An Introduction toSpecific Learning Difficulties in

Adults

Specific Learning Difficulties/Differences (SpLD)

Distinct from global learning difficulties

Discrepancy between the individual’s general intellectual abilities and their abilities in certain areas of learning or under certain circumstances

SpLD arise from processing differences rather than intellectual impairment

Neurodevelopmental conditions that affect the individual’s abilities to learn in normal contexts by traditional methods

Dyslexia (dyscalculia, dysgraphia)

Developmental dyspraxia/developmental coordination disorder (DCD), motor and co-ordination difficulties

Visual and auditory processing difficulties

Attention deficit disorder with or without hyperactivity (ADD/ ADHD)

Autism/Asperger Syndrome

Tourette Syndrome/obsessive compulsive disorder (OCD)

More than one SpLD may occur or SpLD may overlap in the same person.

In adults, SpLD may be undiagnosed

Specific Learning Difficulties/Differences (SpLD)

Dyslexia and SpLD

Dyslexia may be the most common SpLD but may also result from, occur along with or be misdiagnosed for one of the other conditions. Equally, other specific learning difficulties can cause difficulties with reading writing or number skills.

Unexpected difficulties with reading and writing will be detected in school and, because dyslexia is widely understood to affect literacy acquisition, may lead to dyslexia assessment and diagnosis.

Other SpLD, such as dyspraxia, Asperger Syndrome or ADHD may be under-recognised because indications are less visible/less well known and conditions may dismissed as behavioural problems.

Detection and labelling of SpLD

SpLD are “hidden” difficulties with no obvious visible signs and coping strategies and other abilities can further mask SpLD.

Difficulties can range from mild through moderate to severe.

SpLD can be considered as a spectrum of neurodevelopmental differences that share certain features, grade into each other and often co-occur.

Many SpLD are syndromes: detected and defined by clustering of characteristics, most of which, in isolation, are part of ‘neurotypical’ behaviour.

Genetic links – conditions tend to run in families.

SpLD are assessed and defined by these clusters of characteristics rather than by genetics, brain scans etc.

Diagnostic and Statistical Manual of Mental Disorders (DSM)

DSM IV: Oppositional Defiant Disorder

If a child's problem behaviors do not meet the criteria for Conduct Disorder, but involve a pattern of defiant, angry, antagonistic, hostile, irritable, or vindictive this mental disorder of childhood may be diagnosed. These children may blame others for their problems.

Diagnostic criteria for 313.81 Oppositional Defiant Disorder(cautionary statement)

A. A pattern of negativistic, hostile, and defiant behavior lasting at least 6 months, during which four (or more) of the following are present: (1) often loses temper (2) often argues with adults (3) often actively defies or refuses to comply with adults' requests or rules (4) often deliberately annoys people (5) often blames others for his or her mistakes or misbehavior (6) is often touchy or easily annoyed by others (7) is often angry and resentful (8) is often spiteful or vindictive Note: Consider a criterion met only if the behavior occurs more frequently than is typically observed in individuals of comparable age and developmental level.

B. The disturbance in behavior causes clinically significant impairment in social, academic, or occupational functioning.

C. The behaviors do not occur exclusively during the course of a Psychotic or Mood Disorder.

D. Criteria are not met for Conduct Disorder, and, if the individual is age 18 years or older, criteria are not met for Antisocial Personality Disorder.

Neurodiversity

The adult learning worker’s role is not to “cure” or change differences, but to assist/enable learners to achieve their potential by helping overcome barriers to learning that these conditions present.

SpLD conditions are considered by some to be a social construct – there is no measure of divergence other than what’s considered to be “normal”.

They say brain differences, like body differences, should be embraced, and argue for an acceptance of ''neurodiversity.'' AMY HARMON, New York Times: May 9, 2004

It’s possible to respect individual differences and still acknowledge that SpLD make learning more difficult in traditional contexts.

“I’m different – the same as everybody else.”

The Bagatelle Model of SpLDhttp://www.youtube.com/watch?v=41gCL4StyH0

Combination of slots = a ‘syndrome’

Predisposed but not predetermined (a core difference influenced by experience?)

Core difference being a processing difference – holistic or sequential

Related to working memory

Same core difference with lots of overlaps

Not ‘something wrong with people’

The Bagatelle Model of SpLD

Overlapping conditionshttp://www.dystalk.com/talks/57-dyslexia-dyspraxia-amp-overlapping-learning-difficulties

Short term memory

Copy down all the numbers

Short term memory

Copy down all the numbers

Dyslexia

Discrepancy between intellect and the ability to learn literacy

Difficulties with pronunciation or ‘getting the right word out

Organisation difficulties

Timekeeping and directions may be problematic

Forgetting instructions and generally poor short-term memory

Sequencing difficulties

Family history of similar difficulties

Possibly difficulties with co-ordination

Unusual learning styles or coping strategies

Low self esteem is common

Air of distraction Dyslexia

http://www.nhs.uk/conditions/dyslexia/Pages/Introduction.aspx

Dyscalculia  May be similar to dyslexia but with interpretation of number instead of, or as well as reading/writing. Note that abilities to carry out calculations may be limited by other SpLD (e.g learning multiplication tables may be more a language task than a number task; distinguishing between symbols requires visual perceptual skills; short term memory is needed for mental arithmetic).

Limited research into dyscalculia.

Dysgraphia More than simply bad handwriting – it is difficulty in automatising motor movements.

Writing skills that are substantially below those expected given the person's age, measured intelligence, and age-appropriate education. May occur along with other SpLD. Little research into developmental dysgraphia.

