Issues in Learning
Many situations can reduce a person's ability to learn. Red Ladder Optimized Learning approaches suspected learning difficulties first by working to find out how a person learns and identifying specific areas of strength and difficulty. Learning disorders and disabilities, behavioural, emotional, and stress-related difficulties can all affect learning.
We provide psychological and psycho-educational assessment for investigation of many difficulties, including the ones listed below. A person can have more than one learning or behavioural difficulty at the same time. For example, many people with a specific learning disability are also diagnosed with ADHD.
Evaluation of learning problems needs to be conducted properly, and the information that follows is not a substitute for evaluation. If you have questions about whether you, your child, or someone else is struggling with a learning difficulty, consider contacting Red Ladder Optimized Learning or another psychologist to find out more.
For more information, click on any of the following links:
Developmental Dyslexia
Specific Learning Disabilities
Reading Disability
Disability in Written Expression
Mathematics Disability (Dyscalculia)
Handwriting Disability (Dysgraphia)
Oral and Written Language Disability (OWL LD)
Attention Deficit Hyperactivity Disorder (ADHD), Attention Deficit Disorder (ADD), and “Sluggish Cognitive Tempo”
Non-Verbal Learning Disability
Official Definition of Learning Disabilities (Learning Disabilities Association of Canada)
Autism Spectrum - including Asperger Syndrome
Intellectual Disability (aka Mental Retardation)
Addictions
Fetal Alcohol Spectrum Disorders (FASD)
Developmental Delay
The Slow Learner
Giftedness
Kindergarten readiness
Social Skills problems
Depression
Bi-Polar Mood Disorder
Anxiety Disorders and Shyness
Obsessive Compulsive Disorder
Phobias
Adjustment Disorders
Post-Traumatic Stress Disorder
Sleep Disorders
Some Other Issues in Learning
School placement difficulties
Learning styles
Behavioural problems
Oppositional behaviour
Conduct problems
Bullying
Motivation problems
Executive Functioning problems
Tourette's Syndrome
Medical health problems interfering with learning (for example, chronic headaches, bedwetting)
Occupational stress
Family problems (transition, family illness, separation and divorce, family violence)
Grief, loss, bereavement
Abuse
Developmental Dyslexia
Dyslexia is a language-based learning disorder. People with Dyslexia have trouble with reading because their brains do not recognize or process certain aspects of language well. So, despite having normal (or above-average) intelligence, and having no difficulties with thinking or with understanding complex ideas, people with Dyslexia struggle with interpretation of written or spoken language.
A person with Dyslexia may have trouble rhyming words or separating out the component sounds of spoken words, where skills such as these are vital in the process of learning to read. Learning letter-sound correspondences, decoding words phonetically, recognizing words by sight, and understanding the meaning of simple sentences may all be very difficult. Dyslexia is not a matter of confusing or transposing letters (for example confusing the letters b and d), although some people with Dyslexia do struggle with reversals.
A person with Dyslexia may have great difficulty decoding words while reading, may read slowly, disfluently, or inaccurately, and may struggle to understand what he or she reads. Some people with Dyslexia often donʼt enjoy reading, and may be ashamed of their reading. Their reduced reading experience may reduce vocabulary development and slow the growth of a general base of knowledge.
Dyslexia varies in severity and sufferers present with many patterns of strengths and weaknesses. People with Dyslexia usually struggle with spelling and written expression as well as reading, and often have difficulty with arithmetic and math. All of these subjects assume abilities with respect to processing of symbols to convey information. People with Dyslexia may also struggle with aspects of receptive or expressive oral language.
It is the most common learning disability and believed to affect approximately one out of five children to some degree. Of students with specific learning disabilities receiving special education services, 70-80% have deficits in reading. Dyslexia is the most common cause of reading, writing and spelling difficulties.
Dyslexia is neurologically based and often runs in families. Chances are that at least one of a Dyslexic person's parents, grandparents, aunts, or uncles has also struggled with Dyslexia. It affects males and females nearly equally, and people from different ethnic and socio-economic backgrounds as well. It is not a result of lack of motivation, sensory impairment, poor schooling or learning opportunities, or brain injury. (We often use the term "Developmental Dyslexia" to distinguish this lifelong disorder from an acquired language processing problem, resulting, for example, from a brain injury.) As already mentioned, Dyslexia is not caused by low intelligence, and in fact many people are operating with above average intelligence.
