Neurobiology of Learning Disorders

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Neurobiology of Learning Disorders



Drs. Fernette and Brock Eide and their talk to the American Academy of Child and Adolescent Psychiatry in San Francisco, CA. Latest updates in research-based understanding of learning disabilities and ...

Drs. Fernette and Brock Eide and their talk to the American Academy of Child and Adolescent Psychiatry in San Francisco, CA. Latest updates in research-based understanding of learning disabilities and learning differences. Topics covered include: co-morbidity of LD, prevalence, neuropsychological testing, fMRI, auditory and visual processing, development, dyslexia, dysgraphia, dyscalculia, and ADD / ADHD, reward and motivation, creativity, gifted, neurodiversity.

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  • Full Name Full Name Comment goes here.
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  • Yes, it's a good idea to check it out. Rowe and Rand have found a way to counter the negative education effect of RPS kids, and I've emailed an MS Word file attachment to Dr Eide describing our K-1 teacher study showing the positive effect of writing practice.
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  • Here are some identification and remediation links you might want to also look at.
    Peterson Handwriting Co. read the paper and has consequently collaborated with us. They have looked at the condition we studied for many years and had gotten the same results by handwriting position change. We were able to uncover the genetic as well as the cause for what was happening. This was helpful in expanding their work.

    Reverse Position Sensation (RPS) is a previously unrecognized perceptual condition that affects learning of written language. The condition was identified during a long-term study of LD/ADHD aimed primarily at genetic connections to learning disabilities. The fifteen-year study involved hundreds of identified LD subjects. Here is a current letter being sent out. Links to the examination and remediation kits are below.

    To Educators working with special needs students:
    Based upon study data, RPS could be present in 50% to 75% of the students in your support classrooms. The important revelation is that physical training can correct the rotational sensation problems and reduce or eliminate the associated learning difficulty. More importantly, it indicates that good physical training early on could prevent learning problems from developing.

    A Guide to Testing, an Examination Kit and a Guide to Remediation are now available to you at no cost from Peterson Directed Handwriting. A simple, classroom-group screening process is explained. It requires only a few minutes, including management time, and will identify primary children who need help to prevent problems from developing. The RPS Exam combined with the interpretation section in the testing guide will allow identification of the condition in your LD population. The study is complicated and difficult to understand because the condition is very hard to perceive. We have done the best we can to clarify the effects in the RPS Testing Guide linked below. However, it is not difficult to conduct remedial activities or teach proper physical skills in primary grades to avoid learning difficulties that would otherwise develop.

    Please invest some time to review the materials and consider the potential impact of successful instruction. Mastery of physical skills for handwriting that are currently not a priority, could change the lives of many who spend frustrating years in learning support classrooms.

    The links below should allow you to access the documents with your web browser and download them as well. If you have trouble with access please let me know.

    RPS Testing Guide

    RPS EXAM Kit

    RPS/WLD Remediation Guide

    Don't hesitate to contact me directly by telephone with questions. I also maintain an Adobe Connect web meeting that offers easy interaction with individuals or groups and will be happy to provide any assistance I can by working with you live via the internet. There is no need to download software to join a Connect meeting.


    Rand Nelson, President
    Peterson Directed Handwriting
    Greensburg PA
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  • Thanks for sharing, Rowe! We'll check it out!
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  • 10/21/12 18:57 © 2007 Microsoft Corporation. All rights reserved. Microsoft, Windows, Windows Vista and other product names are or may be registered trademarks and/or trademarks in the U.S. and/or other countries. The information herein is for informational purposes only and represents the current view of Microsoft Corporation as of the date of this presentation. Because Microsoft must respond to changing market conditions, it should not be interpreted to be a commitment on the part of Microsoft, and Microsoft cannot guarantee the accuracy of any information provided after the date of this presentation. MICROSOFT MAKES NO WARRANTIES, EXPRESS, IMPLIED OR STATUTORY, AS TO THE INFORMATION IN THIS PRESENTATION.
  • Other approaches – candidate genes based on theoretical roles in the disorder – like DA in ADHD Other is dense map of DNA markers to look for polymorphisms – although some candidate genes identified, they seem to account for a low percentage of phenotypic variability
  • WCST: set shifting in changing situations- match cards by different characteristics CPT commission – continuous performance task – sustained and selective attention, impulsivity
  • Functional magnetic resonance imaging, or fMRI, is a technique for measuring brain activity. It works by detecting the changes in blood oxygenation and flow that occur in response to neural activity
  • Reading letters than rhymed (D and T) or did not rhyme (G and K) after Fast Forword phonics training
  • Visual crowding task – y axis was critical spacing required for flanked letter identification – x-axis was letter size
  • Subitizing is the rapid perceptual appreciation of number
  • IPS = Intraparietal Sulcus Defined WIAT-II < 25 %tile Num Operations
Matched for age, gender, IQ, word reading
  • Spelling to Dictation
  • 18 students with Dyslexia – from familial dyslexia study UW
  • ST Cortex = Superior Temporal; MPH improved omissions more than commission (helped inattention more than impulsivity) MPH: normalized frontostriatal, frontocerebellar, and cerebellow striatal connections- did not normalize cerebello-parietal; changes – also it activated ventromedial frontal cortex including the anterior cingulate and head of the caudatae – MPH had no significant effects on omission and comission errors in kids with ADHD. = small study though – also the kids tested were older (10-15 yo) and medication naive
  • The default network is an interconnected and anatomically defined brain system that preferentially activates when individuals focus on internal tasks – medial temporal lobe, medial prefrontal, posterior cingulate, precuneus, medial, lateral, and inferior parietal cortex
  • Individual Factors: IQ, Developmental Variation
  • Latent inhibition

