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Paul Beljan, PsyD, ABPdN, ABN9835 E. Bell Rd., Ste. 140

Scottsdale, AZ 85260(602) 957-7600

[email protected]@BeljanPsych

http://motorcognition2.com/

9/24/17Paul Beljan (602) 957-7600

DIFFERENTIAL DIAGNOSIS AND LEARNING DISABILITIES: A LOGICAL APPROACH TO

UNDERSTANDING COMMONLY MISDIAGNOSED FEATURES IN CHILDREN

9/24/17Paul Beljan (602) 957-7600

9/24/17 Paul Beljan (602) 957-7600

TOPICS

9/24/17Paul Beljan (602) 957-7600

�Short Term Memory�Processing Speed�Auditory Processing�Sensory Integration�Oppositional Defiant Dx�Fine Motor Deficit

q Learning Disabilities –How They Are Overlooked o Discrepancy Model Wrongso Dyslexiao Dyscalculiao Dysgraphiao LD (NOS) – EFD/PAC

BASE RATESqPhysicians use base rates as a statistical model of clustering

symptoms and factoring them against the age, gender, weight, etc., of their patient to quickly reduce many possible diagnoses down to a few likely diagnoses. o Base rates reduce the number of costly tests used

o Base rates speed the efficiency of diagnosing

o Base rates reduce error variance in diagnosing.

o Ex. Sometimes more information does not provide additive value, but clouds the issue.

9/24/17Paul Beljan (602) 957-7600

SHORT TERM MEMORY

Ø If a child never had a severe blow to the head, became asphyxiated, or had any other birth injury or disease process involving the brain, then what would be the likelihood of them having a short term memory deficit?

�The answer is nearly zero.

9/24/17Paul Beljan (602) 957-7600

�First, consider how significantly impaired a child would be if he had a short term memory deficit.

�Learning would be completely impaired.

SHORT TERM MEMORY�You cannot fake a skill if you do not have it.

�If a child can perform well on only one encoding task, they do not have a short term memory deficit; because how could a child do well on any task of encoding if they have a short term memory deficit? They could not.

�When this is determined, then the door is opened to look at what causes a child to seem like they have a short term memory deficit when in fact they do not.

9/24/17Paul Beljan (602) 957-7600

SHORT TERM MEMORY

�One must pay attention to information meant for encoding in order for that information to be encoded into short term memory.

�Gifted children are often bored in class or taken with their own entertaining thoughts.

�When information is not encoded then the result is a child who seems to have a short term memory problem, when the child actually was not listening or was distracted.

9/24/17Paul Beljan (602) 957-7600

PROCESSING SPEED

David Letterman “Top 10 List”:

How do you know you have a dumb dog?

There is a long delay between Bow and Wow.

9/24/17Paul Beljan (602) 957-7600

PROCESSING SPEED

What are we really talking about when we say SPEED?� NEURONAL COMMUNICATION?� BEHAVIOR?� PERFORMANCE/OUTCOME?

9/24/17Paul Beljan (602) 957-7600

Once defined, how do we measure speed?� Magnetoencephalogram� Stop watch

� Observe

9/24/17Paul Beljan (602) 957-7600

PROCESSING SPEED

PROCESSING SPEED

�The WISC V - Processing Speed Index (PSI).

�Symbol Search�The child is instructed to make cancellations quickly and

accurately within a prescribed paradigm.

�The task is simple and does not load working memory because each cancellation stimulus is novel.

�No errors should occur as the answers are in front of the child.

9/24/17Paul Beljan (602) 957-7600

PROCESSING SPEED�The WISC V - Processing Speed Index (PSI).

�Coding

�The child is instructed to quickly and accurately make novel number and symbol blends on paper.

�This is a complex working memory task.

�The task actually measures learning automaticity (incidental learning)

9/24/17Paul Beljan (602) 957-7600

PROCESSING SPEED

Some children have an idiosyncratic approach to these tasks. � Double checking work on SS and Cd causes the child to earn correct

responses, but less of them, ultimately rendering a lower score.

� The lower score is often incorrectly misinterpreted as slow processing speed.

� Some children work very fast at the cost of accuracy.

� The higher score is a false positive finding.

� Frequent attention errors and dislike for paper and pencil tasks also can cause lower scores not attributable to speed.

The examiner should use qualitative observation along with the scaled scores to interpret the test.

