Learning disability is an assemblage of numerous areas of functioning where by an individual has difficulty in learning in a normal way. Usually the person has significant learning problems in one or more fields of learning. These problems do not to warrant certified diagnosis. Learning disorderÂ on the other hand is typically a clinical diagnosed situation when one has met certain criteria or level of learning difficulty as determined by a professional (Pennington, 2009).
The two situations are caused by factor or factors known or unknown and differ in degree, intensity and frequency of symptoms reported and problems encountered. These factors are either, congenital, genetic or developed neurobiological causes that impair psychological progressions connected to learning. This paper will focus on the different diagnostic procedures of learning disorders.
This paper reviews theory advancement in the field of differential diagnosis. Differential diagnosis is defined in this dissertation as the examination co-occurrence of multiple mental health disorders coupled with mental retardation. Currently, the area has become a major interest of clinical practice and research (Pennington, 2009). Etiologies of differential diagnosis, valuation and occurrence have all been major focuses of research, this etiological theory have practical repercussions for the treatment and prevention of mental disability and suggest significant directions for forthcoming research. Correct diagnosis of learning disorders is essential to differentiate this disorder from other likely causes of similar and identical symptoms or problems.
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Objectives of the Study
This paper's goal is to identify assessment procedures and clinical rationale involved in differential diagnosis of learning disorders.
To highlight correct diagnosis techniques which are essential for the growth and expansion of expert interventions at school, home, workplace and community environment.
To document the strengths and weaknesses of the diagnostic and intervention procedures in order to identify needs that emerge from impairments in definite psychological processes. Â Â Â
Procedure for Learning Disabilities/Disorder Assessment
The following benchmarks must all be met for an accurate diagnosis of a learning disorder;
Clinically significant discrepancies in one or more definite psychological processes which are linked to learning with lower than average abilities necessary for thinking and reasoning. Those physiological processes include processing speed, phonological and language processing, memory, attention, visual-spatial processing, perceptual motor processing and execution.
Low academic achievement or low IQ of less than average when compared to the person's abilities in thinking and reasoning.
An expected level of academic achievement that can only be sustained by very high levels of effort and help.
Proof that observed learning difficulties are correlated to deficits identified in particular psychological processes.
When learning difficulties observed cannot basically accounted for by other conditions which may include primary sensory deficits such as, visual or hearing impairments, environmental factors like abuse, lack of motivation, deprivation, socio-economic status, inadequate education, cultural and linguistic diversity and other co-existing condition such as ADHD or anxiety.
Diagnosis of Learning Disabilities
Since learning difficulties are caused by a variety of factors which includes, biological, developmental psychological, cultural, environmental, physical, emotional, social, and behavioural, The degree of such learning disorders can be determined in the classroom environment by matching individuals to their peers performance on several international and standardized methods of academic success to evaluate if they satisfy age-appropriate progress and milestones.
The formulation of diagnostic methods of learning disabilities is always a complex process that necessitates professional training and expertise. Professionals from various disciplines which include pathology, audiology, psychology, medicine, speech-language therapists and education all work together in evaluation of the individuals at risk, development and execution of intervention measures. From this assessment one can determine which individuals are at danger of failure, the reason, and the support they can be provided.
The following may be signs of mental disability: below average score of Adaptive behaviour, Irregular Denver developmental screening test, Development level below that of peers and an, Intelligence Quotient score of less than 70 on a standardized IQ test. Professionals, who specialize in the diagnosis and assessment of learning disabilities such as a physician occupational therapist special educator or licensed psychologist, can identify if an individual has Dysgraphia. This is difficulty in writing which can be observed in its effects on one or more of the following abilities: (1) spelling words correctly, (2) creating letters, (3) words and numbers by hand and (4) expressing and organizing thoughts on paper.
1). Assessment of thinking Abilities and Reasoning
Always on Time
Marked to Standard
Methods utilized to assess reasoning and thinking abilities should fulfil the Requirements of a standardized psychometrically-sound, individually-administered and psychological test instruments, it must also be reinforced by suitable research, interpreted by professional psychological and medical service providers.
