School Age Children with Learning Difficulties Causes of Learning Difficulties

School age children with learning difficulties Causes of learning difficulties • An intellectual disability • Specific learning difficulties • Physical health problems. Sometimes these cause a child to miss school and get behind. Sometimes illness or medicines make it hard to learn. • Vision or hearing problems • Attention problems - Attention Deficit Hyperactivity Disorder (ADD or ADHD) • Family problems or problems at school (such as being bullied) that worry a child - so she is not able to think about her school work • Behaviour problems Typical Presentations to GP • My child is not learning… • School teacher suggested I go to my doctor to get him referred • He’s only reading at yellow and he should be at gold!! • I think he has dyslexia/auditory processing disorder etc etc. What to do? • Refer or reassure • Know key information for referral • Know where to refer (brainstorm…regional variation…) Curriculum levels by year group Curriculum levels by year group Reading Levels Note! • Not all learning problems belong in health. • For children who’s difficulties are solely educational, the family should be directed back to the school. • Even when there are health or disability needs that need to be addressed, education will still have the major role. Special Education in NZ • The Ministry of Educations vision is a fully inclusive education system – “Every day, every child learns and succeeds” – target of 100% of schools demonstrating inclusive practices by 2014 – “When schools are demonstrating inclusive practice, they adapt to fit the student rather than making the student adapt to fit the school.” Moderate learning needs The SEG Grant • The Special Education Grant (SEG) • All schools receive a Special Education Grant to support children with special education needs. The amount each school receives is based on how many children it has and its decile ranking. • Schools have flexibility over how they spend their Special Education Grant, based on the needs of the children in their school. • Most schools have Special Education Needs Coordinators (SENCO) RTLB service • Resource Teachers: Learning and Behaviour (RTLBs) – RTLBs are trained teachers who work with children experiencing learning or behaviour difficulties. They might provide a classroom teacher with special teaching strategies, they might introduce class or school-wide programmes or they might work directly with a child or with small groups of children. High or very high needs • Ongoing Resourcing Scheme (ORS) provides support for children with severe needs or multiple needs. This scheme provides support for additional teachers, teachers’ aides, specialists and items a child might need in the classroom. • Communication Service provides support for children who have difficulties with talking, listening and understanding language. • Severe Behaviour Service provides support for children experiencing severe behaviour difficulties. More details about this service. • The School High Health Needs Fund provides a teacher’s aide for a child with a medical condition that requires special care in order for them to be able to attend school safely. The Ongoing Resourcing Scheme • The Ongoing Resourcing Scheme (ORS) provides resources for a very small group of students (7000) throughout New Zealand who have the highest need for special education. These students have this level of need throughout their school years. • Students are eligible when they meet one of nine criteria. They require intervention from specialists and/or specialist teachers for access to the New Zealand Curriculum and/or adaptation of curriculum content. ORS cont… • To meet the criteria they must have significant educational needs that arise from extreme or severe difficulty with any of the following: – Learning, hearing, vision, mobility, language use and social communication • or moderate to high difficulty with learning, combined with any two of: – hearing vision mobility language use and social communication. Hemi meets criterion 5 • Hemi (5 yrs 4 mths) has been supported through an early intervention programme since he was six months old. He follows the routines at kindergarten with constant verbal and physical prompting. He is able to finger feed, drink from a cup and help with getting dressed. Hemi has been on a toileting programme and is starting to indicate when he wants to go by holding himself. With frequent adult prompting, Hemi can build a tower of three blocks, match two colours and do a three-piece form board puzzle using trial and error. Hemi makes circular scribbles on paper using a fist grip to hold the pencil. He can put a spade `in' a bucket on request when playing in the sandpit. • Hemi will briefly look at a book with his mother and sometimes label a familiar picture. Hemi communicates using single words but often uses sounds and gestures. He likes to be with other children but does not understand turn taking or sharing and will take what he wants from others. Criterion 5…cont • At five, they are learning skills and developing knowledge usually achieved by children up to or sometimes just beyond 2½ years of age. • Nine- and ten-year-old students will still be learning skills and concepts usually demonstrated independently by four-year-old children. • Towards the end of their schooling students who meet Criterion 5 will still be working within Level One of the New Zealand Curriculum through activities appropriate to their age level. When they leave school they will require supported employment and other relevant services. Moving on… • Intellectual Disability • Specific Learning Difficulty. Intellectual Disability What is intellectual disability? • “Intellectual disability is characterised by deficits in general mental abilities, such as reasoning, problem solving, planning, abstract thinking, judgement, academic learning and learning from experience. The deficits result in impairment of adaptive functioning…fails to meet standards of personal independence and social responsibility in…daily life” * • Onset of intellectual and adaptive deficits during the developmental period. *from DSM5 Signs of Intellectual Disability in Young Children • Language delay: expressive and receptive • Delays in self-cares : self-feeding, toileting, dressing • Cognitive delay: Difficulties with memory, problem- solving, and logical reasoning • Social delays • Gross motor delays infrequent • Behaviour difficulties common • ID more likely among children with seizure disorders, microcephaly, macrocephaly, history of intrauterine or postnatal growth retardation, prematurity, Deficits in general mental abilities • Significantly sub-average intellectual functioning. • IQ of approximately 70 or below on an individually administered IQ test. • The level of disability may be further classified as Profound, Severe, Moderate or Mild. Impairment of adaptive functioning deficits or impairments in present adaptive functioning in at least two of the following areas: communication self care home living social and interpersonal skills use of community resources self direction functional academic skills work, leisure, health, and safety. Formal measures of Adaptive Functioning… Why assess for ID? • There are two main reasons to assess for Intellectual Disability – 1) to help understand the child and to help family, friends and teaching staff have realistic expectations of them – 2) to establish eligibility to health funded disability services. • Access to education funded services is not determined on the basis of a diagnosis of intellectual disability but on the education service’s own functional in depth assessment of current skills and rate of learning. Role of the NASC • Any person can request a Needs Assessment from a NASC • requests for ID Eligibility Assessments are generated by the NASC themselves. • The NASC makes a request for ID eligibility assessment if they believe the person is in need of services and requires eligibility for those services to be established. • Variable access to psychologists around NZ • Wait times for ID eligibility assessments can be long. Summary • Assessment of ID requires assessment of intellectual ability using a formal measure. • Severity of impairment based on adaptive functioning rather than IQ test scores alone. Specific Learning Disorder A small matter of terminology… • In the UK intellectual disability is called Specific Learning Disability…not to be confused with Specific Learning Difficulty • And then there’s the “dys”es… • Dyslexia • Dysgraphia • Dyscalculia • Dyspraxia (or developmental coordination disorder) Definitions • SPELD – “Dyslexia, ADHD, Dyspraxia and Dyscalculia are all Specific Learning Disabilities” • Ministry of Education – “Dyslexia is a term used to describe a range of persistent difficulties with reading and writing, and often including spelling, numeracy or musical notation.” Definitions …cont • In DSM-IV - reading disorder, maths disorder, disorder of written expression. • In DSM5 specific learning disorder is now a single, overall diagnosis. • The DSM5 criteria describe shortcomings in general academic skills and provide detailed specifiers for the areas of reading, mathematics, and written expression. Specific Learning Disorder Diagnosis requires: • Persistent difficulty learning “keystone” academic skills (3Rs) • Symptoms may include inaccurate or slow and effortful reading, poor written expression that lacks clarity, difficulties remembering number facts, or inaccurate mathematical reasoning. – Unlike motor and language skills, academic skills have to be taught

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