Dyspraxia (Developmental Coordination Disorder)

Poor gross motor coordination: clumsiness, poor balance/posture; floppy joints

Accident prone – falling over, bumping into things

Poor fine motor coordination: handwriting difficulties, poor grasp and manipulation

Visual tracking may be a problem in reading

Hypersensitivity to touch, taste, temperature etc

Time management, organisation and directional difficulties

Poor short term/working memory; forgetful, easily distracted

May be messy

http://www.youtube.com/watch?v=1tvrWH4EJmw

http://www.youtube.com/watch?v=say3psC9fp0

ADHD (HD and ADD)

Behavioural disorders with childhood onset – usually before the age of 7 but onset at puberty is also recognised.

HDIndividuals display at least 6 features of hyperactivity and impulsivity including fidgeting, tapping, restlessness, excessive talking, interrupting others.

ADDIndividuals display at least 6 features of inattention, including difficulties in finishing tasks, listening, giving attention to details; makes careless mistakes; may be forgetful and easily distracted.

ADHD6 or more symptoms of inattention and 6 or more symptoms of hyperactivity-impulsivity

Symptoms need to be present for 6 months or more and need to be present in 2 or more settings (e.g. home and school).

http://www.youtube.com/watch?v=SMikx-vjgKc

http://www.youtube.com/watch?v=WcVTiV47Gf8

Visual and visual processing difficulties

Might be seen as SpLD because they can make learning more difficult and yet are unrelated to intellect, education or social factors.

Standard eye examinations are not designed to check for reading efficiency.

What is seen is processed into meaning in the brain and it is possible to have excellent eyesight but still have difficulties with perception of reading material.

Efficient reading and reading comfort requires an amount of stamina in the visual system to sustain functions over time: processes may function adequately for the purposes of an eye examination but may fatigue too quickly for continuous reading.

Problems in the vision system can have serious effects on reading, literacy and learning in general.

http://www.youtube.com/watch?v=uMXQAr6oP-o

Auditory processing difficulties

Auditory processing is the process of changing sound into meaning – which takes place in the brain rather than in the ear.

Not a hearing impairment and may not be detected in a standard hearing test

Can cause difficulties in understanding what is being said

Can cause difficulties in relating sounds to written language and can result in literacy difficulties.

Can be mistakenly diagnosed as other SpLD conditions

Is often associated with dyslexia

It is relatively unusual for an adult to have a positive diagnosis for auditory processing difficulty and therefore it’s important that those working with adults with literacy difficulties are aware of indications.

http://www.youtube.com/watch?v=5xQE2qMVt5M

Auditory processing difficulties 

difficulties in distinguishing between similar phonic sounds (auditory discrimination)

problems recognising words in noisy environments

missing pieces of spoken information

easily distracted by noise

difficulties in following sequences of oral information

problems with locating the direction of sounds

difficulty interpreting degraded sounds

taking longer to process oral information

difficulties with writing while listening

poor memory for sounds and oral information

poor attention with oral information

history of childhood ear infections (glue ear)

asking for information to be repeated and generally poor listening skills

Autism/the autistic spectrum:(Autism/Asperger Syndrome/Pervasive Developmental Disorder – Not Otherwise Specified – PDD-NOS )

Triad of impairments:1 of social interaction (relationships)2 of communication (verbal/non-verbal)3 of imagination (restricted interests and repetitive behaviour)

Autism: early language impairment/Asperger’s: no early language impairment By definition, those with Asperger Syndrome have normal or above normal intellect, however, assessing intelligence in those with autism is problematic by standard IQ measures - estimates of low intellect in those with autism vary so much as to be unhelpful (25%-75% Dawson M, Mottron L, Gernsbacher MA (2008))

Scatter skills; highly focused on interests and details;

difficulties with generalisation, literal interpretations;

disinterest in areas that don’t affect the individual directly.stress in social situations; lack of social skills/difficulty with social “rules” and norms;non-verbal communication (eye contact; body language cues).

Theory of mind – empathy http://www.youtube.com/watch?v=QjkTQtggLH4

Robyn http://www.nhs.uk/Conditions/Autistic-spectrum-disorder/Pages/Robynsstory.aspx

Dave http://www.youtube.com/watch?v=WAfWfsop1e0

Tourette Syndrome and Obsessive Compulsive Disorder (OCD)

Both are characterised by repetitive behaviour.

Tourette’s is a tic disorder while OCD is an anxiety disorder (they may occur together)

Tourette’s is characterised by recurring involuntary tics (motor and/or vocal) that have no purpose. Tics are “suppressible but irresistible”

Repetitive behaviour in OCD is disabling but purposeful.

Obsessive thoughts cause the anxiety (such as fear of germs) compulsive behaviour (such as washing) relieves the anxiety. The OCD sufferer will be aware that the behaviour is unreasonable (otherwise the behaviour would be psychotic).

OCD may be treated by Cognitive Behavioural Therapy (CBT).

What is Tourette's? http://www.youtube.com/watch?v=hNSHLOI_-aU&feature=related

Summary

SpLD co-occur, overlap and share so many common features that labelling, based on behaviour is difficult – the labels themselves may be artificial.

Even within specific labelled conditions, degree of difficulty and profile of problem areas will vary between individuals.

Many adults with SpLD will never have had an assessment or diagnosis for any condition, but may have difficulties achieving their potential in learning or workplace because of unrecognised processing differences.

It is therefore better to work with the individual’s needs and abilities, making adjustments for problem areas rather than looking for a single approach to work with a labelled condition.

Adjustments will need to account for working memory difficulties, organisational and coordination difficulties, learning preferences, learning or work environment issues and physical issues such as stamina and fatigue.