dyslexic individuals, particularly in _______ regions.
LD studies: Duffy’s BEAM studies showed bilateral abnormalities in dyslexic individuals, particularly in frontal regions.
LD studies:Geschwind-- found higher incidence of ________ d/o’s in families w/ a member with LD.
LD studies:Geschwind-- found higher incidence of autoimmune d/o’s in families w/ a member with LD.
LD studies:Geschwind-- found higher rate of LD in [males or females] and ____-handed people.
LD studies:Geschwind-- found higher rate of LD in males and left-handed people.
LD studies: Geschwind-- hypothesized that LD may relate to early _______ influences on brain, delaying development of _____hemisphere, leading to dyslexia and other language processing d/o’s and ______-handedness.
LD studies: Geschwind-- hypothesized that LD may relate to early hormonal influences on brain, delaying development of left hemisphere, leading to dyslexia and other language processing d/o’s and left-handedness.
LD studies: Geschwind-- higher autoimmune d/o frequency reflects concommitant influence of _________ on development of immune system. Follow-up done by ________.
LD studies: Geschwind-- higher autoimmune d/o frequency reflects concommitant influence of testosterone on development of immune system. Follow-up done by Galaburda.
NP model of LDs: Pennington-- Brain functions are _______; i.e. brain systems specialized for processing specific types of info.
NP model of LDs: Pennington-- Brain functions are modular; i.e. brain systems specialized for processing specific types of info.
NP model of LDs: Pennington-- modular brain functions are autonomous in function & neural representation, except for _____ ________; modules differ in _________.
NP model of LDs: Pennington-- modular brain functions are autonomous in function & neural representation, except for exec. fxs; modules differ in vulnerability.
NP model of LDs: Pennington--4 categories of LD sxs:
_______ sxs are core sxs, universal, specific & persistent.
NP model of LDs: Pennington--4 categories of LD sxs:
Primary sxs are core sxs, universal, specific & persistent.
NP model of LDs: Pennington--4 categories of LD sxs: ______ sxs have same etiology, but affects different brain systems.
NP model of LDs: Pennington--4 categories of LD sxs: Correlated sxs have same etiology but affects different brain systems.
e.g. autism & mental retardation: many w/ autism have MR, but MR is not universal to autistic people nor is MR specific to autism
NP model of LDs: Pennington--4 categories of LD sxs: _______ sxs are consequences of 1ary or correl. sxs.
NP model of LDs: Pennington--4 categories of LD sxs: Secondary sxs are consequences of 1ary or correl. sxs.
NP model of LDs: Pennington--4 categories of LD sxs : Artifactual sxs appear assoc. but are not causally related
NP model of LDs: Pennington--4 categories of LD sxs : Artifactual sxs appear assoc. but are not causally related
Pennington posited 5 functional domains that account for nearly all the LDs: phonological processing d/o's involve dysfx in the [left or right] ________ region and may result in ____________.
Pennington posited 5 functional domains that account for nearly all the LDs: phonological processing d/o's involve dysfx in the Lt. Perisylvian region and may result in dyslexia.
Pennington 5 functional domains: executive function deficits may particularly involve the _______ region ; one possible result is ____
Pennington 5 functional domains: executive function deficits may particularly involve the prefrontal region ; one possible result is ADD
Pennington 5 functional domains: spatial reasoning deficits may result from dysfx in the [anterior or posterior] [left or right] hemisphere, and may result in disorders of _____ and/or ______.
Pennington 5 functional domains: spatial reasoning deficits may result from dysfx in the posterior rt. hemisphere, and may result in disorders of math and/or handwriting
Pennington 5 functional domains: social cognition deficits may result from dysfunction in the _______ system, ________ region, and ______ hemisphere; _____ s_______m disorders may result.
social cognition deficits may result from dysfunction in the limbic system, orbitofrontal region, and rt. hemisphere; autistic spectrum disorders may result.
