specific learning difficulties in university
DESCRIPTION
Specific Learning Difficulties in University handout June 2011TRANSCRIPT
Specific Learning Difficulties in Adulthood
Supporting students in further and higher education
Professor Amanda Kirby
How do you support anyone?
Challenges Skills
Setting Past
experiences
outcome
ICF-CY (WHO)
SPECIFIC Learning Difficulties are not in neat boxes….
Tom19 year old
First year – Live event technologyHe is in a hall of residenceHe started another course last year but left in the first term because he couldn’t copeHe lives 2 hours from home
He has difficulties with planning and organising himself and his work- he has lost his mobile phone last weekHe starts projects off but finds it hard to get to the endHe has to reread information several times to understand it and sometimes misjudges the questions in an exam as he tries to answer them too quicklyHis handwriting is poor and he can’t always find or read his notes after lecturesHe borrowed and smashed his mother’s car last week, when he reversed it into a wall! She also received a parking ticket because he did not realise it was a ‘no parking’ zone.He has missed his first two tutorial sessions and has an assignment to hand in next Friday and hasn’t started it this week.He has lost his library card and so does not know his Athens number.He went out and got very drunk and lost his wallet in the first week.
What is a diagnosis of SPLD?
Undertaken using a test or from taking a “ history” from others
5% 15 %
anxietydyscalculia
ASD
ADHD
DCDDyslexia
SLI
anxietydyscalculia
ASD
ADHD
DCDDyslexia
SLI
“multidisciplinary teams tend to work in parallel rather than as a team when working with clients ”
(McGonnell et al, 2009).
anxietydyscalculia
ASD
ADHD
DCDDyslexia
SLI
13
27%
19%3%9%
12%
3%8% 19%
DCD Only
DCD + Dyslexia
DCD + Dyslexia + ADHD
DCD + Dyslexia + ASD
DCD + ADHD
DCD + ADHD + ASD
DCD + ASD
DCD + ASD + ADHD + Dyslexia
DCD and Dyslexia
12,950 children aged 10-11 years tested on a series of motor tasks.
In the group who measured the highest rates of literacy difficulties (2% of the total)
35.3% failed one motor task ( reading group) v 26.8% in td group
16.4% more than one v 7.7% td group( Haslum and Miles ( 2007).
DCD and Dyslexia
0 5 10 15 20 25 30 35 40
1 motor diff
2 or more
td
reading diff
DCD and Dyslexia
0
2
4
6
8
10
12
14
16
M-ABC Man Dex Ball Balance
Dyslexia
Poor readers
Controls
NorwayIversen,et al, Dyslexia,2005.
Kirby and Salmon,2007
DCD+ ADHD
ADHD + Dyslexia
25%-
40%3-6%3-6%
Early manifestation of delayed language & inattention
ADHD + Dyslexia + DCD
A Canadian population study (Kaplan, Crawford, Wilson & Dewey, 1997)
Out of those showing DCD had also25 % ADHD +Dyslexia
22% + Dyslexia
10% + ADHD
Additional work by (Biederman, Faraone, Mick, Moore, & Lelon, 1996,O’Hare and Khalid 2002)
Kadesjo¨ and Gillberg (2001) found that 47% of their ADHD children also had DCD
ADHD + Asperger’s
21% of children with severe ADHD met criteria for Asperger’s syndrome
36% showed ‘autistic traits’
(Fitzgerald and Corvin, 2001)
Executive functioning
The self management system of the brain
“A cluster of skills that are necessary for efficient and effective future-orientated behaviour”(Welsh, cited in Diamantopoulou et al, 2007)
“Not accounted for by IQ” ( Martel et al, 2007)
( Barkley, Brown, Du Paul)
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What is executive functioning?
Involved in handling novel situations outside the domain of some of our 'automatic' psychological processes that could be explained by the reproduction of learned schemas or set behaviours.
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Executive functioning
Role in:
planning
setting priorities
organizing thoughts
suppressing impulses
weighing the consequences of one's actions
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Prefrontal cortex
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1.Self activation/Initiation
Getting going.. (Especially the boring stuff)
Procrastination
Poor time estimation
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2.Working memory
The brains RAM- holding information in your mind while making links
Short term memory-what has just been said, remembering a sequence
Listening to someone talking to you while remembering you need to turn out the light before going out
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3. Effort- Remembering to remember
Internal prompts
‘…after I have finished this I need to do that...’
Frustrating forgetting important things– seen to be lazy/can’t be bothered..
• Regulating alertness..completing tasks, sleep pattern (can’t shut off)
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4.Emotional self control/Action
Thinking and not acting
Taking others perspective into account
• Managing frustrations and modulating emotions
• keeping things in perspective
• impulsive, not considering the context, can’t adjust pace
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5. Focus
• Ability to sustain focus but be able to shift to another task
• Reading over and over
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6. Hindsight and foresight
Learning from past experiences
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7.Time concepts
Time blindness
Time passing
Remembering to do the diary
Allocating time
Moving on
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EF is a core element of all Specific Learning Difficulties
ADHD – all ADHD children have EF impairment to varying degrees (Barkley 2001)
ASD – Pennington and Ozonoff (1996) found children performed 1 SD below control group on EF tasks
DCD – children impaired on tests of working memory (Alloway & Temple, 2007)
Dyslexia – studies have found WM deficits that compound their phonological problems (Wolf 2010)
Dyscalculia – Askenazi & Henik (2010) found evidence of specific EFDs in university students with ‘pure’ dyscalculia
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Executive Functioning/Study Skills in students in higher education
Data capture for the 6 EF domains (planning, organisation, impulse control, working memory, metacognition and time management)Additional 20-item list captured the use of tools - if any – to guide
students to be ‘more organised’ (e.g. Using a diary, software etc..)