9/24/17Paul Beljan (602) 957-7600

�Closely evaluate the WISC V Block Design subtest.� Block Design provides red and white blocks for the child to quickly put together

to match a design displayed in a stimulus book. The test starts by allowing 30 seconds to complete a task and moves to 120 seconds to complete the more difficult items. The child can earn bonus points for speed.

� Children frequently yield fast BD times (under 10 seconds) on the 45 second items.

� Children earn bonus points for fast completion on the more difficult 120 second items.

� Low scores on SS or Cd and high scores on BD rules out a cognitive speed deficit, and vice-versa.

9/24/17Paul Beljan (602) 957-7600

PROCESSING SPEED

AUDITORY PROCESSING

� APD is commonly questioned by parents APD has numerous definitions.

�Most consistently it means the physical elements of the outer and inner ear function, but the child has difficulty processing and making sense of how language sounds in their head.

9/24/17Paul Beljan (602) 957-7600

APD is most frequently diagnosed by audiologist.

�An audiology evaluation has the child try and identify a given sound while a competing sound is presented.

�An audiologist only looks at the child through the framework of audiology scores and does not do other standardized testing or consider other issues that could cause this problem.

9/24/17Paul Beljan (602) 957-7600

AUDITORY PROCESSING

AUDITORY PROCESSING

�Think about how impaired one would be across all of life with APD.

�Think about how low the odds are that this would occur when family history disease and brain injury, etc. are ruled out.

9/24/17Paul Beljan (602) 957-7600

AUDITORY PROCESSING�A disorder called ‘misophonia’, also known as phonophobia, exists.�Misophonia disorder has been described as an extreme negative

reaction to background noise, and not simply annoyance or distraction. �The mechanisms behind the disorder are not known (Green 2002), and

this is not what most people consider APD.�One can determine this problem by standing behind a child and stating

a line from a poem or nursery rhyme while the child plugs one ear. If the child processes the line better in one ear versus the other, then simply using one earplug can significantly help the issue.

qBonus caveat: Ever meet an adult with APD?9/24/17Paul Beljan (602) 957-7600

�In my experience, children with ADHD are easily misdiagnosed with APD.

�The audiology method of testing with competing sounds plays against anyone with ADHD.

�APD more often than not is a receptive language disorder or ADHD.

9/24/17Paul Beljan (602) 957-7600

AUDITORY PROCESSING

SENSORY INTEGRATION

�Sensory Integration Disorder (SID)

�Many prominent neuropsychologists concur:�SID basically means the child’s sensory system is working

well, but their frontal lobe (i.e., thalamo-cortical loop, neostriatal, basal-ganglia, and cerebellar circuitry) mediation of the subcortical sensory stimulus has not developed to the extent that it can be put in the background of experience.

�In other words, the child cannot yet inhibit/modulate sensory experience; it does not mean the sensory system is impaired (Koziol 2010 & 2011).

9/24/17Paul Beljan (602) 957-7600

SENSORY INTEGRATION

�Why does treatment help?�Because the sensory system is already working well. �SID tx feels really good.�SID tx yields a temporary response.�The px comes back fast

�The px resolves with time and higher cortical development (i.e., inhibitory control)

�Bonus caveat: Ever meet an adult with SID?

9/24/17Paul Beljan (602) 957-7600

OPPOSITIONAL DEFIANT DISORDER

�ODD is made, not born.

�Good home; food; warm bed; hugs and told, “I love you.”

9/24/17Paul Beljan (602) 957-7600

OPPOSITIONAL DEFIANT DISORDER�Does the dx exist across environments?

� School only?� Home only?

�Is the child overly indulged for intellect?

�Has the child been assisted to develop a full identity that does not stand solely on intellect?

�Are inappropriate behaviors overlooked and justified as high intellect?

�Sports figure Narcissism

9/24/17Paul Beljan (602) 957-7600

OPPOSITIONAL DEFIANT DISORDER

�Children asynchronous development (AD) and/or ADHD cannot reliably express working memory, inhibition, and sustained attention for as long as they want and whenever they want, and their variable expression causes a ‘Swiss cheese’ effect in academic and behavioral performance.

�These children often are identified as willful or oppositional because when they are experiencing an ‘AD or ADHD moment’ and their working memory, inhibition, and sustained attention is undermined, they cannot execute a previously expressed skills, and that looks willful.