2). Differential Diagnosis of thinking and Reasoning inconsistencies
Learning disabilities are frequently diagnosed via a combination of academic achievement and performance, intelligence testing, social interaction and aptitude byÂ professionals, psychiatrists, psychologists,Â clinical psychologists andÂ neurologists. Perception, memory cognition, attention, and language abilities can also be used to diagnose learning disorder. Many normal assessments are effective in evaluating skills in the primary academic domains such as fluency reading, comprehension, mathematics and computation and problem solving; written expression, spelling and composition.
The major standard for measuring intellectual capacity is the IQ test. In some instances deficiency in specific psychological developments guise normal operation ability in general thinking and reasoning therefore rendering difficult an accurate assessment of global intellectual ability. An individual IQ test score of below 70 is considered a limitation in intellectual functioning; most specifically the IQ must be at least 2 SDs below the mean on an individually administered IQ test.
IQ-Achievement Divergence; individuals with learning difficulties but with IQ score in the average require other estimates of reasoning of thinking abilities independent of impairment such as composite score component , a combination of subtest scores which are taken as a proof of average functioning in these areas, provided results are reinforced by evidence and interpreted clinical judgment. There may be persons for whom the tools in use currently do not fully proof and detect their cognitive abilities. For these situations, real world conditions may need to be examined as a part of a comprehensive assessment in order to demonstrate cognitive capabilities.
The information that results is used to determine if an individual's academic performance is proportionate to their cognitive ability. If this ability is much higher than their academic performance, the student is diagnosed to have learning disability. Most cases there will be a substantial discrepancy between cognitive capability and IQ test scores measurement of achievement in academic capacities. In situations where there was an extremely great effort and support, a significant disparity between cognitive ability and academic achievement may not be detected. All academic assessment methods should always be individually administered and standardized.
The most generally used comprehensive achievement assessments are; the Woodcock-Johnson III (WJ III), the Wide Range Achievement Test III (WRAT III), Wechsler Individual Achievement Test II (WIAT II) and the Stanford Achievement Test-10th edition (Pennington, 2009: Kraft, 2008). Because of their broadness in measuring diverse academic domains, they are more dependable in identifying areas of academic difficulty.
3). Differential Diagnosis of Reading and Language discrepancy.
Dysgraphia is typically evaluated and diagnosed through; academic assessment in writing, reading, arithmetic, language tests and IQ test; measurement of fine motor skills associated with writing; designs copying test; writing of samples evaluated for grammar, spelling, punctuation and the quality of ideas presented (Gina, Smith, & Segal, 2012). Some specialized tests which can measure multiple fields of reading have been used to get information about individual's specific reading disabilities. These assessments include Stanford Diagnostic Reading Assessment and Gray's Diagnostic Reading Tests (GDRT II), Oral Reading and Comprehension Skills Tests (TORCS), Comprehension Reading Test 3 (TORC-3), and the Test of Reading Fluency ( Kraft, 2008).
Weischler intelligence scale for children, integrates standardised measures of language and neuropsychological processes for differential diagnosis of specific learning disabilities. Measured achievement levels, however, should be consistent with an individual's perceived on-going performance and fields of weakness (Gina, Smith, & Segal, 2012). Comprehensive testing must be carried out in observed weakness areas and assessing the components of identified skills. If for example, reading is identified as a weakness area, then assessment should comprise of measures of decoding, reading, oral vocabulary, comprehension and fluency.
Arguments against IQ and Language Discrepancy Model
Even though the discrepancy model has long dominated the school's learning ability assessment system, several substantive criticism of this approach has emerged among researchers.Â Research has also provided little proof that a discrepancy between officially measured IQ and achievement is a perfect indicator of Learning Disability (Pennington, 2009).Â Furthermore, discrepancy diagnosis does not predict the efficiency of treatment. Individuals with low academic achievement with no IQ discrepancy seem to profit from treatment the same way as low academic achievers with IQ discrepancy (higher IQ scores than their academic performance).
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Several arguments has been formulated against the use of ability based achievement discrepancy, one of these school of thought advocates for the total rejection of IQ based assessment of particular learning ability. University of Washington ( UW) approach questions their rigid use as the single approach to academic intervention standards and advocates for the inclusion of other integral components in measurements of intelligence and other neurocognitive functions (Pennington, 2009). The UW approach uses cut offs in identifying children with low levels of intelligence which includes verbal reasoning ability, IQ indexing and other cognitive neuropsychological and language process related to reading, learning and mathematics.