Analysis:Descriptive statistics to describe student sampleChi squared cross-tabulation / analysis of variance to compare
diagnosis groups
Executive Functioning skills deficits in students
in higher education
Participants:
353 students completed the survey
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Frequency% (n)
Male% (n)
Female% (n)
Mean Age(sd)
DCD 6.1 (20) 35.0 (7) 65.0 (13) 23.90 (5.59)
Dyslexia 16.8 (55) 52.7 (29) 47.3 (26) 24.85 (8.83)
DCD and Dyslexia 4.0 (13) 38.5 (5) 61.5 (8) 25.77 (9.63)
No formal diagnosis but difficulties
56.4 (185) 59.0 (108) 41.0 (75) 26.86 (9.68)
No formal diagnosis 16.8 (55) 21.8 (12) 78.2 (43) * 27.17 (8.55)
Significantly more females with difficulties but no diagnosis
0
10
20
30
40
50
60
70
80
Planning Organisation Impulse Control Working Memory Metacognition Time Management
%
DCD
DCD/Dys
Dyslexia
No diag/diff
No diagnosis
Results Using study tools
Significant differences between TD and SpLD groups ( P= < 0.01)
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0
10
20
30
40
50
60
70
80
90
never have study partner Never use End Note/Ref manager Don't use past papers for revision
SPLD %
TD %
Subthreshold
What are specific learning difficulties?
Dyslexia is a literacy and language difficulty. It is a life long condition and affects approximately 10% of the population. Individuals with Dyslexia have difficulties with reading and spelling and may also have difficulties with organisation and planning.
Dyslexia
Literacy and language difficulties associated with Dyslexia may affect reading, note taking in meetings, writing and structuring documents, remembering instructions, copying notes, learning new vocabulary, remembering instructions, spelling and reading speed.
Symptoms and signs
An international
model of reading
An international
model of assessment
An international
model of support
Autism Spectrum Disorder (ASD) is a spectrum of lifelong developmental disabilities that affects how a person communicates with, and relates to, other people. ASD includes Autism, Asperger Syndrome and Pervasive Developmental Disorder Not Otherwise Specified.
Autism Spectrum Disorder
ASD affects around 1 in 100 people.
The ‘spectrum’ element of the disorder means that while all people with ASDs share certain difficulties, their condition will affect them in different ways and to varying degrees.
The three main areas of difficulty social interaction
social communication
social imagination.
ASD
Autism Spectrum Disorders
Asperger's - m:f = 9:1
ASD - m:f = 5:1
Autism - m:f = 2:1
November 2008The Dyscovery Centre
Different types of individuals with same diagnosis
Aloof
Passive- will respond but not initiate
Active but odd
Over mature/pseuodomature
Relates well to only one person
November 2008The Dyscovery Centre
Varied
Degree of insight
Drive to socialise
November 2008The Dyscovery Centre
Pragmatic language
Social use of language
Judging when to start. When to stop
Tone of voice
Intonation
Volume
May appear very able but face difficulties in getting to appointments on their own
Difficulty coping with a change to routine and performing well in interviews.
Take things literally
Not recognise others emotions, unless very obvious
sensory sensitivity or under-sensitivity, for example to sounds, touch, tastes, smells, light or colour.
Symptoms and signs
SLIs affect an individual’s ability to learn and use language. The condition affects receptive and expressive language.
Specific Language Impairment
Individuals with SLIs may have difficulties remembering sequences of instructions, taking down telephone numbers or instructions.
They may appear anxious or angry if they do not understand what is being asked of them.
They may be withdrawn and find it difficult taking turns in meetings.
Symptoms and signs
Dyscalculia is a condition that affects an individual’s ability to understand and acquire mathematical skills. Individuals may also present with difficulties organising and planning.
Dyscalculia
Individuals with Dyscalculia may present with;
difficulties managing money
telling the time
taking measurements.
These difficulties may impact on an individual’s organisation and planning abilities
Symptoms and signs
Difficulties extend to other areas:
Errors doing simple calculations
Difficulty understanding a series of commands- 2 to the left/1 to the right
Difficulty keeping score in a game
Harder to play strategic games like chess
Estimation – cooking, measuring
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Core primary mathematical competencies
NumerosityAbility to accurately determine the quantity of sets up to 3 or 4 items, or events, without counting
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CountingNonverbal system for enumerating small sets of items & implicit knowledge of counting principles (1 to 1 correspondence)
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OrdinalityImplicit understanding of “more than” & “less than” for comparison of sets of 3 to 4 items
Simple arithmeticSensitivity to increases (addition) and decreases (subtraction) in the quantity ofsmall sets of items
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EstimationInexact estimation of relative quantity, magnitude, or size
Geometrymanipulating shapes, visualising
Geary (2007): Child Dev. 78(4)
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Commonest maths problems
memory for arithmetical facts
difficulty include word problem solving
representation of place value
the ability to solve multi-step
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Vision and perception
Language and
comprehension
Sequencing
Fine motor skills
Gross motor skills
Working memory
Focus and attention
Sufficient time
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What is ADHD?
ADHD- true or false?
Adults with ADHD are usually hyperactive
Adults with ADHD usually have conduct disorder
Adults with ADHD are at greater risk of traffic offences
ADHD- true or false?
Adults with ADHD often have planning and organisation difficulties
Adults with ADHD are late for meetings on purpose
Adults can pretend to have ADHD to get a laptop
ADHD cannot be diagnosed before 7 years of age
ADHD- true or false?
1. ADHD is a disorder of our generation
2. ADHD has been invented by drug companies to make money
3. ADHD only occurs in adulthood if the adult has been diagnosed in childhood
4. NICE guidelines recommends adults with ADHD don’t have medication
ADHD is a common disorder starting in childhood.
symptoms continue but change into adulthood.
The definitions of ADHDImpulsivity
Hyperactivity ( in children)
Inattention
causing difficulties at home, in education, in work and social settings.