Dyslexia is not a disease and is not "cured." Dyslexics can however respond well to timely, specialized multi-sensory language programming. Early identification is important. Children identified in Kindergarten or Grade 1 who receive specialized programming tend to experience many fewer problems learning to read (and fewer associated academic problems) than children not identified until Grade 3. A large majority of children who are poor readers in Grade 3 remain poor readers by Grade 9, and may not read well as adults.
This said, it is never too late for people with dyslexia to learn to read, or to process and express language more effectively. Dyslexic teens or adults certainly may benefit from specialized phonics-based language instruction, but also benefit from learning coping strategies and receiving accommodations in school or at work. With correct diagnosis, appropriate instruction, as well as hard work and support from family, friends, and others, people with Dyslexia can succeed in school and at work.
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Specific Learning Disabilities
Learning disabilities are lifelong disorders that exist when there is a marked difference between what a person appears intellectually capable of doing in an academic area, and how they actually perform. People with specific learning disabilities, have average or above average cognitive ability, and their difficulty with learning is not attributable to the effects of a medical problem or sensory deficit (for example, hearing loss or a visual problem). Learning Disabilities occur in a range of academic areas, and should be identified by a psychologist who will conduct standardized tests. The most common specific disabilities follow.
Specific Reading Disability
A diagnosis of a Specific Reading Disability (often referred to as Disorder of Reading) is made when a person underachieves in the development of reading skills, for his or her age, education level and measured intelligence. (Dyslexia is one type of reading disability, but not all reading disabilities point to Dyslexia.)
Reading is a complex process that can break down in one of several areas, including phonological processing, sight word reading, and reading comprehension. Children who have difficulty automatically recognizing words or sounding out words are likely to struggle in understanding what they have read. Having to stop frequently and focus on a particular word or letter combination takes away from the flow of reading. At the end of reading a difficult sentence, a child may have forgotten some of the words at the beginning, as it took a long period of time to decode all of the words. Reading can be laborious for those with Reading Disorder, often requiring a great deal of time and concentration to be able to extract meaning from printed material.
Reading is a central activity to many academic areas. In the elementary school years, children are expected to read in order to practice and further develop their reading skills. As they progress into Junior High and High School, they are expected to use reading as a means of gaining information (for example, reading a book about history) and need to be able to read adequately in order to complete such tasks as math word problems. The development of reading skills is also important in learning how to write. Many children who struggle with reading also have difficulties learning to spell and expressing their thoughts and feelings in written form.
Specific Disability in Written Expression
As with reading, there are many places at which the writing process can break down. A person with a specific disability in writing (also known as Disorder of Written Expression) may have difficulty with visual memory for words, identifying phonemes or connecting sounds with letters (as in Dyslexia), with generating and organizing ideas, or with the fine motor requirements of writing (see Handwriting Disability (Dysgraphia) below). The demands for written expression change through the school years, as they do with reading, and, whereas children learn to write early on (focus on forming letters and words, composing simple sentences, and then paragraphs), competence in writing is assumed later on, and students are expected to apply writing skills to a variety of subject areas. So, a significant delay in writing development can delay academic progress generally, and persistent writing difficulties hamper a person as he or she moves from school into the work world.
Disorder of Written Expression is not typically diagnosed in children under age seven, given that young children had had very little direct instruction in writing. Disorder of Written Expression is diagnosed when there is a discrepancy between an individual's achievement in written expression and his or her potential, based on age, education level and intellectual functioning.
Specific Mathematics Disability (Dyscalculia)
Mathematics Disorder is diagnosed where a person markedly underachieves relative to their apparent potential (given their age, educational opportunities, and measured intelligence). Math difficulties present in a variety of ways, from difficulty counting sequentially, through solving arithmetic problems, and understanding number and mathematical concepts.