Pennington 5 functional domains: long-term memory deficits may result from dysfx in the _______ and _______, resulting in _______.
Pennington 5 functional domains: long-term memory deficits may result from dysfx in the hippocampus and amygdala, resulting in amnesia.
Review: the perisylvian region includes _________ area in the posterior [left/right] ______ lobe and _______ area in the pre_____ portion of the ______ lobe.
Pennington’s Functional Domains(according to Pennington, account for nearly Review: the perisylvian region includes Wernicke’s area in the posterior left temporal lobe and Broca’s area – in premotor portion of frontal lobe
Pennington’s Functional Domains-- spatial cognition--
fxns in this domain include:
______ localization;
spatial/visual m________; attn. to extra______ space; _______ rotations; ________ contruction
Pennington’s Functional Domains-- spatial cognition--
fxns in this domain include:
object localization;
spatial/visual memory; attn. to extrapersonal space; mental rotations; spatial contruction
Pennington’s Functional Domains--spatial cognition:
several brain regions subserve this fxn, e.g.: generation of visual information – [left or right ] [anterior or posterior]; txfr of info to long-term memory involves the _______ s______, esp [l
Pennington’s Functional Domains--spatial cognition:
several brain regions subserve this fxn, e.g.: generation of visual information – left posterior; txfr of info to long-term memory involves limbic system, esp rt. hem.
contrary to ______ knowledge that grows through lifespan, spatial reasoning peaks in ________ and slowly declines thereafter.
contrary to verbal knowledge that grows through lifespan, spatial reasoning peaks in adolescence and slowly declines thereafter
Executive functions-- developmental considerations:
once seen as developing late in normal brain development
studies now showing important changes from beginning in the first ____ to _____ months; exec fx dev. corresponds roughly to _________ s
Executive functions-- developmental considerations:
once seen as developing late in normal brain development
studies now showing important changes from 6-12 mos.; exec fx development corresponds roughly to Piagetian stages of development
Some of the many d/o’s that include exec. fx. difficulties are: A_____; s____________;
T_______ _________; a________.
Some of the many d/o’s that include exec. fx. difficulties are: ADD/ADHD; schizophrenia;
Tourette’s syndrome; autism.
early treated PKU – children will have ______ IQ but incr. rate of ________ and cognitive problems than controls, esp. in areas involving ______ ________.
early treated PKU – children will have WNL IQ but incr. rate of learning and cog. problems than controls, esp. in areas involving exec fxns
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders: 1st is
verbal processing disorder;
disruption of lang. skills in ________ or _______ modality
includes developmental dys______, dys_______, dys______, spell
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders: 1st is
verbal processing disorder;
disruption of lang. skills in aud. or visual modality
includes developmental dysphasia, dyslexia, dysgraphia, spelling d/o’s, some types dyscalculia;
assoc. w/ dysfx or frank damage to language networks in left hemisphere
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders: nonverbal processing disorder (NLD, NVLD) --probs. in perceiving / producing nonverbal info; most notable in development of ____________ skills; well-developed _____ skill
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders: nonverbal processing disorder (NLD, NVLD) --probs. in perceiving / producing nonverbal info; most notable in development of social-interpersonal skills;
well-developed lang. skills; but difficulties in math, nonverbal and visual-spatial abilities, and attn. May have mood d/o’s. Reflects dysfx in rt. hemisphere networks. [Also possible diffs. with facial recognition, coordination, fine motor, proprioception. Tend to be concrete and have difficulty with social pragmatics.]
