Thursday, April 25, 2013

Learning Disabilities

What is a learning disability?
-A learning disability is a neurological disorder.
-A Learning disability affects the brain's ability to receive, process, store, respond to, and communicate information.
-LDs are actually a group of disorders, not a single disorder.
-A Learning disability is any one of a heterogeneous set of learning problems that can affect the acquisition and the use of listening, speaking, writing, reading, mathematical and reasoning skills.
-Learning disabilities are common, affecting between 4% to 6% of school age children.

What causes a learning disability?
--The exact cause of a learning disability is unknown. However it is thought it could be caused by heredity, problems during pregnancy and/or birth, and incidents after birth.

Heredity factors:
--Thought to be caused by family environment

Problems during pregnancy and delivery:
--Umbilical cord being wrapped around the neck cutting off oxygen
--Mother's immune system attacking the fetus as if it were an infection
--Mother smoking can cause low birth weight which is linked to learning disabilities
--Mother's alcohol consumptions mutates developing neurons
--Mother's drug consumption can cause problems in neuron receptors

Incidents after birth
--Serious illness
--Head injuries
--Poor nutrition
--Exposure to toxins can affect the growth of new brain cells and neurons

Signs that may indicate a learning disability
  • Speaks later than most children
  • Pronunciation problems
  • Slow vocabulary growth, often unable to find the right word
  • Difficulty rhyming words
  • Trouble learning numbers, alphabet, days of the week, colors, shapes
  • Extremely restless and easily distracted
  • Trouble interacting with peers
  • Difficulty following directions or routines
  • Fine motor skills slow to develop
--Grades K-4

  • Slow to learn the connection between letters and sounds
  • Confuses basic words (run, eat, want)
  • Makes consistent reading and spelling errors including letter reversals (b/d), inversions (m/w), transpositions (felt/left), and substitutions (house/home)
  • Transposes number sequences and confuses arithmetic signs (+, -, x, /, =)
  • Slow to remember facts
  • Slow to learn new skills, relies heavily on memorization
  • Impulsive, difficulty planning
  • Unstable pencil grip
  • Trouble learning about time
  • Poor coordination, unaware of physical surroundings, prone to accidents
--Grades 5-8
  • Reverses letter sequences (soiled/solid, left/felt)
  • Slow to learn prefixes, suffixes, root words, and other spelling strategies
  • Avoids reading aloud
  • Trouble with word problems
  • Difficulty with handwriting
  • Awkward, fist-like, or tight pencil grip
  • Avoids writing assignments
  • Slow or poor recall of facts
  • Difficulty making friends
  • Trouble understanding body language and facial expressions
--High School Students and Adults
  • Continues to spell incorrectly, frequently spells the same word differently in a single piece of writing
  • Avoids reading and writing tasks
  • Trouble summarizing
  • Trouble with open-ended questions on tests
  • Weak memory skills
  • Difficulty adjusting to new settings
  • Works slowly
  • Poor grasp of abstract concepts
  • Either pays too little attention to details or focuses on them too much
  • Misreads information
Types of Learning disabilities
--Spoken language-listening and speaking
--Written language-reading, writing, and spelling
--Arithmetic-calculation and concepts
--Reasoning-organization and integration of ideas and thoughts

Signs that do not indicate a learning disability:
  • Although the following may contribute to an already present disability, or facilitate a new difficulty, they are not the cause of a learning disability.
    • A learning disability does not include problems that result primarily from mental retardation, or emotional disturbance
    • A learning disability does not include problems primarily due to auditory, visual or motor disabilities
    • A learning disability does not include problems that result from economic, cultural or environmental difficulties


Summary of Learning Disabilities

This chart includes the types of learning disabilities we covered and how problems may manifest for the student.

              diagram with characteristics of reading, writing, oral language, and nonverbal learning disabilities

Brain Function of Reading, Writing and Spelling Learning Disabilities

All lobes of the brain are important for reading, writing and spelling. The Frontal Lobe deals with controlling speech, planning. Also in this lobe is Broca's area. Broca's area deals with organization, production and the manipulation of language and speech. The Parietal Lobe links spoken and written language to memory in order for meaning to be attached. The Temporal Lobe deals with verbal memory. Wernicke's area is in this lobe and is important for language understanding. Lastly, the Occipital Lobe deals with identification of visual information such as letters.