Neurobiology of Learning Disorders Presentation Transcript

  • 1. A Critical Review of the Neurobiology and Co-Morbidity of Learning Disorders Fernette Eide M.D. and Brock Eide M.D. M.A. Edmonds, Washington
  • 2. Books, Intellectual Property: The Mislabeled Childand The Dyslexic AdvantageProfessional Advisory Board: SENG, Supportingthe Emotional Needs of Gifted
  • 3. • Prevalence of Learning Disabilities 5-20% U.S. Children• Prevalence of ADHD is 10% of U.S. Children Shaywitz, 1998; CDC Vital and Health Statistics Dec 2010, 10:247; Larson et al., 2011.
  • 4. NINDS: Learning disabilities are disorders that affect theability to understand or use spoken or written language,do mathematical calculations, coordinate movements,or direct attentionAACAP: Learning Disorders occur when the child oradolescents reading, math, or writing skills aresubstantially below that expected for age, schooling,and level of intelligence.IDEA 2004 : “…Must not require the use of a severediscrepancy between intellectual ability andachievement for determining whether a child has aspecific learning disability…”
  • 5. 46% of children with ADHD have a learning disabilityLarson, et al., Pediatrics, 2011
  • 6. • Higher rates of depression and anxiety among children and adolescents with LD • LD & Anxiety – 9-20% of students with LD • LD and Depression – 13% of 7 year olds, 7% of 10 year olds • In Los Angeles Suicide Prevention Center Study, 50% suicides of children younger than 15 years had LDCasey et al, Dev Beh Paed 1992; Sideris, Int Rev Res MR 2006; Maughan et al,J Abnl Child Psych, 2003; Peck, Youth Suicide 1985; Emerson, 2003
  • 7. Previous LD 28% 53% of outpatient No LDpsychiatry clinic have 47% Learning Disabilities (n=399) Unrecognized LD 25%Sundheim and Voeller, 2004 - Colorado
  • 8. Reading Disability 5-17.5% Math Disability 5-8% Writing Disability 5-20% U.S. Department of Education: 2.8 million children with specific LD 21-23% Adult U.S. can read a little, but not enough to fill out an application or read a food labelShaywitz, 1998; Geary, 2004; Tomblin et al., 1997 ; Mayes and Calhoun, 2006;Smits and Engelman, 1997; ASHA, 2008
  • 9. • Genetics of Learning Disabilities and ADHD• Neuropsychological Overlaps - LD & ADHD• Neurobiological Bases of Reading, Math, Writing Disorders, and ADHD• Unresolved Issues and Individual Factors Influencing Phenotype
  • 10. RD, MD, ADHD are highly Probandwise Concordance heritable MZ DZ But - molecular genetics RD 66% 35% (candidate genes, DNA polymorphisms) suggest RD, ADHD 68% 24% MD, and ADHD are affected by multiple genes with small 40% 24% MD effect sizesWillcutt et al., J Dev Behav Pediatr 2010
  • 11. 90 90 34 6 60 60 23 4Scores 30 30 11 2 0 0 0 0 Phonemic Deletion Orthographic Coding Stroop Color Verbal Working Memory (word sounds) (spelling) Willcutt, Dev Neuropsych 2005
  • 12. 12 12 18 20 14 15 8 8 11Scores 10 7 4 4 5 4 0 0 0 0 WISC Coding WISC Symbol Search Wisconsin Card Sort Test CPT Commission Willcutt, Dev Neuropsych 2005
  • 13. Phonology - sounds within wordsOrthography - spelling or word appearanceSemantics - word meaning Dehaene, 2009; Berl et al., 2010Articulatory loop - saying words to remember
  • 14. ConLeft Temporo-parietal CortexLeft Inferior Frontal Gyrus DysRight Fronto-temporal Reading Rhyming LettersAnterior Cingulate Temple et al, PNAS 2003
  • 15. Phoneme Working Memory Control Control Dyslexia Dyslexia Decreased Processing of Decreased Activation in Dyslexia Rapid Sounds in Dyslexia Good Readers Poor ReadersReading, Listening (especially over backgroundnoise), Note-taking, Foreign languageGaab et al., 2007; Beneventi et al., 2010; Auditory Brainstem ResponsesChandrasekaran et al., 2009 Poorer Speech in Noise with Dyslexia
  • 16. Con Control Dyslexia Dyslexia Decreased Response to Motion With Dyslexia Slower Visual Blink in Dyslexics DyslexiaSpacing Dyslexics need larger font Size and increased s p a c i n g Control Letter size Eden et al, 1996; Hari and Renvall, 2001; Martelli et a., 2009; Zorzi et al, 2012