4). Response to Intervention (RTI)
Treatment-oriented diagnostic process also known as RTI, has been the focus of current study. Research recommendations for implementing such a model include first, early screening for all students and then placing those students with difficulty into research-based intervention programs, this has proved more effective than waiting until they satisfy diagnostic criteria.
Close monitoring of performance can determine whether progressively strong intervention results in adequate improvement.Â The responsive group are not given further intervention, whereas members unresponsive to classroom instruction and a more powerful intervention can then be referred for extra assistance through special education and are often recognised with a learning disability. a third tier of intervention may also be necessary before a child is acknowledged as having a learning disability in some models of RTI (Pennington, 2009).
The principal benefit of this model is that enhances early detection, a child doesn't fall far behind to qualify for assistance henceÂ enables more children to get assistance before undergoing significant failure, resulting in fewer children in need of intensive and costly special education services. The parents, teachers, and fellow student themselves may provide important information about past and current academic successes, challenges and the level of help provided to attain present levels of academic functioning (Pennington, 2009). In the United States, states and school districts have been permitted to use RTI a method of identifying students with learning disabilities (IDEA, 2004). In Florida, this model is accepted principal method of identification of learning disabilities,
Criticisms of RTI
Like any other model of identification of learning disorder, RTI has not been spared of controversy. Critics have highlighted that it does not take into consideration children's or individual's neuropsychological aspects which include phonological consciousness and memory. These factors are not included in this model but can help guide and design instruction.
RTI model by design takes significantly longer time than previously established techniques of ability assessment, sometimes up to several months before an appropriate tier of intervention is found. Strong intervention programs required before students can be diagnosed with learning disability makes it somewhat expensive. RTI is considered an ordinary education enterprise and is not supported by special educators, psychologists, speech and reading specialists.
5). Clinical diagnosis of intellectual disorders
These are either inherited traits or acquired conditions that interferes with brain development and function, they include Down syndrome, phenyl-ketunuria and fragile X syndrome and are the leading cause of cognitive impairment resulting in slow mental and physical development (Pennington, 2009). Risk factors are related to the causes. Causes of mental retardation can be roughly broken down into several categories: (1) Infections which include; congenital CMV, encephalitis, congenital rubella, listeriosis, HIV infection and meningitis and congenital toxoplasmosis, (2) Chromosomal abnormalities such as; Cri du chat syndrome, fragile X syndrome, Prader-Willi syndrome, Angelman syndrome, and Down syndrome, (3) Environmental through Deprivation syndrome, which involve deficiency of essential nutrients for brain growth and development, accidents and brain injury and lack of stimulating environment.
The infections that cause learning disorders can be diagnosed by analysis of plasma, body cells and general body scans. Several diagnostic tests can be used to check for chromosomal abnormalities prenatally or post- natal, these include;
Chorionic villus samplingÂ (CVS) done by inserting a needle in the abdominal wall to collect chorionic villus cell sample from the placenta. Sometimes a catheter is inserted in the vagina (Heyn, 2012) to collect the sample, it is done between 11 and 12 weeks of pregnancy. The chromosomes in the sample are analyzed for deviations and anomalies (Kaneshiro & Zieve, 2011).
Amniocentesis, like CVS a needle is inserted through the abdominal wall to collect a small sample of amniotic fluid. It is performed between fourth and fifth month of pregnancy. The sample is also analyzed for chromosome abnormalities.
Percutaneous umbilical blood sampling (PUB), the procedure is carried out after week 18 of pregnancy. In this test a needle is inserted through the abdomen into the umbilical cord where foetal blood is taken from. The blood sample of the foetus is examined for chromosome abnormalities using DNA technology. It is usually performed after week 18 (Kaneshiro & Zieve, 2011).
