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Adult Dyslexia

Adult Dyslexia

This is a comprehensive guide covering the basics of dyslexia to a wide range of diagnostic procedures and tips to help you manage with your symptoms. These tips and tricks have been used on people with dyslexia of every varying degree and with great success. People just like yourself that suffer with adult dyslexia now feel more comfortable and relaxed in social and work situations.

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Dyslexia Facts You Should Know

Dyslexia, Facts You Should Know Is A Unique Fact Filled E-book That Gathers Easy To Read Information About Dyslexia In One Place For The Interested Reader. Learn How to Cope With A Diagnosis of Dyslexia and What To Do Next. Every bit of this eBook is packed with the latest cutting edge information on Dyslexia. It took months to research, edit, and compile it into this intriguing new eBook. Here's what you'll discover in Dyslexia: Facts You Should Know: What is Dyslexia? History of Dyslexia. Is it Dyslexia or Something Else? How You Can Diagnose Yourself. Benefits of Catching Dyslexia Early. What is the Dyslexia Test? How to Get Everything You Will Need for Help in Coping with Dyslexia. Exploring Your Options for Schools and Programs. What is the Individualized Education Program? Alternatives to the Iep. The Roll Your Childs Teacher Plays. Your Part in Your Childs Education. Why Practice, Patience and Practicality are Most Important. Teens with Dyslexia. Success in Life: Adults Overcoming Dyslexia.

Dyslexia Facts You Should Know Overview


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The Learning Disabilities Challenge

A different challenge to the IQ construct has come full force from experts in the field of learning disabilities, who propose, either explicitly or implicitly, to eliminate IQ from the learning disabilities (LD) or specific learning disabilities (SLD) assessment process because it is nothing more than a vestige, an unwanted relic from the past. Though these arguments have filled recent pages of the Journal of Learning Disabilities (Siegel, 1999 Stanovich, 1999 Vellutino, Scanlon, & Lyon, 2000), neither the anti-IQ special educators, nor their seek-and-destroy mission, has changed much from a decade earlier (Siegel, 1989 Stanovich, 1989), when the same LD journal published a special issue devoted to the IQ controversy.

Learning Disabilities

The diagnosis of learning disabilities is a complex process, but one that inevitably involves an IQ test and an achievement test. Although there has been recent controversy about the use of IQ tests in the diagnosis of learning disabilities (see Chapter 2), for the time being measures of intellectual ability play an integral role in diagnosis, and this featured role has been especially true for the Wechsler scales. Current diagnostic criteria for learning disabilities require achievement, as measured by individually administered standardized tests , that is substantially below that expected given the person's chronological age, measured intelligence, and age-appropriate education (American Psychiatric Association, 1994, p. 50). There are two primary methods by which learning disabilities are determined the simple difference method and the predicted difference method (Reynolds, 1984, 1990). The simple difference (subtracting the achievement score from the IQ) is used by many because it...

Exceptions among College Students with Learning Disabilities Especially Females

Salvia et al.'s (1988) college students with learning disabilities performed relatively low on Ban- natyne's Sequential grouping but unlike samples of children with learning disabilities, or adults with learning disabilities who have not gone to college their greatest strength was not the Spatial category. This college sample did best on WAIS-R Verbal Conceptualization, probably reflecting the fact that students with learning disabilities who attend college are the elite among LD samples and have achieved far more than others with a similar disability. Blalock's (1987) 91 adults with learning disabilities (36 either in college or college graduates) and Vogel's 31 female college students with learning disabilities also scored higher on Bannatyne's WAIS Verbal Conceptualization than Spatial category a third sample of 57 college students with learning disabilities scored about equally well on both WAIS groupings (Cordoni, O'Donnell, Rama-niah, Kurtz, & Rosenshein, 1981). In addition,...

Confused elderly people and those with learning difficulties

The needs of these groups for help in dealing with bereavement have often been ignored. Repeated explanations and supported involvement in the important events, such as the funeral and visiting the grave, have been shown to reduce the repetitious questions about the whereabouts of the dead person by confused elderly people or difficult and withdrawn behaviour in people with learning disabilities. This makes their continuing care less demanding for both family and professional groups.

Assessment of Learning Disabilities

The WJ III includes a variety of cluster scores and interpretive options that can be useful in the assessment and identification of learning disabilities (LD). As described previously in this chapter, the breadth of measures included in the WJ III provides diagnosticians with a large theory-based tool chest for surveying many of the cognitive and achievement abilities associated with comprehensive LD assessments. The WJ III also provides a set of discrepancy-based interpretive features that facilitate the norm-based identification of within-person cognitive and achievement strengths and weaknesses, a practice that has been at the core of LD assessment and identification since the field's inception. Three different discrepancy models for evaluating the strengths and weaknesses between and among WJ III cluster scores are presented. These discrepancy models are then followed by the presentation of preliminary research that identifies potentially important WJ III clusters for the...

