Childhood: Clinical and School Psychology – Lecture summary (UNIVERSITY OF AMSTERDAM)
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Specific learning disabilities are detrimental to one’s well-being. The repeated academic failure associated with this continues to haunt people for years after formal schooling.
A specific learning disability originally included a discrepancy-based definition. This included a discrepancy between IQ and achievement (e.g. high IQ, low reading achievement). However, the degree of discrepancy is arbitrary. This definition favours older children and children with a higher IQ. It is failure-based (e.g. waiting for children to show failure in academics).
The current definition is focused on identification with response to intervention (RTI). It includes achievement in key academic areas that is substantially below the age norm and in excess of sensory deficit (1), linguistic processes (2), attention (3) and memory (4). The prevalence rate is about 2% to 10%.
There are often social deficits in people with SLD but this may be because they get rejected and neglected by peers more often. People with SLD typically have low self-esteem and a poor self-esteem.
The DSM-5 definition of a specific learning disorder includes the following:
The DSM-5 uses a discrepancy definition but not an IQ-discrepancy definition. There are three specifiers for severity:
Positive psychology interventions (PPI) aim to enhance well-being by increasing positive affect, cognition and behaviour (e.g. developing hope; mastery of life). This includes teaching coping skills. This approach holds that dyslexics have unique strengths and there needs to be a focus on this. However, not all dyslexics have unique strengths and their problems need to be addressed. Positive behavioural interventions (PBI) are more common and focus on providing remedies for the problematic behaviours associated with a specific learning disorder. Changing one’s mindset can help in alleviating the negative aspects of a specific learning disorder but is not enough; treatment is necessary.
Response to intervention refers to a tiered system of empirically supported interventions. When a person fails to respond to an intervention, a more specific and intensive intervention will be used. A failure to respond to one of these interventions is a criterium for specific learning disorder. There are several stages:
People in tier 1 should receive high-quality classroom instruction. People in tier two should receive additional teaching in class by the teacher and additional instruction by a reading specialist (e.g. one-to-one; small groups). People in tier three should receive help from a dyslexia specialist outside of school but should not necessarily be placed into special education. In order for RTI to be effective, tier 1 and tier 2 interventions need to be of high quality (e.g. training and focus on phonological awareness while reading for people with dyslexia).
Dyscalculia refers to limitations in mathematical understanding and includes a deficit in the number sense. It impedes activities that involve problem-solving or retrieving mathematical information (e.g. number facts). The problems in acquisition of number sense are due to a poor approximate number system (ANS). The number sense is reflected in a mental number line (e.g. where is 7 on a scale between 0 and 100).
According to the DSM-5, dyscalculia includes several aspects:
The child often has a poor understanding of numbers (1), their magnitude and relationships (2), get lost in the midst of arithmetic computation (3) and counts on fingers to add single-digit numbers (4). The prevalence is 5% to 10% and the heritability is 43%.
According to the triple code model, numbers can be represented in the following ways:
In mathematics, all three codes need to cooperate. The defective number module hypothesis states that in dyscalculia there are problems with the quantities (i.e. analogue codes) and not only symbols (i.e. problems understanding and representing quantities). This means that dyscalculia is a broader disorder. The access deficit hypothesis states that there are problems with accessing quantities via numbers (i.e. symbols) and not with quantities themselves.
These hypotheses can be assessed using numerical magnitude comparisons. This can be symbolic (i.e. comparing the number ‘1’ and ‘9’) or non-symbolic (i.e. comparing *** and *****). Another way to assess it is by using approximate addition tasks. This can be symbolic (i.e. approximate two numerals) or non-symbolic (e.g. approximate two sets of dots).
Children with severe mathematical difficulties (MLD) are similar to children low achievement but both are slower than regular achievers on a symbolic task. There are no group differences in non-symbolic tasks. Children with mild problems are more accurate in approximate addition than children with severe problems.
This provides evidence for the access deficit hypothesis. The distance effect (i.e. ratio effect) states that answers become slower and less accurate when comparing magnitudes and the difference between the magnitudes is small (e.g. compare four and five digits).
