Learning Disabilities & ADHD

Learning Disabilities & Attention Deficit Hyperactivity Disorder: Overview, Treatment and Intervention Sara Goldman & Michael Cady Russell Portland State University

August 10, 2011

Learning Disabilities & ADHD OVERVIEW Some people, despite being of average or even above average intelligence, have difficulty

acquiring basic academic skills. Contrary to popular beliefs, people affected by learning disabilities are not stupid or unintelligent. Their brains simply work a bit differently. The term learning disability in fact refers to a neurological difference in the brain of a learning disabled individual. This difference can manifest in many ways. Some common features of a learning disability are: distractibility, difficulty speaking and/or speaking later than is common, vocabulary difficulties, restlessness, difficulty interacting with peers, difficulty following directions and routines, slow in developing motor skills, and problems learning the alphabet, days of the week and/or numbers (Marshak, Dandeneau, Prezant, & L'Amoreaux, 2009). The IDEA defines a specific learning disability as a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. Disorders included in this definition include such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. Disorders that are NOT included are learning problems are primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage (IDEA). The diagnostic criteria for a learning disability are: 1. A specific learning problem that results from a neurological condition and NOT from a sensory disability, mental illness or as a consequence of an impoverished or disadvantaged environment. 2. A discrepancy between the cognitive potential of the individual and their actual

Learning Disabilities & ADHD performance. 3. The problem must be recognized to have existed throughout the developmental stages of learning, and must be chronic. Pulling information from various studies, learning disabilities affect about 15% of the population. This works out to about one in every 7 Americans. Both learning disabilities and ADHD are more prevalent among boys than girls. In fact, boys are three times more likely than girls to have diagnoses of ADHD without LD. Boys were also more likely than girls to have LD diagnosed, either with or without ADHD. Some common learning disabilities are: dyslexia, which creates difficulty processing language resulting in problems with reading, writing, spelling, and speaking. Dyscalculia, which

creates difficulty with math resulting in problems doing math problems, understanding time, using money. Dysgraphia, which creates difficulty with writing resulting in problems with handwriting, spelling, organizing ideas. Dyspraxia (Sensory Integration Disorder), which creates difficulty with fine motor skills resulting in problems with handeye coordination, balance, manual dexterity. Auditory Processing Disorder, which creates difficulty hearing differences between sounds resulting in problems with reading, comprehension, language. Visual Processing Disorder, which creates difficulty interpreting visual information resulting in problems with reading, math, maps, charts, symbols, pictures. Clearly, learning disabilities can affect a students academic performance. However with the correct interventions and support, students with learning disabilities can achieve high academic outcomes. Learning disabilities can also affect a persons psychosocial development. Often students with learning disorders have difficulty perceiving social emotional and behavioral cues. This leads to difficulty in making and keeping friends. If the person has ADHD in addition to a

Learning Disabilities & ADHD

learning disorder, this difficulty can be intensified (Marshak, Dandeneau, Prezant, & L'Amoreaux, 2009). Post school outcomes for students with LD are bleaker than those of students without. Employment rates are lower, drop out rates higher, and college graduation rates are lower as compared with their non-learning disabled counterparts (www.nlts2.org). According to the National Council on Disabilities, there is some evidence that good interventions can be helpful in closing achievement gaps. ADHD is not considered to be a learning disorder. According to the DSM-V TR, ADHD is: A) Persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequently displayed and is more severe than is typically observed in individuals at comparable level of development. B) Some hyperactive-impulsive or inattentive symptoms must have been present before seven years of age. C) Some impairment from the symptoms must be present in at least two settings. D) There must be clear evidence of interference with developmentally appropriate social, academic or occupational functioning. E) The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorders and is not better accounted for by another mental disorder. Most students will not qualify under IDEA for ADHD unless there are co-existing medical or LDs. If student is not eligible for accommodations under IDEA they are often eligible under ADA section 504. ADHD affects between 3 and 5 percent of children, more males than females (Marshak, Dandeneau, Prezant, & L'Amoreaux, 2009).

