Specific Learning Difficulties in University by amanda kirby

Specific Learning Difficulties in Adulthood Supporting students in further and higher education Professor Amanda Kirby

How do you support anyone?

Challenges

Skills

outcome

Setting

Past experiences

ICF-CY (WHO)

The truth

SPECIFIC Learning Difficulties are not in neat boxesâ&#x20AC;Ś.

19 year old

Tom

First year – Live event technology He is in a hall of residence He started another course last year but left in the first term because he couldn’t cope He lives 2 hours from home He has difficulties with planning and organising himself and his work- he has lost his mobile phone last week He starts projects off but finds it hard to get to the end He has to reread information several times to understand it and sometimes misjudges the questions in an exam as he tries to answer them too quickly His handwriting is poor and he can’t always find or read his notes after lectures He 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 â&#x20AC;&#x153; historyâ&#x20AC;? from others 5%

15 %

Dyslexia

DCD ADHD

dyscalculia anxiety

ASD SLI

Dyslexia

DCD ADHD

dyscalculia anxiety

ASD SLI

“multidisciplinary teams tend to work in parallel rather than as a team when working with clients ” (McGonnell et al, 2009).

Dyslexia

DCD ADHD

dyscalculia anxiety

ASD SLI

DCD Only DCD + Dyslexia

19%

12%

DCD + Dyslexia + ADHD

27% 9%

19%

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

2 or more

1 motor diff

reading diff 0

DCD and Dyslexia 16

Dyslexia

Poor readers

Controls 2

0 M-ABC

Man Dex

Norway Iversen,et al, Dyslexia,2005.

Ball

Balance

DCD+ ADHD

Kirby and Salmon,2007

ADHD + Dyslexia

3-6%

25% 40%

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 also 25 % 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)

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.

Executive functioning

Role in: planning setting priorities organizing thoughts suppressing impulses weighing the consequences of one's actions

Prefrontal cortex

1.Self activation/Initiation

Getting going.. (Especially the boring stuff) Procrastination Poor time estimation

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

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)

4.Emotional self control/Action Thinking and not acting Taking others perspective into account

5. Focus

â&#x20AC;˘ Ability to sustain focus but be able to shift to another task â&#x20AC;˘ Reading over and over

6. Hindsight and foresight Learning from past experiences

7.Time concepts Time blindness Time passing Remembering to do the diary Allocating time Moving on

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 The Dyscovery Centre copyright 2011 Amanda Kirby

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 sample Chi squared cross-tabulation / analysis of variance to compare diagnosis groups

Executive Functioning skills deficits in students in higher education Participants:

ď ś353 students completed the survey

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

DCD 60

DCD/Dys 50

Dyslexia

% 40

No diag/diff 20

No diagnosis 10

Planning

Organisation

Impulse Control Working Memory Metacognition

Time Management

Results Using study tools 90 80

Significant differences between TD and SpLD groups ( P= < 0.01) 70 60 50 SPLD % 40

TD %

30 20 10 0 never have study partner

Never use End Note/Ref manager Don't use past papers for revision

Subthreshold

What are specific learning difficulties?

Dyslexia

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.

Symptoms and signs

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.

An international model of reading

An international model of assessment

An international model of support

Autism Spectrum Disorder

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.

ASD

ASD affects around 1 in 100 people. The â&#x20AC;&#x2DC;spectrumâ&#x20AC;&#x2122; 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.

Autism Spectrum Disorders Asperger's - m:f = 9:1 ASD - m:f = 5:1 Autism - m:f = 2:1

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

The Dyscovery Centre

November 2008

Varied

Degree of insight

Drive to socialise

The Dyscovery Centre

November 2008

Pragmatic language

Social use of language Judging when to start. When to stop Tone of voice Intonation Volume

The Dyscovery Centre

November 2008

Symptoms and signs

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.

Specific Language Impairment

SLIs affect an individualâ&#x20AC;&#x2122;s ability to learn and use language. The condition affects receptive and expressive language.

Symptoms and signs

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.

Dyscalculia

Dyscalculia is a condition that affects an individualâ&#x20AC;&#x2122;s ability to understand and acquire mathematical skills. Individuals may also present with difficulties organising and planning.