Like other core academic skills, Mathematics is an area wherein people need to master one area in order to do well in the next. A person needs to understand addition and subtraction before moving on to multiplication and division, for example, and it will be important for math facts to be more or less automatic before a person will likely do well with algebra. Children with a Specific Disability in Math lag behind their peers in acquisition of mathematical skill and knowledge, and are at risk of falling behind and becoming lost as concepts become increasingly difficult through school. (See also Dyslexia, and Nonverbal Learning Disability)
Specific Handwriting Disability (Dysgraphia)
Handwriting disability is a neurologically-based disability in which a person has unusual difficulty forming letters or writing within a defined space. Given that students are expected to demonstrate their mastery of information throughout their school career, a difficulty with handwriting can hold a person back.
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Oral and Written Language Learning Disability (OWL LD)
People with OWL LD do not struggle with any primary language disability, but show nonverbal reasoning or cognition within the low average range and verbal comprehension, morphological coding ability, and facility with syntax below (and often significantly below) the 25th percentile, or the lower limit of the Average range. Children with OWL LD have selective receptive and expressive language difficulties, rather than primary language disability, as not all of their language skills fall two standard deviations below the mean. Children with OWL LD differ from children with Developmental Dyslexia in that morphological skills (drawing meaning from words or word units) and syntax (the rules and principles that govern sentence structure) are less well developed in OWL LD than in Dyslexia. Children with OWL LD often do not show discrepancies between Verbal Comprehension test scores, or even Full Scale IQ scores on the one hand, and basic reading scores on the other, as those with Dyslexia generally do. That is because children with OWL LD have residual problems in oral language and using language to learn that often go undetected by school professionals.
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Attention Deficit Hyperactivity Disorder (ADHD) and Attention Deficit Disorder (ADD), and “Sluggish Cognitive Tempo”
Attention Deficit/Hyperactivity Disorder, or ADHD, is a diagnosis given to children, teens, and adults who have a lifelong history of impulsivity, hyperactivity, or difficulty sustaining attention and concentration. A diagnosis of ADHD is specified as “ADHD, Predominantly Hyperactive/ Impulsive Type,” or “ADHD, Predominantly Inattentive Type” (formerly Attention Deficit Disorder (ADD)), or “ADHD, Combined Type,” where a person shows clear difficulty both with sustaining attention and resisting hyperactivity or impulsivity. Another term “Sluggish Cognitive Tempo” has been used to describe what may be a sub-subgroup within the ADHD, Predominantly Inattentive area or a learning style entirely separate from ADHD.
People with ADHD, Predominantly Hyperactive-Impulsive Type likely appear as if they are always on the go. It may be difficult for a person with this form of ADHD to sit quietly and await their turn, and their hands or feet may be constantly in motion. They may interrupt others and blurt out answer to questions before the question is completely posed. Students with this type of ADHD may begin assignments before the teacher finishes giving directions, or rush too quickly through a math assignment and get many questions wrong because they use addition in all questions, when many questions ask for subtraction. While engaged in a task, those with ADHD, Predominantly Hyperactive-Impulsive Type may be continuously in motion, tapping their feet, wiggling in their seat.
People with ADHD, Predominantly Inattentive Type often overlook details, appear not to be listening, have difficulty following through on instructions, and staying organized. At school, for example, a child with this form of ADHD may appear to be daydreaming while the teacher is talking, may gaze around the classroom when it is time to work, or have a very messy desk with papers, writing instruments, and other objects all stored together in one pile. Children with ADHD-PI often have difficulty completing assignments on time, at least without a lot of prompting from adults, and may struggle to sustain attention through all the steps they need to follow in an assignment. They are mistakenly seen by parents or teachers as immature or lazy, and, as such, often develop very negative views of themselves. People with ADHD-PI struggle academically and drop out of school far more often than other students. Adults with ADHD-PI struggle with distractibility, disorganization, procrastination, forgetfulness, and often struggle with fatigue. Although an adult with ADHD-PI can do well in an occupation that he or she enjoys and finds very interesting, there maybe struggles in other areas of life.