9/24/17Paul Beljan (602) 957-7600

�In my experience, nearly every child who has been seen in my practice who carried the diagnoses of ODD, APD or SID, in actuality had ADHD-inattentive type or Asynchronous Development. �When those issues were treated, the symptoms of ODD, APD

and SID were significantly reduced.

9/24/17Paul Beljan (602) 957-7600

WHEN DISORDERS ARE NOT DISORDERS:�My solution is that a pediatric neuropsychologist who is versed in

giftedness should be consulted when parents have questions of short term memory, speed, auditory processing, sensory integration issues, or oppositional defiant disorder.

�A pediatric neuropsychologist looks at all elements of functioning as opposed to individuals who specialize in one area and tend to only look for and find issues within their wheelhouse of knowledge.

�It takes a whole brain to function, so the whole brain should be evaluated to rule out erroneous diagnoses.

9/24/17Paul Beljan (602) 957-7600

LEARNING DISABILITIES

�Why discrepancy model is wrong�Reading/Spelling (Dyslexia)�Math (Dyscalculia)�Hand Writing (Dysgraphia)

9/24/17Paul Beljan (602) 957-7600

THE DISCREPANCY MODEL (DM)

• IQ is 23 points (1.5 standard deviations) above achievement scores

• The child functions two grade levels below placement

• Led to most children in USA not receiving specialized reading remediation until 3rd grade because you cannot get two grade levels below 1st or 2nd grade.

�Bush II era replaced PL 94-142 with IDEA, which rang in teaching to the AIMS test

9/24/17Paul Beljan (602) 957-7600

PROBLEMS WITH DM�There is no agreement on what the discrepancy should be

�FSIQ, VCI, PRI, NVI or Quan.�Word reading, spelling, comprehension, thinking (EFD) or math

�Schools obfuscate DM data to their advantage� If you beat discrepancy = no service� If you fail IQ/Ach discrepancy, but are within two grade levels of

placement = no service.

�DM precludes early identification � It is a wait to fail model

9/24/17Paul Beljan (602) 957-7600

� IQ is a predictor of school success, but not reading acumen::high IQ children are overlooked

� **Gifted ascot example

�Low IQ (borderline) but not MI/MR have difficulty showing a discrepancy

� 78 IQ needs a 56 ach score to meet DM, which suggests nearly no ability

�A young child needs very few raw score points on Ach testing to earn an average score

�Early identification is almost impossible because of high floor effects on many achievement tests.

9/24/17Paul Beljan (602) 957-7600

PROBLEMS WITH DM

�DM is an outcome score decision model and not a clinical model – there is no thinking involved as it does not differentiate types of reading, math, or writing disabilities�There is a mountain of research that proves DM is a line in

the sand to choose who receives help, but is not clinically sound::it is unethical for a school psy with a state clinical psy license to use DM.

�DM is not sensitive to the different stages of reading development at different ages (no sensitivity for specificity)

9/24/17Paul Beljan (602) 957-7600

PROBLEMS WITH DM

PROBLEMS WITH DM

�DM does not detect or look for neurological variations that can impact learning, such as ADHD, executive functioning deficit, language disorders, visual or spatial deficit, or sensory and motor deficit

� Once DM is met, schools use the term Specific Learning Disability (SLD) and do not acknowledge terms like dyslexia, dyscalculia, or dysgraphia viable terms, despite the law::treat SLD with global interventions

� Tantamount to your MD diagnosing you with a tumor, but does not acknowledge what kind::treats all cancers the same

9/24/17Paul Beljan (602) 957-7600

PROBLEMS WITH THE DISCREPANCY MODEL

�It is illogical to use one method to identify learning disorders when there are multiple nuanced subtypes of each type of LD.

�Discrepancy models do not detect subtle neurological variations that are indicative of learning difficulties.

�Discrepancy formulas are often adjusted to regulate funding for special education.

�For gifted children, schools may see a discrepancy as irrelevant if the child is performing at or above grade level.

9/24/17Paul Beljan (602) 957-7600

PROBLEMS WITH RESPONSE TO INTERVENTION (RTI)

�We don’t know the child’s initial level of functioning.

�We assume that if the child responds positively to intervention, then the child does not have a learning disorder.

�No specific type of intervention is required, but can be determined by the school and/or the person providing intervention. :: Dumb it down and slow it down.

�In the case of gifted children – to even be eligible or identified as needing RTI, the child must be performing BELOW grade level. Performance at grade level does not necessarily indicate that a child does not have a learning disorder, though.