Symptoms and signs Individuals with Dyscalculia may present with; difficulties managing money telling the time taking measurements. These difficulties may impact on an individualâ&#x20AC;&#x2122;s organisation and planning abilities

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 â&#x20AC;&#x201C; cooking, measuring

Amanda Kirby copyright Dyscovery Centre 2011

Core primary mathematical competencies Numerosity Ability to accurately determine the quantity of sets up to 3 or 4 items, or events, without counting

Amanda Kirby copyright Dyscovery Centre 2011

Counting Nonverbal system for enumerating small sets of items & implicit knowledge of counting principles (1 to 1 correspondence)

Amanda Kirby copyright Dyscovery Centre 2011

Ordinality Implicit understanding of “more than” & “less than” for comparison of sets of 3 to 4 items

Amanda Kirby copyright Dyscovery Centre 2011

Simple arithmetic Sensitivity to increases (addition) and decreases (subtraction) in the quantity of small sets of items

Amanda Kirby copyright Dyscovery Centre 2011

Estimation Inexact estimation of relative quantity, magnitude, or size

Geometry manipulating shapes, visualising

Geary (2007): Child Dev. 78(4) Amanda Kirby copyright Dyscovery Centre 2011

Commonest maths problems

memory for arithmetical facts difficulty include word problem solving representation of place value the ability to solve multi-step

Amanda Kirby copyright Dyscovery Centre 2011

Vision and perception

Language and comprehe nsion

Sufficient time

Focus and attention

Sequencing

Working memory

Fine motor skills Gross motor skills

Amanda Kirby copyright Dyscovery Centre 2011

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 donâ&#x20AC;&#x2122;t have medication

ADHD

ADHD is a common disorder starting in childhood. symptoms continue but change into adulthood. The definitions of ADHD Impulsivity Hyperactivity ( in children) Inattention causing difficulties at home, in education, in work and social settings. Presentation varies depending on external demands

Symptoms and signs

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.

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 fakemeasured in milliseconds

What is ADHD?

A developmental disorder Pervasive â&#x20AC;&#x201C;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) withhyperactivity 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

Symptom groups in children Inattention • Does not pay attention • Avoids sustained effort

Hyperactivity • Fidgets

• Talks excessively

• Leaves seat in class

• Blurts out answers

• Runs/climbs

• Cannot await turn

excessively

• Doesn’t seem to listen • Cannot play/work when spoken to

Impulsivity

quietly

• Fails to finish tasks

• Always ‘on the go’

• Can’t organise

• Talks excessively*

• Loses things, ‘forgetful’ • Easily distracted

• 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. Connerâ&#x20AC;&#x2122;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 (NorthWest, 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

Soâ&#x20AC;Ś

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 â&#x20AC;Ś 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 thoughts Often makes decisions impulsively Often has difficulty stopping activities when he or she should do so Often starts a project or task without reading or listening to the directions properly Often shows poor follow through on promises , commitments he or she may make to others Often has trouble dong things in their proper order or sequence Often 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 activities Often 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

DCD/Dyspraxia

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

Symptoms and signs

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.

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 for Developmental Coordination Disorder (APA, 2000) (DSM1V) A. Performance in daily activities that require motor coordination is substantially below that expected given the personâ&#x20AC;&#x2122;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, â&#x20AC;&#x153;clumsinessâ&#x20AC;?, 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 old John 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 DCD 3-7 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 bike Poor handwriting Poor tool usage -scissor skills, rulers etc Posture at the desk Ball skills- team games Self care tasks

Low self esteem Increased social isolation/difficulties making friends Poor organisational skills

Secondary school

Slower learning new skills Handwriting remains poor- does not get down homework Untidy appearance of work Ball skills and team games Dressing / undressing slow Social skills / fewer friends Organisation / time management /planning Emotionally younger Lowered self esteem Increased 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 MPDADD 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 samplen=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

ca re

ne at ly wr ite fa re st ad wr f in c it i o d ng py wa in y g ro do u wn ot nd he bu rs av ild oi re in d ad gs ho i ng bb wr ie s itin go g od le is co ur -o e rd tim av e oi al d on te e am sp or sp ts or to n av ow o m n i d on clu ey bb m in an g ag em en t

wr ite

se lf

Study of 16-25 year olds with DCD in FE and HE

50 TD %

40 DCD %

Favourite Leisure Choices Leisure choices 80 70 60 50 % of students 40 choosing 30 20 10 0

Movement difficulties TDA

Bar

Reading Films/TV Club** *

Sport*** Other**

Approaching significance at 0.06 level ** Significant at 0.05 level *** Significant at 0.01 level

G et t in or g u p g pa ani be ck s in d g in b g fo su ag ld it c in g a se or c pe ga lo th rfo nis es rm e in roo pl g 2 m an ni th in ge ng gs lo tti ng fol s s ah re low of a e a a d in d g tten y to ins ti pl an ar ra le tru on av ni n c ng g in c o e t tion to g r m he s d o oo ple ho so m a tin u s e g m ta et nd s w h or ing ork ks ga a pl ni t a a re a s a or n ga nin ed set s to ti ni g se s o me le is d c fo u re ia l ra ac is e cl as tiv it i s/ m es ee t in g

0 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 poor Dental hygiene is poor

Anxiety and depression

Evidence for increasing risk factor

ALSO Obesity in males > females and CVS risk

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

We are like.........

boxes – they are easier to understand ... Not … Got ‘it’ or ‘not’

The outcome for the individual is dependent on multiple factors

Task

Individual

Environment

Individual

Knowledge of causation of learning difficulties

Overlap with other learning difficulties

Increased stress

Task

Individual

Environment

Task demands increase More organisation

Technology

Literacy demands

Changes interact with one another

Varying expression

Different genes have differing roles 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).