ACID and Bannatyne Patterns on the WAISR for Individuals with Learning Disabilities

As indicated in the table, Salvia et al.'s (1988) group of 74 college students with learning disabilities earned an ACID standard score of 101.6, about 2 standard deviation below their mean WAIS-R FS-IQ of 108.9. Also, the 11 dyslexic adults evaluated by Frauenhelm and Heckerl (1983) scored 76.3 on the ACID profile compared to their WAIS-R FS-IQ of 92 (a difference of more than 1 SD). Despite the small sample of adults with dyslexia, this result is given credence by previous test data When tested on the WISC more than 15 years previously, they obtained virtually identical IQs and mean scaled scores on the Bannatyne groupings and ACID subtests. Sandoval et al.'s sample of 30 16-year-olds with learning disabilities scored about 4 standard deviation lower on the ACID subtests than on the Full Scale. Like the data for the tiny sample of dyslexic adults, the results for the small group of 16-year-olds are given additional support by the appearance of a highly similar ACID profile on

Additional Measures of Adolescent and Adult IQ

Step 7 Generate Hypotheses about Fluctuations in the KAIT Profile 533 Alternative KAIT Subtest Groupings 539 KAIT Memory Comparisons 540 KAIT Research on Clinical Profiles 541 Assessment of Learning Disabilities 541 Assessment of Alzheimer's-Type Dementia 543 Depression and Pseudodementia 545 Jeff H, Age 17, Possible Learning Disability 550 Summary 560 Assessment of Learning Disabilities 600

Heritability and Malleability of IQ and Attacks on the IQ Construct

Chapter 1 presented evidence for the validity of the IQ construct, particularly for adolescents and adults. This chapter treats topics that are generally controversial and that relate either directly or indirectly to the utility and validity of the IQ construct. The topics of heredity, environment, and IQ malleability are discussed, exploring questions such as How important are genetics and environment in determining a person's IQ Next, Flynn's (1984, 1987, 1998a, 1998b, 1998c) analysis of cross-cultural investigations of the intelligence of people from numerous nations leads to an interesting question that is addressed Do nations differ in their IQ gains from generation to generation Finally, two key challenges to the value of IQ tests are presented, accompanied by our rebuttals to these challenges Lezak's (1988a) dismissal of the IQ construct, as articulated in the eulogy for the IQ that she delivered to the International Neuropsychological Society and the gathering momentum from...

High Spatial versus Low Sequential

For virtually all adolescents or adults believed to be learning disabled, one might anticipate relatively good performance in Spatial Ability versus relatively poor performance in Sequential Ability. In Table 9.1 the college students with learning disabilities scored 5 points higher on Spatial than Sequential the adults with dyslexia scored 36 points higher, and the 16-year-olds scored 22 points higher. The WAIS investigations produced similar findings McCue et al.'s (1986) adults with learning disabilities scored 11 points higher on Spatial than Sequential Blalock's (1987) adults with learning disabilities (40 with college experience) scored 7 points higher and Cordoni et al.'s (1981) college students with learning disabilities scored 14 points higher. In the study that merged WAIS and WAIS-R data (Ackerman et al., 1987), males had a 15-point Spatial > Sequential differential, while the female applicants to a special LD college program had a 10-point discrepancy. Only Vogel's...

Medication Alone May Not Be Enough

For those whose ADD impairments are complicated by symptoms of depression, anxiety, dyslexia, substance abuse, or other disorders, treatment with medications effective for ADD symptoms may be helpful, but not helpful enough. Treatment in these situations often requires very skilled diagnosis and multiple treatment interventions, possibly including careful trials of two or more different medications used in combination. Psychosocial or educational interventions may also play a crucially important role.

Radical Attacks against ADHD

The most aggressive attacks against recognition of ADHD as a legitimate disorder have come from groups such as the Citizens Commission on Human Rights (CCHR), which advocates against using psychiatric or psy-chotropic medicines in any situation. This well-funded group and certain individuals associated with it have circulated allegations that ADHD is a fictitious disorder. One of their publications, Psychiatry Betraying Families The Hoax of ADD ADHD and Other Learning Disabilities, argues, These are made up disorders along with others including severe emotional disorder . . . and dyslexia. ADHD is a total, 100 fraud.

Review of Research Findings on the P V Profile

Because of the lack of consistency of a P > V profile in college students with learning disabilities, we focus here on individuals not in college. Learning-disabled adolescents (ages 13-18) tested on the relevant Wechsler scale displayed P > V profiles whether they were classified as delinquent (N 25) or nondelinquent (N 25) they outperformed the matched normal control group on the Performance Scale (Sobotowicz, Evans, & Laughlin, 1987). Similarly, McCue, Shelly, and Goldstein (1986) evaluated 75 male and 25 female learning-disabled adults (mean age 24 years) referred for assessment by a state vocational rehabilitation agency and found a WAIS P-IQ superiority of 5 points (V-IQ 87, P-IQ 92). Frauenheim and Heckerl (1983) tested 11 severely dyslexic adults on the WAIS-R at ages 25-30 (mean 27) who had been previously diagnosed at age 10J4. As children, they scored 21 points higher on the Performance Scale (WISC V-IQ 84, P-IQ 105) more than 15 years later, they earned almost...

Summary of Evaluation of Hypotheses for Gender Differences in Lesioned Patients

Cumstances are extraordinary, such as having the type of brain dysfunction that might cause a learning disability or having a lateralized brain lesion associated with depressed Verbal or Performance IQ, females may be better equipped to spontaneously compensate for the deficit. Many more boys than girls are learning disabled. Possibly girls respond better to the brain dysfunction conceivably, girls may be able to compensate for a kind of brain dysfunction that in boys would lead to a learning disability. Even LD females may have better compensatory strategies than LD males. Indirect evidence for this hypothesis comes from an examination of subtest profiles of LD children, adolescents, and young adults. Some research suggests that the so-called ACID profile (see Chapter 9) associated with learning disabilities holds only for males females perform poorly on three of the four ACID subtests, but tend to do quite well on Coding Digit Symbol. The latter task has elements of both...