Research has been done to suggest that two more areas/systems of the brain are involved in reading. They are the  left parietotemporal system and the left occipitotemporal area. The left parietotemporal system is used for effortful decoding and word analysis. While, the left occipitotemporal area is used for rapid access of words. These areas are important for understanding spoken and written language as well as being able to read fluently and effectively.

Brain Differences in People With and Without Dyslexia
A study done by Booth and Burman found that people with dyslexia have less gray matter in their parietotemporal lobe than people without dyslexia. Since gray matter aids in processing information this can cause a problem in precessing speed and the ability to process important information. They also found that there was less white matter in this area as well. White matter corresponds with reading skill, less white matter can cause deficiencies in the abilities to communicate with other parts of the brain for reading. A different study by Heim and Keil showed that people with dyslexia have a more symetrical brain structure while people without dyslexia have an asymmetrical brain structure. For example, people without dyslexia their left side or hemisphere of the brain is larger than the right. People with dyslexia their brain hemispheres are the same on each side or the right is slightly bigger.

Brain Functions of People With and Without Dyslexia
Several studies looked at brain activation in people with and without dyslexia in a fMRI. The fMRI looks at brain activity. They examined children that were right-handed with and without a reading disability. These children had to identify names of letters or sounds, saying nonsnese words and comparing meanings of real words. The study found that children without a reading disability had more acitivation in all areas that deal with reading. they also had more acitivty in the left hemisphere than  children with a reading disability.                           
 Children with reading disabilities had less activity in the posterior part of their brains in the areas that are important for reading but had more acitivity in the lower frontal portions of their brain. Researchers think this is  to make up for the lack of activity in the posterior parts of the brain.


Reading, Writing, and Spelling Learning Disabilities

--Learning disabilities are thought to be caused by disruptions in the brain. This is can be due to many factors. For example, if the disruption occurs earlier in the pregnancy, the fetus can die or the infant is born with many different disabilities and are more at risk for developmental delays. If the disruption occurs later, when the cells are becoming specialized and moving into place, it can casue errors in the cell makeup, location, or connections. Some experts believe that these errors can later lead to a learning disability.

2 main types of written, reading and spelling learning disabilities
  • Dyslexia
  • Dysgraphia


Dyslexia is a reading disorder that is caused by a neurological disorder that causes the brain to process information differently than others. Problems with dyslexia vary. This can be mild to severe. Some people have trouble with reading, writing and spelling. As well as telling left from right on the page.   Dyslexia may be a reading disorder but it also affects how people express themselves. For example, people with dyslexia have a hard time organizing their thoughts, they may be misunderstood a lot of the time.

There are two main learning disabilities in reading. They are basic reading problems and reading comprehension. Basic reading problems consist of problems with decoding sounds, letters and words. Reading comprehension is a problem with understanding the meaning of words, sentences and phrases.

Here is a video further explaining dyslexia and the brain

Facilitative activites for Dyslexia that parents can do
--EARLY exposure to oral reading, writing and drawing
--Practice with print, recognition skills, letters and sounds
--Allow for more time to complete tasks at home and in school
--Use books on tape and multi-sensory instruction for all around learning
--Support for your child is key. This can be extremely frustrating and it takes an emotional toll.


Dysgraphia is writing deficit. This can manifest in the physical act of writing or the mental activity it takes to get a thought from your brain to the paper. Dysgraphia is thought to be casued by visual-spatial and language processing deficits.
Chilren with a basic writing disorder have trouble with the physical act of writing letters and words. While, children with expressive writing disorders have a problem with organizing thoughts onto paper.

This is an example of a visual-spatial deficit

Facilitative activites for Dysgraphia that parents can do
--Try different pens and pencils that are comfortable for the child
--Practice writing letters and numbers in the air with big arm movements for motor memory
--Use multisensory learning techniques for shapes, letters and numbers
--Allow more time for writing assignments
--Complete tasks in smaller steps rather than all at once


Saturday, April 20, 2013

Math Learning Disabilities

What is Dyscalculia? 

Dyscalculia refers to a wide range of lifelong learning disabilities involving math. There is no single type of math disability. Dyscalculia can vary from person to person and it can affect people differently at different stages of life. It is related to dyslexia and includes difficulty in understanding numbers, learning how to manipulate numbers, learning math facts, and a number of other related symptoms. Unlike dyslexia however, very little is known about its prevalence, causes or treatment.