“Sluggish Cognitive Tempo” (SCT) is often used to describe a subgroup of people who would otherwise best fit into the ADHD-PI category. (SCT is not recognized in standard manuals such as the DSM-5.) Children, teens, and adults with Sluggish Cognitive Tempo struggle with attention as a result of poor working memory, but donʼt struggle significantly with impulsivity or significant distractibility. They are easily bored and struggle with motivation toward uninteresting tasks, although they may be conscientious. SCT people are not hyperactive and outgoing risk takers, but are more introspective and daydreamy, and tend to be shy and introverted (although when excited, they may behave like a person with (other forms of) ADHD). They often describe feeling like they are in a fog. Because of their difficulties with working memory, they often struggle in such academic areas as reading and mental math.
People with ADHD frequently have sleep difficulties, and sleep deprivation worsens hyperactivity and impulsivity in children. ADHD is associated with social problems, generally as a result of social skills problems, and ADHD can cause or worsen family problems. Children and teens with ADHD may not come close to reaching their academic potential, and academic delays can be global. People with ADHD tend to feel very limited in their relationships, don't like themselves as they are and feel dissatisfied with themselves. People with ADHD are at increased risk of developing a stress disorder, depression, anxiety, or other emotional problems such as Oppositional Defiant Disorder (ODD) and conduct disorder (CD). People with ADHD frequently don't believe their future is very bright.
ADHD is a serious condition causing significant and potentially life-long impairment. ADHD keeps people from reaching their full potential. The consequences of ADHD are long-term, inhibiting adults with the disorder from reaching their full academic potential. Of ADHD adults surveyed recently, 17% did not graduate from high school and only 18% graduated from college, compared with 7% and 26% respectively, for those without ADHD. People with ADHD held an average of 5.4 jobs in a 10-year period, while those without ADHD held an average of 3.4 jobs. Nearly half of people with ADHD reported that they had left or been fired from at least one job in part because of their ADHD symptoms. Unemployment is higher in people with ADHD.
Treatment of ADHD begins with proper evaluation and diagnosis. Treatment is multi-modal and generally includes a combination of family therapy (educating parents), individual or groupbased skills training and counseling for the person with ADHD, school or workplace interventions, alongside stimulant or non-stimulant medication to improve the ability to concentrate or to reduce hyperactivity.
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Autism Spectrum - including Asperger Syndrome
Autism is really a range or spectrum of conditions with many similarities, including unusual difficulty interact socially (or in the development of social cognition” and the development of repetitive behaviours, interests and activities. Some people with such difficulties have intellectual difficulties, while others are very bright intellectually.
Naming of subtypes continues to evolve, so that, for example, the term “Asperger Syndrome” (or AS) is less commonly used than it used to be. People with (what was formerly referred to as) “Asperger Syndrome” may become overwhelmed by multi-step directions when they are given verbally. They often experience difficulty processing verbal information as it is spoken, and forget part of what has been said. As one adult put it, "Words without pictures simply go away." People with this learning style tend to learn most effectively when supplied with visual supports for verbally presented information.
For people with AS the development of social skills necessary to form and maintain friendships does not come naturally. These impairments may include difficulty producing and reading nonverbal behaviours, such as eye contact, body language and gestures. Also, individuals with AS often are not self-motivated to develop social relationships, particularly in childhood years. Those with AS frequently become engrossed in circumscribed interests which seem odd and in some cases uninteresting to other children. In adapting to the social world, individuals with AS often develop theories as to the ways people function, although these theories are often based upon how the person with AS believes he or she would act in a particular situation rather than understanding that everyone has different ways of responding to situations. It is often difficult for individuals with AS to see that others have different points of view, and that these need to be taken into account when interacting with people. A person with AS may have difficulty with perceiving idiom, irony, or sarcasm, or with predicting and responding to others' behaviour.
Many people with AS develop restricted interests. A great deal of time may be spent amassing information about a particular topic or building a collection. Individuals with AS often feel that their daily lives are chaotic and unpredictable, and they look for predictability through patterns in the physical world. The development of circumscribed interests may begin as early as age two or three, and children with AS typically progress through a variety of circumscribed interests as they grow older. Free time is frequently spent searching for more information about a pet subject or for a new piece to add to a collection. Children with AS may be quite attached to particular objects.