Presentation varies depending on external demands
ADHD
Impulsivity could be demonstrated by speaking and acting without thinking, interrupting others, difficulty waiting turn, being oblivious to danger and not learning from experience, lack of awareness of the context in which the person is behaving (e.g. needing to be quiet when others are being quiet). Hyperactivity is more obvious in childhood. In adults this may be observed as a difficulty sitting still, being restless and fidgety such as tapping feet or being over talkative. Inattention can result in an individual being easily distracted, having poor concentration, easily bored, difficulty organising, starting but finding it hard to finish tasks, starting a task and missing steps in the instructions.
Symptoms and signs
Malingering in ADHD(Quinn,2003)
ADHD behaviour rating scales- current and childhood could be faked
Continual Performance Tests- can distinguish differences but may not assess level of functional difficulties- response to a stimuli- harder to fake-measured in milliseconds
What is ADHD?
A developmental disorder
Pervasive –affecting more than one setting
Enduring- difficulties beyond childhood.
Neurological condition
ADHD historically..
1902 Defects in moral character
1934 Organically driven
1940Minimal Brain Syndrome
1957 Hyperkinetic Impulse Disorder
1960Minimal Brain Dysfunction (MBD)
1968 Hyperkinetic Reaction of Childhood (DSM II)
1980 Attention Deficit Disorder - ADD (DSM III) with-hyperactivity without-hyperactivity residual type
Clinical manifestations
Severe, childhood-onset over-activity, inattention and impulsiveness
Impairment due to symptoms, present in more than one setting
Affects 1.4 -5% children-no evidence of rising rates
Excess affected males 3-4:1
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Symptom groups in children
Inattention Hyperactivity Impulsivity
• Does not pay
attention
• Avoids sustained
effort
• Doesn’t seem to listen
when spoken to
• Fails to finish tasks
• Can’t organise
• Loses things,
‘forgetful’
• Easily distracted
• Fidgets
• Leaves seat in class
• Runs/climbs
excessively
• Cannot play/work
quietly
• Always ‘on the go’
• Talks excessively*
• Talks excessively
• Blurts out answers
• Cannot await turn
• Interrupts others
• Intrudes on others
Definitions for ADHD
DSM-IV Attention Deficit Hyperactivity Disorder
Two symptom groups-hyperactive/impulsive and inattention
ICD-10 Hyperkinetic Disorder
Three symptom groups-hyperactivity, impulsiveness and inattention
What causes ADHD?Evidence that genes contribute to ADHD
Runs in families
More than 14 published twin studies-consistent findings of high heritability
h2=75%-91%
5 adoption studies-consistent with a genetic aetiology
Key principles of intervention
Evidence base relates to DIAGNOSIS
Importance of proper diagnosis
Careful clinical assessment- not just completing a checklist
Diagnosing in the UK
Not over diagnosed
Variable from area to area
Need to have information from multiple sources
Need to have information over a period of time
Dependent on age profile
Also on presence of clinical pathways
Parts to the diagnosis
Information from school/college
Information from home/parent/other
Information from child/individual (not always gathered)
In childhood History from parents
Ask about symptoms for different activities
Onset in preschool years
Take development and abilities into account
Functioning/impairment-learning, family life, relationships, friends
Screening questionnaires e.g. Conner’s useful for initial screen or assessing treatment response, but NOT a diagnostic tool
Consider other overlapping difficulties
Also information from other informants
Teacher-checklist(s)
Individual
Management/support in adulthood for ADHD
ADHD adult groups across the country- UKANN and ADDIS
Clinics e.g. - London, Bristol,Swansea,Northampton
Medication- Methylphenidate /Strattera ( not licensed but used)
CBT
Student support- mentor /coaching approaches
Others understanding/adaptations
Consider mental wellbeing as well
CBT
Antidepressants
Type of course
Type of career
Sports and interests
ADHD in adolescents and adults
Cardiff Longitudinal ADHD study
5 year follow up of 157 children with ADHD (North-West, South-West England, Wales)
Diagnosed and treated by services
Full research assessment at baseline and follow-up
Ref: Prof Anita Thapar
Five years later
70% still known to services
93% had received medication
63% currently taking medication
Nearly all had other interventions
So…
Symptoms of ADHD continue into adulthood for many individuals
May be modified because the environment can be altered.
However when leaving school and going to uni/college … some things change
Proposed DSMV criteria for adults with ADHD
A: has six ( or more) of the following symptoms that have persisted for at least 6 months to a degree that is maladaptive and developmentally inappropriate.
Often is easily distracted by extraneous stimuli or irrelevant thoughtsOften makes decisions impulsivelyOften has difficulty stopping activities when he or she should do soOften starts a project or task without reading or listening to the directions properlyOften shows poor follow through on promises , commitments he or she may make to othersOften has trouble dong things in their proper order or sequenceOften is more likely to drive a ,a motor vehicle much faster than others ( or if does not drive use: has difficulty engaging in fun things quietly)Often has difficulty sustaining attention in tasks or play activitiesOften has difficulty organising activities or tasks
Others
B. Some symptoms that caused impairment in childhood to adolescence
C. Some impairments from the symptoms present in more than two settings( e.g. work, educational activities, home life, community functioning, social relationship)
D. There must be clear evidence of clinical significant impairment in social , educational, domestic, occupational or community functioning.
E. The symptoms do not occur exclusively during the course of a Pervasive developmental disorder or other psychotic disorder or are not better accounted for by another mental disorder.( e.g. mood, anxiety disorder or a personality disorder)
Developmental Co-ordination Disorder
Developmental Co-ordination Disorder (DCD), also known as Dyspraxia in the UK, is a common disorder affecting motor co-ordination in 5-6% of children of which 70% continue to experience some level of associated difficulties in adulthood. This condition is formally recognised by international organisations including the World Health Organisation. DCD/Dyspraxia is distinct from other motor disorders such as cerebral palsy and stroke. The range of intellectual ability is in line with the general population
DCD/Dyspraxia
Co-ordination difficulties may affect everyday life skills.
Individuals may present with difficulties writing, typing, learning to drive a car, riding a bike and self care tasks.
