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ADHD
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 Tools
for Parents of Children with Disabilities and
Special Needs
Impact of Developmental Learning Disorders
Content:
Learning Disabilities and Learning Differences
Confusion About Learning Disabilities
Widespread confusion surrounds what constitute learning disabilities, even
among professionals to whom the public is likely to turn.
95% of parents surveyed would seek professional or medical help if their
child was identified with a learning disability. 72% would go to a doctor, 70%
would go to their school administration, 64% would go to their child’s
teacher, and 50% would go to the library.(Roper Starch Survey,
1995) However, studies indicate that most of
these sources are ill-prepared to handle such inquiries, the majority of
Americans surveyed are misinformed about conditions related to learning
disabilities. Over 80% misidentify mental retardation and autism as conditions
associated with learning disabilities. (Lerner, 1997).
Learning Disabilities Defined
- The term "learning disability" describes a neurobiological
disorder in which a person’s brain works or is structured differently.
- Because their minds process words and information differently, people with
learning disabilities have trouble learning and this creates a gap between
ability and performance.
- Learning disabilities interfere with a person’s ability to think and
remember. This can affect their ability to speak, listen, read, write,
reason, recall, organize information and do math.
- People with learning disabilities have normal or above average
intelligence.
- Learning disabilities should not be confused with other disabilities such
as autism, mental retardation, deafness, blindness or behavioral
disorders.
- Attention Deficit/Hyperactivity Disorder (ADHD) and learning disabilities
often co-exist, but the disorders are distinct and separable.
- Many children have difficulty learning but not all of them receive a
learning disability diagnosis. "Learning disability" is a term
referring to a set of specific, definable and diagnosed problems. The term
"learning differences" includes the many children who struggle in
school but may test below the threshold for a diagnosed learning disability.
- Children with learning disabilities can reach their full potential when
provided with early identification, proper instruction, compensation
strategies and motivational support.
The Prevalence of Learning Disabilities
- Learning problems such as dyslexia affect at least 10 million children, or
approximately one in five children in first through ninth grades.
(Cramer & Ellis, 1996)
- While 15% of Americans have learning disabilities, many go untreated due
to lack of diagnosis.
- 60% of adults with severe literacy problems have undetected/untreated
learning disabilities. (NALLDC,1994)
- Deficits in reading are the most prevalent condition associated with
learning disabilities. Among special education students, more than 80% are
identified with this condition. (Lerner, 1997)
- More than 50% of all children in special education programs in public
schools (2.4 million children) have learning disabilities.(Cramer
& Ellis, 1996)
- Learning disabilities often run in families. (Lyon, 1994)
Social Ramifications of Learning Disabilities
- 35% of students with learning disabilities drop out of school—nearly
twice the rate of students without learning disabilities.
- 30% of adolescents with learning disabilities will be arrested three to
five years out of high school. (Wagner, M et al 1993)
- The rate of unemployment for students with learning disabilities two years
out of school is twice that of students in the general population.
- Nearly 60% of adolescents in treatment for substance abuse have learning
disabilities.(Hazelton, 1994)
- Learning disabilities and substance abuse are the two most common
obstacles keeping welfare recipients from achieving stable employment.
(OIG,1992)
- Previously undetected learning disabilities have been found in 50% of
juvenile delinquents. Once remedial services are provided, this population’s
recidivism rate drops to just 2%. (Lerner, 1997)
Attention Deficit Hyperactivity Disorder (ADHD)
Individuals with ADHD may know what to do but do not consistently do what
they know because of their inability to efficiently stop and think prior to
responding, regardless of the setting or task.
Characteristics of ADHD have been demonstrated to arise in early childhood
for most individuals. This disorder is marked by chronic behaviors lasting at
least six months with an onset often before seven years of age.
Four Subtypes of ADHD
At this time,
four subtypes of ADHD have been defined. These include the following:
1. ADHD – Inattentive type is defined by an individual experiencing at
least six of the following characteristics:
- Fails to give close attention to details or makes careless mistakes
- Difficulty sustaining attention
- Does not appear to listen Struggles to follow through on instructions
- Difficulty with organization
- Avoids or dislikes requiring sustained mental effort
- Often loses things necessary for tasks
- Easily distracted Forgetful in daily activities
2. ADHD – hyperactive/impulsive type is defined by an individual
experiencing six of the following characteristics:
- Fidgets with hands or feet or squirms in seat
- Difficulty remaining seated
- Runs about or climbs excessively (in adults may be limited to subjective
feelings of restlessness)
- Difficulty engaging in activities quietly
- Acts as if driven by a motor
- Talks excessively
- Blurts out answers before questions have been completed
- Difficulty waiting in turn taking situations
- Interrupts or intrudes upon others
3. ADHD – combined type is defined by an individual meeting both sets
of attention and hyperactive/impulsive criteria.