Circumscribed interests and repetitive behaviours may serve as a calming mechanism in times of stress and anxiety for individuals with AS. The predictability offered by an understanding of a part of the physical world can be quite comforting to individuals with AS who are experiencing changes to their daily routine or other anxiety-provoking situations. The strict adherence to daily routines is typical in individuals with AS. Disruption to routines, transition from one activity to another, failure at a task, social interaction and other forms of unpredictability create a state of over-arousal in the individual with AS, leading to anxiety, anger and other emotions. Catastrophic emotional or behavioural reactions-screaming, disrupting others, physically abusing others, or running away- can result when a person with AS feel overwhelmed. People with AS are more likely than other people to have Attention Deficit/Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), depression, anxiety, and epilepsy.
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Non-Verbal Learning Disability
People with a nonverbal learning disability (NLD) have difficulty processing information that is not presented in language: for example, social cues, mathematical processes, or athletic concepts, even as they may possess strong ability to express themselves verbally.
People with NLD learn most effectively through discussion. They have excellent rote memory skills, and can store a great deal of specific information about a topic. However, their thinking may be overly concrete, so that when asked about a similar topic, it may become clear that a person with NLD has not truly understood and internalized the information, but simply memorized it. Generalization of information from one setting to the next is not something that comes naturally for people with NLD, so that they treat new topics as distinct and isolated from all other knowledge. They do not automatically make connections between bits of information, but rather engage in a great deal of effort to store new information. Teachers and parents often find that children with NLD have a need to ask questions incessantly. This questioning occurs because children with NLD learn best when information is presented in a concrete verbal manner. By asking specific questions, children are able to access the particular information they require. However, it can be challenging for the teacher of a large class to be bombarded with the questions of one student.
Individuals with NLD often have a great deal of difficulty maintaining, organization, and finding their way around. They often have difficulty with visual-spatial orientation and following sequential directions. As such, these individuals may appear disorganized, get lost more frequently and be late for appointments. In addition, characteristic of people with NLD is a dislike for transitions and changes in routine. They enjoy the structure and predictability offered by a stable daily routine, and may experience stress, anxiety and even feeling of panic when faced with unexpected changes.
When interacting with other people, we use verbal and nonverbal cues to understand their behaviour and plan our responses. Individuals with NLD have a great deal of difficulty perceiving nonverbal cues, and will often misread social situations. For example, a sarcastic remark may be interpreted at face value, without taking the tone of voice of the speaker into account.
Making it through a typical day can be exhausting for individuals with NLD. A child with NLD, for example, may expend a great deal of effort to complete assignments, and ensure that he remains organized, in the right place at the right time. Overcoming the difficulties associated with NLD requires hard work on the part of the individual. In addition, those affected by NLD may experience a hypersensitivity to sensory stimuli, thus making every experience seem more intense than for those of us not affected.
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Official Definition of Learning Disabilities
Adopted by the Learning Disabilities Association of Canada January 30, 2002
http://www.ldac-acta.ca/en/learn-more/ld-defined.html
Learning Disabilities refer to a number of disorders which may affect the acquisition, organization, retention, understanding or use of verbal or nonverbal information. These disorders affect learning in individuals who otherwise demonstrate at least average abilities essential for thinking and/or reasoning. As such, learning disabilities are distinct from global intellectual deficiency.
Learning disabilities result from impairments in one or more processes related to perceiving, thinking, remembering or learning. These include, but are not limited to: language processing; phonological processing; visual spatial processing; processing speed; memory and attention; and executive functions (e.g. planning and decision-making). Learning disabilities range in severity and may interfere with the acquisition and use of one or more of the following:
- oral language (e.g. listening, speaking, understanding);
- reading (e.g. decoding, phonetic knowledge, word recognition, comprehension);
- written language (e.g. spelling and written expression); and
- mathematics (e.g. computation, problem solving)
Learning disabilities are lifelong. The way in which they are expressed may vary over an individualʼs lifetime, depending on the interaction between the demands of the environment and the individualʼs strengths and needs. Learning disabilities are suggested by unexpected academic under-achievement or achievement which is maintained only by unusually high levels of effort and support.