In addition, individuals often have difficulties with organisation and planning skills.
Symptoms and signs
DCD
Prevalence: 5- 6% of individuals (APA) and ASLPAC ( 2009)- Lingham et al
Gender: 3:1 M:F (in children)
Probably 1:1 in adults (Piek et al)
DCD has been called...
“Awkward” - “in the wrong way” derived from “awke” or wrong -from an Old Norse term “öfugr” meaning backward
1949-MBD
1963-“minimal cerebral palsy”; “minimal cerebral dysfunction” (Bax & MacKeith)
1965- perceptual-motor dysfunction (Ayres)
1967-visuo-motor disability in school children ( Brenner)
1968/70 -Clumsy child syndrome ( Illingworth)
1975- Developmental apraxia ( Gubbay)
1982- Developmental dyspraxia ( Denckla)
Diagnostic criteria forDevelopmental Coordination Disorder
(APA, 2000)(DSM1V)
A. Performance in daily activities that require motor coordination is substantially below that expected given the person’s chronological age and measured intelligence. This may be manifested by marked delays in achieving motor milestones (e.g., walking, crawling, and sitting), dropping things, “clumsiness”, poor performance in sports, or poor handwriting.
B. The disturbance in Criterion A significantly interferes with academic achievement or activities of daily living.
C. The disturbance is not due to a general medical condition (e.g., cerebral palsy, hemiplegia, or muscular dystrophy) and does not meet criteria for a Pervasive Developmental Disorder.
D. If Mental Retardation is present, the motor difficulties are in excess of those usually associated with it.
Also known as: Specific Developmental Disorder of Motor Function(ICD10)
Key aspects of DCD/Dyspraxia
Fine motor
Gross motor
Balance
Dual tasking
Learning new skills
Perception
Planning
DCD: In childhood
John is 9 years oldJohn is slow getting dressed in the morning, he still needs help with his top button and his shoe laces. Mum cleans his teeth for him. He is a messy eater and often spills things
In school his writing is poor and he writes short stories despite telling you great stories orally. He is often on his own in the playground as he finds playing ball hard to do and the others laugh at him.
He keeps losing his possessions and gets in trouble for it.
He has an older brother who is in the local football team and his dad is the coach .
His mother is a musician and she wants him to play the piano.
Core symptoms and signs of DCD3-7 year old
Riding a tricycle/bicycle
Painting/jigsaws/ colouring/ cutting/drawing
Hopping/ jumping/ball skills/balance
Self care: Untidy eater/ spills drinks/dressing/ undressing/bottom wiping/teeth cleaning
7-11 year olds
Riding a bikePoor handwriting Poor tool usage -scissor skills, rulers etcPosture at the deskBall skills- team gamesSelf care tasks
Low self esteemIncreased social isolation/difficulties making friendsPoor organisational skills
Secondary school
Slower learning new skillsHandwriting remains poor- does not get down homeworkUntidy appearance of workBall skills and team gamesDressing / undressing slowSocial skills / fewer friendsOrganisation / time management /planningEmotionally younger
Lowered self esteemIncreased anxiety
What happens in adulthood?
Outcomes and presentation are dependent on:
Level of difficulty in childhood
Level of support given
Self esteem and confidence
Choice of course matching skills rather than deficits
Support structure around the individual ( TAA)
Recognition.. Or not
Swedish longitudinal study
At 16 years, the MPD-ADD group were more likely to have speech and language problems.
61% in the MPD-ADD group were still “appeared clumsy”
Substance abuse was more common in boys in the MPD-ADD group than controls.
•Children seen at 5-7-11-16- 22 years
Swedish group at 22 years ADHD/DCD
16% of the ADHD and DCD group also had a diagnosis of Aspergers syndrome
33% had personality disorders diagnosed.
58% reading /writing disorder.
49% inattention but hyperactivity was now at a much lower level.
Persistence of motor difficulties
72% 25 year olds continued to have difficulties ( Menkes and Menkes, 1967)73% 15-17 years continued to have difficulties ( small sample-n=15)
(Losse et al (1991) 10 year follow up study)65% Finnish 17 year olds remained having some difficulties especially in visual motor integration
(Cantell et al' study,1998)50%- 17 year olds still had difficulties
( Van Dellen and Gueuze,1988)80% of the participants in the follow up study with DCD had poorer outcomes compared to 13% in the comparison group without DCD. (Rasmussen and Gillberg, 2000)
Presentation in college/Uni
Study of 16-25 year olds with DCD in FE and HE
0
10
20
30
40
50
60
70
80
90
self ca
re
writ
e ne
atly
writ
e fa
st
read
writ
ing
copy
ing
down
find
way
roun
d buildings
othe
rs re
ading
writ
ing
avoid
hobbi
es g
ood co-
ord
leisur
e tim
e alo
ne
avoid
team
spo
rts
spor
t on
own
avoid
club
bing
mon
ey m
anag
emen
t
TD %
DCD %
Favourite Leisure Choices
Approaching significance at 0.06 level
** Significant at 0.05 level
*** Significant at 0.01 level
0
10
20
30
40
50
60
70
80
% of students
choosing
Bar Reading
*
Films/TV Club** Sport*** Other**
Leisure choices
Movement difficulties
TDA
EF
0
10
20
30
40
50
60
70
80
Get
ting
up b
ed
orga
nising
bag
pack
ing
suitc
ase
folding
cloth
es
orga
nise
room
perfo
rming
2 th
ings
plan
ning
ahe
ad
loss
of a
ttent
ion
follo
wing in
stru
ctions
getti
ng re
ady to
leav
e the
house
com
plet
ing
task
s
arra
nging
room
and
wor
k are
as
plan
ning
to d
o so
met
hing
at a
set
tim
e
orga
nise
d to
soc
ialis
e
plan
ning
leisure
activities
orga
nise
d fo
r a class
/mee
ting
TD %
DCD %
Handwriting. “keeping handwriting tidy at the same time as writing quickly”.
