1

Reading for Educational Studies Topic 11, Teaching students with Special Educational Needs

Autism Spectrum Disorder

Diagnostic Criteria

A. Persistent deficits in social communication and social interaction across multiple contexts, as manifested
by the following, currently or by history (examples are illustrative, not exhaustive, see text):

1. Deficits in social-emotional reciprocity, ranging, for example, from abnormal social approach
and failure of normal back-and-forth conversation; to reduced sharing of interests, emotions, or
affect; to failure to initiate or respond to social interactions.

2. Deficits in nonverbal communicative behaviors used for social interaction, ranging, for
example, from poorly integrated verbal and nonverbal communication; to abnormalities in eye
contact and body language or deficits in understanding and use of gestures; to a total lack of facial
expressions and nonverbal communication.

3. Deficits in developing, maintaining, and understanding relationships, ranging, for example,

from difficulties adjusting behavior to suit various social contexts; to difficulties in sharing
imaginative play or in making friends; to absence of interest in peers.

B. Restricted, repetitive patterns of behavior, interests, or activities, as manifested by at least two of the
following, currently or by history (examples are illustrative, not exhaustive; see text):

1. Stereotyped or repetitive motor movements, use of objects, or speech (e.g., simple motor
stereotype, lining up toys or flipping objects, echolalia, idiosyncratic phrases).

2. Insistence on sameness, inflexible adherence to routines, or ritualized patterns or verbal

nonverbal behavior (e.g., extreme distress at small changes, difficulties with transitions, rigid
thinking patterns, greeting rituals, need to take same route or eat food every day).

3. Highly restricted, fixated interests that are abnormal in intensity or focus (e.g, strong
attachment to or preoccupation with unusual objects, excessively circumscribed or preservative
interest).

4. Hyper- or hyporeactivity to sensory input or unusual interests in sensory aspects of the

environment (e.g., apparent indifference to pain/temperature, adverse response to specific sounds
or textures, excessive smelling or touching of objects, visual fascination with lights or movement).

C. Symptoms must be present in the early developmental period (but may not become fully manifest until
social demands exceed limited capacities, or may be masked by learned strategies in later life).

D. Symptoms cause clinically significant impairment in social, occupational, or other important areas of
current functioning.
 2

E. These disturbances are not better explained by intellectual disability (intellectual developmental
disorder) or global developmental delay. Intellectual disability and autism spectrum disorder frequently co-
occur; to make comorbid diagnoses of autism spectrum disorder and intellectual disability, social
communication should be below that expected for general developmental level.

Note: Individuals with a well-established DSM-IV diagnosis of autistic disorder, Asperger’s disorder, or
pervasive developmental disorder not otherwise specified should be given the diagnosis of autism spectrum
disorder. Individuals who have marked deficits in social communication, but whose symptoms do not
otherwise meet criteria for autism spectrum disorder, should be evaluated for social (pragmatic)
communication disorder.

Severity levels for autism spectrum disorder

Severity level Social communication Restricted, repetitive behaviors

Level 3 Severe deficits in verbal and nonverbal Inflexibility of behavior, extreme

"Requiring very substantial social communication skills cause difficulty coping with change, or other
support” severe impairments in functioning, restricted/repetitive behaviors
very limited initiation of social markedly interfere with functioning in
interactions, and minimal response to all spheres. Great distress/difficulty
social overtures from others. For changing focus or action.
example, a person with few words of
intelligible speech who rarely initiates
interaction and, when he or she does,
makes unusual approaches to meet
needs only and responds to only very
direct social approaches
Level 2 Marked deficits in verbal and Inflexibility of behavior, difficulty
"Requiring substantial nonverbal social communication skills; coping with change, or other
support” social impairments apparent even restricted/repetitive behaviors appear
with supports in place; limited frequently enough to be obvious to
initiation of social interactions; and the casual observer and interfere with
reduced or abnormal responses to functioning in a variety of contexts.
social overtures from others. For Distress and/or difficulty changing
example, a person who speaks simple focus or action.
sentences, whose interaction is
limited to narrow special interests,
and how has markedly odd nonverbal
communication.
Level 1 Without supports in place, deficits in Inflexibility of behavior causes
"Requiring support” social communication cause significant interference with
noticeable impairments. Difficulty functioning in one or more contexts.
initiating social interactions, and clear Difficulty switching between activities.
 3

examples of atypical or unsuccessful Problems of organization and planning

response to social overtures of others. hamper independence.
May appear to have decreased
interest in social interactions. For
example, a person who is able to
speak in full sentences and engages in
communication but whose to- and-fro
conversation with others fails, and
whose attempts to make friends are
odd and typically unsuccessful.