Learning disabilities are due to genetic and/or neurobiological factors or injury that alters brain functioning in a manner which affects one or more processes related to learning. These disorders are not due primarily to hearing and/or vision problems, socio-economic factors, cultural or linguistic differences, lack of motivation or ineffective teaching, although these factors may further complicate the challenges faced by individuals with learning disabilities.
Learning disabilities may co-exist with various conditions including attentional, behavioural and emotional disorders, sensory impairments or other medical conditions.
For success, individuals with learning disabilities require early identification and timely specialized assessments and interventions involving home, school, community and workplace settings. The interventions need to be appropriate for each individual's learning disability subtype and, at a minimum, include the provision of:
- specific skill instruction;
- accommodations;
- compensatory strategies; and
- self-advocacy skills.
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Intellectual Disability (formerly “Mental Retardation”)
Intellectual Disability (ID) is characterized by unusual limitations in both adaptive behaviour (development of a range of everyday practical skills) and intellectual functioning. Although not always identified early in life, ID is, by definition, present before age 18.
Measurement of IQ used to be most central to an evaluation of possible Intellectual Disability, but contemporary evaluation focuses most heavily on the evaluation of adaptive skills, ranging from conceptual (e.g. language and literacy; money, time) to social (including social vulnerability and social problem solving), to practical skills.
Intellectual functioning or intelligence refers to mental capacities such as non-verbal reasoning ability and verbal problem solving. The most common way of measuring intelligence is with IQ testing. With Intellectual Disability, IQ is around 70 or lower, but low IQ is not enough to warrant diagnosis of ID and people with ID sometimes do score higher than this on standardized testing. In the assessment of possible Intellectual Disability, evaluators need to investigate the impact of linguistic and cultural factors and many specifics of a person’s background.
It is very important to identify specific strengths that coexist with a person’s limitations, for the sake of developing individualized support plans to maximize independent functioning and quality of life. Often people with ID struggle most with the stereotypes and negative perceptions that others hold. Intellectual Disability used to be called Mental Retardation or MR and, while this term is often still used, it tends to be stigmatizing, and preferred term is now Intellectual Disability.
The terms “Developmental Delay” and “Intellectual Disability” are often confused. A diagnosis of intellectual disability should only be made when mental abilities and adaptive functioning are found to be far below average. The term "developmental delay" is reserved for children under the age of five who are slow to reach developmental milestones (e.g. speech and language, social, motor) but where the delays are insufficient for a diagnosis of intellectual disability. A child may be too young to complete a full assessment or may be unable to complete tests because of speech and language limitations. Children with Developmental Delay don’t necessarily have Intellectual Disability. Put another way, people identified as intellectually disabled have experienced developmental delays as young children, but not all developmentally delayed children will eventually be identified as intellectual disabled.
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The Slow Learner
“Slow learner” is not a formal diagnostic category; instead, it is a term sometimes used to describe a student who is able to develop and use academic skills, and who can reason both verbally and non-verbally, but who needs more time and more practice than others their age or in their grade at school. With reasoning abilities somewhat delayed, a slow learner needs more time to understand new concepts as well as more help from teachers and parents, but may still not learn to the same depth as others. Special Education services are unlikely to be provided for these children, teens, or adults, students, even though they need extra support.
Although cognitive ability (or IQ) is only one factor that psychologists consider when we assess learning ability and skill, the following may help to understand the situation of a person who struggles more than most others, but who has more ability than a person with an intellectual disability. Cognitive testing for a “slow learner” generally finds an overall IQ score one standard deviation below the mean, but less than two standard deviations below the mean. The middle of the Average Range for IQ scores is 100, and the scores of most students will fall within one standard deviation of 100, or in other words will show overall IQ scores of between 85 and 115. A person whose overall cognitive ability is found to be two standard deviations below the mean may have an Intellectual Disability (with IQ below 70). IQ scores for a slow learner are likely to be lower than the Average Range, but higher than those seen with Intellectual Disabilities.