Speaking includes going from a concept to a spoken sound. Reading going from a written word to a sound to a concept. There needs to be a good connection between orthography and phonology. There are different phases of reading development:
Children first show letter by letter decoding (e.g. b-a-t). There is no automatic phonology. For adults, there is parallel activation of letters (1), a word superiority effect (2) and automatic phonology (3). Children with dyslexia decode letter by letter for a longer period of time and have problems in integrating.
Spelling is learned through self-teaching (i.e. orthographic learning). This means that a child sees a word one has already heard and then reads a text where this word is used. The child then knows how to spell this word. This requires decoding from visual to auditory code. Dyslexic children learn how to spell words but need more exposure using orthographic learning.
For dyslexia, the basic characteristics and causes are understood well enough for identification and treatment. The behavioural deficits are a solid basis for identification. The prevalence of dyslexia is 3.6%. About 8.8% of the population are poor readers. There is a large genetic component. The left-hemisphere posterior brain system does not respond appropriately when reading in people with dyslexia.
According to the DSM-5, impairment in reading includes:
It includes problems with word reading accuracy (1), reading rate or fluency (2) and reading comprehension (3). According to the Dutch health system, dyslexia is a specific reading and spelling disability that has a neurological basis and is caused by cognitive processing problems in the connection of orthography and phonology. Other language processing skills are less impaired and specific reading and spelling problems persist despite education.
With dyslexia, there is a wide IQ range. IQ is not a strong predictor of intervention responses. It includes people at the low end of normal reading distribution and requires treatment. Dyslexia falls on a continuum but is chronic as people do not ‘grow out of it’. The identification and targeted treatment of dyslexia are important for well-being (1), health (2) and success (3).
There is a phonological deficit (i.e. problems in decoding sound-symbol associations) (1), comprehension problems (2) and fluency problems (3) in dyslexia. This is not caused by general cognitive limitation or environmental factors (e.g. poor instruction).
Reading comprehension consists of phonological decoding and language comprehension. Slow phonological decoding leads to a slow word reading fluency and this leads to poor reading comprehension. Fast decoding is important because working memory focused on phonological decoding does not have capacity for comprehension. Therefore, the more efficient lower-level word processes are, the more cognitive attention can be directed to higher-level processes at the sentence and text level. Many people with dyslexia become accurate readers but fluency problems are more persistent. This means that reading remains effortful (1), slow (2) and laborious (3).
The phonological deficit theory states that in dyslexia there is a deficit in simple phonological processing leads to dyslexia. The reduced awareness of sound structure leads to problems making connections between spoken and written language. There are underspecified word representations (e.g. not sufficiently discriminative). Decoding is essential for new words because there are no word representations in memory.
In the double deficit model, there can be a deficit in phonological awareness or rapid naming for dyslexia. Either deficit is sufficient for dyslexia although children with both deficits likely have worse outcomes. Rapid automized naming (RAN) refers to a mini-circuit of the later-developing reading circuitry. It allows for ease of access to representation stored in memory. RAN tasks include timed naming of familiar stimuli presented repeatedly in a random order. Pause and thinking time are predictive of reading performance in later life rather than articulation time. The relationship between RAN and reading is strong and lasting but only for poor readers. It appears to predict reading ability in later life.
Deficits in phonological awareness and rapid naming predict dyslexia across orthographies. Deficits in phonological awareness are more predictive of dyslexia in opaque orthographies (e.g. English) and deficits in rapid naming are more predictive of dyslexia in transparent orthographies (e.g. Dutch). An opaque orthography exists when the correspondence between phonemes and graphemes are not consistent. A transparent orthography exists when there is a high correspondence between phonemes (i.e. sounds) and graphemes (i.e. letters). The orthographic depth of a language dictates when the shift from reliance on phonology to fluency-related skills occurs.