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders:
attention deficit disorder (w/ or w/o hyperactivity)--
disruptions of systems of ____________ and/or of ___________/______________; may or may not have an associ
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders:
attention deficit disorder (w/ or w/o hyperactivity)--
disruptions of arousal and/or of attention/concentration;
may or may not have an associated learning disorder; may do well or poorly across the board;
assoc. w/ dysfx in rt. hem and/or bifrontal regions and/or reticular activating system (RAS) that regulates arousal
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders: insight/ judgment/comportment disorder:
disruption of insight, judgment, comportment (e.g. _______ Disorder); difficulty with ________-_________ strategies and learni
Rourke’s 4 Major Syndromes of Developmental Neurocognitive Processing Disorders: insight/ judgment/comportment disorder:
disruption of insight, judgment, comportment (e.g. Conduct Disorder); difficulty with decision-making strategies and learning rules of socially acceptable behavior; stimulus-bound, concrete; poss. reflects poor dev. of frontal networks
Autistic Spectrum Disorder (ASD)--defining characteristics:
developmental d/o in which main symptom is severe deficit in _______ relatedness, emerging ______ in life and persisting into _______; [ration] of ASD population once thought to have MR, ma
Autistic Spectrum Disorder (ASD)--defining characteristics:
developmental d/o in which main symptom is severe deficit in _______ relatedness, emerging ______ in life and persisting into _______; [ration] of ASD population once thought to have MR, may be overestimate; most of those who have Asperger’s Syndrome have normal IQ; male : female ratio = 3:1
Autism vs. Asperger’s Syndrome : autism involves early _______ deficits, poss. ______ giftedness; Asperger’s often the converse; both on the same spectrum (Asperger’s as a kind of “autism plus” per Sally Ozonoff of the Mind Institute); both may
Autism vs. Asperger’s Syndrome : autism involves early language deficits, poss. visual-spatial giftedness; Asperger’s often the converse;
both on the same spectrum (Asperger’s as a kind of “autism plus” per Sally Ozonoff of the Mind Institute); both may have difficulties with executive fxns
Autistic Spectrum Disorder (ASD) etiology unclear – possible heritable; specifically assoc. w/ _____ ___ syndrome and untreated _____; environmental factors may also be involved
Autistic Spectrum Disorder (ASD) etiology unclear – possible heritable; specifically assoc. w/ Fragile X syndrome and untreated PKU;
environmental factors may also be involved
Autistic Spectrum Disorder (ASD)-- brain mechanisms--
neurological basis still unknown in part b/c of debate over what core symptom is; current research suggests dysfxn in _______ system and _______ lobes affecting ______ functioning; diff. with reg
Autistic Spectrum Disorder (ASD)-- brain mechanisms--
neurological basis still unknown in part b/c of debate over what core symptom is; current research suggests dysfxn in limbic system and frontal lobes affecting social functioning; diff. with regulating attention also key to some; enlarged ventricles on scanning indicate cortical atrophy; cerebellar atrophy also shown
ASD-- Theory of Mind:
ability to predict/identify others’ _______ and _______;
[like the "______" part of empathy; empathy involves both cognitive ________ and emotional _______];
seen as core difficulty in ASD
ASD-- Theory of Mind:
ability to predict/identify others’ thoughts, feelings
[like the “insight” part of empathy; empathy involves both cognitive understanding and emotional resonance];
seen as core difficulty in ASD
ASD--treatment: ______ medication contraindicated in some cases of autism; may increase some symptoms such as ________; _________ treatments preferred; wide range of treatments pursued by laypeople that have not been validated
ASD--treatment: stimulant medication contraindicated in some cases of autism; may increase some symptoms such as stereotypies; behavioral treatments preferred; wide range of treatments pursued by laypeople that have not been validated
Dyslexia--basic definition: unexpected difficulty in learning to ____ and _____ – “unexpected” meaning not due to schooling, sensory handicap, acquired brain injury, low IQ e.g.; reading involves visual _____ processes, word _______,
comprehe
Dyslexia--basic definition: unexpected difficulty in learning to read and spell – “unexpected” meaning not due to schooling, sensory handicap, acquired brain injury, low IQ e.g.; reading involves visual perceptual processes, word recognition,
comprehension; dyslexia involves word recognition component due to deficit in use of phonological codes to rec. words
dyslexia-- types of reading errors: ________ refers to slow or halting reading due to decreased automatic ________ skills
dyslexia-- types of reading errors: dysfluency – slow or halting reading due to decreased automatic decoding skills [note: though some dyslexics compensate well by adulthood, this difficulty typically remains when reading aloud]
dyslexia-- types of reading errors: ______ word errors – substitutions on small words such as articles and prepositions
dyslexia-- types of reading errors: function word errors – substitutions on small words such as articles and prepositions
dyslexia-- types of reading errors: ______ word errors – whole word guesses, e.g. misreading “car” for “cat”
dyslexia-- types of reading errors: visual word errors – whole word guesses, e.g. misreading “car” for “cat”
dyslexia-- types of reading errors: _________ errors – when reading nonwords, misreading nonword as a real word, e.g. “bim” being read as “boy”
dyslexia-- types of reading errors: lexicalization errors – when reading nonwords, misreading nonword as a real word, e.g. “bim” being read as “boy”
dyslexia rehash: what are the 4 typical types of difficulties seen?