9/24/17Paul Beljan (602) 957-7600

LEARNING DISABILITIES ARE BRAIN BASED DISORDERS

�The neuropsychology of LD it too vast and complex for this discussion; suffice it to say the following:

�To execute skills and tasks the brain functions in a multimodal manner that is highly interdependent upon the interactions between the micro-systems of neurochemicals and neurons to pathways, and the macro-systems of the limbic system, white matter, grey matter (higher cortical processing), and the cerebellum.

9/24/17Paul Beljan (602) 957-7600

SO… WHAT SHOULD WE DO INSTEAD?

�Understand the brain basis of learning.�Analyze error patterns.

9/24/17Paul Beljan (602) 957-7600

READING

�Occipital & Temporal regions (left & right)

�Visual recognition of meaningful symbols

�Visual recognition of meaningful symbols in a meaningful order (i.e., based upon orthographic rules of reading)

�Frontal regions

�Focused attention

�Registration of emotional information

�Generation of speech

9/24/17Paul Beljan (602) 957-7600

READING�Temporal regions & Hippocampus

�Registration of newly learned information

�Working memory for reading comprehension

�Understanding of language

�Parietal regions

�Mapping linguistic information into functional units

�Cerebellum

�Conscious selection of a new skills

�Left Insula

�Automation of reading9/24/17Paul Beljan (602) 957-7600

READING FROM START TO FINISH

Eyes

Optic Nerve

Thalamus

Visual Cortex Right Occipital Lobe

Corpus Callosum

Left Temporal Lobe

Angular Gyrus & Supramarginal

GyrusInsular Cortex

Frontal Lobes

Arcuate Fasciculus

Broca’s Area

9/24/17Paul Beljan (602) 957-7600

EVALUATING DYSLEXIA� Tests should include

� Intellect

� Visual/Spatial Skills & Language

� Executive Functioning

� Working memory

� Inhibition

� Planning & Organization

� Perception-action coupling

� Sustained Attention

� Cognitive Shift

� Family & developmental history

� Phonological Awareness

� Rapid Naming

� Word Reading

� Nonsense Word Reading

� Passage Reading

� Reading Comprehension

9/24/17Paul Beljan (602) 957-7600

DYSLEXIC ERRORSPhonological Errors

WORD READ AS

Violin Vilen

Possession Persessuve

Material Mitear

Orthographic Errors

WORD READ AS

Island Izland

Grind Grinned

Mother Muthr

Deep Dyslexia – Visual Miscues

WORD READ AS

For FromHaving HardHis This

Deep Dyslexia – Semantic Miscues

WORD READ AS

Dinner FoodWatch ClockCemetery Burial

9/24/17Paul Beljan (602) 957-7600

WRITING�Temporal Lobe & Hippocampus

�Language comprehension

�Working Memory

9/24/17Paul Beljan (602) 957-7600

Frontal Lobe/Broca’s AreaLanguage productionPlanning & organization for languageProblem-solvingInitiating, sustaining, inhibiting, and shifting

Occipital & Parietal Lobes, Motor Strip, CerebellumVisual motor integration for writingAutomation of motor movement for writingAutomation of letter formation

Expressive writing is the most complex activity the brain performs.It takes everything to write language.

DYSGRAPHIA

�Language-Based:�Phonological�Lexical

(Orthographic/Surface)�Mixed (Dyslexic)�Gerstmann�Semantic/Syntactic

�Non-Language-Based:�Motor Apraxia�Ideational Apraxia�Constructional Apraxia�Mechanical Agraphia

9/24/17Paul Beljan (602) 957-7600

EVALUATING DYSGRAPHIA� Tests should include

� Intelligence

� Working Memory

� Motor Function

� Executive Function

� Inhibition

� Planning & Organization

� Perception-action coupling

� Sustained Attention

� Cognitive Shift

� Family & developmental history

� Sensory Motor/Visual Spatial Integration

� Phonological Awareness

� Retrieval Fluency

� Writing & spelling skills

9/24/17Paul Beljan (602) 957-7600

DYSGRAPHIC ERRORS

Mixed ErrorsWORD WRITTEN AS ERROR TYPE

Advantage Advangate Letter Order Reversal

Cobweb Coweb Consonant Omission

Illusion Lshn Syllable Omission

Pocket Poct Syllable Omission

Kitchen Kinchen Insertion Error

Worried Werie Consonant Deletion

Syntactic ErrorsWord omissions

Word ordering errors

Incorrect verb & pronoun use

Word ending errors

Lack of & incorrect punctuation

Lack of & incorrect capitalization

Discrepancy between oral & written lang.

