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Specific Learning Difficulties in adulthood
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Specific Learning Difficulties in Adulthood
Transition into employment
Professor Amanda Kirby
How do you support anyone?
Challenges Skills
Setting Past
experiences
outcome
ICF-CY (WHO)
SPECIFIC LEARNING DIFFICULTIES ARE NOT IN NEAT BOXES….
anxietydyscalculia
ASD
ADHD
DCDDyslexia
SLI
anxietydyscalculia
ASD
ADHD
DCDDyslexia
SLI
“multidisciplinary teams tend to work in parallel rather than as a team when working with clients ”
(McGonnell et al, 2009).
anxietydyscalculia
ASD
ADHD
DCDDyslexia
SLI
12
27%
19%3%
9%
12%
3%8% 19%
DCD Only
DCD + Dyslexia
DCD + Dyslexia + ADHD
DCD + Dyslexia + ASD
DCD + ADHD
DCD + ADHD + ASD
DCD + ASD
DCD + ASD + ADHD + Dyslexia
DCD and Dyslexia
• 12,950 children aged 10-11 years tested on a series of motor tasks.
• In the group who measured the highest rates of literacy difficulties (2% of the total)– 35.3% failed one motor task ( reading group) v
26.8% in td group
– 16.4% more than one v 7.7% td group( Haslum and Miles ( 2007).
DCD and Dyslexia
0 5 10 15 20 25 30 35 40
1 motor diff
2 or more
td
reading diff
DCD and Dyslexia
0
2
4
6
8
10
12
14
16
M-ABC Man Dex Ball Balance
Dyslexia
Poor readers
Controls
NorwayIversen,et al, Dyslexia,2005.
Kirby and Salmon,2007
DCD+ ADHD
ADHD + Dyslexia
25%-
40%3-6%3-6%
Early manifestation of delayed language & inattention
ADHD + Dyslexia + DCD
A Canadian population study (Kaplan, Crawford, Wilson & Dewey, 1997)
Out of those showing DCD had also– 25 % ADHD +Dyslexia
– 22% + Dyslexia
– 10% + ADHD
– Additional work by (Biederman, Faraone, Mick, Moore, & Lelon, 1996,O’Hare and Khalid 2002)
– Kadesjo¨ and Gillberg (2001) found that 47% of their ADHD children also had DCD
ADHD + Asperger’s
21% of children with severe ADHD met criteria for Asperger’s syndrome
36% showed ‘autistic traits’
(Fitzgerald and Corvin, 2001)
Executive functioning
The self management system of the brain
“A cluster of skills that are necessary for efficient and effective future-orientated behaviour”(Welsh, cited in Diamantopoulou et al, 2007)
“Not accounted for by IQ” ( Martel et al, 2007)
( Barkley, Brown, Du Paul)
The Dyscovery Centre copyright 2011 Amanda Kirby
What is executive functioning?
Involved in handling novel situations outside the domain of some of our 'automatic' psychological processes that could be explained by the reproduction of learned schemas or set behaviours.
The Dyscovery Centre copyright 2011 Amanda Kirby
Executive functioning
Role in:
• planning
• setting priorities
• organizing thoughts
• suppressing impulses
• weighing the consequences of one's actions
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Prefrontal cortex
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1.Self activation/Initiation
• Getting going.. (Especially the boring stuff)
• Procrastination
• Poor time estimation
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2.Working memory
• The brains RAM- holding information in your mind while making links
• Short term memory-what has just been said, remembering a sequence
• Listening to someone talking to you while remembering you need to turn out the light before going
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3. Effort- Remembering to remember
• Internal prompts
• ‘…after I have finished this I need to do that...’
• Frustrating forgetting important things– seen to be lazy/can’t be bothered..