Learning Disabilities & ADHD TREATMENT & INTERVENTION Treatment of students with learning disabilities varies based on disability. Categories

covered in this section will include, various math learning disabilities, dyslexia, nonverbal learning disabilities (NVLD), dyspraxia, dysgraphia, auditory and visual processing disorders, central auditory processing disorder, attention deficit hyperactivity disorder (ADHD) inattentive and hyperactive. High comorbidity rates of ADHD and LD have been documented in individuals. Pliszka, as cited by Elia, Ambrosini, and Berrettini, found that 20% to 25% of individuals diagnosed with ADHD meet the criteria for LD (2008). Rief places the range of comorbidity between a range of 20% and 60% (2008). The U.S. Department of Health and Human Services Centers for Disease Control and Prevention (CDC) lists the prevalence of individuals age 3-17 with a LD as 8 percent (2007). The discrepancy between boys (10%) and girls (6%) may be due to actual prevalence or due to an under-diagnosis of girls. The CDC also states that boys are twice as likely to be diagnosed with ADHD (4% in girls and 11% in boys) giving a total rate of 7 percent. Another point of interest in the CDC report is that in families with an income less than $20,000 there is a 12% diagnosis rate for ADHD and in families with an income of $75,000 the diagnosis rate is only 6%. Treatment options for LD are primarily given in the classroom through specialized curriculum and accommodations. A variety of treatment options exist for ADHD including behavioral, diet and pharmaceutical interventions. Best practices for students with and without learning disabilities are the similar. Reduced class sizes, more individualized attention, structure, and organization help all students. On page 172 of The School Counselors Book of Lists, Blum and Davis list important counselor actions in relation to working with students with learning disabilities:

Learning Disabilities & ADHD Provide accepting relationship and unconditional positive regard Obtain a basic knowledge of the problem General characteristics Symptoms Needs specific to exceptional condition Assessment instruments Prognosis Learn the student's particular strengths and potential Help student and parent adjust to and cope with the handicapping condition Help student deal with feelings of rejection Help student gain feelings of self-worth Help student deal with repeated failures Listen to, accept, and reflect student's fears, anxieties, doubts, and insecurities Reframe student's expressions into appropriate statements Use a variety of techniques to assist students Teach personal/social skills in a group setting when possible Help strengthen self-confidence

While this list is not comprehensive, it does highlight the need for counselors to establish a relationship, teach specific skills and to provide the student with information. It will also be important to make staff aware of interventions and accommodations that can be made for individual students. It is the role of the counselor to act as a strengths advocate and to work as a team to help students utilize strengths, rather than focus on weaknesses (Capuzzi, 2008) For students with ADHD a school counseling focus should be placed on behavioral techniques related to social skills, problem solving, and strategies for managing frustration (Blum & Davis, 2010). A Portland high school named, Thomas A. Edison High School (TAEHS) works with

Learning Disabilities & ADHD students with LD and ADHD. Best practices according to TAEHS include, highly structured, intensive instruction with emphasis placed on research-based instruction and learning in small increments. Rapid paced instruction that is multimodal is vital to maintaining focus. At TAEHS a high value is placed on student's sense of achievement. To accomplish this the school provides

daily, weekly, and quarterly progress checks. Consistent, regular monitoring helps students stay on task and on track. Small class sizes help students maintain focus. In a larger classroom preferential seating is an option to help students maintain focus and to give the teacher the opportunity to redirect LD and ADHD students. Depending on LD, notetakers, may be provided. Audiobooks can assist students who have difficulty reading and processing text. Response to Intervention Model From our research, the most common intervention related to LD and ADHD is the response to intervention (RTI) model. IDEA 2004 states that, lack of appropriate instruction in reading, lack of instruction in math, or limited English proficiency shall not contribute to a determination of a disability ((Sec. 614 (b) (5) (B)). RTI was a response to IDEA 2004 to ensure that adequate instruction is given to students who struggle. The 2004 IDEA also states that, a local school district may include a student's response to research based intervention as part of the SLD determination process (Sec. 614 (b) (6) (B)). This means that it is not mandated, but the option is given for school staff to use the research based intervention, such as RTI, as a response to a students poor success. RTI is used to prevent at-risk students from falling behind, as an intervention for students who are having academic or behavioral difficulties, and as a component in the LD or ADHD eligibility determination process. There are three levels of intervention in RTI. According to the National Research Center on Learning Disabilities (NRCLD) 80% of students are adequately served by primary interventions, 15% by secondary interventions, and 5% by tertiary

Learning Disabilities & ADHD interventions (2007). Primary intervention happens in every classroom. All students receive highquality, research-based instruction by a highly qualified teacher. At this stage students receive research-based interventions to address individual difficulties. At this stage monitoring of

performance is conducted regularly. If a student does not respond with learning gains they move to the next level of intervention. Secondary intervention is designed for students with additional needs beyond the regular classroom setting. Smaller class sizes are utilized and more intensive research-based instruction is used. Learning gains are measured more often at the secondary intervention level than the primary intervention level. At this level diagnostic testing for a disability may occur if the student does not respond with learning gains. If learning gains are established the student will move back to the primary intervention level. If learning gains are not adequate the student will move to the next level of intervention. Tertiary intervention is highly individualized and is designed for students with intensive needs. This third tier of intervention is performed by a highly qualified special education employee. To be assigned to this level the student would need to be diagnosed with a learning disability. Learning gains continue to be assessed on a regular basis to track if the specialized interventions are showing learning gains. If learning gains are established the student can move back to secondary or primary intervention levels. At this third tier of intervention, if the student does not respond with learning gains they will stay at this level, receiving specialized instruction. The RTI model is designed to be flexible and to act quickly on documented lower levels of learning gains. Interventions and assessment are designed to be initially provided by the highly qualified teacher, then by more specialized staff. Other Information Students, families and faculty working with students with LD and ADHD need to be aware