Retrieved from http://www.autismspeaks.org/what-autism/diagnosis/dsm-5-diagnostic-criteria

_____________________________________________________________________________

Specific Learning Disorder

DSM-5 defines the term “Specific Learning Disorder” (commonly referred to as “LD” in the past) as "a
neurodevelopmental with a biological origin that is the basis for abnormalities at a cognitive level that are
associated with the behavioral signs of the disorder". This is the most recently used term for children who
suffer significant difficulties an acquiring basic academic skills. This is the less technical term for what was
previously termed as “Academic Skills Disorders” or dyslexia (defined in DSM-5 as one of the most common
specific learning disorders and comprising of difficulties learning to map letters with the sounds of one's
language - to read printed words), dyscalculia, dysgraphia, etc. The actual term for a particular learning
disorder consists of the area of academic difficulty. DSM-5 requires persisting learning keystone academic
skills (Criteria A) with onset during years of formal schooling.

Key Academic Skills:

Reading of single words accurately and fluently

Reading comprehension
Written expression and spelling
Arithmetic calculation
Mathematical Reasoning

DSM-5 defines "persistence" in children and adolescents as "restricted progress in learning (i.e. no evidence
the individual is catching up with classmates)."

DSM-5 further requires that the learning difficulties "manifest as a range of observable description behaviors
or symptoms (Criterion A1-A6). At least one symptom must persist for a period of 6 months despite
interventions targeting the symptom. A synopsis of the qualifying symptoms is presented below:
 4

1. Inaccurate or slow and effortful word reading, frequently guesses words, or has difficulties sounding out
words.
2. Difficulty understanding what is read.
3. Difficulties with spelling.
4. Difficulties with written expression (such as multiple grammatical and punctuation errors, poor paragraph
organization, written expression lacks clarity).
5. Difficulties mastering number sense, number facts or calculations.
6. Difficulties with mathematical reasoning.

A second key feature and requirement in DSM-5 Diagnosis of Specific Learning Disorder is that the individuals
performance of the specific academic skill be "well below average for age" (Criterion B), but it goes on to state
that average performance sustainable only through "extraordinarily high levels of support" may also be
evidence of Specific Learning Disorder. These deficits interfere with academic performance on measures such
as grades and tests. Avoidance of subject areas or school may be seen. It is noted "However, this criteria also
requires psychometric evidence from an individually administered, psychometrically sound, and culturally
appropriate test of academic achievement that is norm-referenced or criterion-referenced".

While DSM-5 describes a necessity that skills be well below average, it notes academic skills lie on a
continuum "so there is no natural cutpoint that can be used to differentiate people with and without specific
learning disorder". A criterion of -1.5 S.D. below age norms or a Standard Score of 78 is identified as providing
the greatest diagnostic certainty, but DSM-5 indicates clinical judgment may be used to identify specific
learning disabilities in the range of -1.0 to -2.5 S.D. below the mean for age when there is other converging
evidence from clinical assessment, academic history or school reports, or test scores.

The third criterion (Criterion C) specifies that the learning disabilities are "readily apparent" in the early
grades, but at the same time notes that they may not appear until later grades in some individuals due to
increased learning demands.

Specific Learning disabilities generally preclude academic deficits that are attributable to intellectual
disabilities.; global developmental delay, hearing or vision disorders, or neurological or motor disorders. DSM-
5 notes specific learning disorders are diagnosed in individuals with "normal" levels of intellectual functioning
defined as approximately and IQ score of 70 +/- 5. There is discussion of learning disability in "gifted"
individuals, but no specific alternate criteria are described.

DSM-5 notes that if an intellectual, sensory, motor or neurological disorder is suspected, then assessment
should include "methods appropriate for these disorders".

Classification Terms have changed, with Specific Learning Disorders being specified by the primary area of
difficulty:

Specific Learning Disorder

 with impairment in reading

 with impairment in written expression (includes problems with spelling accuracy)
 5

 with impairment in mathematics

Furthermore, disorders are specified by severity:

Mild: Some difficulty in one or two academic domains, but mild enough that the individual may be able
compensate or function well when provided appropriate accommodations or support services.

Moderate: "Marked" difficulties in one or more academic domains so that the individual is unlikely to become
proficient without intervals of specialized and intensive teaching during the school years. Some
accommodations for at least part of the day may be needed at school, home or work to complete activities
accurately and efficiently.

Severe: Severe difficulties in learning skills affecting several academic domains, so that the individual is
unlikely to learn those skills without ongoing individualized and specialized teaching for most of the school
years. Even with appropriate accommodations and/or services the individual may still not be able to complete
activities efficiently.

Mathematics Disorder and Written Expression difficulties usually co-exist with Reading Disorders, but
sometimes are diagnosed alone. DSM-5 estimates 5-15% of school age children will be diagnosed with a
learning disorder. Children who have early developmental difficulties with speech, such as not saying their
first words by 12-14 months or two-word sentences by approximately two years may be prone to reading
disorders. Children who suffer developmental coordination difficulties such as difficulties in eye-hand
coordination or learning to walk may also be at increased risk for these disorders.