9/24/17Paul Beljan (602) 957-7600

DYSGRAPHIC ERRORS

Phonological ErrorsWord Written As Error Type

Point Pot Phoneme Substitution

Train Chan Phoneme Substitution

Old Od Phoneme Deletion

Climbing Cling Phoneme Deletion

Job Joib Vowel Substitution

Video Veio Consonant Deletion

Orthographic ErrorsWord Written As

Knock Nok

Build Bild

Mighty Mite

Plate Plat

Yacht Yot

Laugh Laf

9/24/17Paul Beljan (602) 957-7600

MATH LEARNING DISORDER (MLD)

9/24/17Paul Beljan (602) 957-7600

MLD

I have worked with children for 31 yearsand have seen only one child diagnosed with MLD by a

public school!

9/24/17Paul Beljan (602) 957-7600

PART I: THE PROBLEM OF MLD

• Myths of MLD• Math abilities are only based on IQ and formal education

• Animals and infants can make basic estimates of 4 - subitize• A rabbit has to estimate the size of their burrow opening so a predator cannot enter

• Math is a completely lateralized task (no, dual tiered-Koziol)• Boys do better at math than girls (only true until HS and the difference is small)• Paul is good at math• Math is not always related to language; prepositions

*Once you have language, you cannot think without it

9/24/17Paul Beljan (602) 957-7600

PART I: THE PROBLEM OF MLD•TRUTHS

• Mathematical learning disorder (dyscalculia) far less researched than reading disorders.

• Comparatively less research means less identification and treatment of the disorder, especially among the gifted population.

• Scientifically proven treatments for Dyslexia far exceed those for MLD

• Kumon is not for MLD because it is generally repetition or filling in old skipped or unlearned gaps• If repetition improved the problem, it would not be an LD• In reading, we do not simply direct the child try and read over and over; Lindamood-Bell,

Wilson, Orton-Guillingham, etc. work at the level of phonics, recognition of graphemes, and the rules of spelling and reading.

9/24/17Paul Beljan (602) 957-7600

• TRUTHS

1. Singapore & Core Math are confusing: Math is not wired this way.Core fundamental skills first mastered: What else in life do you learn to do the first time using multiple methods???

2. If Singapore is taught then children cannot take traditional math achievement tests (WIAT WJR Kaufman WRAT) to meet the ridiculous discrepancy model. For example, they don’t know what is.

3. Basic math problems have to do with a failure to habituate or automate skills (procedural memory).

PART I: THE PROBLEM OF MLD

9/24/17Paul Beljan (602) 957-7600

PART II: EFD THE CEREBELLUM AND MLD

9/24/17Paul Beljan (602) 957-7600

Consider large scale brain systems working together: there is no math lobule in your head.

PART II: EFD AND MLD

9/24/17Paul Beljan (602) 957-7600

• Large Scale Brain Systems

To execute A/EF skills and tasks the brain functions in a multimodal manner that is highly interdependent upon the interactions between the micro-systems of neurochemicals and neurons to pathways, and the macro-systems of the limbic system, white matter, grey matter (higher cortical processing), and the cerebellum.


9/24/17Paul Beljan (602) 957-7600


�MATH REQUIRES A/EF� Traditional definitions indicate a combination of:

� Working memory

� Inhibition

� Planning and organization

� Perception-action coupling (Mirsky’s focus execute)

� Cognitive shift

� Sustained attention

� Encoding

� Memory and learning

9/24/17Paul Beljan (602) 957-7600


�For cognitive and A/EF efficiency, we also need to integrate large scale systems:

�automate specific behavioral sequences,

� integrate those automated sequences,

� inhibit an automated sequence when it is inappropriate so we can learn and engage in a new sequence,

�and execute these sequences automatically.

9/24/17Paul Beljan (602) 957-7600


�Two thoughts:

�Knowledge for behavior (for all animals) is derived from sensorimotor anticipation.

�The reuse of sensorimotor learning mechanisms can account for the development of procedural and declarative knowledge. (Pezzulo, 2011)

9/24/17Paul Beljan (602) 957-7600

EF AS SENSORIMOTOR ANTICIPATION


�To do this, the brain has developed localized areas of function and connections between functional areas to facilitate efficiency.

