Dyslexia is a learning disability that impairs reading fluency and comprehension accuracy. It is characterized by difficulties with phonological awareness, phonological decoding, orthographic coding, auditory short-term memory, or rapid naming. Dyslexia is not caused by poor vision, hearing, or instruction, but there may be genetic or early childhood hearing factors that contribute. Symptoms include delays in speech and word learning, difficulty with rhyming, and letter reversals. While there is no cure, early intervention and accommodations can help dyslexic individuals learn to read and write.
Somatoform disorders
A disorder in which people have physical illnesses or complaints that cannot be fully explained by actual medical conditions
Dissociative disorders
A personality disorder marked by a disturbance in the integration of identity, memory, or consciousness.
Historically, both somatoform and dissociative disorders used to be categorized as hysterical neurosis
in psychoanalytic theory neurotic disorders result from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms
"schizophrenia" "split mind" but it refers to a disruption of the usual balance of emotions and thinking.
Schizophrenia is chronic and a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior .
Clinical Assessment of Children and Adolescents with DepressionCarlo Carandang
“Clinical Assessment of Children and Adolescents with Depression,”
Halifax, Nova Scotia, Canada; October 1, 2008
Pediatric Grand Rounds, IWK Health Centre
*Although the core symptoms of depression are similar across the life span, developmental differences exist and should be taken into account in the assessment
*With increasing age, there generally is an increase in melancholic symptoms, delusions, substance abuse, and suicidal ideation/attempts.
*In contrast, younger children tend to have more somatic sxs, separation anxiety, behavior problems, temper tantrums, and hallucinations
*Direct interviews with children and adolescents are critical because parents and teachers may not be aware of the youth’s depressive symptoms
*Discrepant information between parents and their children should be solve in a cordial and non judgmental way
*Assessment of suicidal and homicidal ideation and behaviors is mandatory
*The interview process and screening questions utilized by research interviews such as the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (KSADS-PL) can be useful
*Detection and diagnosis can be enhanced by available parent and child self-report measures
Somatoform disorders
A disorder in which people have physical illnesses or complaints that cannot be fully explained by actual medical conditions
Dissociative disorders
A personality disorder marked by a disturbance in the integration of identity, memory, or consciousness.
Historically, both somatoform and dissociative disorders used to be categorized as hysterical neurosis
in psychoanalytic theory neurotic disorders result from underlying unconscious conflicts, anxiety that resulted from those conflicts and ego defense mechanisms
"schizophrenia" "split mind" but it refers to a disruption of the usual balance of emotions and thinking.
Schizophrenia is chronic and a severe brain disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior .
Clinical Assessment of Children and Adolescents with DepressionCarlo Carandang
“Clinical Assessment of Children and Adolescents with Depression,”
Halifax, Nova Scotia, Canada; October 1, 2008
Pediatric Grand Rounds, IWK Health Centre
*Although the core symptoms of depression are similar across the life span, developmental differences exist and should be taken into account in the assessment
*With increasing age, there generally is an increase in melancholic symptoms, delusions, substance abuse, and suicidal ideation/attempts.
*In contrast, younger children tend to have more somatic sxs, separation anxiety, behavior problems, temper tantrums, and hallucinations
*Direct interviews with children and adolescents are critical because parents and teachers may not be aware of the youth’s depressive symptoms
*Discrepant information between parents and their children should be solve in a cordial and non judgmental way
*Assessment of suicidal and homicidal ideation and behaviors is mandatory
*The interview process and screening questions utilized by research interviews such as the Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (KSADS-PL) can be useful
*Detection and diagnosis can be enhanced by available parent and child self-report measures
Presentation based on Class 12 Chapter-4 Psychological Disorders. This ppt explains the first four major psychological disorders: Anxiety, OCD, PTSD, Somatic Disorders. This is based of CBSE and NCERT.
If you want more kindly mail or comment.
This slide contains information regarding Dissociative Disorder. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Presentation based on Class 12 Chapter-4 Psychological Disorders. This ppt explains the first four major psychological disorders: Anxiety, OCD, PTSD, Somatic Disorders. This is based of CBSE and NCERT.