• Regulating alertness..completing tasks, sleep pattern (can’t shut off)
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4.Emotional self control/Action
• Thinking and not acting
• Taking others perspective into account
• Managing frustrations and modulating emotions
• keeping things in perspective
• impulsive, not considering the context, can’t adjust pace The Dyscovery Centre copyright 2011
Amanda Kirby
5. Focus
• Ability to sustain focus but be able to shift to another task
• Reading over and over
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6. Hindsight and foresight
• Learning from past experiences
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7.Time concepts
• Time blindness
• Time passing
• Remembering to do the diary
• Allocating time
• Moving on
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EF has developmental stagesBuilding Blocks
(Diamond et al,2007)
Inhibitory control
Selective attention
Working Memory
Planning
Age years
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EF is a core element of all Specific Learning Difficulties
• ADHD – all ADHD children have EF impairment to varying degrees (Barkley 2001)
• ASD – Pennington and Ozonoff (1996) found children performed 1 SD below control group on EF tasks
• DCD – children impaired on tests of working memory (Alloway & Temple, 2007)
• Dyslexia – studies have found WM deficits that compound their phonological problems (Wolf 2010)
The Dyscovery Centre copyright 2011 Amanda Kirby
Executive Functioning/Study Skills in students in higher education
Data capture for the 6 EF domains (planning, organisation, impulse control, working memory, metacognition and time management)Additional 20-item list captured the use of tools - if any – to guide
students to be ‘more organised’ (e.g. Using a diary, software etc..)
Analysis:Descriptive statistics to describe student sampleChi squared cross-tabulation / analysis of variance to compare
diagnosis groups
Executive Functioning skills deficits in students
in higher education
Participants:
353 students completed the survey
The Dyscovery Centre copyright 2011 Amanda Kirby
Frequency% (n)
Male% (n)
Female% (n)
Mean Age(sd)
DCD 6.1 (20) 35.0 (7) 65.0 (13) 23.90 (5.59)
Dyslexia 16.8 (55) 52.7 (29) 47.3 (26) 24.85 (8.83)
DCD and Dyslexia 4.0 (13) 38.5 (5) 61.5 (8) 25.77 (9.63)
No formal diagnosis but difficulties
56.4 (185) 59.0 (108) 41.0 (75) 26.86 (9.68)
No formal diagnosis 16.8 (55) 21.8 (12) 78.2 (43) * 27.17 (8.55)
Significantly more females with difficulties but no diagnosis
0
10
20
30
40
50
60
70
80
Planning Organisation Impulse Control Working Memory Metacognition Time Management
%
DCD
DCD/Dys
Dyslexia
No diag/diff
No diagnosis
Results Using study tools
Significant differences between TD and SpLD groups ( P= < 0.01)
The Dyscovery Centre copyright 2011 Amanda Kirby
0
10
20
30
40
50
60
70
80
90
never have study partner Never use End Note/Ref manager Don't use past papers for revision
SPLD %
TD %
What are specific learning difficulties?
Dyslexia is a literacy and language difficulty. It is a life long condition and affects approximately 10% of the population. Individuals with Dyslexia have difficulties with reading and spelling and may also have difficulties with organisation and planning.
Dyslexia
Literacy and language difficulties associated with Dyslexia may affect reading, note taking in meetings, writing and structuring documents, remembering instructions, copying notes, learning new vocabulary, remembering instructions, spelling and reading speed.
Symptoms and signs
• Autism Spectrum Disorder (ASD) is a spectrum of lifelong developmental disabilities that affects how a person communicates with, and relates to, other people. ASD includes Autism, AspergerSyndrome and Pervasive Developmental Disorder Not Otherwise Specified.
• ASD affects around 1 in 100 people. The ‘spectrum’ element of the disorder means that while all people with ASDs share certain difficulties, their condition will affect them in different ways and to varying degrees. The three main areas of difficulty for all people on the Autistic Spectrum include difficulties with social interaction, social communication and social imagination.
ASD
• May appear very able but face difficulties in getting to appointments on their own
• Difficulty coping with a change to routine and performing well in interviews.
• Take things literally
• Not recognise others emotions, unless very obvious
• sensory sensitivity or under-sensitivity, for example to sounds, touch, tastes, smells, light or colour.
Symptoms and signs
• SLIs affect an individual’s ability to learn and use language. The condition affects receptive and expressive language.
Specific Language Impairment
• Individuals with SLIs may have difficulties remembering sequences of instructions, taking down telephone numbers or instructions.
• They may appear anxious or angry if they do not understand what is being asked of them.
• They may be withdrawn and find it difficult taking turns in meetings.