�EF is often conceptualized as consciously initiated, but it has been estimated that as much as 95% of adult human activity or behavior is routine and automatic.

�In other words, we aren’t always thinking about thinking, because it’s slower and less efficient than automatically executing the appropriate behavior.

9/24/17Paul Beljan (602) 957-7600


• The procedural memory of CEREBELLAR FUNCTION is key to EF, MLD, reading recognition, spelling automaticity, and mastering the rules of spelling, reading, and grammar.

o Consolidation of procedural memory takes place in the cerebellum and frees cognition.

o Mastering mathematical fundamentals is key to habituating them into a procedural memory.

9/24/17Paul Beljan (602) 957-7600

CEREBELLAR FUNCTION

• Elkhonon Goldberg (Wisdom Paradox) � Procedural Memory

� Stored in cerebellum� Habituated procedural memories are in the service of freeing higher

cortical reasoning.

9/24/17Paul Beljan (602) 957-7600

PAC – MADE SIMPLE

The ability to add a novel trait or behavior to an automated/habituated behavior/skill (i.e., the brain modifies what it knows).

9/24/17Paul Beljan (602) 957-7600

WithoutPACtheonlytoolinyourtoolbagisahammersoeverythinglookslikeanail.

PAC – MADE SIMPLE

Procedural memory is a consolidated skill that streamlines problem solving because it frees cognition for problem-solving efficiency in real time.

9/24/17Paul Beljan (602) 957-7600

• Training Wheels to Two Wheels• Multiplication to Long Division• Automatic Shift to Stick Shift• Airplane to Jet Fighter• Dating to Marriage

PART III: ASSESSMENT OF MLD

9/24/17Paul Beljan (602) 957-7600

1.The most common type of MLD I SEE is failure to habituate fundamentals.

A. If fundamentals are not habituated, then fluency is compromised, because the child has to factor each problem as if it was brand new; add ADHD to the mix and error rate goes up.

B. The child can perform better on the WIAT numerical operations subtest because it is untimed so they can inefficiently calculate the fundamental portion of larger problems to still get the answer correct.

2. The second most common is the conceptual/number sense variety – failure to grasp procedures-poor understanding of the prepositions of math.

3. The visual spatial deficit variety is very rare and is easy to rule out.

PART III: ASSESSMENT OF MLD

9/24/17Paul Beljan (602) 957-7600

9/24/17Paul Beljan (602) 957-7600

• How did they crawl as an infant? • How do they eat?• Can they establish motor routines (toileting, toileting hygiene, getting ready,

washing, daily living skills etc.)?• Can they adapt and adjust routines (do they get rigid because they can’t)?• Are social behavior & communication difficulties present?• Can they master the rules of spelling and grammar?• Do they learn the concept and forget it minutes, hours, or days later?

Dyscalculia Interview Questions

PAC – TESTING MLD (without giving a math test)

� WISC V SS and Cd

� Trails x5

� NEPSY II Inhibition� Others for Qualitative Interest

� WCST (FTMS)� TOL (Start Position)� Speeded Naming = Naming on Inhibition test.� Stroop

9/24/17Paul Beljan (602) 957-7600

9/24/17Paul Beljan (602) 957-7600

WISC V SS(PR) # IncorrectSymbol Search 7(16) -1Coding 5(5) -2

TRAILS A Time Errors SS(PR) TRAILS B Time Errors SS(PR)

A1 15” 0 87(19) B1 29” 0 96(39)A2 12” 0 107(68) B2 35” 2 90(25)A3 12” 1 107(68) B3 30” 1 95(37)A4 8” 0 133(99) B4 25” 2 100(50)A5 14” 1 93(32) B5 15” 0 110(75)

NEPSY II - Inhibition (as times get faster, scaled scores go up)

Time SS(PR) Total Err.(PR)

SC Err. (PR)

UC Err.(PR)

TotalSS(PR)

Naming 47” 7(16) 2 (2-5) 2 (2-5) 0 (26-50) 4(2)Inhibition 51” 10(50) 1 (51-75) 1 (26-50) 0 (51-75) 10(50)Switching 93” 9(37) 14 (<2) 9 (<2) 5 (11-25) 4(2)