4. ADHD – not otherwise specified is defined by an individual who
demonstrates some characteristics but an insufficient number of symptoms to
reach a full diagnosis. These symptoms, however, disrupt everyday life.
The majority of adults with ADHD have been described as experiencing symptoms
very similar to the problems experienced by children. They are often restless,
easily distracted, struggle to sustain attention, are impulsive and impatient.
They have been described as experiencing problems with stress intolerance
leading to greater expressed emotion. Within the workplace they may not achieve
vocational positions or status commensurate with their siblings or intellectual
ability.
Statistics on ADHD:
- About 1% to 3% of the school-aged population has the full ADHD
syndrome, without symptoms of other disorders. Another 5% to 10% of the
school-aged population have a partial ADHD syndrome or one with other
problems, such as anxiety and depression present.
- Another 15% to 20% of the school-aged population may show transient,
subclinical, or masquerading behaviors suggestive of ADHD. A diagnosis of ADHD
is not warranted if these behaviors are situational, do not produce impairment
at home and school, or are clearly identified as symptoms of other disorders.
- Gender and age affect the ways in which people with ADHD express their
symptoms. Boys are about three times more likely than girls to have symptoms
of ADHD
- Symptoms of ADHD decrease with age, but symptoms of associated features and
related disorders increase with age. Between 30% and 50% of children still
manifest symptoms into adulthood.
Causes of ADHD:
ADHD is NOT caused by poor parenting, family problems, poor teachers or
schools, too much TV, food allergies, or excess sugar. One early theory was that
attention disorders were caused by minor head injuries or damage to the brain,
and thus for many years ADHD was called "minimal brain damage" or
"minimal brain dysfunction." The vast majority of people with ADHD
have no history of head injury or evidence of brain damage however. Another
theory which is still heard in the media was that refined sugar and food
additives make children hyperactive and inattentive. Scientists at the National
Institutes of Health (NIH) concluded that this may apply to only about 5 percent
of children with ADHD, mostly either very young children or children with food
allergies.
Experts have investigated genetic and environmental causes for ADHD. Some
children may inherit a biochemical condition, which influences the expression of
ADHD symptoms. Other children may acquire the condition due to abnormal fetal
development, which has subtle effects on brain regions that control attention
and movement.
ADHD is very likely caused by biological factors which influence
neurotransmitter activity in certain parts of the brain, and which have a strong
genetic basis. Studies at NIMH using a PET (positron emission tomography)
scanner to observe the brain at work have shown a link between a person's
ability to pay continued attention and the level of activity in the brain.
Specifically researchers measured the level of glucose used by the areas of the
brain that inhibit impulses and control attention. These scientists have
localize the brain areas involved in ADHD and have found that areas in the
frontal lobe and basal ganglia are reduced by about 10 percent in size and
activity in ADHD children. In people with ADHD, these brain areas that control
attention used less glucose, indicating that they were less active. It appears
from this research that a lower level of activity in some parts of the brain may
cause inattention and other ADHD symptoms.
There is a great deal of evidence that ADHD runs in families, which is
suggestive of genetic factors. If one person in a family is diagnosed with ADHD
there is a 25% to 35% probability that any other family member also has ADHD,
compared to a 4% to 6% probability for someone in the general population. Recent
research based on genetic mechanisms has focused on dopamine as the primary
neurotransmitter involved in ADHD. Dopamine pathways in the brain, which link
the basal ganglia and frontal cortex, appear to play a major role in ADHD.
Research on ADHD:
Controversial and important areas of ADHD research include investigations
into the definitions of this disorder. These include the validity of partial
syndromes, the need for gender-specific criteria and age-specific criteria, and
the importance of accompanying troublesome conditions.
In the areas of current ADHD statistical research: Epidemiological
investigations of the true prevalence to determine how many children have the
symptoms of ADHD and of administrative prevalence to determine how many children
are recognized and treated are controversial and important topics.
Scientists are also researching the causes of ADHD by performing
investigations of the brain and genetics. Brain asymmetries and developmental
changes in specific anatomical structures linked to ADHD and a genome scan to
confirm and refute multiple hypothesized genes and to identify unexpected genes
linked to ADHD are also controversial and important research topics in this area
of research on ADHD.
Research into the treatment of ADHD is aimed at developing new
pharmacological treatments for ADHD, evaluating long-term outcomes of
multi-modality treatments. Pharmaceutical companies are developing new
medications and longer acting medications.