“Remembering stuff, writing lecture notes whilst listening, reading to understand - have to read a difficult page 8 times”.
Organisation
Student reporting“Integrating information, attention”“Too easily distracted. Not very confident, Find it hard to concentrate for more than about 1/2 and hour.”“Cannot remember obvious tasks and consequently become overwhelmed and flustered. Prone to losing bank card, mobile phone and other important items.” “Information is hard for me if I am disinterested in the subject”.“my organisation was just shocking, my time keeping and I even turned up for my, on the wrong day for an exam at one point”And[I] “just have stacks of paper everywhere and actually have to find something to look at it. But even more than that is time related organisation when I should be where”
Parent reporting
“Organisation is abysmal, can’t seem to get things together to sort herself out e.g. dental appointments, finances or workload.”
“He tends to do things routinely still”
“he is very good at everything because he meticulous.”
Independent living skills
Parent comments
“anything that involves sequencing, like making a cup of tea or a sandwich.” However she describes how “He can make a very simple meal, taking something out of the fridge and putting it into the microwave, or toast or a sandwich”. “Impulsive, lacks stability for daily living skills e.g. difficulty in pouring drink in a controlled way”.personal hygiene was still poorDental hygiene is poor
Evidence for increasing risk factor
ALSO
Obesity in males > females and CVS risk
Anxiety and depression
What is the rationale for this?
BUT Ye shall know the truth, and the
truth shall make you mad.
~Aldous Huxley
ENVIRONMENTAL
BEHAVIOURAL
NEURAL
GENETIC
“Meshes of influence”Turvey,2006
boxes – they are easier to understand
... Not … Got ‘it’ or ‘not’
We are like.........
The outcome for the individual is dependent on multiple factors
Individual
Knowledge of causation of
learning difficulties
Overlap with other learning difficulties
Increased stress
Individual
Environment
Task
Task demands increase
More organisation
TechnologyLiteracy
demands
Individual
Environment
Task
Changes interact with one another
Varying expression
e.g. ADHD
DRD4 influences persistence of ADHD over time (El-Faddagh et al, 2004).
MAOA associated with antisocial behaviour in ADHD but not with ADHD itself (Thapar et al, 2006).
Different genes have differing roles
BUTenvironment has an effect
on genes
Gene – environment interaction
Conception
Ref: Giedd
Early years
Supporting individuals with SPLDs’
The longer an individual is on a particular developmental pathway the less likely he or she will deviate from this pathway
(Bowlby, 1973,Cicchetti, 1993, Sroufe, 1997)
They may present as:
Moving to college or uni
New people
New subjects
New surroundings
Less support
Less knowledge of what is expected
Home
Home/hall/flat
Social interaction
Self care/ILS
Self organisation
Fitness levels
Uni/college/work
Career choice
Assessments
Work experience
Rules of the uni
Specific language difficulties
EF difficulties related to work planning
Holistic support requires..
Map out areas of difficulty
Predict areas of difficulty
Physical fitness- appearance
Self esteem
Social confidence
Psychological status
Independent living skills
Level of help seeking behaviour
Risk assessment
Prior difficultiess
Prior experiences
Existing views of competency
Level of support before and now
Mental health
Exec functioning
Whole skills- ILS
Start at the beginning
© The Dyscovery Centre 2007
Bronfenbrenner’s Ecological Systems Theory,1994
OTHER INFORMATION is also
IMPORTANT to consider when planning
Start from the beginning
An inclusive approach
Information
Awareness by others
Adaptations of assessments
Think 24 hours
How do you ‘advertise’ your services?
What do you say about all specific learning difficulties on the website, prospectus?What can you offer?Where do you offer it?How is it labelled?Which ‘door’ do students come through?What are the lecturers knowledge of these difficulties?How do you decide what type of support and how much,where,when and by whom?Is there equity of provision compared to Dyslexia and ASD?
ENVIRONMENT
individual
TASK
How joined up are you?
Application Pre entry InductionBetween
departmentsOutside uni
Pre employment
University/college context
EnvironmentWhat happens on enrolment?
Application forms
Orientation around campus
Handbooks
Contracts
How do students find out about support services?
Introductory Lectures/timetables
Halls of residence
© The Dyscovery Centre 2007
Course content and design
Task
Specific demands of the course
Type of assignments, examinations, ICT skills required
Output measures
Methods of teaching
Group work
© The Dyscovery Centre 2007
Identifying Students
Identify themselves – have had previous support
Identified once they arrive themselves or by others and seek support
Not want to be identified and labelled
© The Dyscovery Centre 2007
What are the implications?
For those who have had previous support:
Have an idea about the support they require
Where are support services- near library?
Who does study skills?
Identify themselves to lecturers
© The Dyscovery Centre 2007
What are the implications?
For those who have been identified by themselves or by others while at University:
Emotions around the identification (grief, relief, anger, way forward)
What to disclose and to whom
Time taken for trialling different support strategies
© The Dyscovery Centre 2007
What are the implications?
For those who do not want to be identified:
May not accept direct support
May try to hide there difficulties or opt out of tasks
May need alternatives which are integrated into the courses
© The Dyscovery Centre 2007
Why do students with SpLDs drop out?
Cumulative risk factors - greater the variability the greater the riskSocially isolated, living away from homeLess parental support Part time job – managing study and workFilling in formsGreater organisational demandsNew skills sets requiredMental health
© The Dyscovery Centre 2007
Assessment and screening procedures
Assessments/tests
Standardised- against a typically developing population- age matched
Criterion referenced- can they do it.. Or not? E.g.
