Cognitive Impairment

The DSM states
There are no specific personality or behavioral features uniquely associated with intellectual disability, and that some people are passive, placid, and dependent, whereas others can be aggressive and impulsive and that unless the disability is apart of a specific syndrome or condition, there are no specific facial features associated with mental retardation. The DSM also notes that when intellectual disability is associated with, or results from, specific medical conditions or syndrome (down syndrome, william’s syndrome) there are predictable learning and behavioral characteristics.
Certain expectations from syndromes, not from intellectual disabilities, and certain syndromes have certain learning and behavioral characteristics.
True
To qualify as Intellectual Disability
1. Before 18
2. Negative impact on adaptive functioning and intellectual functioning
3. IQ lower than 70
Age
IQ
Adaptive skills
Adaptive Skills
One’s effectiveness in coping with life’s demands wile meeting expected age and cultural standards.
Conceptual Skills
Reading comprehension, math (e.g. time, money) and planning out one’s future.
Social Skills
Following rules and laws, developing self esteem, solving social problems and taking social responsibility, not being naive, gullible, or becoming a victim.
Practical skills
These skills range from hygiene and health care, to using money, a phone, and transportation, to occupational skills.
IQ: A standardized test score comparing an individual to a group. Normal IQ in the USA is 100.
Mild:
Moderate:
Severe:
Profound:
Mild: 50-70
Moderate: 35-55
Severe: 20-40
Profound: 0-25
What percentage of those with ID are classified as mild to moderate?
85%
Levels of support: The American Association of Intellectual and Developmental Disabilities prefers using levels of support ranking (which are based on the supports: Type, Frequency, and Duration), over IQ scores.
I. Intermittent (Low frequency and duration) – mild
II. Limited (Higher Frequency and short duration) – moderate
III. Extensive (Regular Frequency and Ongoing Duration) – Severe
IV. Pervasive (Consistent Frequency and Duration) – Profound
Students with Intellectual disabilities are likely to need support with
Motivation & Self-determination, Attention, Memory, Self-regulation & metacognition, Language, and Social Development
Motivation & Self Determination:
Motivation is partly a skill that is dependent on metacognition. How do you motivate yourself? Self determination is making choices for one’s self. Students with intellectual disabilities are often told what to do, how to do it, and when to do it and hence don’t have opportunities to develop making choices and experiencing the outcomes of their choices (Which are exactly the two things needed to build ones metacognition). In addition, due to processing errors and lack of metacognition building opportunities, students with ID often do not learn that failure is due to method and that method can be changed. Hence they are at high risk for failure and are at risk for learned helplessness.
Attention:
The ability to focus in on one thing, while blocking out other things. They may attend to the wrong target (when anyone attends to the wrong target, it is difficult for them to track cause & effect relationships. Hence the world operates as if by magic). They may need support in maintaining attention (as self-regulation and motivation can be challenging under normal circumstances: what keeps the normal person on task may not work for them).
Memory (mostly working memory)
I was walking down the street and I met a cognition and he told me not to boil waffles, it’s the wrong method.
Frontal lobe damage:
trouble with metacognition and executive functioning
Self regulation & metacognition:
These are related. Self regulation is the ability to adjust one’s thinking, behaviors, and emotions to fit the situation. Metacognition is being aware of what specific type of thinking should be used to solve a problem. Metacognition and self regulation are skills that can be taught and raising these skills helps improve adaptive functioning.
Language (Comprehension and production)
correct
Learning Disabilities
A disorder in one or more of the central nervous system processes involved in perceiving, understanding, and/or using concepts through verbal (spoken or written) language or nonverbal means.
Learning Disabilities manifest themselves with a deficit in one or more of the following areas:
attention, reasoning, processing, memory, communication, reading, writing, spelling, calculating, coordination, social competence, and emotional maturity.
To have a Learning disability, IQ must be
Normal to above normal
Two causes for Learning disabilities
Congenital: specific neuropathways are not formed or correctly formed.
Acquired: Specific neuropathways have been interrupted (condition may be acute or chronic)
Dyslexia
Brain based reading problems: Dys = Difficulty + Lexia = word (Reading). The reading troubles do not result from eye problems. (Those with dyslexia do not see letters backwards or perceive lines of text as dancing about the page: as there are controlled by brain functions different from those impacted in dyslexia. But they may display dysnemkinesia- brains motor control system causes writing and letters and numbers backwards. Treat dyslexia in the first two grades, 80% brought up to grade level, if after 5th grade, only 10% to 15%.
Dyslexia is often comorbid with
ADHD
Phonological Awareness model
The brain has structural differences that negatively impact or prevent word decoding & instant word recognition.
Visual attention model
Some with dyslexia have brains that are favoring one hemisphere processing over the others resulting in a processing bias for some visual materials and neglect of others. The studies point to people who cannot decode new words (words not seen before) but have no phonological processing deficits. The idea is that the brain is neglecting to see parts of words (i.e. the brain does not see the beginning, or end, or only sees the middle of a word).
Duel route theory:
A word that is new to the brain must be decoded to be read. To do this, the brain uses indirect/sounding out processing this uses (parietal temporal region). Each time the brain decodes the new word, it forms a new neuropathway in the brain’s occipital temporal region; After 4, or more, exposures to the new word the brain uses the newly formed pathway-meaning that the brain can now use direct/whole word processing in which the word is not decoded, but recognized instantly.
Decoding:
Words are made of phonemes (smallest unit of sound. The word cat has 3 phonemes. C-A-T.) In decoding the brain ascribes the learned associated sounds of speech to its written symbolic representation- using indirect/sounding out processing
Fluency:
Fluency is the speed of accurate reading: In fluent readers words are decoding using Direct/whole word processing. The use of indirect word processing results in slow reading. (Note: problems in decoding lead to problems in fluency.)
Comprehension:
Reading comprehension refers to one’s ability to make connections between what is read and the information contained therein. (Note: Problems in decoding and fluency lead to problems in comprehension.
Spelling:
Encoding from spoken language to writing: The opposite of decoding.
Word choice / substitution:
The brains of students with dyslexia have problems using language neuropathways which will-at times- cause them to conjure up a word that is different than what they intended (e.g. some salads have cucumbers, tomatoes, and tornadoes.) Their brain may or may not detect this processing error. In addition, if the person is having a problem conjuring up the intended word, they may substitute the word with a synonym or a description of the object or event (using the word, hat, baseball cap, or calling it the thing you put on your head to block out the sun.). Often specific terms become stuff, things, place
LD is a category like cars. What kind of car? What kind of LD?
correct
Dysnomia:
Problems naming things and places
Dysgraphia:
Problems with writing: sloppy, poor spelling. (fix: use a word processor.)
Dyscalculia:
Problems with mathematical operations: numbers transposed, poor alignment, confusing symbols, calculation errors. Math concepts may be clearly apprehended and comprehended with the performance aspects of math being disrupted.
Auditory processing Disorder
Ears work normally, but the brain can not process the sounds of speech quickly and/or correctly. (Talk with clear diction and wait 5-10 seconds for a response when the question is asked- while the brain processes what was said; present instructions in writing)
Nonverbal Learning Disability
Problems with the nonverbal components of language (e.g. facial expressions, vocal tone, miming) problems seeing the gestalt, big picture, understanding cause and effect relationships, sizing up a situation, recognizing peoples intentions and emotions. Problems in math in terms of understanding amounts and time (it is increasingly considered to be part of the autistic spectrum disorders)

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