Symptoms and signs
• Dyscalculia is a condition that affects an individual’s ability to understand and acquire mathematical skills. Individuals may also present with difficulties organising and planning.
Dyscalculia
• Individuals with Dyscalculia may present with difficulties managing money, telling the time and taking measurements. These difficulties may impact on an individual’s organisation and planning abilities
Symptoms and signs
• Developmental Co-ordination Disorder (DCD), also known as Dyspraxia in the UK, is a common disorder affecting motor co-ordination in 5-6% of children of which 70% continue to experience some level of associated difficulties in adulthood. This condition is formally recognised by international organisations including the World Health Organisation. DCD/Dyspraxia is distinct from other motor disorders such as cerebral palsy and stroke. The range of intellectual ability is in line with the general population
DCD/Dyspraxia
• Co-ordination difficulties may affect everyday life skills. Individuals may present with difficulties writing, typing, learning to drive a car, riding a bike and self care tasks. In addition, individuals often have difficulties with organisation and planning skills.
Symptoms and signs
• ADHD is a common disorder starting in childhood.
• symptoms continue but change into adulthood.
• The definitions of ADHD– Impulsivity
– Hyperactivity ( in children)
– Inattention
causing difficulties at home, in education, in work and social settings.
Presentation varies depending on external demands
ADHD
• Impulsivity could be demonstrated by speaking and acting without thinking, interrupting others, difficulty waiting turn, being oblivious to danger and not learning from experience, lack of awareness of the context in which the person is behaving (e.g. needing to be quiet when others are being quiet).
• Hyperactivity is more obvious in childhood. In adults this may be observed as a difficulty sitting still, being restless and fidgety such as tapping feet or being over talkative.
• Inattention can result in an individual being easily distracted, having poor concentration, easily bored, difficulty organising, starting but finding it hard to finish tasks, starting a task and missing steps in the instructions.
Symptoms and signs
BUT
• boxes – they are easier to understand
• ... Not … Got ‘it’ or ‘not’
We are like.........
BUT Ye shall know the truth, and the
truth shall make you mad.
~Aldous Huxley
ENVIRONMENTAL
BEHAVIOURAL
NEURAL
GENETIC
“Meshes of influence”Turvey,2006
The outcome for the individual... E.g. Employment/independence is dependent on multiple factors
Individual
Knowledge of causation of
learning difficulties
Overlap with other learning difficulties
Increased stress
Individual
Environment
Task
Task demands increase
More organisation
TechnologyLiteracy
demands
Individual
Environment
Task
Changes interact with one another
First .....genetics
Varying expression
e.g. ADHD
DRD4 influences persistence of ADHD over time (El-Faddagh et al, 2004).
MAOA associated with antisocial behaviour in ADHD but not with ADHD itself (Thapar et al, 2006).
Different genes have differing roles
BUTenvironment has an effect
on genes
Gene – environment interaction
Conception
Ref: Giedd
Early years
The longer an individual is on a particular developmental pathway the less likely he or she will deviate from this pathway
(Bowlby, 1973,Cicchetti, 1993, Sroufe, 1997)
Supporting students into employment
Study of 16-25 year olds with DCD in FE and HE
0
10
20
30
40
50
60
70
80
90
self ca
re
writ
e ne
atly
writ
e fa
st
read
writ
ing
copy
ing
down
find
way
roun
d buildings
othe
rs re
ading
writ
ing
avoid
hobbi
es g
ood co-
ord
leisur
e tim
e alo
ne
avoid
team
spo
rts
spor
t on
own
avoid
club
bing
mon
ey m
anag
emen
t
TD %
DCD %
Favourite Leisure Choices
Approaching significance at 0.06 level
** Significant at 0.05 level
*** Significant at 0.01 level
0
10
20
30
40
50
60
70
80
% of students
choosing
Bar Reading
*
Films/TV Club** Sport*** Other**
Leisure choices
Movement difficulties
TDA
EF
0
10
20
30
40
50
60
70
80
Get
ting
up b
ed
orga
nising
bag
pack
ing
suitc
ase
folding
cloth
es
orga
nise
room
perfo
rming
2 th
ings
plan
ning
ahe
ad
loss
of a
ttent
ion
follo
wing in
stru
ctions
getting
ready
to le
ave th
e ho
use
com
plet
ing
task
s
arra
nging
room
and
wor
k are
as
plan
ning
to d
o so
met
hing
at a
set
tim
e
orga
nise
d to
soc
ialis
e
plan
ning
leisure
activities
orga
nise
d fo
r a class
/mee
ting
TD %
DCD %
They may present as:
Implications for assessment and support
Home
Dress code
Social interaction
Self care
Self organisation
Fitness levels
Uni/college/work
Career choices
Interview
Work experience
Rules of the workplace
Specific language difficulties
EF difficulties related to workplanning
• Perfect- full assessment on all students to assess individual needs
• Good enough- screen and guide all, give focussed support to some- triage
Approaches
Support
• Avoid e.g. use computer, change job
• Adapt- extra time, use templates for report
• Practice.. Necessary skill
http://www.readwritethink.org/files/resources/interactives/essaymap/
© The Dyscovery Centre 2007
www.ghotit.com
Mind mapping -www.ikon.com
KIDSPIRATION
Colouredoverlays
Classroom computer strategies
Changing colour
background
Speech-to-text
Dragondictate 11
Text-to-speech e.g.