The magnocellular theory is a visual model of dyslexia and states that people with dyslexia are less sensitive for contrasts and movements and show less stable eye-fixations. Visual stress may play a role in reading problems as visual deformation (e.g. blurry letters) may occur or visual problems (e.g. headache) may be the result of reading. The deficits in the visual theories are very specific and the relationship with reading is unclear. It also does not have an explanation for specific word-level reading problems. These problems occur more often in people without dyslexia than in people with dyslexia.
The multideficit model holds that multiple deficits (e.g. phonological problems; visual problems; insecurity) lead to dyslexia.
The common deficit account holds that comorbid dyscalculia and dyslexia can be explained by phonological problems. In this case, there is partial overlap in the problems so there are fewer problems in total in the comorbid group. However, reading difficulties seem to aggravate rather than cause math difficulties.
The domain-specific deficit account states that dyscalculia and dyslexia have two separable cognitive profiles. According to this account, dyslexia consists of deficits in phonological awareness (1), phonological short-term and working memory (2) and lexical access (3). Phonological short-term and working memory may impact the development of number fact knowledge. Deficits in lexical access may explain dyscalculia because it is needed to store and retrieve orthographic information.
Comorbid dyslexia and dyscalculia seem to have additive problems and the problems appear to be independent of each other. This provides evidence for the domain-specific deficit account.
Non-verbal learning disability (NLD) refers to having significant weaknesses in visuospatial performance areas. However, these children have significant strengths in verbal areas (e.g. single word reading). They experience problems with learning from visual information and have poor visual-constructive skills. This means that what is seen is difficult to translate into motor movement (e.g. build Lego from an example). There are also attention problems when visual information is offered and poor proprioception. It is not clear what the essential characteristics are and there is no clear explanatory theory. It may be due to damage to the white matter tracts. The prevalence is 0.1% but it overlaps with Asperger’s syndrome, meaning that the actual prevalence may be underestimated.
Dysgraphia refers to a deficit in written expression. The deficits include organization (1), spelling (2), grammatical structure (3), punctuation (4), revising (5), planning (6), transcribing (7) and translating ideas into written content (8). There may be problems with handwriting (1), spelling (2) and global deficits (3). The prevalence rate is 1.3% to 2.7% in early primary school and 6% to 22% in middle school.
Dyspraxia refers to a developmental coordination disorder (DCD) and deficits include balance (1), fine and gross motor skills (2) and manual dexterity (3). There are problems in posture, movement and coordination. The prevalence is 5% to 6% and is more common in males than in females. Motor milestones are often delayed and it may be caused by a central nervous system dysfunction.
A case formulation refers to a hypothesis about why the problem behaviour exists and how it is maintained. This should be based on the longevity of the problems (1), consistency of problematic behaviour across situational contexts (2) and family history (3). Problematic behaviour is characterized by the four d’s:
The duration should also be taken into account. Clinical decisions are often taken based on measures of intensity (1), duration (2) and frequency of the behaviour relative to the norm. To have a valid diagnosis, several things need to be taken into account:
It is essential to take the developmental stage of a child into account when assessing behaviour. According to Erikson, children develop through psychosocial stages with socioemotional tasks that must be mastered to allow for positive growth across the lifespan (e.g. trust vs. mistrust). Behavioural theories state that behaviour is shaped by associations (i.e. contingencies) resulting from positive and negative reinforcement.
There are three questions that need to be answered by the clinician after assessment:
The adaptation theory states that early attachment relationships have an impact throughout the lifespan. Triadic reciprocity refers to the dynamic system between the person, the environment and behaviour where all three influence each other.
Family systems theory states that the family is a system made up of subsystems (e.g. parent and child; parent and parent). The behaviours in a system are aimed at maintaining or changing boundaries, alignment and power. A family’s degree of dysfunction can be determined by boundaries that are poorly or inconsistently defined.
The DSM is a categorical diagnostic system. It makes use of clear-cut categories as this is needed for health care service (e.g. insurance). However, there are several problems with this:
Fear refers to the emotional response to real or perceived immediate threat. Anxiety refers to the anticipation of future threat. Phobia refers to being fearful or anxious about or avoidant of a certain object or situation. There is no specific cognitive ideation.
