7
Communication and Learning
Disorders
Eric J. Mash
A. Wolfe
©David
Cengage Learning
2016
© Cengage Learning 2016
Definitions and History
• Learning disability: learning problems that
occur in the absence of other obvious
conditions
– The term has been replaced in the DSM-5 by
more specific terms, communication disorders
and learning disorders
– Affects how individuals of at least normal
intelligence take in, retain, or express
information
© Cengage Learning 2016
Categories of Communication Disorders
•
•
•
•
Language disorder
Speech sound disorder
Childhood-onset fluency disorder
Social (pragmatic) communication disorder
© Cengage Learning 2016
Specific Learning Disorder
• Co-occurring problems in:
– Reading
– Math
– Written expression
• Determined by achievement test results
that are lower than would be expected for
one’s age, schooling, and intellectual
ability
© Cengage Learning 2016
Language Development
• Infants selectively attend to parental
speech sounds
• By age 1, a child can recognize several
words as well as say a few words to
express needs and emotions
• Over the next two years, language
development increases exponentially
along with the ability to formulate complex
ideas and express new concepts
© Cengage Learning 2016
Language Development (cont’d.)
• Perceptual maps are formed in the brain
when children hear phonemes (basic
sounds) repetitively
– By 6 months - infants differentiate their own
language from other languages
– By age 1 - the map is complete and infants
have lost the ability to discriminate sounds not
important to their own language
© Cengage Learning 2016
Phonological Awareness
• Language development
– Early language problems are highly predictive
of subsequent communication and learning
disorders and should not be ignored
• Phonology
– Deficits in phonology are a chief reason that
individuals develop communication and
learning disorders
– About 80% of children can use phonemes
properly by the age of 7
© Cengage Learning 2016
Phonological Awareness (cont’d.)
• Phonological awareness
– Broad construct that includes recognition of
the relationship that exists between sounds
and letters
– Detection of rhyme and alliteration
– Awareness that sounds can be manipulated
within syllables
© Cengage Learning 2016
Communication Disorders
• Diagnostic subcategories in the DSM-5
– Language disorder
– Speech sound disorder
– Childhood-onset fluency disorder
– Social communication disorder
© Cengage Learning 2016
Language Disorder (LD)
• Characterized by deficits in expression
despite normal comprehension of speech
– LD occurs when a child’s language matures at
least 12 months behind his or her
chronological age
• Children with LD often have:
– Delayed/slowed speech development; limited
vocabulary; and speech marked by short
sentences and simple grammatical structure
© Cengage Learning 2016
Diagnostic Criteria for Language Disorder
© Cengage Learning 2016
Diagnostic Criteria for Language Disorder
(cont’d.)
© Cengage Learning 2016
Language Disorder (cont’d.)