dysfluency, function word errors, visual word errors, lexicalization errors
Dyslexia-- types of dyslexia: surface dyslexia-- read by well established _______ rules; _____ words read more easily than _____; diff. with ______access; trouble with nonwords; diff. with _____ aspects of word recognition; good _______ skills; poor comp
Dyslexia-- types of dyslexia: surface dyslexia-- read by well established phonological rules; short words easier than long; diff. with semantic access; trouble with nonwords;
diff. with visual aspects of word recognition; good phonological skills; poor comprehension; generally sound language skills; may have some features of Gerstman’s syndrome
Dyslexia-- types of dyslexia: deep dyslexia-- reads _____ words well, esp. nouns; makes many semantic __________s in oral reading (e.g. reading “lamb” and saying “sheep”); reliance on imageability, concreteness, and word frequency; often superior
Dyslexia-- types of dyslexia: deep dyslexia-- reads familiar words well, esp. nouns; makes many semantic paralexias in oral reading (e.g. reading “lamb” and saying “sheep”); reliance on imageability, concreteness, and word frequency; often superior perceptual skills but marked language disabilities
Dyslexia: Types of Spelling Errors: __________ inaccurate errors (e.g., consonants are added, omitted, or substituted); ______ errors (e.g. “bog” for “dog”)
Dyslexia: Types of Spelling Errors: phonetically inaccurate errors (e.g., consonants are added, omitted, or substituted); reversal errors (e.g. “bog” for “dog”)--these used to be viewed as classically indicating dyslexia but are less robust signs than were thought
Dyslexia: Causes, Common Characteristics--both genetic and environmental factors may be involved; common early characteristics include
difficulty learning _____ _______s; generally ok or good at math _________ and _______ tasks but problems with ma
Dyslexia: Causes, Common Characteristics--both genetic and environmental factors may be involved; common early characteristics include
difficulty learning letter names; generally ok or good at math concepts and spatial tasks but problems with math procedures common; spelling and reading aloud often remain difficult even if otherwise well compensating
Often Associated with Dyslexia: slow speed in reading and/or writing; _____/_____ reversals (though often seen in “normals” as well, and sometimes not in dyslexics); diff. memorizing basic math ______; spoken language problems more prevalent, includi
Often Associated with Dyslexia: slow speed in reading and/or writing; letter/number reversals (though often seen in “normals” as well, and sometimes not in dyslexics);
diff. memorizing basic math facts; spoken language problems more prevalent, including early articulation d/o’s; problems with word-finding or memorizing sequences; comprehension diffs. that stem from laboriousness of reading
Sometimes Associated with Dyslexia: diff. ______ directions; ______ speech;
diffs. with self-_____;
diffs. with peer relations; acting out, withdrawal
Sometimes Associated with Dyslexia: diff. following directions; reduced speech;
diffs. with self-expression;
diffs. with peer relations; acting out, withdrawal
Brain Mechanisms Assoc. w/ Dyslexia-- developmental anomaly of _____ hemisphere
involving p_____ t_______, a superior posterior portion of temporal lobe (assoc. w/ _________’s area); differences in whole ______ lobe volume vs. “normals”; poorl
Brain Mechanisms Assoc. w/ Dyslexia-- developmental anomaly of left hem.