In practical terms, a slow learner can struggle in school in various ways, because higher order thinking or reasoning doesnʼt come as easily as it does to classmates. Learning new concepts is more challenging, and itʼs especially important for new concepts or skills to be firmly based upon already mastered concepts or skills, because it is more difficult for this student to fill in gaps, as it were. And where the majority of the class may have mastered a concept and is ready to move on, a slow learner needs more time and, following the rest of the class, will either fail to grasp the first concept (because she needs more time) or wonʼt learn the next idea (because she is still working on the previous one). This can lead to gaps in knowledge and basic skills, where the more gaps there are, the more challenging future learning will be. For someone struggling to keep up through most school days, school can be very draining or exhausting.
Typically, these students are keenly aware they are struggling, and maintaining self confidence may be a challenge. Where academic learning doesnʼt come easily, children, teens, or adults develop low self image, become anxious about school or demoralized, may worry about what others think of them. They may start to think of themselves as “dumb” or “stupid,” start to hate school, and may be quick to give up. Finding activities other than academics where the person is more successful is very important; parents, teachers, and other supporters need to keep the learner focused on strengths.
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Depression
Depression is the most common mood disorder, and one that affects people of all ages. There are various kinds of depression with different criteria for diagnosis. See also Bi-Polar Mood Disorder. In general, depression is diagnosed when a person feels sad or blue most of the day, nearly every day, or when he or she feels a loss of pleasure or interest in daily activities. Instead of presenting as sad, children are often irritable and angry. Other symptoms of depression include significant weight change (or failure to gain appropriate weight in children), sleep disturbances (insomnia, trouble staying asleep, sleeping too much), psychomotor changes, fatigue and loss of energy, feelings of worthlessness or guilt, and thoughts of death, with or without thoughts of, and plans for, suicide.
People who are depressed typically see negative events as resulting from their inadequacy, even when this cannot be the case. Accordingly, people with depression can be perfectionistic in school, at home, or work, and very sensitive to criticism. Being turned away from a play activity by peers may be viewed by the child as proof that he or she is unlikable or unattractive. In contrast, a person with depression may unreasonably view positive events as accidents and as untrustworthy. For example, if a depressed child receives a good grade on a test, he or she might explain the good grade to the test being easy or to the teacher marking generously, rather than to his or her hard work or ability. Children who are depressed have been found to experience more victimization at school.
Depression can interfere with the ability to learn and work because it often results in decreased concentration ability and reduced attention. When sleep is affected by depression, a sufferer can be exhausted during the school day or work day. Processes that have become automatic start to take more time for those who are depressed, as a person has to think consciously through problem-solving steps that used to be automatic. The demoralization that goes along with depression can represent a major problem in learning, and people sometimes throw up their hands and give up on learning.
Parents frequently do not realize that their child or teen is depressed. In fact, a recent study has shown that most adolescents who report suicidal behaviour on a screening questionnaire are not known by their teachers or other school staff to be at risk. It is therefore obviously important to identify depression as early as possible, even before a person manages to ask for help, and before problems worsen. Depression can be treated with counselling or psychotherapy, family therapy, school interventions, medication, or a combination of these.
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Bipolar Mood Disorder
Bipolar disorder (formerly called "Manic-Depression") and bipolar spectrum disorders affect people of all ages. They are neurologically-based disorders that cause instability of mood and energy level. Bipolar disorders are serious. People affected often have difficulty maintaining relationships, performing consistently in school or at work, and people with bipolar disorder have an increased risk of suicide. Bipolar disorder has a lifetime prevalence rate somewhere between 0.4% to 1.6% of people, and it is now seen that the disorder frequently has its onset during the early teenage years, and can even begin during childhood. These are familial illnesses. Although the mode of inheritance is unclear, as is the relationship between the genetic predisposition and environmental stress, it is clear that first-degree relatives of people with bipolar disorder have a significantly higher chance of developing mood disorders, including depression and bipolar disorder than a control group.
Whether in adults and children, bipolar disorders vary in its severity, subtype, and phase. There are two general phases of bipolar disorder, the manic "highs" and the "lows" of depression, and some form of alternation or swing between the two phases. Manic (or less pronounced "hypomanic") states are characterized by euphoria, increased energy level, and a sense of being able to accomplish anything. A person needs less sleep, judgement and insight are reduced, restlessness, hyperactivity and impulsivity, racing thoughts, rapid and pressured speech sometimes with inappropriate humour or behaviour, reckless spending and increased religious activity. A person may be irritable or given to rages. Serious manic states can include very disorganized thinking and flight of ideas, hallucinations, and paranoia. The depressive symptoms are similar to those seen in clinical depression.