readplease.com
Readability statistics
http://www.expressivo.com/say/WkLFzDXR
Areas to address
• Home– Organising his room for work and living– Working with others– Appearance– Physical activity
• University/College– Time management– Mentorship
• Next step– CV writing– Interview techniques– Appearance– Job description
Deciding on the right direction
• Motivation and Interests
• Strengths
• Support level required
– Home or away
• Gaps that need preparation
– Core skills to be addressed
– Level of adaptations needing to be made
Seeking Strengths
• Can he drive?• He has lived away from home?• Good IT skills?• Voluntary work or any jobs?• Groups/interests in university?• Travelled independently• Hobbies- e.g.cooking?• School activities?• Overcoming adversity?• Empathy?
Level of home support
• Finances to start off with- or debts to pay off
• Day to day support required
• Insight into difficulties
What are the gaps that need addressing?
• Appearance
• Attitude
• Skills
– Independent living
– IT- alternatives to recording
– Social skills
– Literacy
• History of difficulties in school
• History of ‘failing’ or being failed’
• Have ‘life histories’ that need listening to
Adults presenting for literacy support
• Focus on the correct parts
• Most adults will present with a pattern of strengths and difficulties
Unpack areas of difficulty
Key issues prior to the job
• I don't do things the way other people do. I have to work out my own strategies, which makes me seem "odd" to others. I can't work in a team though I have tried many, many times. I don't process verbal instructions. I have to bluff my way through situations where I've only partly heard something. I wonder how long I will last before the others recognise there's something wrong and the rejection starts.
• Project management Administration Auto Cad Technical drawing/office space planning Health & safety Contract management (tendering) Manage 12 staff
• My organisation is very poor I can't take notes in meetings as I can't read what I've wrote. If I am hosting the meeting I have to take a member of my team to take the minutes.
Challenges
• Bar worker :People watching me when I pour drinks, Talking to people at times, getting on with a job without being told, organisational skills, being quick.
• Lawyer: the handwriting legally required for my work.keeping on top of a large number of tasks to be dealt with from incidents that happened earlier while dealing with fresh incidents at the same time.
• Admin worker: Doing new things when I'm not sure exactly what it is I'm supposed to be doing. Idealy I would like someone to go through somthing with me in detail by showing/explaining it to me before I attempt doing it alone.
Fears for some
• After difficulties with education, 1st job, further education, 2nd job, 3rd job, running own business, enrolled on boat-building course and half-way through had a break-down with a week on a drip at hospital followed by self-discharging; left with 2 days/wk gardening self-employment, because it appears that I will incur a fatigue,(around 2 days out-of-action) above a level of physical effort. N.B. otherwise I'm strong & fit for my age without excessive depression.