BUT environment has an effect on genes

Gene â&#x20AC;&#x201C; environment interaction

Conception

Early years

Ref: Giedd

Supporting individuals with SPLDsâ&#x20AC;&#x2122;

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

Uni/college/work

Home/hall/flat

Career choice

Social interaction

Assessments Work experience

Self care/ILS Rules of the uni Self organisation

Fitness levels

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

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?

TASK

ENVIRONMENT

individual

How joined up are you?

Application

Pre entry

Induction

Between departments

Outside uni

Pre employment

University/college context

Environment What happens on enrolment? Application forms Orientation around campus Handbooks Contracts

How do students find out about support services? Introductory Lectures/timetables Halls of residence ÂŠ 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

ÂŠ The Dyscovery Centre 2007

Identifying Students

Identify themselves â&#x20AC;&#x201C; have had previous support Identified once they arrive themselves or by others and seek support Not want to be identified and labelled

ÂŠ 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

ÂŠ 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

ÂŠ 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

ÂŠ The Dyscovery Centre 2007

Why do students with SpLDs drop out? Cumulative risk factors - greater the variability the greater the risk Socially isolated, living away from home Less parental support Part time job â&#x20AC;&#x201C; managing study and work Filling in forms Greater organisational demands New skills sets required Mental health ÂŠ 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

DoIT profiler

Started in in 2001 Been used in colleges, schools, workplace setting, prisons

Web based profilng or stand alone Text to speech enabled Translated Can undertake parallel profiles

Organisational level

Uni /college level

Year/class level

Individual DoIT profiler copyright Kirby, Smythe

Range of tests and questionnaires

Range of tests for college /uni

Short report

Examples of reporting Macro- across college/uni Banding Detailed break down test by test

Meso Between classes

Micro- tutor and adult Advice for both

Uni Courses Individuals

Visual style report

Detailed advice

School /group comparison â&#x20AC;&#x2DC;scores adjusted to protect schoolsâ&#x20AC;&#x2122;

SEN Questionnaire 800 700 600

500

Series4

400

Series3

300

Series2

200

Series1

100 0 1

13 15

17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57 59

SEN Study skills

300 Se rie s5

200 100

Se rie s4

0 1

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40

Reading/Spelling

30 25 20 Series1

15 10

5 0 1 4 7 10 13 16 19 22 25 28 31 34 37 40434649 52 55 58 61 6467 70

120.00 100.00 80.00 60.00 Series1 40.00 20.00

0.00 1 4 7 10 13 16 19 22 25 28 31 34 37 40 434649 52 55 58 61 64

Social

50 40 30 Series1 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

120.00 100.00 80.00 60.00 Series1 40.00 20.00

0.00 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

Attention

40 30 Series1 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

120.00 100.00 80.00 60.00 Series1 40.00 20.00

0.00 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

Organisation and Coordination

40 30 Series1 20 10 0 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

120.00 100.00 80.00 60.00 Series1 40.00 20.00 0.00 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43

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 download Wender Utah Rating Scales â&#x20AC;&#x201C;free to download Brown ADD scale-40 items that assess five clusters of ADHD-related executive function impairments Organizing, Prioritizing and Activating to Work Focusing, Sustaining and Shifting Attention to Tasks Regulating Alertness,SustainingEffort and Processing Speed Managing Frustration and Modulating Emotions Utilizing Working Memory and Accessing Recall

Turn to the checklists

The ideal assessment considers

Multimodal - information from more than once personinvolving 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

ASRS- free to download http://www.nyuepilepsy.org/psy ch/assets/adhdscreen18.pdf

Assessment

Consider the impact of comorbidity/overlap What level of skill present- social, ICT, recording Associated mental health difficultiesanxiety/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 situation in lectures- note taking Library Lecturers/tutors Socially Small group work Exams/course work- understanding what is expected, referencing

Assessments for DCD

Motor Balance, fine motor and gross motor Movement ABC- 3-16 years ( Henderson and Sugden) BOTMP ( BruininksOseretskytest of motor performance)- 4-24 years

Perception Motor-Free Visual Perception Test-MVPT- up to 70 years â&#x20AC;&#x201C; considers visual perceptual skills

Motor and Perception VMI-Beery-Buktenica Developmental Test of Visual-Motor Integration ( 2100 years!)- motor and perception

Handwriting DASH- 9-16 years- writing speed â&#x20AC;&#x201C; 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

Handwriting Handwriting 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 response Problems with pencil grip, pressure Inattention (ADHD) Working Memory Reading and Spelling abilities Other factors (table height, pen used, paper used, posture for writing)

Important elements in handwriting performance are legibility and speed.