What is going on in the brain? 
  • Very little was known about how the brain represents mathematics until about the last 15 years or so
  • Developmental dyscalculia is thought to be caused by a difference in brain function and/or structure, in areas of the brain associated with mathematics 
  • Studies either show less grey matter (brain cells), or less brain activity in a specific area of the brain known to process mathematics
  • A recent brain imaging study showed less brain activity in parietal and frontal areas of the brain associated with mathematical cognition
  • All of these studies show either less grey matter (brain cells), or less brain activity in a specific area of the brain known to process mathematics, the intra-parietal sulcus.

How many people are effected by Dyscalculia?
  • 3-6% of the population are described as ‘purely’ dyscalculic
  • 50-60% of dyslexic individuals also have difficulties with math 
  • The remaining 40-50% of dyslexics do not show signs of dyscalculia

2 major areas of weakness can contribute to math learning disabilities:
  • Visual-spatial difficulties: result in a person having trouble processing what the eye sees
  • Language processing difficulties: result in a person having trouble processing & making sense of what the ear hears

  • Poor understanding of the signs +, -, ÷ and x, or may confuse these mathematical symbols
  • Difficulty with addition, subtraction, multiplication and division or may find it difficult to understand the words "plus," "add," "add-together."
  • May reverse or transpose numbers
  • Difficulty with times tables
  • Poor mental arithmetic skills
  • Inability to grasp and remember mathematical concepts, rules, formulae, and sequences
  • May have trouble even with a calculator due to difficulties in the process of feeding in variables

    Other difficulties: 
    • Making sense of what the ear hears 
    • Following sequential directions
    • Dealing with the exchange of money
    • Remembering specific facts and formulas for mathematical calculations   
    • Easily disoriented 
    • Learning abstract concepts of time & direction 
    • Poor sense of direction  


       There is no formal diagnostic test specifically for dyscalculia, however, tests are available online. Examples of testing available for dyscalculia are:

      Quick Test: The quick test is a list of 24 questions regarding math, such as "I have never been able to do times tables" and "when people mention odd and even numbers I don't understand what they mean". If the test taker answers yes to half or more of the questions presented, then it is likely that he/she has a problem with mathematics that requires assistance or remediation.

      Computer Testing: There is a computer test called the "Dyscalculia Screener" that was created by Professor Brian Butterworth of University College London in 2004. It measures both the speed and accuracy of student responses in order to figure out mathematical proficiency.

      Comparative Testing: The comparative test is meant to be used with classes of school children. It offers a variety of mathematical tests meant to distinguish children who are having problems from those who are not. It is offered by Tony Attwood in his book "Tests for Dyscalculia."

      Although testing is available, it is not always beneficial to be diagnosed with dyscalculia. It is not guaranteed that teachers will provide the student with more time to complete tests. For this reason, it is important to discuss a child's dyscalculia with a teacher in order to improve the learning environment.

      • Find different methods to approach mathematical problems
      • Use concrete answers to teach new skills instead of dealing with the abstract first
      • Work with the student and encourage them to ask questions as they work
      • Have all the tools you’ll need to work at hand
      • Work in a place that has few, if any, distractions  
      • Tutoring 

          Equipped with the right learning tools and alternate learning methods, people with dyscalculia can achieve success. Although prevention is always better than curing, it is never too late to overcome a learning disability.



          Wednesday, April 17, 2013

          Listening and Speaking Learning Disabilities

          A Learning Disability can hinder both spoken and auditory information. One form of a LD that impacts language is an Auditory Processing Disorder.

          Auditory Processing Disorder: A neurological deficit that affects how the processes spoken language.

          ASHA's Position Statement on Central Auditory Processing Disorder "Central auditory processing disorder (CAPD) refers to difficulties in the processing of auditory information in the central nervous system (CNS) as demonstrated by poor performance in one or more of the following skills: sound localization and lateralization; auditory discrimination; auditory pattern recognition; temporal aspects of audition, including temporal integration, temporal discrimination (e.g., temporal gap detection), temporal ordering, and temporal masking; auditory performance in competing acoustic signals (including dichotic listening); and auditory performance with degraded acoustic signals".

          The Central Auditory Nervous System

           The pathway that sound takes from the ear up to the temporal lobe of the brain.

          Major Structures Involved:

          1. Auditory Nerve: connects the hair cells of the inner ear to the CN
          2. Cochlear Nucleus
          3. Superior Olivary Complex: 80% of fibers cross over here
          4. Lateral Lemniscus
          5. Inferior Colliculus
          6. Medial Geniculate Body
          7. Auditory Radiations: Fibers that connect the MGB to the AC
          8. Auditory Cortex in the Temporal Lobe

          Regions of the Brain:

          -Hearing Information is received and processed inside the Temporal Lobe.
          - Broca's Area is used for speech.