High Spatial versus Low Acquired Knowledge

Vogel's (1986) sample of female college students with learning disabilities did show a more substantial 6-point difference when comparing Spatial Ability to Acquired Knowledge. Of the samples in Table 9.1, large discrepancies of about 15 or more points favoring Spatial Ability over Acquired Knowledge were observed for all LD samples except Salvia et al.'s (1987) college students, who performed equally on the two categories. Among samples tested on the WAIS or on both the WAIS and WAIS-R, Spatial > Acquired Knowledge differences of at least 10 points were found for McCue et al.'s (1986) adults with learning disabilities, Cordoni et al.'s (1981) college students with learning disabilities, Acker-man et al.'s (1987) males, and Ackerman et al.'s females. However, Blalock's (1987) adults with learning disabilities, many with college backgrounds, joined Salvia et al.'s college students with learning disabilities in demonstrating a trivial Spatial-Acquired Knowledge difference. Note,...

Implications for Examiners

When clinicians examine Bannatyne profiles on Wechsler scales for LD referrals, research suggests that they should anticipate strength in Spatial Ability contrasted with weakness in Sequential Ability and Acquired Knowledge. For college students, Verbal Conceptualization Ability may conceivably join Spatial Ability as an area of relative strength, and Acquired Knowledge may fail to emerge as a weakness. For females referred for learning disabilities, Sequential Ability may not emerge as a striking weakness because of good performance on Digit Symbol. In addition, there is some evidence that the Working Memory and Processing Speed indexes may prove to be more depressed than the Perceptual Organization index in adolescents and adults with learning disabilities. Although some of the profile patterns are reported fairly consistently for adolescents and adults with learning disabilities, these patterns are not powerful enough to make differential diagnosis. All of the previous discussions...

Group Membership Differentiation LDNormal Mean Score Comparisons

Tion of the Bonferroni adjustment to control for overall experiment-wise error rate, all but 3 of the 22 i-tests were significant at the .05 level of significance. As would be expected, given the prominence achievement plays in the identification and classification of individuals with learning disabilities, the largest mean score differences were on five of the six achievement clusters. With the Normal subject mean scores ranging primarily in the average to above average ranges (98.2 for Basic Reading Skills to 112.0 for Academic Fluency), the LD subjects scored approximately one standard deviation lower on Basic Writing Skills (-17.8), Academic Fluency (-17.3), Broad Reading (15.8), Basic Reading Skills (-14.0), and Phoneme Grapheme Knowledge (-13.5). Oral Expression scores were not significantly different. The LD subjects were also -11.8 points lower on the GIA-Std cluster. The largest differences on the cognitive clusters occurred in domains related to the efficiency of cognitive...

IQ Discrepancies A Clinical Approach

This is the second of two chapters on V-P IQ discrepancies. Chapter 8 explored Verbal-Performance IQ discrepancies as related to brain damage. The patterns obtained by patients with left versus right lesions provided some insight into the greater sensitivity of the V-P IQ difference for patients with right damage (V > P of 9 points) compared to those with left damage (P > V of only 3K points), and examined the relationship between patient variables and V-P discrepancy in adults with brain damage. This chapter focuses on Verbal-Performance discrepancies in various types of clinical profiles, such as learning disabilities, delinquency, bilingualism, autism, mental retardation, psychiatric disorders, alcoholism, multiple sclerosis, and dementia. The chapter will conclude with the presentation of clinical case reports that exemplify V-P discrepancies within a profile.

Clinical Implications of Research Findings

The implications of Wechsler research with children and adults diagnosed with learning disabilities are that the obtained IQs may be misleading. Low Verbal IQs are likely to reflect, at least to some extent, the poor school achievement of these individuals, along with impaired functioning in subtests associated with the Working Memory and Freedom from Distractibility factors. Whereas the Performance IQ is often the best estimate of LD children and adults' intellectual ability (except for those who attend or graduate from college despite their disability), this nonverbal estimate of intelligence is likely to be depressed by poor scores on the subtests that constitute the Processing Speed factor. The best solution is to group the tasks in accordance with the WAIS-III's four factors (or three WAIS-R factors if examining WAIS-R data), or to apply Bannatyne's four groupings of subtests (Chapter 10) Spatial, Verbal Conceptualization, Sequential, and Acquired Knowledge. For many individuals...

Waisiii Profile Interpretation Steps

This chapter begins by touching on recent criticisms of our approach to profile interpretation and then continues with a discussion of a step-by-step approach to interpreting the WAIS-III profile. Here we will provide a description of the first seven of nine steps of interpretation. In these steps we will lead you through an examination of the most global score (Step 1), to examination of the IQs (Steps 2 to 4) and then the factor indexes (Steps 5 to 7). The final two steps, which deal with determining the strengths and weakness in the profile (Step 8) and how to generate specific hypotheses from the statistically significant subtest strengths and weaknesses (Step 9), are discussed in Chapter 12. To aid in interpreting the global dimensions of the WAIS-III, we refer readers to the empirical research presented in Chapter 9 on characteristic profile patterns associated with learning disabilities (e.g., the ACID grouping), Alzheimer's-type dementia (Fuld profile), psychiatric disorders,...