Methods of Handwriting Speed Assessment Speed of Handwriting Either time limit and see how much written Or record how long it takes to finish a task Account for legibility as well Different Tasks used Cats and Dogs The 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 possible Write alphabet continuously for a minute 10 minute free writing Graphic speed task (crosses in circles) measures perceptual motor proficiency administered 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 â&#x20AC;&#x2DC;markerâ&#x20AC;&#x2122; of motor difficulties For exam purposes at the present time

Other tests

The Morrisby manual dexterity test has been recommended by SpLD working group butâ&#x20AC;Ś.

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 â&#x20AC;&#x153;assessing candidates for small parts assembly, e.g. within the electronics industry.â&#x20AC;? (Morrisby,1991).

â&#x20AC;&#x153;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.â&#x20AC;? (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 â&#x20AC;&#x2DC;campâ&#x20AC;&#x2122; 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 old First year â&#x20AC;&#x201C; Live event technology Hall of residence Diagnosed 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 percentile Visual perceptual difficulties Auditory 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 â&#x20AC;&#x201C; keeping desk/equipment in good order, files or notes well kept / tidy Confidence

Suggestions for Tom Assignments Creating an assignment template Post-it notes for structuring assignment ideas Revision and exams Making revision notes or assignment drafts on PowerPoint slides Reducing clutterin room ( with help) Using headphones to help block out noise 25% extra time in exams Use of a computer for note taking Organising self Using mobile phone syncing with Outlook Peer mentorship scheme

Suggestions for Tom

Filing system online and offline

Task list and reminders With an alarm

Organisation Using mobile phone

Change in set up of the computer

GPS system

Speech to text

Text to speech

Computer strategies

Touch typing Changing colour background

Screen ruler

Suggestions for Tom

www.refworks.com/ www.adeptscience.co.uk

www.nuance.co.uk www.dyslexic.com www.clarosoftware.co.uk www.texthelp.com

Stationary drawer

Pin board

In room- declutter and sort

Laundry basket

Cleaning products

Sort bookshelf

Suggestions for Tom continued Organising your work File for each subject on his computer Computer strategies Text to speech and spell checker programmes Develop his touch typing skills End Note referencing programme Motor Creating larger handled tools by wrapping tape around the handles Getting into a stable position if completing ‘fiddly’ tasks If 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-ordinationrisk assessment

http://www.readwritethink.org/files/resources/inter actives/essaymap/

www.ghotit.com ÂŠ The Dyscovery Centre 2007

Mind mapping -www.ikon.com

KIDSPIRATION

Coloured overlays

Areas to address Home

Organising his room for work and living Working with others Appearance Physical activity

University/College

Time management Mentorship

Next step

CV writing Interview techniques Appearance Job 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 independently Hobbies- 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.

Challenges

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.

Fears for some

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.

Preparing for exit

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.

Key issues prior to starting a job

Disclosure- how and to whom Questions beforehand Information about â&#x20AC;&#x2DC;testâ&#x20AC;&#x2122;- does this match the reality of the job Extra time at interview stage Dealing with anxiety

Challenges in the 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 colocated 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 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

Adaptations

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

Approaches

Perfect- full assessment on all students to assess individual needs Good enough- screen and guide all, give focussed support to sometriage

Support

Avoid e.g. use computer, change job Adapt- extra time, use templates for report Practice.. Necessary skill

Conclusions

Clarity Communication Compassion Coping with change Continuum

Practice what you need to Adapt what you can( scaffold) Avoid what you cannot

Further guidance

www.dyscovery.org www.spldtransitions.co.uk www.boxoifideas.org- information, organisations and strategies http://www.learnerprofiler.co.uk/ws/webinarresources.aspx - free software

Conclusions

Amanda.kirby@newport.ac.uk

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

Support groups www.hadd.ie/ www.adhdireland.com/ www.addis.com- parent support organisation in UK www.adhd.ie-Irish group www.danda.org-Neurodiverse adults Www.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...

References Alloway, 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

References Clark, 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 childrenâ&#x20AC;&#x2122;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