involving planum temporale, a superior posterior portion of temporal lobe (assoc. w/ Wernicke’s area); differences in whole temporal lobe volume vs. “normals”; poorly developed corpus callosum--
involves efficiency of interhemispheric info txfr [less validation for this last theory]
Developmental Course of Dyslexia--should be evident by _____ grade; in KG may be evident due to difficulty learning the alphabet; ____ familial concordance
Developmental Course of Dyslexia--should be evident by 1st or 2nd grade; in KG may be evident due to difficulty learning the alphabet; high familial concordance
Asperger's may be mistaken for NLD or vice versa: many sx are in common – some debate about difference b/w the 2 dxs; those with Aspergers may have ____ eye contact, ____ social interest, ____ vocal differences (flat tone, unusual prosody), ____ “odd
Asperger's may be mistaken for NLD or vice versa: many sx are in common – some debate about difference b/w the 2 dxs; those with Aspergers may have worse eye contact, less social interest, more vocal differences (flat tone, unusual prosody), more “odd-seeming” qualities, more restricted interests
NLD-like presentation may also result from varied neurological disorders, or genetic disorders (e.g. ________ syndrome)
NLD-like presentation may also result from varied neurological disorders, or genetic disorders (e.g. Williams syndrome)
ADHD--Barkley: disorder of ______ attn., lack of behavioral _______, and deficits in _____ functions; ADHD is a ________dx
ADHD--Barkley: disorder of sustained attn., lack of behavioral inhibition, and deficits in executive functions; ADHD is a behavioral dx
ADHD--Barkley: study examining validity of ADHD measures; generally able to discriminate children with ADHD from _______ (i.e. sensitive), but not as good at discriminating from other clinical groups (i.e. not _________-- many questionnaires load on fact
ADHD--Barkley: study examining validity of ADHD measures; generally able to discriminate children with ADHD from “normals” (i.e. sensitive), but not as good at discriminating from other clinical groups (i.e. not specific-- many questionnaires load on factors assoc. w/ LD)
ADD & ADHD -- Neuroanatomy: areas of dysfunction incl. fronto-________ pathways, c_________; Inattention issues thought linked to p_________ cortex as well as rt. _____ lobe
ADD & ADHD -- Neuroanatomy: areas of dysfunction incl. fronto-subcortical pathways, cerebellum; Inattention issues thought linked to prefrontal cortex as well as rt. parietal lobe
ADD/ADHD-- neurotransmitters: Thought to be problems with levels of ____________ and _______(NTs targeted by psychostimulants and Strattera)
ADD/ADHD-- neurotransmitters: Thought to be problems with levels of norepinephrine and dopamine(NTs targeted by psychostimulants and Strattera)
Assessment of LDs—General: rule-out considerations include m______ d/o, s________ deficits, primary p____________ illness, s_________ or e_______deficit, mental __________; consider complicating factors if English is [ ]
Assessment of LDs—General: rule-out considerations include mood d/o, sensorimotor deficits, primary psychiatric illness, social/educational deficit, MR; consider complicating factors if ESL
Epidemiological surveys suggest as many as [ratio] of boys and [ratio] of girls are described as inattentive by their teachers
Epidemiological surveys suggest as many as one-half of boys and 1/4 of girls are described as inattentive by their teachers (i.e., relatively common in normal children)
Serious attentional deficits occur in [%ile range] of school-age children
Serious deficits occur in 3-10% of school-age children (i.e., most prevalent of all childhood neuropsychological disorders)

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