Autistic Spectrum Disorder
Autistic Spectrum Disorder is a complex developmental disability that
typically appears during the first three years of life. The result of a
neurological disorder that affects the functioning of the brain, autism and its
associated behaviors. Autism impacts the normal development of the brain in the
areas of social interaction and communication skills. Children and adults with
autism typically have difficulties in verbal and non-verbal communication,
social interactions, and leisure or play activities. The disorder makes it hard
for them to communicate with others and relate to the outside world. In some
cases, aggressive and/or self-injurious behavior may be present. Persons with
autism may exhibit repeated body movements (hand flapping, rocking), unusual
responses to people or attachments to objects and resistance to changes in
routines. Individuals may also experience sensitivities in the five senses of
sight, hearing, touch, smell, and taste.
Statistics on Autistic Spectrum:
Categories under Autistic Spectrum Disorder:
Autism is a spectrum disorder. In other words, the symptoms and
characteristics of autism can present themselves in a wide variety of
combinations, from mild to severe. Although autism is defined by a certain set
of behaviors, children and adults can exhibit any combination of the behaviors
in any degree of severity. Two children, both with the same diagnosis, can act
very differently from one another and have varying skills. Therefore, there is
no standard "type" or "typical" person with autism. Parents
may hear different terms used to describe children within this spectrum, such
as: autistic-like, autistic tendencies, autism spectrum, high-functioning or
low-functioning autism, more-abled or less-abled. More important to understand
is, whatever the diagnosis, children can learn and function productively and
show gains from appropriate education and treatment. Several related disorders
are grouped under the broad heading "Pervasive Developmental Disorder"
or PDD-a general category of disorders which are characterized by severe and
pervasive impairment in several areas of development (American Psychiatric
Association 1994). When professionals or parents are referring to different
types of autism, often they are distinguishing autism from one of the other
pervasive developmental disorders.
Individuals who fall under the Pervasive Developmental Disorder category in
the DSM-IV exhibit commonalties in communication and social deficits, but differ
in terms of severity. The following outline emphasizes major points that help
distinguish the differences between the specific diagnoses used:
Autistic Disorder: impairments in social interaction, communication, and
imaginative play prior to age 3 years. Stereotyped behaviors, interests and
activities.
Asperger's Disorder: characterized by impairments in social interactions
and the presence of restricted interests and activities, with no clinically
significant general delay in language, and testing in the range of average to
above average intelligence.
Pervasive Developmental Disorder- Not Otherwise Specified: (commonly
referred to as atypical autism) a diagnosis of PDD-NOS may be made when a child
does not meet the criteria for a specific diagnosis, but there is a severe and
pervasive impairment in specified behaviors.
Rett's Disorder: a progressive disorder which, to date, has occurred only
in girls. Period of normal development and then loss of previously acquired
skills, loss of purposeful use of the hands replaced with repetitive hand
movements beginning at the age of 1-4 years.
Childhood Disintegrative Disorder: characterized by normal development
for at least the first 2 years, significant loss of previously acquired skills.
(American Psychiatric Association 1994)
What Causes Autism?
Researchers from all over the world are devoting considerable time and energy
into finding the answer to this critical question. Medical researchers are
exploring different explanations for the various forms of autism. Although a
single specific cause of autism is not known, current research links autism to
- biological or neurological differences in the brain.
- In many families there appears to be a pattern of autism or related
disabilities— which suggests there is a genetic basis to the disorder—although
at this time no gene has been directly linked to autism.
- The genetic basis is believed by researchers to be highly complex,
probably involving several genes in combination.
Several outdated theories about the cause of autism have been proven to be
false.
- Autism is not a mental illness
- Children with autism are not unruly kids who choose not to behave
- Autism is not caused by bad parenting
- No known psychological factors in the development of the child have been
shown to cause autism.
How is Autism Diagnosed?
There are no medical tests for diagnosing autism. An accurate diagnosis must
be based on observation of the individual's communication, behavior, and
developmental levels. However, because many of the behaviors associated with
autism are shared by other disorders, various medical tests may be or dered to
rule out or identify other possible causes of the symptoms being exhibited.
Since the characteristics of the disorder vary so much, ideally a child
should be evaluated by a multidisciplinary team which may include a neurologist,
psychologist, developmental pediatrician, speech/language therapist, learning
consultant, or another professional knowledgeable about autism. Diagnosis is
difficult for a practitioner with limited training or exposure to autism.
Sometimes, autism has been misdiagnosed by well-meaning professionals.
Difficulties in the recognition and acknowledgment of autism often lead to a
lack of services to meet the complex needs of individuals with autism.
A brief observation in a single setting cannot present a true picture of an
individual's abilities and behaviors. Parental (and other caregivers') input and
developmental history are very important components of making an accurate
diagnosis. At first glance, some persons with autism may appear to have mental
retardation, a behavior disorder, problems with hearing, or even odd and
eccentric behavior. To complicate matters further, these conditions can co-occur
with autism. However, it is important to distinguish autism from other
conditions, since an accurate diagnosis and early identification can provide the
basis for building an appropriate and effective educational and treatment
program. Sometimes professionals who are not knowledgeable about the needs and
opportunities for early intervention in autism do not offer an autism diagnosis
even if it is appropriate. This hesitation may be due to a misguided wish to
spare the family. Unfortunately, this too can lead to failure to obtain
appropriate services for the child.