Children with disruptive behavior disorders such as Conduct Disorder, Oppositional Defiant Disorder
or Attention-deficit Hyperactivity Disorder or may suffer from depressive disorders may also suffer from
specific learning disorders. Perinatal injuries, medical disorders, lead poisoning, fetal alcohol syndrome, and
chromosomal abnormalities have also been associated with learning disorders. The most common risk factor,
however, is heredity.

Reading disorders, which may effect 4% of school children may be diagnosed as early as Kindergarten but
often may not be diagnosed until formal reading instruction in first grade. Brighter children may not be
diagnosed until demands increase in fourth grade or later.

Disorder of Written Expression is more difficult to estimate. Difficulty in writing, handwriting, difficulty
remembering letter sequences of common words may appear as early as first grade but may not be diagnosed
until writing demands increase towards the end of the year. It usually is identifiable by second grade.

Mathematics disorder is less frequent than reading disorders, effecting approximately 1% of school children. It
is particularly important to rule out mathematics anxiety or attention difficulties since these can interfere with
accuracy of calculation skills and cognitive flexibility. It often may not be diagnosed until 3rd or 4th grade, or
sometimes later.
The impact of learning disorders on emotional adjustment and achievement has to be understood to
appreciate the seriousness of these academic difficulties. Deficits in social skills and self-esteem are not
 6

uncommon, and nearly 40% of children with LD may drop out before graduating high school and may go on to
have difficulties with employment.

Learning disorders are likely due to very subtle brain difficulties in processing visual and/or auditory material.
While the difficulties may be subtle and require special testing by a licensed psychologist, school psychologist
or sometimes a speech and language pathologist, these subtle difficulties can impact severely on writing and
on reading speed, accuracy, and comprehension.

Children with reading difficulties may have difficulty in the phonological or “sounding out” aspects of reading.
Children with combinations of both or multiple difficulties often exhibit the most severe reading difficulties.

Retrieved from http://cpancf.com/articles_files/learning_disorders.asp

_____________________________________________________________________________

Attention Deficit Hyperactivity Disorder

DSM-5 Criteria for ADHD

People with ADHD show a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes
with functioning or development:

1. Inattention: Six or more symptoms of inattention for children up to age 16, or five or more for
adolescents 17 and older and adults; symptoms of inattention have been present for at least 6 months,
and they are inappropriate for developmental level:
o Often fails to give close attention to details or makes careless mistakes in schoolwork, at work,
or with other activities.
o Often has trouble holding attention on tasks or play activities.
o Often does not seem to listen when spoken to directly.
o Often does not follow through on instructions and fails to finish schoolwork, chores, or duties in
the workplace (e.g., loses focus, side-tracked).
o Often has trouble organizing tasks and activities.
o Often avoids, dislikes, or is reluctant to do tasks that require mental effort over a long period of
time (such as schoolwork or homework).
o Often loses things necessary for tasks and activities (e.g. school materials, pencils, books, tools,
wallets, keys, paperwork, eyeglasses, mobile telephones).
o Is often easily distracted
o Is often forgetful in daily activities.

2. Hyperactivity and Impulsivity: Six or more symptoms of hyperactivity-impulsivity for children up to age
16, or five or more for adolescents 17 and older and adults; symptoms of hyperactivity-impulsivity
have been present for at least 6 months to an extent that is disruptive and inappropriate for the
person’s developmental level:
 7

o Often fidgets with or taps hands or feet, or squirms in seat.

o Often leaves seat in situations when remaining seated is expected.
o Often runs about or climbs in situations where it is not appropriate (adolescents or adults may
be limited to feeling restless).
o Often unable to play or take part in leisure activities quietly.
o Is often "on the go" acting as if "driven by a motor".
o Often talks excessively.
o Often blurts out an answer before a question has been completed.
o Often has trouble waiting his/her turn.
o Often interrupts or intrudes on others (e.g., butts into conversations or games)

In addition, the following conditions must be met:

 Several inattentive or hyperactive-impulsive symptoms were present before age 12 years.

 Several symptoms are present in two or more setting, (e.g., at home, school or work; with friends or
relatives; in other activities).
 There is clear evidence that the symptoms interfere with, or reduce the quality of, social, school, or
work functioning.
 The symptoms do not happen only during the course of schizophrenia or another psychotic disorder.
The symptoms are not better explained by another mental disorder (e.g. Mood Disorder, Anxiety
Disorder, Dissociative Disorder, or a Personality Disorder).

Based on the types of symptoms, three kinds (presentations) of ADHD can occur:

Combined Presentation: if enough symptoms of both criteria inattention and hyperactivity-impulsivity were
present for the past 6 months

Predominantly Inattentive Presentation: if enough symptoms of inattention, but not hyperactivity-

impulsivity, were present for the past six months

Predominantly Hyperactive-Impulsive Presentation: if enough symptoms of hyperactivity-impulsivity but

not inattention were present for the past six months.

Because symptoms can change over time, the presentation may change over time as well.

Retrieved from http://www.cdc.gov/ncbddd/adhd/diagnosis.html