There are four symptoms of anxiety:
The purpose of anxiety is to alarm one of danger (1), prepare the body to act quickly (2) and keep distance from the danger (3). There is no strict boundary between typical and deviant anxiety. Therefore, the four d’s need to be evaluated when assessing anxiety.
What a child is afraid of changes with age. Children may be more afraid of animals due to their magical thinking. They may be afraid of the dark because of their inability to control it. At seven or eight years old children start to become more concerned with the future.
There is an increase in the prevalence of any anxiety disorders from the age of 11. There is a strong decline in separation anxiety disorder after the age of 10. For phobias, the prevalence can reach up to 16% in adolescence.
Children who suffer from anxiety disorders will be clinging (1), show physical complaints (2), have sleep problems (3), concentration problems (4), avoid certain situations (5), demonstrate a lot of ‘just in case’ behaviour (6), feel small (7), get angry (8), get easily upset (9), demonstrate perfectionism (10), stay home from school (11), lie (12) and alarm adults (13). There is comorbidity between ADHD and anxiety disorders.
Behavioural inhibition refers to inhibited behaviour. As an infant, there is high reactivity to stimuli (e.g. crying). In preschool, these children do not approach strangers (1), stare at strangers (2) and stays close to the mother (3). Modelling behaviour is stronger in the same-sex parent.
There are several risk factors for anxiety disorders:
About 5% of the children and 2.5% of the adults are diagnosed with ADHD. There are several requirements for a diagnosis:
There are three subtypes:
Children with the inattentive presentation are often misdiagnosed and misunderstood. It is often misinterpreted as a lack of motivation. The children may be characterized by a sluggish information processing style and there are problems with focused or selective attention. These children are unable to filter essential from non-essential details. This lack of attention may result from information overload and the inability to selectively limit the focus of attention. They have poor performance on tests because of this problem with attention and their poor concept of time and time management.
Children with the hyperactive-impulsive presentation experience academic problems due to their impulsive nature. They emphasize speed over accuracy and approach tasks incorrectly because they do not wait for all instructions. They are at social risk due to their impatient nature and they often have poor social skills and difficulties making and maintaining friends. They often gravitate towards other rule-breaking children.
A difficult temperament (1), poor sleep patterns (2), excessive activity (3), irritability (4) and a difficulty soothing the child when they are upset (5) are risk factors in infancy for the development of ADHD. During toddlerhood, the child may demonstrate higher levels of underregulated behaviours and a lack of self-control may persist during the transition to preschool.
The symptom presentation of ADHD differs with age. Inattention symptoms are consistent over time but the hyperactive/impulsive symptoms decrease over time. There is
.....read moreAutism spectrum disorder (ASD) is a neurodevelopmental disorder with five criteria:
Symptoms of autism may not manifest themselves in early development if there is a mild version of the disorder. Most children with ASD will demonstrate difficulties in the key symptom clusters but the symptomatology and severity differ. The severity is based on support needed. This ranges from support to very substantial support.
In ASD, there is abnormal language development and several language difficulties are associated with ASD. The child with ASD:
There are several symptoms of Asperger’s syndrome:
While many people with Asperger’s syndrome see it as part of their identity, it was removed from the DSM-5 together with PDD-NOS (1), childhood disintegrative disorder (2) and autistic disorder (3). Asperger’s may not be severe enough to classify as part of the autistic spectrum. However, Asperger’s syndrome may be a separate category due to differences in language development.
.....read moreThe WISC-IQ test measures the following:
The focus of an IQ test is on school-based skills (e.g. language; math; understanding; spatial skills; planning; problem-solving; logical skills) and it also measures acquired knowledge and skills. This means that an IQ test does not only measure potential but also current intelligence. It is important to assess whether deficits are the results of lack of opportunities (i.e. deprivation) or limitations in capacity.
There is not a perfect relationship between school performance and IQ as school performance may be lower than somebody’s IQ due to socio-emotional circumstances (e.g. being bullied) or other issues making school performance more problematic (e.g. dyslexia).