The student can do up his shoe laces
The student can record at a set speed in lectures
Screening tools
Capturing a large number of individuals in order to highlight who may have difficulties
Advantage:
should be easy, quick and relatively cheap
Disadvantage:
may miss some people
may pick up some people who don’t have ‘it’ and worry them
Started in in 2001
Been used in colleges, schools, workplace setting, prisons
DoIT profiler
Web based profilng or stand alone
Text to speech enabled
Translated
Can undertake parallel profiles
Individual
Year/class level
Uni /college level
Organisational level
DoIT profiler copyright Kirby, Smythe
Range of tests and questionnaires
Range of tests for college /uni
Short report
Macro- across college/uni
Banding
Detailed break down test by test
Meso
Between classes
Micro- tutor and adult
Advice for both
Examples of reporting
Uni
Courses
Individuals
Visual style report
Detailed advice
School /group comparison
‘scores adjusted to protect schools’
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SEN Study skills
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Screening for DCD
DCD- ADC checklist (Kirby and Rosenblum,2009)
Free paper base- see www.dyscovery.org
Will be online included in Learnerprofiler packages
ADC checklist (Kirby et al,2009)
How was it constructed?
What does it do?
What additional information does it gather?
Normed with adults 16 + in UK and Israel.
Distinguishes those with DCD and TD
Based on DSM1V criteria
Turn to the checklist and instructions
Screening for ADHD
Barkley Rating Scales- in clinical handbook ASRS checklists-free to downloadWender Utah Rating Scales –free to downloadBrown ADD scale-40 items that assess five clusters of ADHD-related
executive function impairmentsOrganizing, Prioritizing and Activating to WorkFocusing, Sustaining and Shifting Attention to TasksRegulating Alertness,SustainingEffort and Processing SpeedManaging Frustration and Modulating EmotionsUtilizing Working Memory and Accessing Recall
Turn to the checklists
The ideal assessment considers
Multimodal - information from more than once person-involving the parents/other/tutor (school reports)
Provides information about competencies as well as difficulties in order to plan support and management
What has helped in the past
Who has helped
When have their been difficulties
Reflective learning
ASRS- free to download
http://www.nyuepilepsy.org/psych/assets/adhdscreen18.pdf
ASRS
Assessment
Consider the impact of comorbidity/overlap
What level of skill present- social, ICT, recording
Associated mental health difficulties-anxiety/depression
Considers the context of the course, campus etc
Who needs to be involved in supporting the individual
Disclosure procedures
Assessments needs to include:
Must gain evidence that this is developmental- need childhood history
Evidence in DCD of motor difficulties!
Cognitively able ( >70)
See guidelines
Report
Areas of motor difficulties
How they impact on every day living and potentially on course
Adaptations required
Level of support needed- esp if MH difficulties
If review needs to be done
Need to consider:
Level of support
By whom and where
Home and uni/college situationin lectures- note taking
Library
Lecturers/tutors
Socially
Small group work
Exams/course work- understanding what is expected, referencing
Assessments for DCD
MotorBalance, fine motor and gross motorMovement ABC- 3-16 years ( Henderson and Sugden)BOTMP ( BruininksOseretskytest of motor performance)- 4-24 years
PerceptionMotor-Free Visual Perception Test-MVPT- up to 70 years – considers visual perceptual skills
Motor and PerceptionVMI-Beery-Buktenica Developmental Test of Visual-Motor Integration ( 2-100 years!)- motor and perception
HandwritingDASH- 9-16 years- writing speed – extension to 25 years in 2010
Diagnostic issues at present
Who gives it?
Not done from a WAIS
If diagnosing need to be aware of exclusionary criteria
Other causes effecting co-ordination:
stroke, CP, visual impairment, muscular dystrophy
Other causes of inattention
Language
Reading and spelling
Anxiety
Epilepsy
Depression
Visual perceptual testing
Why do it?What does the information add?How would it change current advice?
4 -70 years
HandwritingHandwriting is a complex skill with cognitive, kinaesthetic and perceptual-motor components.
Not just a motor task.Many different extrinsic and intrinsic factors affect handwriting
Problems with fine motor control, timing of movements (DCD)Problems with visual motor integration (ability to coordinate visual information with a motor responseProblems with pencil grip, pressureInattention (ADHD)Working MemoryReading and Spelling abilitiesOther factors (table height, pen used, paper used, posture for writing)
Important elements in handwriting performance are legibility and speed.
Difficulties with one or both of these factors can impact on a child’s
Methods of Handwriting Speed Assessment
Speed of HandwritingEither time limit and see how much written Or record how long it takes to finish a taskAccount for legibility as wellDifferent Tasks used
Cats and DogsThe quick brown fox jumps over the lazy dog
Detailed Assessment of Speeded Handwriting (DASH)Involves five subtasks: Copy same sentence for 2 mins either in best handwriting or as fast as possibleWrite alphabet continuously for a minute10 minute free writingGraphic speed task (crosses in circles) measures perceptual motor proficiencyadministered individually or to a whole class
DASH
Up to 25 years
Needs some training
If all students use a computer for assignments
Why do we need to assess handwriting???
May be a ‘marker’ of motor difficulties
For exam purposes at the present time
Other tests
The Morrisby manual dexterity testhas been recommended by SpLD working group but….
The Morrisby test only examines manual dexterity in one setting, and this may not transfer well to assess a range of tasks being asked of students. It was also primarily devised for “assessing candidates for small parts assembly, e.g. within the electronics industry.” (Morrisby,1991).
“To date however, no specific statistical studies have taken place looking into dyspraxia or other similar difficulties and their affect on test performance. There are many reasons for this, but the main factor is that individual differences do vary considerably, so even if a candidate has informed us about a diagnosed or reported difficulty, we have no idea of the extent of the problem. The manual dexterity tests may provide an insight into such problems of course, but they were never developed as clinical diagnostic tests.”
(Personal correspondence from Sharp on behalf of the Morrisby Foundation, 2008)
Other tests
BADS
Test of every day attention
Working Memory
Continuous performance test
What can you put in place?