14.3Y Male: 150 IQ, dyscalc, pac, adhd

WIAT III SS(PR) AE GENumerical Operations 119(90) >19:11 12.9Math Fluency - Addition 85(16) 11:0 5.8Math Fluency - Subtraction 82(12) 9:4 4.4Math Fluency - Multiplication 84(14) 10:4 5.2

9/24/17Paul Beljan (602) 957-7600

WIAT III SS(PR)Numerical Operations 105(63)Math Fluency - Addition 83(13)Math Fluency - Subtraction 87(19)Math Fluency - Multiplication 81(10)

WIAT III SS(PR) AE GE

Spelling 92(30) 13:8 8.4Sentence Composition 73(4) 8:10 3.6Sentence Combining 82(12) -- --Sentence Building 67(1) -- --

WISC V SS(PR) # IncorrectSymbol Search 6(9) -0Coding 5(5) -1 (first item)

TRAILS Time Errors SS(PR) Time Errors SS(PR)A1 29” 1 94(34) B1 85” 0 65(1)A2 29” 3 94(34) B2 60” 0 90(25)A3 21” 1 108(70) B3 62” 2 81(21)A4 19” 1 111(77) B4 44” 1 106(66)A5 22” 4 106(66) B5 45” 4 105(63)

NEPSY II - Inhibition (as times get faster, scaled scores go up)Time SS(PR) Total Err.

(PR)SC Err.

(PR)UC Err.

(PR)Total

SS(PR)Naming 32” 13(84) 1 (11-25) 1 (6-10) 0 (26-50) 8(25)Inhibition 52” 9(37) 4 (11-25) 4 (2-5) 0 (51-75) 7(16)Switching 86” 9(37) 3 (51-75) 3 (11-25) 0 (>75) 10(50)

16 y Male 120 GAI

9/24/17Paul Beljan (602) 957-7600


(PR)SC Err.

(PR)UC Err.

(PR)Total

SS(PR)Naming 51” 9(37) 5 (<2) 3 (2-5) 2 (2-5) 4(2)Inhibition 71” 10(50) 6 (11-25) 4 (11-25) 2 (26-50) 7(16)Switching 120” 9(37) 13 (11-25) 7 (11-25) 6 (11-25) 7(16)


WISC V SS(PR) # IncorrectSymbol Search 9(37) 2Coding 5(5) 0

NEPSY II Raw SS(PR)Speeded Naming -- --

Total Time 68” 6(9)Self-Corrected Errors 3 (2-5)UnCorrected Errors 2 --Total Correct 73/75 (11-25)Combined (Total) Score -- 6(9)

WIAT III SS(PR) AE GENumerical Operations 93(32) 9:8 4.5Math Fluency - Addition 93(32) 9:4 4.2Math Fluency - Subtraction 84(14) 8:4 3.2Math Fluency - Multiplication 76(5) 8:8 3.6

10.4 female 116 IQ 124 GAI

9/24/17Paul Beljan (602) 957-7600

WIAT III SS(PR) AE GENumerical Operations 144(99.8) 12:8 7.4Math Fluency - Addition 98(45) 9:0 4.0Math Fluency - Subtraction 85(16) 8:0 2.6Math Fluency - Multiplication 91(27) 8:8 3.8


(PR)SC Err.

(PR)UC Err.

(PR)Total

SS(PR)

Naming 45” 12(75) 0 (>75) 0 (>75) 0 (51-75) 14(91)Inhibition 57” 14(91) 4 (26-50) 3 (26-50) 1 (51-75) 10(50)Switching 103” 11(63) 6 (51-75) 5 (26-50) 1 (>75) 11(63)


WISC V SS(PR) # IncorrectSymbol Search 13(84) 0Coding 11(63) 0

Female 9.7 130 IQ

School said no intervention due to the Numerical Ops score. This child learnsfundamentals and cannotconsolidate them. Poor routines.

Paul Beljan, PsyD, ABPdN, ABN9835 E. Bell Rd., Ste. 140

Scottsdale, AZ 85260(602) 957-7600

[email protected]

9/24/17Paul Beljan (602) 957-7600

REFERENCES

Elkhonon Goldberg (Wisdom Paradox) Feifer, S. G., & De Fina, P. A. (2005). The neuropsychology of mathematics: Diagnosis and intervention. Middletown, MD: School Neuropsych Press, LLC.

Pezzulo, G. (2011). Grounding Procedural and declarative knowledge in sensorimotor anticipation. Mind& Language, 26(1), 78-114.