Drugs and Brain Development

The precise effects of drug intake on brain development are poorly understood, but the overall conclusion from current knowledge is that children with prenatal exposure to a variety of psychoactive drugs have an increased likelihood of later drug use (Malanga & Kosofsky, 2003). Many experts suggest that, although, again, poorly studied, childhood disorders such as learning disabilities and hyperactivity may be related to prenatal exposure to drugs such as nicotine or caffeine or both. Malanga and Kosofsky note poignantly that society at large does not yet fully appreciate the impact that prenatal drug exposure can have on the lives of its children.

Overview and Description

The Matrix Analogies Test (MAT Naglieri, 1985 a, 1985b) is a figural matrices test, similar to others of like names (e.g., K-ABC Matrix analogies, K-BIT Matrices, WAIS-III Matrix Reasoning). The MAT comes in two forms a group-administered short form that consists of 34 multiple-choice items and an expanded form that consists of 64 individually administered multiple-choice items. The test consists of abstract designs printed two per page, in the colors of black, white, blue, and yellow. The nature of the test is abstract reasoning with four item types pattern completion, reasoning by analogy, serial reasoning, and spatial visualization. The MAT Short and Expanded forms are designed for administration to individuals ages 5 through 18 years. Because of the minimal language involvement in the test, the MAT is particularly well suited to assessing the intelligence of individuals whose native language is not English, and of those with hearing impairments or learning disabilities.

Illustrative Case Report

Prior to his accident, Walt was enrolled in public school and was placed in a learning disabilities resource room. Difficulties were noted in reading, spelling, and behavior. Both before and after the accident, Walt was taking Cylert for diagnosed hyperactivity. He is currently taking no medications. Subsequent to the accident, Walt enrolled in a new public high school following his family's move to another state. Placement in a learning disabilities resource room was continued. During this period, presenting problems included severe motor deficits and limited vision. Partial paralysis continued to affect his left side, and his balance was tenuous. Walt was naturally left-handed and, consequently, was forced to learn to use his right hand for writing activities. His remaining vision permitted him to do most academic tasks however, he experienced significant difficulties in tracking across a page or across the blackboard. Cognitively, Walt evidenced similar deficits to those noted...

Preliminary Research on Adult LD Identification with the WJ III

Preliminary research evidence on potentially important diagnostic patterns of WJ III scores in adult university subjects was recently extracted from the Gregg Hoy LD Normal university sample previously described in this chapter. The results, briefly summarized here, demonstrate the potential of the WJ III in the identification of adolescents and adults with or without learning disabilities. Using the above WJ III-based decision-tree rules, the cross-validation classification table revealed classification accuracy rates of 81 (LD) and 85 (Normal). Given that the initial sample was almost equally divided between LD (n 101) and Not-LD (n 103) subjects, this classification agreement rate suggests that the WJ III COG and ACH variables included in Figure 14.3 can improve over a 50 chance base-rate classification of newly referred university subjects by approximately 30 . This indicates that the WJ III COG and ACH batteries include measures that may be particularly helpful in the...

Overview of Variables Believed to Be Correlates of High Performance IQ

The research reviews with adolescents and adults are no more compelling for several other variables long believed to be associated with high Performance IQ. Individuals with learning disabilities are defined more by their high and low areas of functioning when Wechsler subtests are regrouped by Bannatyne's system or by acronyms (e.g., ACID) than by V-P IQ discrepancy. Individuals with mental retardation do not show consistent P > V profiles, and neither do those with Autistic Disorder (especially if they are high functioning). Although Wechsler's children's scales, including the WISC-III, frequently yield substantial P > V patterns for Hispanic individuals, data from the WAIS-III reveal only small P > V IQ discrepancies, especially when Hispanics and other ethnic groups are matched on age, gender, and education indeed, when these other

The Achievement Battery

The 22 tests and 20 clusters provided by the WJ III ACH allow for a comprehensive or selective diagnostic assessment. Seven of the clusters on the WJ III ACH are aligned with the seven areas of Learning Disability specified in the Individuals with Disabilities Education Act (IDEA, 1997). In addition, the WJ III includes an important eighth area of disability, expressive oral language. Of particular relevance to assessments of students at the secondary level are the fluency measures in reading, mathematics, and written language and the Academic Fluency cluster. The movement of the oral language tests from the WJ III COG also adds increased diagnostic utility to the WJ III ACH battery. Testing time will vary, depending on the age of the person evaluated, the reason for referral, and the number of tests administered. The 22 tests in the WJ III ACH are described in Table 14.5.

Illustrative Case Reports

Nicole (Nikki) volunteered for testing and evaluation available through the psychoeducational assessment class as she has been concerned about her poor performance on tests in a collegelevel statistics course, inconsistent performance in her college coursework, test anxiety, and a possible learning disability. She is interested in finding out if she has the ability to complete a degree from the University of Alabama. Nikki has been aware of a problem since grade school (she repeated the 7th grade). Her particular problems are with numbers and details. She has noticed that she reverses numbers (as well as some letters, but to a lesser extent).

Additional Studies From Our Laboratory 41 Pribram Task

We proposed, on the basis of our earlier work and that of others (72,114,115), that attention deficits characterize LD, as well as HY, children. Like Douglas in her classic 1972 (50) paper Stop, Look and Listen, we argued that attentional deficits rather than motoric restlessness should be of central research interest. Even though the majority of LD children exhibit ADD symptoms, ADD cannot be said to be the sole or major cause of a learning disability, because many ADD children, even HY ones, learn to read and spell at an age-appropriate rate. This observation led us to believe that the major problem for LD children might be in the area of selective attention and for HY children in the area of sustained attention. Moreover, we LD in this case reading disability was determined by the method of discrepancy scores, i.e., standardized achievement scores in reading and spelling at least 10 points lower than the WISC-R full-scale IQ. Eighty-two (74 boys and 8 girls) met criteria for...