Generically across the campus
Generic support suggestions
Support
Orientation ‘camp’ before start if possible
Offer study skills
CBT where appropriate
Mentor/study buddy
Older student on arrival for orientation
Also consider advice re exec functioning/ILS/social
Course related
Ppt. slides on intranet
Notes not to be taken in group work
Risk assessment of specific tasks requiring co-ordination
Work placement issues
Assignment templates
Specific examples of referencing
Training in Outlook/Ref Manager
Case studies
Tom
19 year oldFirst year – Live event technologyHall of residenceDiagnosed with ADHD, Dyslexia and DCD 6 months into his course
Writing speed of 15 words per minute with 30% of words illegible (17 year old should be around 24 words per minute)
Reading comprehension 87th percentile, spelling 5th
percentileVisual perceptual difficultiesAuditory short term memory and sequencing difficulties Organisational difficulties at home and in college
Tom
Help wanted for:Tidiness of writing (other are able to read it)
Spelling
Concentrating
Blocking out distractions such as noise or activity around you
Organisational skills – keeping desk/equipment in good order, files or notes well kept / tidy
Confidence
Suggestions for Tom
AssignmentsCreating an assignment templatePost-it notes for structuring assignment ideas
Revision and examsMaking revision notes or assignment drafts on PowerPoint slidesReducing clutterin room ( with help)Using headphones to help block out noise 25% extra time in examsUse of a computer for note taking
Organising selfUsing mobile phone syncing with OutlookPeer mentorship scheme
Filing system online and offline
Change in set up of the computer
Organisation
Using mobile phone
Task listand
remindersWith an alarm
GPS system
Computer strategies
Changing colour background Screen ruler
Speech to text
Touch typing
Text to speech
Suggestions for Tom
www.refworks.com/www.adeptscience.co.uk
www.clarosoftware.co.uk
www.texthelp.com
www.nuance.co.uk
www.dyslexic.com
Pin board Stationary drawer
Laundry basket Cleaning products Sort bookshelf
In room- declutter and sort
Suggestions for Tom continued
Organising your workFile for each subject on his computer
Computer strategiesText to speech and spell checker programmes Develop his touch typing skillsEnd Note referencing programme
MotorCreating larger handled tools by wrapping tape around the handlesGetting into a stable position if completing ‘fiddly’ tasksIf working at heights try to ‘attach’ tools to belt with elastic so that if they are dropped they do not fall to the ground
Suggestions for tutors/learning support
Ppt. slides on intranet
Meeting with student support
Notes not to be taken in group work
Awareness of specific tasks requiring co-ordination-risk assessment
http://www.readwritethink.org/files/resources/interactives/essaymap/
© The Dyscovery Centre 2007
www.ghotit.com
Mind mapping -www.ikon.com
KIDSPIRATION
Colouredoverlays
Areas to address
HomeOrganising his room for work and livingWorking with othersAppearancePhysical activity
University/CollegeTime managementMentorship
Next stepCV writingInterview techniquesAppearanceJob description
Deciding on the right direction
Motivation and Interests
Strengths
Support level required
Home or away
Gaps that need preparation
Core skills to be addressed
Level of adaptations needing to be made
Seeking Strengths
Can he drive?He has lived away from home?Good IT skills?Voluntary work or any jobs?Groups/interests in university?Travelled independentlyHobbies- e.g.cooking?School activities?Overcoming adversity?Empathy?
Level of home support
Finances to start off with- or debts to pay off
Day to day support required
Insight into difficulties
What are the gaps that need addressing?
Appearance
Attitude
Skills
Independent living
IT- alternatives to recording
Social skills
Literacy
What can we learn from the next stage...
EMPLOYMENT
I don't do things the way other people do. I have to work out my own strategies, which makes me seem "odd" to others. I can't work in a team though I have tried many, many times. I don't process verbal instructions. I have to bluff my way through situations where I've only partly heard something. I wonder how long I will last before the others recognise there's something wrong and the rejection starts.
Project management Administration Auto Cad Technical drawing/office space planning Health & safety Contract management (tendering) Manage 12 staff
My organisation is very poor I can't take notes in meetings as I can't read what I've wrote. If I am hosting the meeting I have to take a member of my team to take the minutes.
Challenges
Bar worker :People watching me when I pour drinks, Talking to people at times, getting on with a job without being told, organisational skills, being quick.Lawyer: the handwriting legally required for my work.keeping on top of a large number of tasks to be dealt with from incidents that happened earlier while dealing with fresh incidents at the same time.Admin worker: Doing new things when I'm not sure exactly what it is I'm supposed to be doing. Idealy I would like someone to go through somthing with me in detail by showing/explaining it to me before I attempt doing it alone.
Fears for some
Doing assessment tests as i have very weak recall of information. Particularly under pressure. Instantaneous information retrieval during pressured questioning. (One's answers are scored out of five....the answers are added up at the end. The person with highest score gets the job. Also questions are long and multi-clausal and I can't remeber all the parts of such long questions. It took me ages to get a new job a couple of years ago. I think I may have got it because the director of the organisation had to interview me with manager at eleventh hour (replacing someone else who should have been on the panel) and she has a child with special needs, so reframed the questions and let me have them written down to look at.
Preparing for exit
Disclosure- how and to whom
Questions beforehand
Information about ‘test’- does this match the reality of the job
Extra time at interview stage
Dealing with anxiety
Key issues prior to starting a job
Working in an open plan office (although I always have to these days.) I cannot siphon off background sounds whatsoever.
My headsets always take ages to arrive. In my last open plan office for this job the equipment took seven months to be sorted. In this bigger still open plan office that organisation is now all co-located in, I have repeatedly been ordered the wrong headset since beginning of November and for which I was trying to get help from Access to Work since September.
How many times people will forget not to stand in middle of noisy open plan office and mumble a long sequence or list of tasks they want done, rather than writing them down for me or allowing me time to.
Challenges in the job
In last job, going to court. Dealing with the court 'bundle'. Finding pages quickly that were being referred to by judge. defence etc.
Taking verbal instructions is difficult as i cannot remember all of them
Challenges
I get help with reduced targets and an electronic letter opener.