6) Differential Diagnosis of Developmental Delay
Ontario Ministry of Education classifies all individuals whose abilities essential to thinking and reasoning are considered to be below globally average and lagging behind their peers in cognitive-developmental milestones adaptive behaviour as either having developmental disability (DD) or a mild intellectual disability (MID) depending upon the severity of impairment (Kaneshiro & Zieve, 2011). Such individuals tend to have significant complications in all academic fields; they are consequently unlikely to satisfy the diagnostic benchmarks for learning disabilities.
Intellectually functioning in the MID category, such students may be at certain occasions be diagnosed with learning disability. However, developmental disability plainly eliminates diagnosis of a learning disability. Exams and Tests may be used to assess and diagnose age-appropriate adaptive behaviour deficiency. These developmental screening tests help identify individual who fail to achieve developmental milestones as mentally challenged or with learning disorder.
Intervention and Treatment Mechanisms for Learning Disorders
The main objective of treatment is to advance the person's potential to the maximum. Special education and training should begin at infancy. The training should provide social and adaptive skills to enable the person function normally. Since these disorders are interrelated, a specialist must strive to evaluate the individual for other affective disorders and possible treatment of those disorders.
Roles of the parent and guardians in intervention
Learning disabilities, and their associated academic challenges, can lead to isolation, low self-esteem, and behaviour problems. These can be managed by creating a robust support structure for children with learning disabilities and helping them learn self-expression, how to deal with frustration and work through challenges (Kaneshiro & Zieve, 2011).By focusing on a child's growth as an individual, and not just entirely on academic accomplishments, you'll be able to help him or her inculcate good emotional practices that are foundation for success throughout lifespan.
Research, services, treatments, advocacy and knowing about the nature of learning disability an individual has and how the disability affects the process of learning and cognitive skills involved can help individual attain their potential. Parents are advised to nurture their child's strengths and pay attention to the child's interests and passions. Children with learning disabilities in one area of learning, may shine in another area, disability is not inability. Supporting children with learning disorders help develop their strengths, passions and will most likely help them advance in their areas of difficulty.
There are three common options available for individuals with reading and language disabilities and they include; handwriting instruction that employs multisensory approaches programs like handwriting without tears and, Orton-Gillingham Method for dyslexic children (Riversideschool.org, 2011). Therapy addressing children's writing problems given by a trained occupational therapist may comprise direct instruction in grammar, spelling and composition. It also accommodates use of keyboard and electronic technology to write as a substitute for writing by hand.
Treatment for Genetic disorders
Prenatal examination for genetic abnormalities and genetic counselling for families at danger for identified inherited disorders can lower the risk of inherited mental retardation.
Intervention for Social and environmental causes of learning disorders may include provision of Government nutrition programs to poor children in their most critical years of physical and cognitive development. These nutritional programs can decrease retardation linked to malnutrition. Timely intervention in conditions involving abuse and poverty also help to reduce learning disorders (Kaneshiro & Zieve, 2011).
Environmental programs to minimise lead and mercury exposure will decrease toxin-associated retardation.. Increasing public awareness on the risks of drugs and alcohol during pregnancy will help lower the incidence of retardation.
Control of disease and infections like rubella, toxoplasmosis, meningitis, HIV and other viral infection that cause mental retardation (Kaneshiro & Zieve, 2011)..
The various assessment and diagnostic procedures studied in this paper and of course their drawbacks have formed the basis of determining the benchmark for definitions of learning disability. while learning disorders require clinical diagnosis which may involve gene or chromosomal analysis to determine the cause of the disorder generally the degree of success of intervention strategies and severity of symptoms will generally depend to a great degree on the specific types of disorder, the causes of the difficulties, the timeliness of diagnosis and detection, and the appropriateness of the intervention and remedial programs used (Pennington 2009). Despite detailed assessment, no cause can be identified in approximately 30% of cases of severe mental retardation and in 50% of cases of mild mental retardation. This, of course, reflects the inadequacy of diagnostic techniques, rather than a lack of causation (Pennington 2009).
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Riversideschool.org, (2011). The Orton-Gillingham Approach To Teaching Dyslexic Children:
A 49 Hour Introductory Course. http://www.riversideschool.org/downloads/teacher-training-program.pdf
Kaneshiro N. K. & Zieve, D., (2011). Mental Retardation. The New York Times. http://health.nytimes.com/health/guides/disease/mental-retardation/overview.html
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