Learning Disabilities & ADHD

of techniques to connect and maintain engagement in education. Students in these categories are at a higher risk for not achieving academic and social success for a multitude of reasons. By connecting with these students and focusing on their strengths, educators families can help these students have a greater chance of success.

Learning Disabilities & ADHD LESSON PLAN - Overview

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Title: Helping Educators Understand Accommodations and Resources for LD & ADHD Kids Name: Sara & Michael Topic: Educators & LD/ADHD Age/Grade: Time Allotted: Educators K-12 45 min (more time can be allotted for more detailed lessons) Preparation: Gather resources, current articles and data on LD/ADHD Purpose/Rationale for the lesson: To challenge preconceived ideas of ADHD and LD educators hold. Many educators have been working with LD/ADHD students for years and have been successful. This lesson helps those educators refresh their skills and details current statistics on LD/ADHD. For teachers who have not been successful working with students with LD/ADHD this lesson is a chance to connect with successful teachers and gather information and data on best practices. Learning Objectives for the lesson: To learn more about the specifics of LD and ADHD To better understand the needs of students with LD and ADHD To find ways to help students with LD and ADHD engage in class To give teachers tools to be more effective when working with students with LD and ADHD To introduce the RTI model to educators and discuss how it could help the school Developmental level of students: Masters level educators, currently working in schools Key Questions: What is LD? What is ADHD? Is ADHD a LD?

Learning Disabilities & ADHD How many students do you work with who have LD or ADHD? (speculative and diagnosed) How do your students with LD and ADHD advocate for themselves? What do you do to encourage advocacy in your class? What successes have you had with students with LD and ADHD? What areas of growth do you notice in yourself when working with LD/ADHD students? Materials/Resources Needed: Paper & pencil Example overhead What it is like for students with Dyslexia paragraph Handout Description of common LD & ADHD (http://www.ndcpd.org/jobcorps/pdf/Disability %20Characteristics%20Handout-LD.pdf) Group of Documents - LD Resource Kit (http://www.nrcld.org/resource_kit/) Tables & movable chairs

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Anticipatory Set: Join in groups of 3 and discuss what you currently know about LD. What would you like to know more about related to LD and ADHD? Be prepared to share a portion of your discussion with the group. Have groups share what they know most about and what they would like to learn more about. Body of the Lesson: Lecture/Discussion style I. LD Specifics Handout A. Review What is it? i. Ask class for specific examples of LD and what they look like in the classroom B. Review Common characteristics i. Ask class for specific examples of LD characteristics and what they look like in the

Learning Disabilities & ADHD classroom C. Review Strategies for working with person i. Ask class for specific examples of LD strategies and what they look like in the classroom D. Review - For more information E. Questions about the handout? II. Using the LD Resource Kit (http://www.nrcld.org/resource_kit/)

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A. Review documents available with the class and discuss Response to Intervention (RTI). B. Discuss how RTI could help with the LD determination process. C. Review the documents available in the LD Resource Kit Closure: Ask class to join in groups of three and discuss the things learned in the lesson that will have the most impact on their classes. Be prepared to share with the larger group Assessment/Evaluation of Student Learning: Class groups will share what they learned today that will have the most impact on their class. Reflection on the process: (to be completed after the lesson is taught)

Lesson can be expanded if the school will be utilizing the RTI model in the future. All educators will need to

Learning Disabilities & ADHD SUPPLEMENTAL READING Learning Disabilities and ADHD: Overlapping Spectrum Disorders.

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See class website on https://d2l.pdx.edu/ for full version of article.

Mayes, S. D., Calhoun, S. L., & Crowell, E. W. (2000). Learning disabilities and ADHD: Overlapping spectrum disorders. Journal of Learning Disabilities, 33(5), 417-424.

Abstract: Investigates learning problems in children with attention-deficit/hyperactivity disorder (ADHD). Learning disabilities (LD) frequency in children; Prevalence of LD in children with ADHD; Impact of ADHD and LD on learning and attention and other cognitive measures; Relationship between attention and learning problem.