Lists.
Practice, ad nauseam.
Work very very hard, as everything takes so much longer.
Take rests in a quiet place, can sleep anywhere. Grip tools very tightly for fine movement. Steady hand on something. Lean on walls when standing wherever possible.
Zip up or velcro shoes. Clothes where the back is different to the front, or where there is a label for orientation.
Adaptations
Use computer, so I can work on lists, or get my head around complex situations.
Write down instructions and directions.
Put finger under numbers I have to copy or telephone numbers to dial so can find my place again. Worse when tired.
Put plain paper under line of text that I'm reading.
Never drive with the radio on.
Adaptations
If possible take someone with me when I go to a new place. If not, get and write down directions.
Use my ring to distinguish right and left.
Take notes in formal situations to keep track of conversation and of what I want to say.
Put my hand up when I want to speak
sitting down whilst speaking and only talking to one person at a time. I have always tended to gravitate towards people on their own in social situations, or stick by the people I already know.
Ask a lot of questions, and seek help when necessary, e.g. with paperwork and forms
Adaptations
Perfect- full assessment on all students to assess individual needs
Good enough- screen and guide all, give focussed support to some-triage
Approaches
Support
Avoid e.g. use computer, change job
Adapt- extra time, use templates for report
Practice.. Necessary skill
Clarity
Communication
Compassion
Coping with change
Continuum
Conclusions
Practice what you need to
Adapt what you can( scaffold)
Avoid what you cannot
www.dyscovery.org
www.spldtransitions.co.uk
www.boxoifideas.org- information, organisations and strategies
http://www.learnerprofiler.co.uk/ws/webinar-resources.aspx - free software
Further guidance
Conclusions
Useful resources
http://www.disabilitytoolkits.ac.uk/
Employers Forum on Disability (EFD) http://www.efd.org.uk/
British Association for Supported Employment (BASE) http://www.afse.org.uk/
Useful organisations
DANDA-www.danda.org.uk
Dyspraxia Foundation www.dyspraxiafoundation.org.uk
Dyspraxic adult groups
http://www.daa.colsal.org.uk/
http://www.dyspraxicadults.org.uk/
Websites
www.adhdtraining.co.uk
www.dcd-uk.org
www.boxofideas.org
www.spldtransitions.org
The Dyscovery Centre copyright 2008
Support groups
www.hadd.ie/
www.adhdireland.com/www.addis.com- parent support organisation in UKwww.adhd.ie-Irish groupwww.danda.org-Neurodiverse adultsWww.dyspraxiafoundation.org.uk
What would help?
I would probably benefit from a "personal coach";
someone who can draw up a timetable with me, and
remind me that it is compulsory for me to be wherever I
need to be to study; shout at me that I can do things, that I
just need to focus more.
Basically, a real old fashioned study room with the
necessary equipment (Adobe CS3), imposed silence and
tutors available to help someone with a raised hand...
ReferencesAlloway, T.P. and Temple, K.J. (2007) A comparison of working memory skills and learning in children with developmental coordination disorder and moderate learning difficulties. Applied Cognitive Psychology, 21,4,473-487
Askenazi, S. and Henik, A. (2010) Attentional networks in developmental dyscalculia. Behavioral and Brain Functions, 6:2 [http://www.behavioralandbrainfunctions.com/content/6/1/2]
Barkley, R. A., Edwards, G., Laneri, M., Fletcher, K. and Metevia, L. (2001) Executive Functioning, Temporal Discounting, and Sense of Time in adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). Journal of Abnormal Child Psychology, 29, 6, 541-556
Biederman, J., Monuteaux, M. C., Doyle, A. E., Seidman, L, J,. Wilens, T. E., Ferrero, F., et al (2004) Impact of Executive Function deficits and Attention-Deficit/Hyperactivity Disorder (ADHD) on academic outcomes in children. Journal of Consulting and Clinical Psychology, 72, 757-766
Biederman, J., Petty, C. R., Fried, R. et al (2007) Stability of executive function deficits into young adult years: a prospective longitudinal follow-up study of grown up males with ADHD. Acta Psychiatr Scand, 116, 129-136
Brown, T. E. (2009) ADD/ADHD and impaired Executive Function in clinical practice. Current Attention Disorder Reports 2009, 1:37-41
ReferencesClark, C., Prior, M. and Kinsella, G. (2002) The relationship between executive function abilities, adaptive behaviour, and academic achievement in children with externalising behaviour problems. Journal of Child Psychology and Psychiatry, 43:6, 785-796
Diamantopoulou, S., Rydell, A-M., Thorell, L. B. and Bohlin G. (2007) Impact of Executive Functioning and symptoms of Attention Deficit Hyperactivity Disorder on children’s peer relations and school performance. Developmental Neuropsychology, 32(1), 521-542
Martel, M., Nikolas, M. and Nigg, J. T. (2007) Executive Function in adolescents with ADHD. J. Am. Acad. Child Adolesc. Psychiatry, 46:11, 1437-1444
Nigg, J. T., Quamma, J. P., Greenberg, M. T., and Kusche, C. A. (1999) A two-year longitudinal study of neuropsychological and cognitive performance in relation to behavioral problems and competencies in elementary school children. Journal of Abnormal Child Psychology, 27, 51-63
Pennington, B.F. and Ozonoff, S. (1996) Executive functions and developmental psychopathology. Journal of Child Psychology and Psychiatry. 37,1,51-87
Shur-Fen Gau, S., Chui-De C., Chi-Yung, S. et al (2009) Executive function in adolescence among children with Attention-deficit/hyperactivity disorder in Taiwan. J Dev Behav Pediatr 30, 525-534
Wolf, R. C., Sambataro, F., Lohr, C., Steinbrink, C., Martin, C., Vasic, N. (2010) Functional brain network abnormalities during verbal working memory performance in adolescents and young adults with dyslexia. Neuropsychologia, 48, 309-318