Learning Difficulties Dr Rose MAK 16 October 2004
Topics 1 Learning 2 Learning difficulties 3 Diagnosis & Assessment 4 Intervention 5 Developmental conditions that interfere with learning e.g. Mental Retardation, ADHD, Autistic Spectrum Disorders
Learning Learning is the process by which we acquire knowledge about the world. Learning leads to a relatively permanent change in behaviour.
Goal of Development autonomy/independence / emotional well-being self-esteem capacity to form lasting relationships intimacy
Ways to learn Basic learning mechanisms (all ages) Habituation ( ) Classical Conditioning ( ) Stimulus-response learning (Operant Conditioning) ( ) Observational learning & imitation Cognitive learning ( )
Executive Function from external to internal control from immediate to delayed gratification from here & now to the future
Age 12 months old 24 months old 36 months old 4 years old 5 years old 7-10 years old Adult Attention span 1 minute 7 minutes 9 minutes 13 minutes 15 minutes 20 minutes 45-60 minutes
Factors that influence Learning Nature & Nurture Child factors Maturation of the brain ( ) Temperament/personality / Cognitive abilities Intelligence Motivation Experience Emotion Motor ability Environment (physical & social) Physical health Opportunity
Consequence of having learning problems Academic failure Low self esteem, anxiety, depression, anger Behaviour/Conduct problems Social isolation Dependence,
Education Child societal, operational Parents Developmental
Variations Problems Disorders ICD-10 衞 10 DSM-4 统 4
Commonly associated problems Developmental Problems Learning Problems Emotional Problems Behaviour Problems
Factors affecting outcome Multiple diagnoses/problems e.g. SLD + attention deficit + conduct disorder Aetiology untreatable or irreversible Severe Intelligence impaired Deficits in cognitive & other abilities Inadequate coping skills Difficult temperament/personality ( ) / Lack of goodness of fit / Unsupportive social environment
Medical conditions that interfere with learning Chronic medical conditions e.g. anaemia, asthma Visual, hearing, and other sensory impairments e.g. recurrent middle ear infections Conditions Seizure & other neurological conditions that impair the function Long-term medications of the brain e.g. antihistamines ( ) Perinatal adverse events e.g. birth weight <1.5Kg Sleep problems
Developmental conditions that interfere with learning Specific Learning Disorders Disorders Attention Deficit (Hyperactivity) Disorder Autistic Spectrum Mental Retardation Cerebral Palsy Conditions that impair the growth & development of the brain
Psychological & psychiatric conditions that interfere with learning anxieties, worries, & fears about attending school low self esteem, depression relationship problems with family, teachers, peers tics & habit disorders Obsessive Compulsive Disorders psychosis
Common alerting complaints Failing in school, deteriorating academic performance Behaviour problems Speech delay Developmental delay Psychosomatic complaints
How to help
e.g.
Managing behaviour Encourage desirable behaviour Positive descriptive praise Managing misbehaviour Ground rules Clear calm instructions Quiet time Time out Preventing problem behaviour
衞 统
Mental Retardation 1 IQ 70 (by clinical judgement in case of infants) 2 significant limitations in adaptive functioning 3 <18yrs onset before age 18 yrs
Wechsler Intelligence Scale for Children - Revised (WISC-R) 6-16
Mental Retardation Mild Moderate Severe Profound Grade Special Schools Mild Moderate Severe
Mental Retardation Grades Mild Moderate Severe Profound Mental Age (adult) 9 - <12yrs 6-9 yrs 3-6 yrs <3 yrs
Specific Learning Difficulties ( ) Dyslexia Mathematics Learning Disorder Developmental Coordination Disorder Visual-spatial perceptual problems Specific Language Impairment
ADHD Attention Deficit Hyperactivity Disorder Core features Inattention Hyperactivity Impulsivity
ADHD Severe & persistent Across different settings ( ) Symptoms from an early age Significant learning and social difficulties Not due to other causes
ADHD 3-5% 2 :1 ( ) (dopamine )
ADHD Associated conditions Learning problems 10-25% Emotional & mood problems e.g. low self esteem, low motivation, depressed mood Oppositional Defiant Disorder Developmental Coordination Disorder Inadequate social skills, poor relationships
ADHD Cognitive behaviour therapy ( ) social skills training (ritalin )...
Autistic Spectrum Disorders 1 2 3 ( )
10-20/10,000 3-4 :1
e.g. TEACCH e.g. ABA : 强
Executive Control Function Direct, select, & monitor Environmental input Response Sensory Register Perceptual & attention processes Short term & Working Memory Execution of memory & problem-solving strategies Limited capacity, minutes-hours Rehearsal Retrieval automatic Long term Memory Storage of strategies & knowledge gained Unlimited capacity, relatively permanent
disinterested slow, forgetful disorganiseddistractiblebehaviour disruptive inattentive problems academic failure developmental delay inconsistent performance oppositional lazy frustration anxiety anger depression despair tire easily discrepant performances impairm constitutional deficit
Child s Environm ent Government Policies Community Friends, Teachers Family, Relatives Child