• Linguistic abilities vary significantly among
those with LD
• Children with LD may have difficulty
understanding particular types of words or
statements
• Speech sound disorder – difficulty with
articulation or sound production
© Cengage Learning 2016
Prevalence and Course of Language
Disorder
• Language disorder affects 7% of younger
school-age children
• Communication disorders are identified
twice as often in boys than girls
• Most children acquire normal language by
adolescence
• 50% fully outgrow the problems
• LD is associated with higher-than-normal
rates of negative behaviors
© Cengage Learning 2016
Causes of Language Disorder
• Genetics
– Temporal processing deficits
• Brain
– Circular feedback loop in the left temporal
lobe
– Problems in connections between brain areas
and less brain activity in left temporal region
© Cengage Learning 2016
Areas of the brain involved in language
functions
© Cengage Learning 2016
Other Causes of Language Disorder
• Recurrent middle ear infections (otitis
media) in first year of life may lead to
speech and language delays
• Home environment
– It is unlikely that communication disorders are
caused by parents
• Except in cases of extreme neglect and abuse
© Cengage Learning 2016
Treatment of Language Disorder
• LD and other similar communication
disorders usually self-correct by age 6 and
may not require intervention
• Strategies for parents to stimulate
language development
– Enroll child in a specialized preschool
• Using a combination of computer- and teacherassisted instruction to teach early academic skills
– Build on the child’s existing strengths
© Cengage Learning 2016
Childhood-Onset Fluency Disorder
• The repeated and prolonged pronunciation
of certain syllables that interferes with
communication
• Prevalence and course
– Gradual onset between ages 2 and 7; peaks
at age 5
– About 3% of children are affected
– Affects males about three times more often
than females
– 80% of those who stutter before age 5 stop
after a year in school
© Cengage Learning 2016
Causes and Treatment of Childhood-Onset
Fluency Disorder
• Genetic factors account for 70% of
variance in causes
• Environmental factors account for
remaining influences
• Possible treatments
– Parental changes - speak to the child slowly
in short sentences
– Contingency management procedures
– Habit reversal procedures
© Cengage Learning 2016
Social (Pragmatic) Communication Disorder
• New addition to DSM-5
• Persistent difficulties in pragmatics (social
use of language and communication)
© Cengage Learning 2016
Diagnostic Criteria of Social Communication
Disorder
© Cengage Learning 2016
Diagnostic Criteria of Social Communication
Disorder (cont’d.)
© Cengage Learning 2016
Specific Learning Disorder
• A discrepancy of more than two standard
deviations between the IQ findings and the
actual achievement test findings in a child
• Learning disorders include reading,
mathematics, and writing
• The different learning disorders overlap
and build on the same brain functions
– A person can have more than one form of
learning disorder
© Cengage Learning 2016
SLD With Impairment in Reading
• Most common underlying feature is the
inability to distinguish or separate sounds
in spoken words
• Involves difficulty learning basic sight
words, such as: the, who, what, laugh,
said
© Cengage Learning 2016
SLD With Impairment in Reading (cont’d.)
• Errors in reversals (b/d, p/q),
transpositions (was/saw, scared/sacred.),
inversions (m/w, u/n), and omissions
(place for palace, section for selection)
– These errors are common in young children
• Core deficits in reading disorders are in
decoding rapidly enough to read the whole
word – coupled with problems reading
single, small words
© Cengage Learning 2016
SLD with Impairment in Written Expression
• Writing disorders are often associated with
problems with eye/hand coordination
– Leads to poor handwriting
• Children with writing disorders:
– Produce shorter, less interesting, and poorly
organized essays
– Are less likely to review spelling, punctuation,
and grammar to increase clarity
© Cengage Learning 2016
Impairment with Written Expression
Example
© Cengage Learning 2016
SLD With Impairment in Mathematics
• Difficulty in recognizing numbers and
symbols, memorizing facts, aligning
numbers, and understanding abstract
concepts
• May include problems in comprehending
abstract concepts or in visual-spatial ability
• Involves core deficits in arithmetic
calculation and/or mathematics reasoning
abilities
© Cengage Learning 2016
Example of SLD With Impairment in
Mathematics
© Cengage Learning 2016
Prevalence and Course of SLDs
• Estimates: 2-10% of the population
• SLD with reading impairment
– 5-17% of school-aged children
– Reading difficulties may be part of reading
abilities continuum, rather than a discrete
phenomenon
© Cengage Learning 2016
Prevalence and Course of SLDs (cont’d.)