More Specialized Treatments

As mentioned earlier, some persons with ADD syndrome also suffer from severe learning disorders such as reading disorder, math disorder, or disorder of written expression. During the school years, they are likely to need special education services in addition to treatment for ADD impairments. Others with ADD syndrome are actively caught up in abuse or dependence on alcohol, marijuana, or other drugs for them, effective treatment of their substance abuse will be required before their ADD impairments can adequately be alleviated. Still others with ADD syndrome may have chronic and severe problems with panic attacks or OCD. And severe social impairments on the Asperger's autistic spectrum or severe problems with mood regulation, depression, or bipolar disorder can also complicate the patient's struggles with ADD syndrome. Detailed information about treatment options for ADHD in combination with these various comorbid disorders is the primary focus of my edited textbook Attention Deficit...

Disorders of Learning and Language

Most physicians and mental health clinicians are similarly not educated to understand specific learning disorders (LD) that often overlap with ADHD. There are three major types of learning disorders reading disorder, mathematics disorder, and disorder of written expression. Reading Disorder Shaywitz noted that 70 to 80 percent of American children learn how to translate the code of written letters into spoken sounds without much difficulty. The remaining 20 to 30 percent have varying levels of persisting difficulty in learning to convert combinations of letters into spoken words. It is this impairment in learning to process phonemes, not the tendency to reverse letters and numbers, that is the major ingredient in dyslexia, another name for reading disorder. There is strong evidence to suggest that dyslexia is associated with specific impairments in brain function. Sally Shaywitz and Bennett Shaywitz (2002) used functional MRI imaging to study the brains of dyslexic children compared...

Evidence For Monoamine Contributions To Adhdne And 5ht Activity

Analyses of CSF, blood compartments, and urine (Table 1) indicate that in the ADHD condition MHPG levels (NE metabolite) are usually lower than normal less clearly, NE levels may be increased. Overall this suggests a decreased turnover. There is a hint that other catabolic pathways may be differentially affected (NMN levels). The severity of the core symptoms do not influence the results (161,162). But, over the 4-5 yr from pre- to post-puberty when a number of symptoms regress, MHPG levels have been noted to increase or normalize (163). Further, some studies that deliberately contrasted subgroups find that several comorbidities (independent of their nature) appear to counteract the metabolic decrease e.g., in those with a reading disorder (159), and in 15 subjects with high levels of anxiety (not in table 103).

The ACID Profile versus Bannatyne System or Scald Profile

The ACID pattern represents a deficient area for adolescents and adults with learning disabilities, but the three LD samples shown in Table 9.1 scored even lower on the WAIS-R Sequential standard score than on the ACID score. On the WAIS, the same finding occurred for Blalock's (1987) adults with learning disabilities, whereas McCue et al.'s (1986), Cordoni et al.'s (1981), and Ackerman et al.'s (1987) LD samples earned closely similar means on the Sequential and ACID standard scores. Only Vogel's (1986) allfemale sample of college students with learning disabilities scored lower on the ACID than Sequential score. (We computed standard scores for the WAIS studies as well, but preferred to report only WAIS-R data in Table 9.1. Using correlational data in the WAIS Manual for ages 25-34, we discovered that all formulas for the WAIS were identical to the ones for the WAIS-R.) We believe that the Bannatyne system is a better way to look for a characteristic Wechsler profile for adolescents...

Intracranial Calcification

Intracranial Calcification Torch

In oculo-dento-osseous dysplasia (oculo-den-to-digital dysplasia, OMIM 164200), a narrow nose with hypoplastic alae and thin nostrils, microcornea with iris anomalies, postaxial syndactyly and or camptodactyly, hypoplasia aplasia of the 5th fingers and toes, and enamel hypoplasia are leading features (Meyer-Schwickerath et al. 1957). Additional features include short palpebral fissures, epicanthal folds, skull hyperostosis, hypotrichosis, strabismus, glaucoma, orbital hypotelorism, and a variety of neurological symptoms, such as progressive paraparesis, cerebral white matter abnormalities, ataxia, tremor, bladder dysfunction, epilepsy, migraine, and learning disabilities (Beighton et al. 1979 Fara and Gorlin 1981 Gutmann et al. 1991 Loddenkemper et al. 2002). Calcification occurs in the basal ganglia (Barnard et al. 1981). The syndrome is inherited in an autosomal dominant pattern and is caused by mutation in the connexin-43 gene mapped to 6q21-q23.2 (Gladwin et al. 1997...

Standardization and Psychometric Properties

A sample of 80 college students with learning difficulties was used to examine the validity of the GAMA in comparison with the WAIS-R (Lassiter, Leverett, and Safa, 2000). Similar to the findings with the WAIS-III and college students without learning difficulties, the GAMA correlated most strongly with the WAIS-R P-IQ (.69) and least with the V-IQ (.36). The GAMA-WAIS-R FS-IQ correlation was .60. The GAMA IQ more accurately predicted the ability of individuals with learning difficulties who scored within the Average and High Average ranges on the WAIS-R. In contrast, the GAMA underestimated the WAIS-R IQs of those who fell in the Superior to Very Superior ranges of intelligence.

