The video below is the section for Specific Learning Disorders from Part 4 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 4, click HERE. To watch earlier lectures in this series, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Specific Learning Disorders
NARRATIVE DEFINITION: Specific learning disorder is a neurodevelopmental disorder with a biological origin that is the basis for cognitive abnormalities associated with behavioral signs of the disorder. Genetic, epigenetic, and environmental factors can affect the brain’s ability to accurately and efficiently perceive or process verbal and non-verbal information. An essential feature of specific learning disorders is the persistent difficulty to learn key academic skills, despite interventions that target those difficulties. Academic skills affected include reading, reading comprehension, written expression, spelling, arithmetic calculation and mathematical reasoning. The onset of difficulty in learning is during the years of formal schooling. Diagnostic criteria are to be met based on a synthesis of multiple sources of information, including school reports, the individual’s history (developmental, medical, family, and educational), and psychoeducational assessment.
Learning disorders are coded according to the demonstrated impairment and its characteristics: with impairment in reading, with impairment in written expression, and with impairment in mathematics. The impairment(s) in reading can be specified by area affected: word reading accuracy, reading rate or fluency, reading comprehension. Dyslexia is another term that can be used in reference to a pattern of learning difficulties affecting the abilities of accurate or fluent word recognition, decoding, and spelling.
Impairment(s) in written expression can be in the areas of spelling accuracy, grammar and punctuation accuracy, and/or clarity or organization of written expression.
The impairment(s) in mathematics can be specified as affecting the areas of number sense, memorization or arithmetic facts, accurate or fluent calculation, and/or accurate math reasoning. Dyscalculia is a term that refers to a pattern of learning characterized by problems processing numerical information, learning arithmetic facts, and performing accurate or fluent calculations. Any additional difficulties that might be present (e.g., math reasoning) must also be described when using the term dyscalculia.
Specifiers for severity of the learning disorder are mild (difficulty in one or two academic domains can be compensated for, allowing the person to function well with some accommodations or support services), moderate (one or more domain are affected, requiring some intervals of intensive and specialized teaching during school years, and accommodations are needed at school and at work), or severe (severe learning difficulties affect several domains, requiring ongoing intensive individualized and specialized teaching during most of the school years; even with many appropriate accommodations and support services in the home, at school or work may be insufficient for the individual to complete all activities efficiently).
Learning disorders appear in aggregates in families, especially when affecting reading, mathematics and spelling. In addition to heritability as a risk factor, prematurity or very low birth rate and prenatal exposure to nicotine also increase likelihood of an individual experiencing clinically significant learning difficulties.
The prevalence of specific learning disorders is 5%-15% among school age children, measured across academic domains, different languages and diverse cultures. Specific learning disorder is more common in males than in females. Specific learning disorder occurs in all cultures and ethnicities, and all levels of socioeconomic status and intelligence, but the manifestations of the problems are affected by the nature of the spoken and written symbol system (alphabetic or non-alphabetic), as well as cultural and educational practices. Individuals with a specific learning disorder may experience negative functional consequences throughout the lifespan, with lower academic achievement, higher school dropout, low rates of postsecondary education, more psychological distress, greater underemployment and unemployment, and lower incomes.
Because learning disorders can co-occur with neurodevelopmental and other mental disorders, clinical judgment is required to distinguish learning difficulty that can be attributed to another mental disorder, in which case a specific learning disorder should not be diagnosed. Differential diagnoses frequently considered are normal variations in academic attainment, intellectual disability, learning difficulties due to neurological or sensory disorders, and ADHD (attention-deficit/hyperactivity disorder).
In practical terms, learning disorders occur when an individual’s academic achievement in reading, mathematics, or written expression is well below what would be expected for an individual’s chronological age, grade level, and (traditionally) intelligence. In most states, in order to be diagnosed with a Learning Disorder, the individual’s achievement level in a specific academic domain must be at least two standard deviations below his or her IQ. More recent formulations emphasize low academic achievement, regardless of IQ. Additionally, these learning problems must cause significant impairment in academic achievement or disrupt activities of daily living that rely on reading, mathematical, or written expression skills. When left untreated, Learning Disorders are associated with low self-esteem, delinquency, aggression, and social withdrawal and isolation.
In surface or orthogonal dyslexia, children are able to read words with “regular” spellings, but have difficulty reading words with unusual or irregular spellings. For example, children with surface dyslexia may read the word might as “mit” or be unable to decipher the word “segue.” Deep dyslexia involves multiple reading errors, even with “regular” words.
Dyslexia may also manifest itself in non-reading areas. For example, individuals with dyslexia can have difficulty comprehending rapid verbal instructions, have difficulty in engaging in activities that require sequential or strategic planning, and demonstrate left-right confusion. Similar to dyslexia is alexia, a language disturbance in which reading deficits develop in brain-damaged individuals whose premorbid reading skills were intact.
Evidence-based treatments, which used to focus on correction of alleged, underlying perceptual or sensorimotor processes, now pertain to direct instruction in the area of deficit. Intensive intervention is associated not only with academic gains but also with enhanced functioning in underlying brain regions (e.g., language-processing centers related to the reading disorder).
- Significantly sub average (or below predicted levels, based on IQ) performance in reading, mathematics, or writing
- Reading disorder (dyslexia) most common form; attributable to poor phonological processing in most cases
- Close to 1:1 male:female ratio
- Untreated, leads to considerable impairment in later life
- Achievement level in a specific academic domain must be at least two standard deviations below his or her IQ
- 40 percent don’t complete high school
- 20 percent to 30 percent have ADHD
- Treatment involves direct remediation rather than a focus on underlying, alleged sensorimotor deficits
Optimal intervention for reading disorders involves:
A. spinning exercises designed to enhance cerebellar functioning.
B. direct instruction in the underlying functional deficit areas.
C. visual training designed to undo reversal areas.
D. focused Learning Training
RATIONALE: B is correct, as direct instruction has come to replace training in alleged, underlying perceptual or sensorimotor processes for reading disorders. A and C are incorrect, and examples of such older procedures. D is incorrect and a distractor term.