Koziol, L., Beljan, P., & Bree, K. (2016 In Press). Large scale brain systems and neuropsychological assessment. New York, NY: Springer.

9/24/17Paul Beljan (602) 957-7600

REFERENCES

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA: American Psychiatric Association.

Feifer, S. G, & De Fina, P. A. (2000). The neuropsychology of reading disorders: Diagnosis and intervention workbook. Middletown, MD: School Neuropsych Press, LLC.

Feifer, S. G, & De Fina, P. A. (2002). The neuropsychology of written language disorders: Diagnosis and intervention. Middletown, MD: School Neuropsych Press, LLC.

Feifer, S. G, & De Fina, P. A. (2005). The neuropsychology of mathematics: Diagnosis and Intervention. Middletown, MD: School Neuropsych Press, LLC.

U.S. Department of Education. (2006). IDEA Regulations: Identification of specific learning disabilities. Retrieved from: http://idea.ed.gov/explore/view/p/%2Croot%2Cdynamic%2CTopicalBrief%2C2 3%2C

9/24/17Paul Beljan (602) 957-7600

REFERENCESChristensen, A., et al. (2014). An intact action-perception coupling depends on the integrity of the cerebellum. Journal of Neuroscience. 34(19), 6707-6716.

Ito, M. (2011 ). The Cerebellum: Brain for an implicit self. Upper Saddle River, NJ: FT Press.

Koziol, L., et. al. (2013). Consensus paper: The Cerebellum’s Role In Movement and Cognition. Cerebellum, 13(1), 151-177.

Lum, J. A., et. al. (2010). Procedural and declarative memory in children with and without specific language impairment. International Journal of Language & Communication Disorders, 45(1), 96-104.

9/24/17Paul Beljan (602) 957-7600

REFERENCES

McNab, F., & Klingbverg, T. (2008). Prefrontal cortex and basal ganglia control access to working memory. Nature Neuroscience, 11(1), 103-107.Moore, A. B., et. al. (2013).

Bilateral basal ganglia activity in verbal working memory. Brain and Language, 125(3), 316-323.

Bostan, A., et. al. (2013). Cerebellar networks with the cerebral cortex and basal ganglia. Trends in Cognitive Sciences, 17(5), 241-254.

Schmahmann J. D. & Pandya, D. N. (2008). Disconnection syndromes of basal ganglia, thalamus and cerebrocerebellar systems. Cortex, 44(8), 1037-1066.

9/24/17Paul Beljan (602) 957-7600

REFERENCESDoyon, J., et al. (2002). Experience-dependent changes in cerebellar contributions to motor sequence learning. 99(2), 1017-1022.

Galea, J. M., et al. (2011). Dissociating the roles of the cerebellum and motor cortex during adaptive learning: the motor cortex retains what the cerebellum learns. Cerebral Cjortex, 21(8), 1761- 1770.

Koziol, L., et al. (2013). ADHD as a model of brain-behavior relationships. New York, NY:Springer.

Shadmehr, R., et. al. (2010). Error Correction, Sensory prediction, and adaptation in motor control. Annual Review of Neuroscience, 33(1), 89-108.

9/24/17Paul Beljan (602) 957-7600

REFERENCES

Feifer, S. G, & De Fina, P. A. (2000). The neuropsychology of reading disorders: Diagnosis and intervention workbook. iddletown, MD: School Neuropsych Press, LLC.

Feifer, S. G, & De Fina, P. A. (2002). The neuropsychology of written language disorders: Diagnosis and intervention. Middletown, MD: School Neuropsych Press, LLC.

Feifer, S. G, & De Fina, P. A. (2005). The neuropsychology of mathematics: Diagnosis and intervention. Middletown, MD: School Neuropsych Press, LLC.

9/24/17Paul Beljan (602) 957-7600

REFERENCES

Koziol, L. F., & Budding, D. E. (2010). Subcortical structures and cognition: Implications for neuropsychological assessment. New York, NY: Springer. pp. 125-166.

Magallón, S., Narbona, J., & Crespo-Eguílaz, N. (2016). Acquisition of motor and cognitive skills through repetition in typically developing children. PLoS ONE, 11(7), 1-17. doi: 10.1371/journal.pone.0158684

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th

Edition. Arlington, VA: American Psychiatric Association.

9/24/17Paul Beljan (602) 957-7600

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