Disorders of Social Emotional Regulation

Patients with Asperger's also tend to have a lot of trouble shifting focus flexibly between details and context. Martha Denckla (2000) described this problem as it appears in adults with nonverbal learning disabilities affecting not only their social relationships, but also other aspects of their thinking. Psychologist Byron Rourke (2000) has shown that many individuals with Asperger's have essentially the same profile on psychological tests as do those identified with nonverbal learning disorders (as described by Denckla). He notes that this may be a basis on which those with Asperger's and individuals with high functioning autism might be differentiated.

Neurobiological Theories Of Adhd

Animal models also support a dopaminergic hypothesis in ADHD. Mice without a functioning dopamine transporter (DAT1 knockout KO mice) have high extracellular striatal dopamine levels, a doubling of the rate of dopamine synthesis (15), decreased dopamine and tyrosine hydroxylase in striatum (16), and a nearly complete loss of functioning of dopamine autoreceptors (17). They display markedly increased locomotor and stereotypic activity compared to normal (wild-type) mice (15,18). The reduced striatal dopamine may be most relevant to a hypodopaminergic theory of ADHD. Also, selective destruction of dopamine neurons by 6-hydroxydopamine results in hyperactivity and learning difficulties in mice (19). The spontaneously hypertensive rat (SHR) has also been used as an animal model of ADHD because of the SHR's locomotor hyperactivity and impaired discriminative performance. Russell (20) showed that the altered presynaptic regulation of dopamine in SHR led to the downreg-ulation of the...

Response to the Critics

Selective Examination of Pertinent ReSEARCH. The critics do present an impressive compilation of research to support their claims that IQ does not discriminate between individuals with LD and LA in reading. However, they ignore other lines of research that support the opposite position. Kavale and Forness (2000), for example, cite several studies that show that students with LD and LA could be reliably distinguished with the population with LD being the lowest of the low on the achievement distribution but equivalent to the LA population on the ability (i.e., IQ) distribution (p. 248). Nicholson takes Stanovich and other antidiscrepancy theorists to task for (1) switching the focus from research on the causes of dyslexia to research on the causes of poor reading and (2) treating the much acclaimed notion of phonological deficit as the cause, rather than as a symptom, of dyslexia. Nicholson (1996) provides a well-reasoned logical attack on Stanovich's line of thinking, strongly...

Inattention Interferes with Learning to Read and Do Math

Among individuals with ADHD there is a markedly elevated incidence of dyslexia (Tannock and Brown 2000). As was shown in the Ra-biner study, attentional problems and other impairments of the ADD syndrome can severely impair an individual's ability to read. Children with significant attention impairments during their early school years are likely to experience difficulties not only in reading, but also in learning mathematics. Elizabeth Benedetto-Nasho and Rosemary Tannock (1999) studied students aged seven to eleven years, half of them with an ADHD diagnosis, half without. The two groups of students were matched for equal math skills and none had any learning disability. When asked to complete sets of math problems appropriate for their ability level, the ADHD students attempted fewer problems, were three times less effective in solving the problems, and made six times as many errors when doing subtraction problems. Errors in subtraction were mostly errors in borrowing for example,...

General Intellectual Ability Achievement Discrepancy Model

Corporated the notion of a learning disability being defined by a discrepancy between a person's actual (measured) and expected achievement (usually predicted from general intellectual ability) (Flanagan et al., 2001). The WJ III provides reliable and valid procedures that can contribute useful information for use in these procedures. The GIA Ability-Achievement Model and the Predicted Achievement Model are both presented in Figure 14.3. It is important to note that neither the WJ III GIA or PA discrepancy procedures were designed for the diagnosis of LD, if the intent is to identify a specific learning disorder. The GIA and PA approaches are intended to answer the question, Given the person's present cognitive abilities, is he she achieving as well as could be expected The WJ III GIA Model is straightforward. Either the differentially weighted WJ III GIA-Std or GIA-Ext g standard scores are used to provide a prediction of what a person's achievement standard score would be, given...

Intra Ability Discrepancy Model

The intra-ability discrepancies allow examiners to analyze an individual's cognitive and academic strengths and weaknesses across the cluster scores of the WJ III COG and WJ III ACH. These discrepancies, and the combined COG and ACH procedure in particular (intra-individual), can assist in the identification of a learning disability by providing information that complements (but does not supplant) the information provided by the GIA and PA ability achievement discrepancies. Schrank and Mather (2001) believe that the intra-individual discrepancy procedure may be particularly useful in the identification of a specific learning disability when the examiner needs to determine what is specific about the problem. The intra-individual procedure is conceptually similar to recent recommendations to identify an individual with a learning disability via the evaluation of domain-specific achievement skills conjointly with their related cognitive abilities (Brackett & McPherson 1996...

Depression and Pseudodementia

Assessment tool in diagnosing depression however, they can be useful to this end. For instance, many individuals with learning disabilities also have major depression (APA, 1994 Culbertson & Edmonds, 1996). Additionally, it can be difficult, particularly in elderly persons, to determine whether cognitive symptoms are due to dementia or to a major depressive episode (APA, 1994). In fact, the literature suggests that the cognitive symptoms associated with depression are the most common type of pseudodementia and the most easily misdiagnosed (Lishman, 1987). Thus, neu-ropsychological testing and other tests assessing cognitive abilities can be helpful in the differential diagnosis of depression versus other disorders.

