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Specific Learning Difficulties in Adulthood Transition into employment Professor Amanda Kirby


How do you support anyone?

Challenges

Skills

outcome Setting

Past experiences


ICF-CY (WHO)


The truth


SPECIFIC LEARNING DIFFICULTIES ARE NOT IN NEAT BOXES….


Dyslexia

DCD ADHD

dyscalculia anxiety

ASD SLI


Dyslexia

DCD ADHD

dyscalculia anxiety

ASD SLI

“multidisciplinary teams tend to work in parallel rather than as a team when working with clients ” (McGonnell et al, 2009).


Dyslexia

DCD ADHD

dyscalculia anxiety

ASD SLI


12


DCD Only

3% 12%

DCD + Dyslexia

19%

8%

DCD + Dyslexia + ADHD

27%

9% 3%

19%

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

2 or more

td 1 motor diff reading diff 0

5

10

15

20

25

30

35

40


DCD and Dyslexia 16

Dyslexia

14

12

10

Poor readers

8

6

4

Controls 2

0 M-ABC

Man Dex

Norway Iversen,et al, Dyslexia,2005.

Ball

Balance


DCD+ ADHD

Kirby and Salmon,2007


ADHD + Dyslexia

3-6%

25% 40%

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

The Dyscovery Centre copyright 2011 Amanda Kirby


Prefrontal cortex

The Dyscovery Centre copyright 2011 Amanda Kirby


1.Self activation/Initiation

• Getting going.. (Especially the boring stuff) • Procrastination • Poor time estimation The Dyscovery Centre copyright 2011 Amanda Kirby


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 The Dyscovery Centre copyright 2011 Amanda Kirby


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

The Dyscovery Centre copyright 2011 Amanda Kirby


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

The Dyscovery Centre copyright 2011 Amanda Kirby


6. Hindsight and foresight • Learning from past experiences

The Dyscovery Centre copyright 2011 Amanda Kirby


7.Time concepts • Time blindness • Time passing • Remembering to do the diary • Allocating time • Moving on

The Dyscovery Centre copyright 2011 Amanda Kirby


EF has developmental stages Building Blocks (Diamond et al,2007)

Inhibitory control

Selective attention

Working Memory

Age years The Dyscovery Centre copyright 2011 Amanda Kirby

Planning


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 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 sample Chi squared cross-tabulation / analysis of variance to compare diagnosis groups


Executive Functioning skills deficits in students in higher education Participants:

ď ś353 students completed the survey


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 The Dyscovery Centre copyright 2011 Amanda Kirby


80

70

DCD 60

DCD/Dys 50

Dyslexia

% 40

30

No diag/diff 20

No diagnosis 10

0

Planning

Organisation

Impulse Control Working Memory Metacognition

Time Management


Results Using study tools Significant differences between TD and SpLD groups ( P= < 0.01) 90 80

70 60 50 SPLD % 40

TD %

30 20 10 0 never have study partner

Never use End Note/Ref manager

Don't use past papers for revision

The Dyscovery Centre copyright 2011 Amanda Kirby


What are specific learning difficulties?


Dyslexia 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.


Symptoms and signs 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.


ASD • 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, Asperger Syndrome 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


Symptoms and signs • 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.


Specific Language Impairment â&#x20AC;˘ SLIs affect an individualâ&#x20AC;&#x2122;s ability to learn and use language. The condition affects receptive and expressive language.


Symptoms and signs • 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.


Dyscalculia â&#x20AC;˘ Dyscalculia is a condition that affects an individualâ&#x20AC;&#x2122;s ability to understand and acquire mathematical skills. Individuals may also present with difficulties organising and planning.


Symptoms and signs â&#x20AC;˘ Individuals with Dyscalculia may present with difficulties managing money, telling the time and taking measurements. These difficulties may impact on an individualâ&#x20AC;&#x2122;s organisation and planning abilities


DCD/Dyspraxia â&#x20AC;˘ 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


Symptoms and signs â&#x20AC;˘ 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.


ADHD • 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


Symptoms and signs â&#x20AC;˘ 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). â&#x20AC;˘ 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. â&#x20AC;˘ 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.


BUT


We are like......... • boxes – they are easier to understand • ... Not … Got ‘it’ or ‘not’


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


Task

Individual

Environment

Individual

Knowledge of causation of learning difficulties

Overlap with other learning difficulties

Increased stress


Task

Individual

Environment

Task demands increase

More organisation

Technology

Literacy demands


Changes interact with one another


First .....genetics


Varying expression


Different genes have differing roles 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).