          There is much controversy surrounding Auditory Processing Disorder (APD). The following is a list of agreed upon facts.

             -There is a breakdown in receiving, remembering, understanding and using auditory information
             -Hearing ability in not impaired
             -There is a neurological cause
             -The child's ability to listen is somehow impaired

          Lesions in Brain:
          Certain disorders are associated with lesions in specific parts of the human brain. The picture demonstrates the different damages and diseases that result in specific neurologic disorders.

          What is needed for Normal Auditory Processing:

          -Auditory Awareness: The ability to detect or become aware of a sound or speech signal
          -Auditory Discrimination: The ability to recognize a sound. Auditory discrimination also allows the listener to hear the difference between two different sounds.
          -Localization: The ability to track a sound in space.
          -Listening in Noise: The notion of how well one can attend to a signal and ignore background noise.
          -Phonological Awareness: The ability to recognize that words are made up of a variety of sound units.
          -Auditory Memory: The ability to process, recall and analyze orally presented information
          -Sequencing: Ability to keep a list of things in order.
          -Closure: The ability to fill in the blanks, exposure to sound and repetition is needed in order to have this skill

          Common behaviors seen in children with APD:

          -Sound Discrimination errors
          -Trouble following directions
          -Distracted easily by background noise
          -Oral and written expression deficits
          -Auditory memory problems
          -Difficulty with reading
          -Listening for only a short duration of time

          Auditory Processing and Reading:Children with APD often have trouble with reading.

          Reading difficulties are often due to trouble with:
              -Sound-Symbol Association: Difficulty associating a sound with a letter
              -Sound Blending: Difficulty blending individual sounds to form a word

          Video Clip: Auditory Processing Disorder and Dsylexia

          Assessment of APD:

          -Most testing is not done until the 1st grade
          -Speech Language Patholgist: Assessment of Language
          -Audiologist: Assessment of Auditory Processing
          -Pschologist: Assessment of Cognitive and Behavior abilities
          -Occupational Therapist: Assessment of Sensory Systems

          Accommodation and Modification Strategies for children with APD:
          -Keep directions simple
          -Only tell one step at a time
          -Give directions both orally and visually
          -Speak slowly
          -Maintain eye contact while speaking
          -Limit background noise
          -Provide specific opportunities that practice skills to build vocabulary, rhyming, segmenting and blending words

          ASHA suggested intervention of APD:
          -Interdisciplinary approach to therapy involving Audiologist, SLP, and other professionals
          -Treatment and management goals are highly individualized to client
          -Treatment should include both top down and bottom up approaches to therapy
                -Top down approach provides compensatory strategies designed to minimize the impact of APD,     by strengthening higher order resources
                - Bottom up approach is designed to enhance the acoustic signal and to train specific auditory skills.
          -Direct skills remediation, compensatory strategies and environmental modifications should all be used

          Treatments available for Auditory Processing: National Institute on Deafness and other Communication Disorders

          • Auditory trainers are electronic devices that allow a person to focus attention on a speaker and reduce the interference of background noise. They are often used in classrooms, where the teacher wears a microphone to transmit sound and the child wears a headset to receive the sound. Children who wear hearing aids can use them in addition to the auditory trainers
          • Environmental modifications such as classroom acoustics, placement, and seating may help. An audiologist may suggest ways to improve the listening environment, and he or she will be able to monitor any changes in hearing status.
          • Exercises to improve language-building skills can increase the ability to learn new words and increase a child's language base.
          • Auditory memory enhancement, a procedure that reduces detailed information to a more basic representation, may help. Also, informal auditory training techniques can be used by teachers and therapists to address specific difficulties.
          • Auditory integration training may be promoted by practitioners as a way to retrain the auditory system and decrease hearing distortion. However, current research has not proven the benefits of this treatment.


          Disability seen with Reasoning: NVLD

          Nonverbal Learning Disability (NVLD)
                          Nonverbal Learning Disabilities affect many children, but can be difficult to diagnose early in a child’s life. These individuals usually have above average abilities when it comes to language. For example; they normally have very strong reading, writing, and vocabulary skills. The deficits occur in spatial processing and reasoning. Children with Nonverbal Learning Disabilities catch every detail when it comes to learning, but rather than being able to put all the details together, they miss the “big picture.” 