When to Administer Brief Tests

Cal impairment to determine which areas need a thorough follow-up. Or the time spent with a client is limited by practical constraints, and intelligence is but one of several areas (vocational interests, educational achievement, adaptive behavior, special abilities, personality development) requiring evaluation. Or any similar circumstances in which the clinicians' goals are not (1) to categorize the individual's intelligence into a specific level of functioning such as retarded, gifted, or (in the case of learning-disabilities assessment) normal (2) to make neuropsycho-logical or clinical inferences about the person's ability profile or (3) to diagnose cognitive disorders. Brief tests are also ideal for use in research investigations, when an individual's precise score is less important than group performance. But King and King (1982) far overstate the case, in our opinion, when they argue that perhaps the most valuable and only justifiable use of short forms is for research purposes...

Biophysiological Factors

Presenting problems may be related to neurological or biochemical factors. Such factors may place boundaries on how much change is possible. Malnutrition, hypoglycemia, and allergic reactions have been associated with hyperactivity, learning disabilities, and mental retardation. Biochemical abnormalities are found in some children with serious behavior disturbances such as those labeled autistic. However, this only establishes that abnormalities in biochemistry are present, not that they cause a certain disorder (e.g., cause certain behaviors). Biochemical changes may be a result of stress related to social conditions such as limited opportunities due to discrimination. Drugs, whether prescribed or not, may influence how clients appear and behave. Certain kinds of illness are associated with particular kinds of psychological changes.

Why Does ADD Syndrome Often Overlap with Other Disorders

Having described three clusters of learning and psychiatric disorders that very often overlap with ADD syndrome, we now return to the question I raised earlier in this chapter. Why is it that having ADD substantially increases the likelihood of having another disorder Why is it that a child with ADHD, if untreated, has twice the risk of developing a substance use disorder at some time in his or her life Why do children with ADHD have double or triple the risk of having reading disorder, math disorder, or disorder of written expression Why do adults with ADHD have additional psychiatric disorders at six times the rate reported for the general U.S. population Many researchers and clinicians point to genetics, as though one afflicted with ADHD is just unfortunate in being much more likely to be burdened with the inheritance of additional disorders of learning, emotions, or behavior. But there is another way to look at the high incidence of overlap between ADD syndrome and other learning...

Chronic Suppurative Otitis Media And Cholesteatoma

CSOM can be insidious, persistent, and very often destructive, with sometimes irreversible sequelae, such as hearing deficit and subsequent learning disabilities in children. In many patients with CSOM, a cholesteatoma may develop a cholesteatoma is a pocket of skin that invades the middle ear and mastoid spaces from the edge of a perforation (43).

The AntiIQ Sentiments

Siegel (1999) cites many references to document that there are no differences between individuals with dyslexia and poor readers on measures of the processes most directly related to reading (p. 312). Vellutino et al. (2000) add In independent studies , it was found that poor readers who manifested no significant IQ-achievement discrepancy performed no differently on independent measures of reading achievement than poor readers who did manifest such discrepancies. More important is the finding in both studies that these two groups also performed no differently on tests of the cognitive abilities believed to underlie one's ability to learn to read (p. 225). And the results of Vellutino et al.'s (2000) remediation study indicated that the IQ-achievement discrepancy does not reliably distinguish between disabled and nondisabled readers Neither does it distinguish between children who were found to be difficult to remediate and those who were readily remediated, prior to initiation of...


Alfred Binet was truly the pioneer of IQ testing. His concepts and approach dominated the field for years, and Terman's adaptation, the Stan-ford-Binet, became the criterion of intelligence in the United States. The nonverbal Performance tests developed during World War I to assess non-English-speaking recruits, low-functioning individuals, and suspected malingerers joined with the verbal-oriented Binet tradition to pave the way for David Wechsler's creative contribution of a dual Verbal and Performance approach to intellectual assessment. Wechsler went on to become a proponent of clinical, not just psychometric, assessment. The need for multiscore measurement that accompanied the learning disabilities movement in the 1960s catapulted the Wechsler series

Attacks on

The IQ construct has been in the line of fire for controversy from the moment of its inception. Two of these controversies are presented in the sections that follow (1) the clinically based challenge issued by Lezak (1988a) as a result of her practical experience as a neuropsychologist, and (2) the research-based and decision-making-based challenge issued by leaders in the field of learning disabilities assessment (e.g., Siegel, 1999). Both of these anti-IQ approaches are described and rebutted in the sections that follow.


Deemed by most adults as worthy of a grownup (p. 69) have been used as a rough and ready measure of intelligence (p. 69) prior to the advent of psychometrics and have long been recognized as a sign of mental alertness (p. 69). Such tests are flawed by the impact on test scores of attention span, temporary emotional reactions, and of educational and occupational attainment. As Wechsler notes Clerks, engineers and businessmen usually do well on arithmetic tests, while housewives, day laborers, and illiterates are often penalized by them (p. 69). However, he believed that the advantages of an arithmetical reasoning test far outweighed the negative aspects. He pointed out that adults may be embarrassed by their inability to do certain problems, but they almost never look upon the questions as unfair or inconsequential (p. 69). He took much care in developing the specific set of items for the W-B I and the WAIS and believed that his particular approach to constructing the Arithmetic...

Sensory Deficits

Sensory effects could result in deficits on tests of human cognitive function. Language disorders in children, for example, have been linked to deficits in higherorder auditory processing 14, 61 . Dyslexia and other disorders of language development have been traced, in some cases, to the initial processing of auditory information in the primary auditory cortex. For example, difficulties in distinguishing stop consonants can delay language development because of resulting difficulties in distinguishing between, say, the phonemes b and t , with the consequence that, say, the syllables ba and ta sound the same. It is not known at present whether sensory deficits associated with developmental exposure to MeHg have such consequences.