If you want more kindly mail or comment.
This slide contains information regarding Dissociative Disorder. This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated.
Lesson about abnormal psychology which help to understand who are suffering from psychological problems and guide us to understand other peoples behavior, attitude. some of the type of abnormal behavior are the DID, somatoform, hypochondriasis and understanding psychosomatic behavior.
Dissociative disorders (DD) are conditions that involve disruptions or breakdowns of memory, awareness, identity, or perception.
People with dissociative disorders use dissociation, a defence mechanism, pathologically and involuntarily. Dissociative disorders are thought to primarily be caused by psychological trauma.
INTRODUCTION
Dissociative Disorders are a group of conditions defined as psychological
disturbances that impact an individual’s ability to function and closely
overlap with psychotic disorders.
These include disturbances affecting:
Memory
Motor Control
Concept of Identity
Behaviours
Emotions
Perceptions
The symptoms of a dissociative disorder usually first develop as a
response to a traumatic event, such as abuse or military combat, to
keep those memories under control.
Stressful situations can worsen symptoms and cause problems with
functioning in everyday activities.
However, the symptoms a person experiences will depend on the
type of dissociative disorder that a person has.
TYPES OF DISSOCIATIVE DISORDER
DSM-5
Dissociative Identity Disorder (DID)
Dissociative Amnesia (Fugue)
Depersonalization/ Derealization Disorder
Other Specified Dissociative Disorder
Unspecified Dissociative Disorder
ICD-10
Dissociative Amnesia
Dissociative Fugue
Dissociative Stupor
Trance and Possession Disorders
Dissociative Motor Disorders
Dissociative Convulsions
Dissociative Anaesthesia and Sensory Loss
Mixed Dissociative (Conversion) Disorders
Other Dissociative (Conversion) Disorders:-
Ganser Syndrome
Multiple Personality
Psychogenic: Confusion and Twilight State
Dissociative (Conversion) Disorder
Dissociative Amnesia
Dissociative amnesia involves not being able to recall information about
oneself (not normal forgetting).
Dissociative amnesia is associated with having experiences of
childhood trauma, and particularly with experiences of emotional
abuse and emotional neglect.
The main symptom is memory loss that's more severe than normal
forgetfulness and that can't be explained by a medical condition.
Dissociative amnesia can be specific to events in a certain time, such
as intense combat, or more rarely, can involve complete loss of
memory about yourself.
This amnesia is usually related to a traumatic or stressful event and may be:
Localized: inability to remember all events occurring during a circumscribed
period of time.
Selective: inability to remember specific events occurring during a
circumscribed period of time.
Generalized: loss of memory encompasses everything, including one’s
identity.
Continuous: inability to recall events subsequent to a specific point in time
through the present.
Systematized: inability to recall memories related to a certain category of
information, e.g. memories related to an individual’s father.
Dissociative fugue (formerly called psychogenic fugue) is a psychological
state in which a person loses awareness of their identity or other important
autobiographical information and also engages in some form of unexpected
travel.
People who experience a dissociative fugue may suddenly find themselves
in a place, such as the beach or at work, with no memory of travelling
there.
The DSM-5 refers to dissociative fugue as a state of “bewildered
wandering.”
Dissociative Fugue
Formerly known as Mul
the presentation describes in detail about the mental illness, i.e. schizophrenia along with its diagnostic criteria, symptoms, prognosis, course as well as its causes.
ASSIGNMENT
HISTORY TAKING
ON
BIPOLAR DISSOCIATIVE DISORER CURRENT MANIC EPISODE
SUBMITTED TO:
Dept. of Mental Health (Psychiatric) Nursing
Institute of Nursing Education
INTRODUCTION
• DSM-IV-TR describes the essential features of dissociative disorders as a disruption in the usually integrated functions of consciousness, memory, identity, or perception (APA 2000).
• Dissociative responses occur when anxiety becomes overwhelming and the personality becomes disorganized.