Learning Disabilities & ADHD Resources CHADD - Children and Adults with Attention-Deficit/Hyperactivity Disorder 8181 Professional Place Suite 150 Landover, MD 20785 http://www.chadd.org http://www.help4adhd.org/ Tel: 301-306-7070 / 800-233-4050 Fax: 301-306-7090 Local Chapter: Portland Metro CHADD, [email protected] National Research Center on Learning Disabilities Vanderbilt University site P.O. Box 328 Peabody College Vanderbilt University Nashville, TN 37103 http://www.nrcld.org/ [email protected] International Dyslexia Association 8600 LaSalle Road Chester Building, Ste. 382 Baltimore, MD 21286-2044 [email protected] http://www.interdys.org Tel: 410-296-0232 800-ABCD123 Fax: 410-321-5069 Oregon Branch of the International Dyslexia Association (ORBIDA) PO Box 2609 Portland, OR 97208-2609 [email protected] (General Info) www.orbida.org 503-228-4455 (Voice Mail) Learning Disabilities Association of America 4156 Library Road Suite 1 Pittsburgh, PA 15234-1349 [email protected] http://www.ldaamerica.org Tel: 412-341-1515 Fax: 412-344-0224 National Center for Learning Disabilities 381 Park Avenue South Suite 1401

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Learning Disabilities & ADHD New York, NY 10016 http://www.ld.org Tel: 212-545-7510 888-575-7373 Fax: 212-545-9665 National Institute of Child Health and Human Development (NICHD) National Institutes of Health, DHHS 31 Center Drive, Rm. 2A32 MSC 2425 Bethesda, MD 20892-2425 http://www.nichd.nih.gov Tel: 301-496-5133 Fax: 301-496-7101 National Institute of Mental Health (NIMH) National Institutes of Health, DHHS 6001 Executive Blvd. Rm. 8184, MSC 9663 Bethesda, MD 20892-9663 [email protected] http://www.nimh.nih.gov Tel: 301-443-4513/866-615-NIMH (-6464) 301-443-8431 (TTY) Oregon Health & Science University Child Development Program Child Development and Rehabilitation Center/Portland 707 SW Gaines Street Portland, OR 97239 http://www.ohsu.edu/cdrc/clinical/portland/child_dev.html (800) 452-3563 Thomas A. Edison High School (LD/ADHD High School) 9020 SW Beaverton Hillsdale Hwy Portland, OR 97225 www.taedisonhs.org (503) 297-2336 Providence Gately Academy (LD/ADHD 4th - 8th Grade School) 205 NE 50th Avenue Portland, OR 97213 http://www.gatelyacademy.org (503) 215-2672

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Learning Disabilities & ADHD References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington, DC: Author. Blum, D. J., Davis, T. E. (2010). The School Counselor's Book of Lists. San Francisco, CA: Jossey-Bass. Capuzzi, D., Cross, D. R. (Eds.). (2008). Youth at Risk: A Prevention Resource for Counselors, Teachers, and Parents. Alexandria, VA: American School Counseling Association. Elia, J., Ambrosini, P., Berretini, W. (2008). ADHD characteristics: I. Concurrent co-morbidity

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patterns in children and adolescents. Child and Adolescent Psychiatry and Mental Health, 2(15), 15-23. doi:10.1186/1753-2000-2-15 Marshak, L.E. , Dandeneau, C.J., Prezant, F.P., & L'Amoreaux, N.A. (2009). The school counselor's guide to helping students with disabilities. San Francisco, CA: Jossey-Bass National Council On Disability, (n.d.). Retrieved from http://www.educationalpolicy.org/pdf/NCD.pdf National Research Center on Learning Disabilities (2007). A researched-based view of the specific learning disabilities determination process: Response to intervention overview. Retrieved from http://www.nrcld.org (n.d.). Retrieved from http://www.nlts2.org/ Quickstats: Percentage of children aged 5--17 years ever having diagnoses of attention deficit/hyperactivity disorder (ADHD) or learning disability (LD), by sex and diagnosis --united states, 2003. (n.d.). Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5443a8.htm Reif, S. F. (2008). The ADD/ADHD checklist: A practical reference for parents and teachers. San

Learning Disabilities & ADHD Francisco, CA: Jossey-Bass. Topic: identification of specific learning disabilities. (n.d.). Retrieved from http://idea.ed.gov/explore/view/p/%2Croot%2Cdynamic%2CTopicalBrief%2C23%2C U.S. Department of Health and Human Services Centers for Disease Control and Prevention

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(2007). Summary health statistics for U.S. children: National health interview survey, 2006. Vital and Health Statistics, 10(234), 5 & 12.