Mathematics Disorder

Much remains to be learned about the specifics of such impairments in the cognitive skills required for mathematics. There is some evidence that impairments in this domain, like those of dyslexia, are heritable, but the brain mechanisms involved are not yet known. After reviewing relevant research, Rosemary Tannock and I (2000) reported that all three of the basic learning disorders occur at rates two to three times higher among children with ADHD than among children in the general population. One of the few studies that looked for all three basic learning disorders in children with ADHD was reported by Susan Mayes and colleagues (2000). In a sample of children referred to a clinic, they found that 27 percent met diagnostic criteria for reading disorder, 31 percent for mathematics disorder, and 65 percent met diagnostic criteria for disorder of written expression. In sum, 70 percent of those children diagnosed with ADHD fully met the diagnostic criteria for at least one of these three...

Tourette Syndrome

A variety of factors, including severe tics, psychosocial problems, ADHD, OCD, learning disabilities, and medications, can result in poor school performance in children with tics. Individuals with TS typically have normal levels of intellectual functioning, although there may be a discrepancy between performance and verbal IQ, an impairment of visual perceptual achievement, or a decrease in visualmotor skills.60-62 Learning difficulties are most common in children who have both TS and ADHD.6364 Testing of executive function in children with TS with and without ADHD has indicated that those without ADHD perform significantly better in areas of executive function and perceptual organization.6365

Animal Models

Recent reviews on the contribution of transmitter systems to ADHD give prominence to NE alongside DA, to the neglect of 5-HT and other candidates (135). These views are predicated on the undisputed role of impaired frontal activity in ADHD performance where delayed reinforcement (136), response inhibition, and error- (137) and change-detection were studied (138). But the weight of the argument lies on a series of studies demonstrating that stimulation of NE activity in monkeys, when catecholamines are depleted, enhances working memory (WM) task performance too little transmitter impairs, facilitated by a-2 stimulation too much transmitter impairs, reflecting a-1 stimulation (where the low affinity of a-1 sites for NE means that they are active at high NE concentrations 77,139). Yet the evidence for WM dysfunction rather than impairments of other executive functions in ADHD remains equivocal. A few studies have reported impairments of digit arithmetic (140,141) and visuospatial span...


Some PET studies in normal volunteers suggest that GMR decreases after learning a complex task, suggesting that the brain becomes more efficient, perhaps in learning what areas not to use for good performance. Other PET studies show a shift in the pattern of GMR use after learning, suggesting that different brain areas become involved. Some fMRI studies suggest that learning increases the size of the cortical brain area used during a task, suggesting that adjacent neurons are recruited to the effort. At this point, brain imaging studies of learning are preliminary and not completely consistent. Children with learning disabilities or attention deficit disorder have not been studied extensively, although a number of fMRI projects are underway. Even at this early stage of research, the results indicate the enormous potential for further work to help understand brain mechanisms of learning.


Turning to the merits of categorical analysis, DSM-IV provides the possibility of classifying subjects in any one category into a large number of other co-occurring categories. The problem is that most research, which targets any one diagnostic category, tends to ignore the co-occurring disorders, and in ADHD the most frequent ones are learning disabilities and ODDs. The latter identifies the type of HY child that Dykman et al. (147) referred to as the ADDHA. Of course, it would not be necessary in future modifications of DSM-IV to include LD or aggression as a part of the definition of ADHD, if investigators were more rigorous in defining co-occurring disorders and not treating LD or ADHD as pure categories unless children with only one disorder were recruited. Pure types, however, are difficult to find.


What other factors influence our level of attention Key factors include the degree of similarity between competing sources of information, the difficulty of the learning task at hand, and our ability to direct our own attention. If sources of information are very similar to one another, each one is likely to make less of an impression. If, on the other hand, every other instructor for the day simply recited the lecture notes but one proceeded by asking questions of the students, the questioning approach is likely to evoke more attention from learners. When learning tasks are especially difficult, it becomes especially important to exclude competition for learners' attention. The more difficult the material, the harder students are likely to need to concentrate. In fact, concentration is one of the key learning abilities, and learning disabilities and even mental illnesses are often associated with concentration deficits. If we are going to solve a problem, we need to be able to keep...

Tuberous sclerosis

A neurocutaneous disease associated with hamartomas in multiple organ systems, skin lesions, and learning difficulties. Skeletal muscle is not involved. It is an autosomal dominant condition and recent genetic linkage studies have implicated abnormalities of the 9q34 protein encoded by the tuberin and hamartin genes. Both are tumour suppressor genes on chromosomes 9 and 16 (O'Callaghan 1999). For full diagnostic criteria, see Webb and Osbourne (1995).

KAIT Case Study

JEFF H., AGE 17, POSSIBLE LEARNING DISABILITY Jeff H. was referred for an evaluation due to his parents' concern about the presence of a possible learning disability. His parents also wanted information to determine if there was any way to help Jeff get into college, and to succeed once he enters college. Mr. and Mrs. H. stated that Jeff has difficulty with comprehension of written passages, processing information and coming out with an appropriate response, vocabulary, and self motivation. Jeff's parents developed questions about his ability and a potential learning disability after he received low scores on the SAT exam he recently took (Verbal 260, Math 260). Jeff stated that he is able to remember vocabulary for a test, but cannot remember it later. He also stated concern over the fact that it is sometimes difficult for him to concentrate well enough to fully comprehend what he is reading.