  • 17. Dyslexia – Slower response times, Less ‘Automatic’ Learning Dyslexia ControlDyslexia – less Supplementary Motor Cortex – S1-2; more Cb S4-5 Writing, Working Memory Overload Robertson, 2007; Meghini et al., 2006
  • 18. Development of Number Sense and Number Line Aster and Shalev, 2007; Dehaene et al., 2004
  • 19. Butterworth, 2011
  • 20. 9 B IPS, prefrontal, Controls > Dyscalculia + 5 superior parietalDyscalculics have Lower R IPS ___Lower Performance Number Perception Number Quantity, Spatial Working Memory Problem Representation, Math Facts Retrieval Price et al., 2007; Ashkenazi et al., 2012
  • 21. Incorrect vs. Correct High Math IncorrectDLPFC Low Math Incorrect fMRIPoor Math Subjects Show Weaker Response When Incorrect Ansari et al., Learning Indiv Diff 2011
  • 22. “Neglect of written expression is a shortcoming in researchon learning disabilities.” - Mayes et al. Penn State • 50% of children in a university-based psychiatric clinic had dysgraphia or writing disability (ADHD, ODD, autism, anxiety, depression; n = 905) • WIAT-II / III more sensitive than WJ • Writing is complex - phonology, word meaning and retrieval, spelling, sentence organization, handwriting, executive function - planning sequencing, prioritizing, working memory, sustained attention, self-monitoring Mayes et al Percept Motor 2005
  • 23. Poor Writers More Visual MonitoringIrregularly formed letters,Erratic spacing, pseudochorea Richards et al., 2011
  • 24. “I am, myself, a very poor visualizer and find that I can seldom call to mindeven a single letter of the alphabet in purely retinal terms. I must trace theletter by running my mental eye over its contour in order that the image of itshall leave any distinctness at all. ” - William James Spelling Spelling requires more left hemispheric Activation than reading Under-recognized as a specific learning disability Often in the context of dyslexia / ‘stealth dyslexia’ Reading Handwriting and spelling errors found in 89% of suicide notes by adolescents Overlap Purcell et al Neuroimage, 2011 McBride and Siegel, J LD 1997
  • 25. Complex Differences in Brain fMRI Activation Dyslexics vs. Controls on Spelling Tasks Multiple Different Brain Regions Orthographic task - 20 areas in controls, 11 in dyslexics; 6 areas in dyslexics not in controls Orthographic: bead – feal Morphological: build - builder Richards et al., J Neurolinguistics 2006; J Writing Res 2009
  • 26. • Learning Problems associated with ADD and ADHD recognized under IDEA in 1991 (OSER Joint Policy Memo)
  • 27. “Clearly a single abnormality of any one region does not cause ADHD. ” Selective Attention, Motivation / Novelty /Reward, Executive Function, Behavioral Inhibition, Working Memory, Attention Shifting Bush, Neuropharmacology 2010
  • 28. ADHD – Weaker Fronto-Striato-Parieto-Cerebellar Activation Rubia et al Neuropharm 2009
  • 29. Money Reward CPT ADHD Higher Activation with Reward; partially Normalized with Methyphenidate MPH Helped Omissions More than CommissionsLuman et al J Abn Child Psych 2012; Rubia et al Neuropharm 2009
  • 30. ADHD Off Meds - Low Incentive: Lowerdeactivation Default NetworkADHD Off Meds - High Incentive:Increases deactivation Default NetworkADHD On Meds: Low Incentive:Deactivation like ControlADHD On Meds: High Incentive:No ChangeControls Deactivate Default Networkfor Inhibitory Control Task + IncentiveLiddle et al J Child Psych Psychiat 2011
  • 31. Core Features of RD, MD, WD, ADHD•Broad vs. Narrow, Disease vs. Trait, Assessmentsand Screening, Medical vs Educational DefinitionsEffect of Individual Factors Such as IQ orDevelopmental Variation on Phenotype•Neurodiversity –Strengths as Well as Weaknesses