• Defense mechanisms that normally govern consciousness, identity, and memory breakdown and behavior occur with little or no participation on the part of the conscious personality.
Dissociation:
The unconscious separation of painful feelings and emotions from an unacceptable idea, situation or object.
Dissociative Disorders:
Dissociative disorders are characterized by
Persistent
maladaptive disruptions in the integration of memory
Consciousness or identity—verge on the unbelievable.
• The person with a dissociative disorder may be unable to remember many details about the past; he or she may wander far from home and perhaps assume a new identity; or two or more personalities may coexist within the same person.
• Dissociative disorders once were viewed as expressions of hysteria.
• In Greek, Hystera means “uterus,” and the term hysteria reflects ancient speculation that these disorders were caused by frustrated sexual desires, particularly the desire to have a baby.
• According to the theory, the uterus becomes detached from its normal location and moves about in the body, causing a problem in the location where it eventually lodges.
• Variants of this somewhat sexist view continued throughout Western history, and as late as the nineteenth century many physicians erroneously believed that hysteria occurred only among women.
• New speculation about the etiology of hysteria emerged toward the end of the nineteenth century.
Symptoms of Dissociative Disorders:
• Like many ordinary cognitive processes, the extraordinary symptoms of dissociative disorders apparently involve mental processing that occurs outside of conscious awareness.
1) Extreme cases of dissociation include a split in the functioning of the individual’s entire sense of self.
2) Depersonalization is a less dramatic form of dissociation wherein people feel detached from themselves or their social or physical environment.
3) Another dramatic example of dissociation is amnesia—the partial or complete loss of recall for particular events or for a particular period of time.
4) Brain injury or disease can cause amnesia, but psychogenic (psychologically caused) amnesia results from traumatic stress or other emotional distress.
5) Psychogenic amnesia may occur alone or in conjunction with other dissociative experiences.
• It is widely accepted that fugue and psychogenic amnesia are usually precipitated by trauma, thus providing another link between dissociation and traumatic stress disorders.
6
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Francesca Gottschalk - How can education support child empowerment.pptxEduSkills OECD
Francesca Gottschalk from the OECD’s Centre for Educational Research and Innovation presents at the Ask an Expert Webinar: How can education support child empowerment?
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
Home assignment II on Spectroscopy 2024 Answers.pdf
Psychological disorders
1.
2.
3.
4. Dissociative identity disorder is a psychiatric
diagnosis and describes a condition in which a
person displays multiple distinct identities
(known as alters or parts), each with its own
pattern of perceiving and interacting with the
environment.
In the International Statistical Classification of
Diseases and Related Health Problems the name
for this diagnosis is multiple personality disorder.
In both systems of terminology, the diagnosis
requires that at least two personalities (one may
be the host) routinely take control of the
individual's behavior with an associated memory
loss that goes beyond normal forgetfulness; in
addition, symptoms cannot be the temporary
effects of drug use or a general medical condition.
5.
6. It has been theorized that severe sexual, physical, or
psychological trauma in childhood by a primary caregiver
predisposes an individual to the development of DID. The
steps in the development of a dissociative identity are
theorized to be as follows:
The child is harmed by a trusted caregiver (often a
parent or guardian) and splits off the awareness and
memory of the traumatic event to survive in the
relationship.
The memories and feelings go into the subconscious and
are experienced later in the form of a separate
personality.
The process happens repeatedly at different times so
that different personalities develop, containing different
memories and performing different functions that are
helpful or destructive. Sometimes this is done
deliberately, as in the case of the more morbid abusive
group practices of various sects, or torture variations.
Dissociation becomes a coping mechanism for the
individual when faced with further stressful situations.