For some a pattern of starting lots of new jobs….and fatigue
• I play racquet sports (on rare occasions when I play them) with my right hand, cut with scissors with my right hand and use computer mouse (just about) with right hand. I write and draw and cut bread etc with left hand. I can use old Woolworth's type key style tin opener very oddly and I turn the wine bottle on the table into the butterfly wing type wine opening screwer in order to uncork wine. I write lists a lot....always to pack for holiday.....I am a mini control freak as my daughter has Dyspraxia as well and in her organisational deficits are a big problem for her. My weakest deficit is my working memory (4% centile) so I have to write everything down constantly.
• I have avoided anything complicated finance-wise over the years.....I do not understand maths at all. Every April the staff on the helpline at Tax credits let me say just that my financial situation is the same as last year so that I do not have to fill in a form to renew my claim.
Work associated difficulties
• Doing assessment tests as i have very weak recall of information. Particularly under pressure.
• Instantaneous information retrieval during pressured questioning. (One's answers are scored out of five....the answers are added up at the end. The person with highest score gets the job.
• Also questions are long and multi-clausal and I can't remeber all the parts of such long questions. It took me ages to get a new job a couple of years ago. I think I may have got it because the director of the organisation had to interview me with manager at eleventh hour (replacing someone else who should have been on the panel) and she has a child with special needs, so reframed the questions and let me have them written down to look at.
Interview stage challenges
• Disclosure- how and to whom
• Questions beforehand
• Information about ‘test’- does this match the reality of the job
• Extra time at interview stage
• Dealing with anxiety
Key issues prior to starting a job
• Does the Job description match the job
• Clarity in line management
• Learning a new skill at the same pace
• Needing to be shown as well as told, perhaps a few times
• What is a reasonable adjustment- quickly in place
Key issues starting and staying in the job
• large notebook for everything which are a chronological record of everything. The latter has jobs to do list which I make a habit of managing on the train.
• Whereever I go I start to prepare three hours before
• I like processes which I stick carefully to. I also try to do things by the rules. One of them is prioritising - Box 1 Urgent and Immediate, Box 2 Urgent not immediate etc.
What does a 50 year old with DCD do to help:
Working in an open plan office (although I always have to these days.) I cannot siphon off background sounds whatsoever.
My headsets always take ages to arrive. In my last open plan office for this job the equipment took seven months to be sorted. In this bigger still open plan office that organisation is now all co-located in, I have repeatedly been ordered the wrong headset since beginning of November and for which I was trying to get help from Access to Work since September.
How many times people will forget not to stand in middle of noisy open plan office and mumble a long sequence or list of tasks they want done, rather than writing them down for me or allowing me time to.
Challenges in the job
• In last job, going to court. Dealing with the court 'bundle'. Finding pages quickly that were being referred to by judge. defence etc.
• Taking verbal instructions is difficult as i cannot remember all of them
Challenges
• I get help with reduced targets and an electronic letter opener.
• Lists.
• Practice, ad nauseam.
• Work very very hard, as everything takes so much longer.
• Take rests in a quiet place, can sleep anywhere. Grip tools very tightly for fine movement. Steady hand on something. Lean on walls when standing wherever possible.
• Zip up or velcro shoes. Clothes where the back is different to the front, or where there is a label for
Adaptations
• Write things down a lot.
• Use computer, so I can work on lists, or get my head around complex situations.
• Write down instructions and directions.
• Put finger under numbers I have to copy or telephone numbers to dial so can find my place again. Worse when tired.
• Put plain paper under line of text that I'm reading.
• Never drive with the radio on.
Adaptations
• If possible take someone with me when I go to a new place. If not, get and write down directions.
• Use my ring to distinguish right and left.
• Take notes in formal situations to keep track of conversation and of what I want to say.
• Put my hand up when I want to speak
• sitting down whilst speaking and only talking to one person at a time. I have always tended to gravitate towards people on their own in social situations, or stick by the people I already know.
• Ask a lot of questions, and seek help when necessary, e.g. with paperwork and forms
Adaptations
• Clarity
• Communication
• Compassion
• Coping with change
• Continuum
Conclusions
• Practice what you need to
• Adapt what you can( scaffold)
• Avoid what you cannot
• www.dyscovery.org
• www.spldtransitions.co.uk
• www.boxoifideas.org- information, organisations and strategies
• http://www.learnerprofiler.co.uk/ws/webinar-resources.aspx - free software
Further guidance