What are People with Autism Like?
Children within the pervasive developmental disorder spectrum often
appear relatively normal in their development until the age of 24-30 months,
when parents may notice delays in language, play or social interaction. Any of
the following delays, by themselves, would not result in a diagnosis of a
pervasive developmental disorder. Autism is a combination of several
developmental challenges. The following areas are among those that may be
affected by autism:
Communication: language develops slowly or not at all; uses words without
attaching the usual meaning to them; communicates with gestures instead of
words; short attention span
Social Interaction: Spends time alone rather than with others; shows
little interest in making friends; less responsive to social cues such as eye
contact or smiles
Sensory Impairment: may have sensitivities in the areas of sight,
hearing, touch, smell, and taste to a greater or lesser degree
Play: lack of spontaneous or imaginative play; does not imitate others'
actions; does not initiate pretend games
Behaviors: may be overactive or very passive; throws tantrums for no
apparent reason; perseverates (shows an obsessive interest in a single item,
idea, activity or person); apparent lack of common sense; may show aggression to
others or self; often has difficulty with changes in routine
Some individuals with autism may also have other disorders which affect the
functioning of the brain such as: Epilepsy, Mental Retardation, Down Syndrome,
or genetic disorders such as: Fragile X Syndrome, Landau-Kleffner Syndrome,
William's Syndrome or Tourette's Syndrome. Many of those diagnosed with autism
will test in the range of mental retardation. Approximately 25-30 percent may
develop a seizure pattern at some period during life. Every person with autism
is an individual, and like all individuals, has a unique personality and
combination of characteristics.
References
Learning Disability - Much of the information from this section came
from the Schwab Foundation for Learning site: www.schablearning.org
Cramer, SC, Ellis, W (eds)(1996): Learning Disabilities, Lifelong Issues.
Baltimore: Brookes
Hazelden Foundation, 1992
Lyon G R. (ed) (1994): Frames of Reference for the Assessment of Learning
Disabilities: New Views on Measurement Issues. Baltimore: Brookes
Lerner, J. W.(1997): Learning Disabilities: Theories, Diagnosis and Teaching
Strategies. Boston: Houghton-Mifflin, 1997
National Adult Literacy and Learning Disabilities Center Report, 1994
Roper Starch Survey, (1995) Learning Disabilities and the American
Public
Wagner, M et al 1993: National Longitudinal Transition Study. SRI
International for U.S. Dept. of Education, 1993
Office of the Inspector General, 1992. Report on Functional Impairments of AFDC
Clients, Washington, D.C.
ADHD - Much of the information from this section came from the
CHADD website: www.chadd.org.
Barkley, R.A. (1990). Attention Deficit Hyperactivity Disorder: A Handbook
for Diagnosis and Treatment. New York, NY; Guilford Press
Barkley, R.A. (in press). Attention Deficit Hyperactivity Disorder: a
Handbook for Diagnosis and Treatment -–2nd edition. New York, NY; Guilford
Press
Barkley, R.A. (1997). ADHD and the Nature of Self-Control. New York, NY:
Guilford Press
DuPaul, G.J. & Stoner, G. (1994). ADHD in the Schools: Assessment and
InterventionStrategies. New York, NY: Guilford Press.
Goldstein, S. (1997). Managing Attention and Learning Disorders in Late
Adolescence and Adulthood: A Guide for Practitioners. New York, NY: Wiley
Interscience Press.
Goldstein, S. & Goldstein, M. (1990). Managing Attention Disorders in
Children: A Guide for Practitioners. New York, NY: Wiley Interscience Press.
Goldstein, S. & Goldstein, M. (in press). Attention Deficit Hyperactivity
Disorder: A Guide for Practitioners. New York, NY: Wiley Interscience Press.
Greenhill, L.L. & Osman, B.B. (1991). Ritalin, Theory and Patient
Management. New York, NY: Mary Ann Liebert, Inc. Publisher
Matson, J.L. (1993). Handbook for Hyperactivity in Children. Boston, MA:
Allyn& Bacon
Nadeau, K.G. (1995). A Comprehensive Guide to Attention Deficit Disorder
in Adults. New York, NY: Brunner/Mazel Publishers.
Autism - Much of the information for this section came from the Autism
Society of America What is Autism? http://www.autism-society.org/autism.html#contents.
CDC, 1997. Report on Incidence of developmental disabilities in America
Waltz, M.,(1999) Pervasive Developmental Disorders - Finding a Diagnosis and
Getting Help. Sebastobal, CA: O'Reilly & Associates, Inc.
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