  • 32. “It is more important to know what sort of person has adisease than to know what sort of disease a person has.” - Hippocrates• Developmental and IQ Effects on ADHD and Dyslexia• Strengths Associated with ADHD and Dyslexia
  • 33. Average IQHigh IQSuperior IQ Superior IQ Late Bloom Prefrontal CxAge Shaw et al. Nature 2006
  • 34. Gifted ‘Overexcitabilities’ DSM IV ADHD• Active and energetic • Often ‘on the go• Love of movement • Runs about, climbs• Rapid speech • Talks excessively• Intense physical activity • Fidgets, squirms• Need for action • Often leaves seat• Heightened play of imagination • Difficulty playing quietly• Elaborate dreams • Distractible, forgetful, careless mistakes (daydreaming in DSM-III) Ackerman, Roeper Review 1997
  • 35. Diffuse Attention Associated with Higher Creativity Among High IQ Harvard Study Latent Inhibition Carson et al J Personality Soc Psych 2003
  • 36. 80 CPT6040 High IQ Can Compensate for20 Omission and Commission Errors on CPT0 Vis O Vis Com Aud O Aud ComPark et al. Psychiatr Invest 2011 (n=266, p’s: 0.013, 0.009, < 0.001, 0.001)
  • 37. High IQ Does Not Fully Compensate for Working Memory in ADHD 74% of High IQ-ADHD children had at least 1 S.D. Discrepancy Between VCI/PRI and Working Memory Index 40% had 2 S.D. DiscrepancyWISC III/IV Composite IQ Scores Brown et al. Open J Psych 2011 (n=117)
  • 38. High IQ Does Not Fully Compensate for Processing Speed in ADHD 80% of High IQ-ADHD children had at least 1 S.D. Discrepancy Between VCI/PRI and Working Memory Index 42% had 2 S.D. DiscrepancyWISC III/IV Composite IQ Scores Brown et al. Open J Psych 2011 (n=117)
  • 39. High IQ students with ADHD don’tshow developmental lag of lowIQ students with ADHD Control High IQ ADHD High IQ ADHD Low IQ show developmental lag (not shown)
  • 40. High IQ Does Not FullyCompensate for WorkingMemoryHigh IQ Does Not FullyCompensate forProcessing SpeedHigh VCI and PRI can exist (n = 50; Eide et al., in prep)
  • 41. High IQ May Compensate for Some, Not All Language TasksProblem with defining dyslexiaby reading comprehension:working memory, processingspeed, and non-contextualreading may be inaccurate (n = 50; Eide et al., in prep)
  • 42. High IQ Does NotCompensate for Writing (n = 50; Eide et al., in prep)
  • 43. 10 yo SBLM 172 11yo VIQ 13716 yo SBLM 150
  • 44. Weaker: Visual Search, Visual Sequencing, Central Attention Stronger: Spatial Contextual Learning, Peripheral Attention, 3D Maze 3,500 2,625 Dyslexia 1,750 Control 875 0 Response Time (msec) Shorter Response Times with Dyslexia No Significant Difference in AccuracySchneps et al., 2007; Attree et al., 2009; Karolyi et al., 2003
  • 45. Problems SolvedConnect dots with 4 lines not lifting pen.Make B from A only moving 3 circles Everatt et al, Dyslexia1999
  • 46. Dyslexics OutperformControls on Divergent Thinking Tasks Everatt et al, Dyslexia1999
  • 47. Mother: “I asked my 11 year old Dyslexic son, ‘What do youthink of when I say the word "cat?“’ After about 5SECONDS I said, ‘I think of a fuzzy kitten.’ Eventually he said,‘Well, first I wondered are you talking about someonenamed Cat or are you talking about a tiger or a lion, ormaybe you mean a mama cat with her kittens or maybe acute little kitty, or maybe you mean a cat walk up in thesky.’ This is what he thought of in the 5 seconds while Ithought of a fuzzy kitten before I interrupted his train ofthought. Now imagine what these people are capable ofthinking about. They arent slow, they are just thinking of somany things while we with our simple minds are thinking ofone simple thing.”
  • 48. Verb Generation - Control vs Dyslexic Specific Activation Different Networks Activated for Specific Tasks Dyslexia-Specific: parahippocampal gyrus, fusiform, lingual gyrus ? context word retrieval, imageryGenerate a Verb Associated with a NounExample: Boat...Sailing Baillieux et al., 2009
  • 49. Fernette Eide M.D. and Brock Eide M.D. M.A. Edmonds, Washington Please complete your evaluation forms. Thank you!