• SLD with impairment in mathematics
– 20% of children with learning disorders (1% of
school-age children)
• SLD with impairment in written expression
– Rare by itself
– Overlap with reading and math disorders
– May affect 10% of school-age children
© Cengage Learning 2016
Cultural, Class, and Gender Variations in
SLDs
• Social and cultural factors are less
relevant to LDs than other types of
cognitive and behavioral problems
– The disorders reflect an interaction between a
child’s inherent abilities and
resources/opportunities available
• When learning to read, some teaching approaches
neglect specific ethnic sound-symbol relationships
• SLDs are more common in males
© Cengage Learning 2016
Development of SLDs
• Daily experience of being labeled and
unable to keep up can cause children to
withdraw or become angry and
noncompliant
• Three-fourths of children with a reading
disorder in elementary school continue to
have problems in high school and young
adulthood
© Cengage Learning 2016
Psychological and Social Adjustment
• Students with reading disorders feel less
support from parents, teachers, and peers
• Difficulty in managing a child with SLD
– Behavior problems are about three times
higher than the norm by age 8
– Co-occurring problems across ages: CD,
ODD, and ADHD
– About three of every four students have
significant deficits in social skills
© Cengage Learning 2016
Percentage of Behavior Problems Among
Children With and Without SLDs
© Cengage Learning 2016
Adult Outcomes of SLDs
• May continue into adulthood because of
inadequate recognition and services
• Many excel in nonacademic subjects
• Men with learning disorders perceive lower
levels of social support
• Women with learning disorders have more
adjustment problems and face greater risk
of sexual assault and related forms of
abuse
© Cengage Learning 2016
Causes of SLDs
• Difficulties bringing information from
various brain regions together to integrate
and understand information
• Recent findings suggest two
distinguishable types of reading disorder
– Children who are persistently poor readers
– Children who are accuracy-improved
• Heritability accounts for 60% of variance in
reading disorders
© Cengage Learning 2016
Neurobiological Causes of SLDs
• Reading and language-based problems
are associated with cellular abnormalities
in the brain’s left hemisphere
– This part of the brain is responsible for
understanding phonemes, analyzing words,
and automatically detecting words
© Cengage Learning 2016
Neurobiological Causes of SLDs (cont’d.)
• Behavioral and physiological abnormalities
in the processing of visual information
• Non-verbal learning disabilities are
associated with deficits in righthemisphere brain functioning
© Cengage Learning 2016
How the Brain Processes Speech
© Cengage Learning 2016
Social and Psychological Causes of SLDs
• Co-occurring emotional disturbances and
other signs of poor adaptive ability
– The overlap between dyslexia and ADHD
ranges from 30-70%
– Reading disorder is associated with deficits in
phonological awareness
– ADHD has effects on cognitive functioning,
especially in rote verbal learning and memory
– Some children with learning disorders show
symptoms similar to ADHD
© Cengage Learning 2016
Prevention and Treatment
• Interventions rely primarily on educational
and psychosocial methods
• No biological treatments exist
• Issues of identification are important
– There is a brief window of opportunity for
successful treatment
• Prevention involves training children in
phonological awareness activities at an
early age
© Cengage Learning 2016
The Inclusion Movement
• Integrate children with special needs into
the regular classroom
– Individuals with Disabilities Education
Improvement Act (IDEA) in U.S. and provincial
Educational Acts in Canada
– No Child Left Behind (2002)
– 14% of school-age children in the U.S.
receive some level of support through special
education
© Cengage Learning 2016
Instructional Methods
• Direct instruction is best for children with
LDs
• Early interventions must address
phonological and verbal abilities
• Effective reading instruction focuses on:
– Phonemic awareness and phonemic decoding
skills, fluency in word recognition,
construction of meaning, vocabulary, spelling,
and writing
© Cengage Learning 2016
Behavioral and Cognitive Treatments
• Behavioral principles of learning are used
to teach systematically
– Used in conjunction with complete program of
direct instruction
• Cognitive-behavioral approaches
– Teach children to monitor their own thought
processes
– Emphasize strategies such as self-monitoring,
self-assessment, self-recording, and selfmanagement of reinforcement
© Cengage Learning 2016
Computer-Assisted Learning
• Provides more academic engagement and
achievement than traditional pencil-andpaper-methods
– Compute programs slow down grammatical
sounds allowing young children to process
them more slowly and carefully
© Cengage Learning 2016