7. Individuals diagnosed with DID demonstrate a variety of symptoms with wide
fluctuations across time; functioning can vary from severe impairment in daily
functioning to normal or high abilities. Symptoms can include:
Multiple mannerisms, attitudes and beliefs which are not similar to each other
Unexplainable headaches and other body pains
Distortion or loss of subjective time
Depersonalization
Derealization
Severe memory loss
Depression
Flashbacks of abuse/trauma
Sudden anger without a justified cause
Frequent panic/anxiety attacks
Unexplainable phobias
Auditory of the parts inside their mind
Patients may experience an extremely broad array of other symptoms such as
pseudo seizures that may appear to resemble epilepsy, schizophrenia, anxiety
disorders, mood disorders, post traumatic stress disorder, personality disorders, and
eating disorders.
8. The proposed diagnostic criteria for DID in the DSM-5 is:
Disruption of identity characterized by two or more distinct
personality states (one can be the host) or an experience of
possession, as evidenced by discontinuities in sense of self, cognition,
behavior, affect, perceptions, and/or memories. This disruption may
be observed by others, or reported by the patient.
Inability to recall important personal information, for everyday events
or traumatic events, that is inconsistent with ordinary forgetfulness.
Causes clinically significant distress and impairment in social,
occupational, or other important areas of functioning.
The disturbance is not a normal part of a broadly accepted cultural or
religious practice and is not due to the direct physiological effects of a
substance (e.g., blackouts or chaotic behavior during alcohol
intoxication) or a general medical condition (e.g., complex partial
seizures).
9. Treatment of DID may attempt to reconnect the identities of disparate alters
into a single functioning identity with all its memories and experiences intact
- functioning much like the normal brain. In addition or instead, treatment
may focus on symptoms, to relieve the distressing aspects of the condition
and ensure the safety of the individual. Treatment methods may include
psychotherapy and medications for comorbid disorders. Some behavior
therapists initially use behavioral treatments such as only responding to a
single identity, and using more traditional therapy once a consistent
response is established.[55] It has been stated that treatment
recommendations that follow from models that do not believe in the
traumatic origins of DID might be harmful due to the fact that they ignore
the posttraumatic symptomatology of people with DID.
10.
11. Schizophrenia is a mental disorder
characterized by a disintegration of thought
processes and of emotional responsiveness.It
most commonly manifests itself as auditory
hallucinations, paranoid or bizarre delusions,
or disorganized speech and thinking, and it is
accompanied by significant social or
occupational dysfunction. A person diagnosed
with schizophrenia may experience
hallucinations (most reported are hearing
voices), delusions (often bizarre or
persecutory in nature), and disorganized
thinking and speech. The latter may range
from loss of train of thought, to sentences
only loosely connected in meaning, to
incoherence known as word salad in severe
cases.
12. Schizophrenia was first described as a distinct syndrome
affecting teenagers and young adults by Bénédict Morel
in 1853, termed démence précoce (literally 'early
dementia'). The term dementia praecox was used in
1891 by Arnold Pick in a case report of a psychotic
disorder. The word schizophrenia—which translates
roughly as "splitting of the mind" and comes from the
Greek roots schizein, "to split") and phrēn, "mind")_term
was coined by Eugen Bleuler in 1908 and was intended
to describe the separation of function between
personality, thinking, memory, and perception. Bleuler
described the main symptoms as 4 A's: flattened Affect,
Autism, impaired Association of ideas and Ambivalence.
Bleuler realized that the illness was not a dementia, as
some of his patients improved rather than deteriorated,
and thus proposed the term schizophrenia instead.
13. Genetic
Estimates of heritability vary because of the difficulty in separating the
effects of genetics and the environment.
Environment
Environmental factors associated with the development of
schizophrenia include the living environment, drug use and prenatal
stressors. Parenting style seems to have no effect, although people
with supportive parents do better than those with critical parents.
Living in an urban environment during childhood or as an adult has
consistently been found to increase the risk of schizophrenia by a
factor of two, even after taking into account drug use, ethnic group,
and size of social group. Other factors that play an important role
include social isolation and immigration related to social adversity,
racial discrimination, family dysfunction, unemployment, and poor
housing conditions. There is evidence that childhood experiences of
abuse or trauma are risk factors for a diagnosis of schizophrenia later
in life.
Factors such as hypoxia and infection, or stress and malnutrition in
the mother during fetal development, may result in a slight increase in
the risk of schizophrenia later in life.