          They also have problems socially. They do not pick up the nonverbal/social cues such as; gestures (body language), facial expressions, and tone of voice. These cues are primarily spatially based. Individuals with a Nonverbal Language Disorder may have difficulty in social situations because of their problems with spatial reasoning. These individuals also have trouble generalizing information they have, to new situations. Their ability to “carry – over” is impaired. All of the problems described above would be of major concern to a speech – language pathologist and how one would go about treatment. 

                          There are three major areas that include specific symptoms associated with a Nonverbal Learning Disability (NVLD).

                          The three areas are:

          1.       Neuropsychological Deficits
          a.       Includes difficulties with tactile and visual perception, psychomotor coordination, tactile and visual attention, nonverbal memory, reasoning, executive functions, and specific aspects of speech and language.

          2.       Academic Deficits
          a.       Includes math calculations, mathematical reasoning, reading comprehension, specific aspects of written language and handwriting (part of spatial reasoning).

          3.       Social – Emotional Deficits
          a.       Includes problems with social perception and social interaction.

          For the purposes of this blog, we will focus on the Neuropsychological Deficits

          ·         Primary Neuropsychological Deficits:
          o   Tactile perception
          o   Visual Perception
          o   Motor Coordination

          ·         Secondary Neuropsychological Deficits
          o   Modality – specific aspects of attention
          o   Extent to which children actively explore their environment.

          ·         Tertiary Neuropsychological Deficits
          o   Abstract Reasoning
          o   Spatial Reasoning
          o   Executive Functions
          o   Specific aspects of speech and language.
          Prefrontal Cortex

          Executive Functioning is one of the primary impairments in individuals with NVLD. Executive function describes the processes the brain uses to create, organize, and follow plans. These functions include higher level abilities, such as:
          ·         Abstract Reasoning
          ·         Logical Analysis
          ·         Hypothesis Testing
          ·         The ability to change from one thought to another mentally.

          Executive functioning, reasoning, and abstract thinking are all cognitive functions of the prefrontal cortex, which is shown in the picture above. Even though this deficit in executive functioning, which includes abstract and spatial reasoning, may not be seen in all individuals with a Nonverbal Learning Disorder; it is thought that this deficit is a problem with subcortical white matter. The deficit in the subcortical white matter is responsible for the symptoms seen in NVLD. Whether it is directly related to right hemisphere systems (which was the first assumption) or the inability to access these right hemisphere systems due to deficits in white matter (which is the present assumption), it is believed to result in this disorder. These deficits are usually more common in cases of severe NVLD. (Rourke, 1995).
          Some conditions that can lead to white matter areas of the brain being affected are:

          ·         Callosal Agenesis: congenital disorder where there is a partial or complete absence of the corpus callosum.

          ·         Hydrocephalus: too much fluid in the skill that can lead to brain damage.

          ·         Multiple Sclerosis: disease that attacks the Central Nervous System that destroys connects from
                                           the brain to the rest of the body.

          ·         Certain types of TBI: Traumatic brain injuries. 

          The symptoms of a Nonverbal Learning Disorder may be similar to symptoms someone might see in other disorders. For example, individuals with:

          ·         Right Hemisphere Dysfunction:
          o   This would be differentiated from NVLD by more severe speech prosody deficits, more pronounced deficits with planning and organization, and more severe tactile – spatial deficits.

          ·         Asperger’s Syndrome:
          o   This would be differentiated from NVLD based on the degree of functioning an individual has.
          o   For low functioning individuals, they may be more properly diagnosed with autism.
          o   For high functioning individuals who have been diagnosed with Asperger’s syndrome, they may have been misdiagnosed and actually have a NVLD.

          ·         Central Processing Disorders

          Even though the symptoms for the above disorders may overlap with Nonverbal Learning Disabilities, they can be differentiated by proper assessments. Some of the tests that may be administered to assess problems of executive functioning are:
          ·         The Wisconsin Card Sorting Test
          ·         The Trail Making Test
          ·         The Progressive Figures and Color Form Test
          ·         Assessments that also test working memory and attention might also be used to assess this problem.

          ·         There is no cure to reduce symptoms of NVLD. It is important for the intervention to focus on helping individuals compensate for the deficits that they do have. This depends on proper diagnosis. If an individual is experiencing any of these deficits they need to have a neuropsychological evaluation to figure out their strengths and weaknesses with this disorder.