An IQ score is not a school advice in the Netherlands. The schools give an advice and CITO scores and IQ scores could change this advice. The traditional view of giftedness holds that a child with an IQ of 130 is gifted. The current view of giftedness holds that there needs to be high ability but not necessarily an IQ score of 130 or higher. Somebody is not only gifted if somebody has potential but also if this person shows gifted behaviour.
According to Renzulli, giftedness does not depend on a single criterion (e.g. IQ) but refers to the interaction between three clusters of traits;
This definition is applicable to any valuable area of performance (e.g. music; arts) and not just academics. People who are gifted score above average on each of the clusters but not necessarily in the superior range. Whether somebody is gifted depends on the needs and values of a culture.
Persistence in the accomplishment of ends (1), integration toward goals (2), self-confidence (3) and freedom from inferiority feelings (4) are personality factors that predict achievement among individuals with high intellect.
While intelligence on IQ test is relatively stable it does not say anything about development. Giftedness focuses on exceptional behaviour. Gifted children need educational opportunities that are normally not provided in regular instruction. However, this may be needed for all children but the outcomes differ depending on talent.
According to Gardner, there are multiple intelligences. This includes the following:
According to this view, giftedness includes a biopsychological potential to process information. This can be activated by the appropriate cultural setting (e.g. teachers should present lessons through a variety of methods, such as music).
Sternberg’s
.....read moreMultilingualism refers to speaking multiple languages. It is not just a technical task which only requires a cognitive dimension as it also has emotional, social and cultural significance. There are three dimensions for describing people’s associations with the languages they speak:
Simultaneous multilingualism (i.e. balanced bilingual) refers to learning the first and second language simultaneously. Both languages are learned in the home environment and the level of both languages is maximal depending on socioeconomic status and input. Successive multilingualism (i.e. functional bilingual) refers to learning the first language first and the second language after mastering the first one. The first language is learned in the home environment whereas the second language is learned at school or work. The level of the first language is maximal but the level of the second language varies. This multilingualism can be domain-specific (e.g. only reading; only speaking).
Lower order processes refer to the level of letter and word recognition. Higher-order processes refer to the comprehension of the content of text. Efficient lower-order processes allow to allocate optimal attention to the interpretation of meaning communicated in the text. Metacognitive skills in reading refer to the ability to use strategies to regulate the reading process.
When learning a language at home, exposure to the best language is essential. It appears as if the first language skill can predict second language learning early on in life. This could help with early diagnoses of reading and spelling problems of the second language. There are several theories as to how the first language influences learning the second:
In a structural model of languages, there are relations between skills in language one and language two. Lower
.....read moreSpecific learning disabilities are detrimental to one’s well-being. The repeated academic failure associated with this continues to haunt people for years after formal schooling.
A specific learning disability originally included a discrepancy-based definition. This included a discrepancy between IQ and achievement (e.g. high IQ, low reading achievement). However, the degree of discrepancy is arbitrary. This definition favours older children and children with a higher IQ. It is failure-based (e.g. waiting for children to show failure in academics).
The current definition is focused on identification with response to intervention (RTI). It includes achievement in key academic areas that is substantially below the age norm and in excess of sensory deficit (1), linguistic processes (2), attention (3) and memory (4). The prevalence rate is about 2% to 10%.
There are often social deficits in people with SLD but this may be because they get rejected and neglected by peers more often. People with SLD typically have low self-esteem and a poor self-esteem.
The DSM-5 definition of a specific learning disorder includes the following:
The DSM-5 uses a discrepancy definition but not an IQ-discrepancy definition. There are three specifiers for severity:
Positive psychology interventions (PPI) aim to enhance well-being by increasing positive affect, cognition and behaviour (e.g. developing hope; mastery of life). This includes teaching coping skills. This approach holds that dyslexics have unique strengths and there needs to be a focus on this. However, not all dyslexics have unique strengths and their problems need to be addressed. Positive behavioural interventions (PBI) are more common and focus on providing remedies for the problematic behaviours associated with a specific learning disorder. Changing one’s mindset can help in alleviating the negative aspects of a specific
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Thank you Comment Irmak contributed on 19-03-2021 12:59
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