14. Social withdrawal, sloppiness of dress and
hygiene, and loss of motivation and
judgment are all common in
schizophrenia. There is often an
observable pattern of emotional
difficulty, for example lack of
responsiveness. Impairment in social
cognition is associated with
schizophrenia, as are symptoms of
paranoia; social isolation commonly
occurs. In one uncommon subtype, the
person may be largely mute, remain
motionless in bizarre postures, or exhibit
purposeless agitation, are all signs of
schizophrenia.
15.
16. The first-line
psychiatric treatment
for schizophrenia is
antipsychotic
medication,[ which can
reduce the positive
symptoms of
psychosis in about 7–
14 days. Like :
Zyprexa.
Risperdal Tablets
17. A number of psychosocial
interventions have been useful in
the treatment of schizophrenia
including: family therapy, assertive
community treatment, supported
employment, cognitive
remediation, skills training,
cognitive behavioral therapy (CBT),
token economic interventions, and
psychosocial interventions for
substance use and weight
management.
18.
19. Dyslexia is a broad term defining a learning
disability that impairs a person's fluency or
comprehension accuracy in being able to read,
and which can manifest itself as a difficulty with
phonological awareness, phonological decoding,
orthographic coding, auditory short-term
memory, or rapid naming. Dyslexia is separate
and distinct from reading difficulties resulting
from other causes, such as a non-neurological
deficiency with vision or hearing, or from poor or
inadequate reading instruction. It is difficult to
obtain a certain diagnosis of dyslexia before a
child begins school, but many dyslexic individuals
have a history of difficulties that began well
before kindergarten. Children who exhibit these
symptoms early in life have a higher likelihood of
being diagnosed as dyslexic than other children.
20. •· Identified by Oswald Berkhan in 1881, the
term 'dyslexia' was later coined in 1887 by Rudolf
Berlin, an ophthalmologist practising in Stuttgart,
Germany, from the Greek prefix (dus-), "hard,
bad, difficult“ (lexis), "speech, word".
In 1896, W. Pringle Morgan published a
description of a reading-specific learning
disorder in the British Medical Journal titled
"Congenital Word Blindness’’.
21. Inherited factors
It is clear that dyslexia is very frequently found in families, and
is often accompanied by left-handedness somewhere in the
family. This does not mean to say that a dyslexic parent will
automatically have a dyslexic child, or that a left-handed child
will necessarily be dyslexic. But where dyslexia is identified,
between a third and a half of children have a history of learning
difficulties in their family, and more than half have a family
member who is left-handed.
Hearing problems at an early age.
If a child suffers frequent colds and throat
infections in the first five years, the ears can
be blocked from time to time so that hearing
is impaired. The parents can easily be
unaware of this until a doctor actually looks
into the child's ear. This condition is
sometimes known as 'glue ear' or 'conductive
hearing loss'. If the difficulty is not noticed at
an early stage, then the developing brain
does not make the links between the sounds
it hears
22. symptoms include:
•delays in speech
•slow learning of new words
•difficulty in rhyming words, as
in nursery rhymes
•low letter knowledge
•letter reversal or mirror writing
for example, "Я" instead of "R")
23. There is no cure for dyslexia, but dyslexic individuals can learn to read
and write with appropriate educational support. Early intervention is
very helpful.
Especially for undergraduates, some consideration of what 'reading' is and what it is
for can be useful. There are techniques (reading the first sentence [and/or last] of each
paragraph in a chapter, for example) which can give an overview of content. This can
be sufficient for some purposes .Since stress and anxiety are contributors to a
dyslexic's weaknesses in absorbing information, removing these can assist in
improving understanding. When a dyslexic knows that not every reading experience
must be onerous, it greatly helps their mental approach to the task.
For dyslexia intervention with alphabet writing systems the fundamental aim is to
increase a child's awareness of correspondences between graphemes and phonemes,
and to relate these to reading and spelling. It has been found that training focused
towards visual language and orthographic issues yields longer-lasting gains than
mere oral phonological training.[63]