BUT environment has an effect on genes


Gene â&#x20AC;&#x201C; environment interaction


Conception

Early years

Ref: Giedd


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


ca re

ne at ly wr ite fa re st ad wr f in c it i o d ng py wa in y g ro do u wn ot nd he bu rs av ild oi re in d ad gs ho i ng bb wr ie s itin go g od le is co ur -o e rd tim av e oi al d on te e am sp or sp ts or to n av ow o m n i d on clu ey bb m in an g ag em en t

wr ite

se lf

Study of 16-25 year olds with DCD in FE and HE

90

80

70

60

50 TD %

40 DCD %

30

20

10

0


Favourite Leisure Choices Leisure choices 80 70 60 50 % of students 40 choosing 30 20 10 0

Movement difficulties TDA

Bar

Reading Films/TV Club** *

Sport*** Other**

Approaching significance at 0.06 level ** Significant at 0.05 level *** Significant at 0.01 level


G et t in or g u p g pa anis bed ck i in ng b g a fo sui g ld t in ca s g clo e or pe ga t rfo nis h es rm e in roo pl g 2 m an t ni h in ge ng gs lo tti ng fol ss ah re low of a e a a d in d g tten y to ins ti pl le an ar ra tru on av ni c ng ng in co e th tion g s to m e d o roo ple ho so m a tin u se g m t et nd w ask hi or ng ork s g a pl an t a a re a i as s or s n ga nin ed et ti to ni g se s o me le is d c fo u re ia l ra ac ise cla tiv ss itie /m s ee t in g

EF

80

70

60

50

40

30

20

10

0 TD %

DCD %


They may present as:


Implications for assessment and support


Home

Uni/college/work

Dress code

Career choices

Social interaction

Interview Work experience

Self care Rules of the workplace Self organisation

Fitness levels

Specific language difficulties EF difficulties related to workplanning


Approaches â&#x20AC;˘ Perfect- full assessment on all students to assess individual needs â&#x20AC;˘ Good enough- screen and guide all, give focussed support to some- triage


Support • Avoid e.g. use computer, change job • Adapt- extra time, use templates for report • Practice.. Necessary skill


http://www.readwritethink.org/files/resources/inter actives/essaymap/


www.ghotit.com Š The Dyscovery Centre 2007


Mind mapping -www.ikon.com


KIDSPIRATION


Coloured overlays


Speech-to-text Dragondictate 11

Text-to-speech e.g. readplease.com http://www.expressivo.com/say/WkLFzDXR

Classroom computer strategies

Changing colour background

Readability statistics


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


Adults presenting for literacy support

• History of difficulties in school • History of ‘failing’ or being failed’ • Have ‘life histories’ that need listening to


Unpack areas of difficulty â&#x20AC;˘ Focus on the correct parts â&#x20AC;˘ Most adults will present with a pattern of strengths and difficulties


Key issues prior to the job


â&#x20AC;˘ 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.


Challenges â&#x20AC;˘ Project management Administration Auto Cad Technical drawing/office space planning Health & safety Contract management (tendering) Manage 12 staff â&#x20AC;˘ 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.


Fears for some • 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


For some a pattern of starting lots of new jobsâ&#x20AC;Ś.and fatigue â&#x20AC;˘ 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 breakdown 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.


Work associated difficulties â&#x20AC;˘ 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. â&#x20AC;˘ 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.


Interview stage challenges â&#x20AC;˘ Doing assessment tests as i have very weak recall of information. Particularly under pressure. â&#x20AC;˘ 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. â&#x20AC;˘ 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.


Key issues prior to starting a job • 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 starting and staying in the 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


What does a 50 year old with DCD do to help: • 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.


Challenges in the job 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 â&#x20AC;˘ In last job, going to court. Dealing with the court 'bundle'. Finding pages quickly that were being referred to by judge. defence etc. â&#x20AC;˘ Taking verbal instructions is difficult as i cannot remember all of them


Adaptations • 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


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


Conclusions • • • • •

Clarity Communication Compassion Coping with change Continuum


• Practice what you need to • Adapt what you can( scaffold) • Avoid what you cannot


Amanda.kirby@newport.ac.uk


Further guidance • www.dyscovery.org • www.spldtransitions.co.uk • www.boxoifideas.org- information, organisations and strategies • http://www.learnerprofiler.co.uk/ws/webinarresources.aspx - free software

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