Although some children present with a typical pattern of mood highs and lows, where their parents can look back over months or years and discern a pattern of shifts, juvenile bipolar disorder is seldom characterized by euphoric mood. Some children show shorter hypomanic episodes or ultrarapid cycling of mood, where alternations last only hours or a couple of days. They may present with chronic episodes of mood lability, severe irritability, agitation, explosiveness, and temper outbursts which have been referred to as "affective storms." Accurate diagnosis can be difficult given that juvenile bipolar disorder can look so much like other disorders. In children, bipolar disorder frequently occurs with other syndromes, including ADHD, conduct disorder, and anxiety disorders, and the symptoms of the bipolar mood disorder may not be easily distinguishable from these other disorders. For example, impulsivity, hyperactivity, depression, irritability, aggression, inattention, and anxiety symptoms overlap the different disorders. In addition, children have a hard time communicating their symptoms and subjective experience. In fact, there is continuing controversy about whether there is an actual juvenile bipolar spectrum of disorders, or whether the symptoms are a kind of recurrent unipolar major depression with severe behavioural outbursts, or ADHD with serious mood swings and depression, or an early sign of bipolar disorder.
The cycles of depression and mania can be controlled with mood stabilizing medication, and other medications may be prescribed by a patient's physician as well. Individual psychotherapy, family therapy, and education about the illness alone are usually not effective, but can be of enormous help is managing the illness.
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Anxiety Disorders and Shyness
Phobias
Obsessive Compulsive Disorder
Anxiety is a feeling everyone experiences from time to time. People feel anxious when faced with deadlines, meeting new people, or completing difficult tasks. A small amount of anxiety actually improves our performance on many tasks. However, many people suffer from anxiety problems which reduce the quality of their lives and compromise their academic and occupational performance.
In Panic Disorder, a person experiences periods of unexpected intense fear and dread, usually accompanied by shortness of breath, dizziness or faintness, increased heart rate, trembling and shaking, hot or cold flushes, and a sense of detachment. A person can feel she is dying or "going crazy" and terrified about losing control.
A specific phobia-formerly called a "simple phobia"-is an intense, unrealistic fear, which sometimes interferes with the ability to socialize, work, or go about everyday life. It is brought on by exposure to, or sometimes even the thought of exposure to, a specific object, event, or situation that can be anything from airplane travel to dentists to spiders to heights. People with phobias generally know that their fears are unreasonable, but cannot control them and may be tormented by them. Phobias seem to run in families and are roughly twice as likely to appear in women. If a person rarely encounters the feared object, the phobia may not cause a lot of harm, but if the feared object or situation is common, it can disrupt everyday life. Social phobia and agoraphobia are kinds of phobias which may interfere with daily life in a serious way.
Social anxiety disorder or social phobia is an intense fear of being criticized or evaluated by other people. People with social anxiety are nervous, anxious, and afraid about many social and performance situations. It tends to start early in life, and to be referred to as "shyness". For a child, leaving home for school, or for an adult, attending a business meeting can be nervewracking and intimidating. Although a person with social anxiety may want to be sociable and to fit in with everyone else, their anxiety about not performing well around others is strong enough that it tends to undo their best efforts. Their self-consciousness and shyness is overwhelming and they freeze up when they meet new people, especially people in authority. People with social anxiety tend to avoid social situations.
Agoraphobia is the fear of having a panic attack in a public place, and the accompanying avoidance of these places. This is usually the result of having experienced a panic attack in a public place before. As panic attacks occur more often and in different locations, the person with the disorder begins to feel that going anywhere outside of a small safe zone is impossible.
In Generalized Anxiety Disorder, a person worries excessively about more than one circumstance. A child or adult with this problem feels worried most of the time, and the worry is free-floating, coming or going without apparent reason. The worries may be unrealistic and farfetched, but the person who suffers with generalized anxiety disorder fixates on them and can't get them out of their mind. Physical symptoms can include bodily tenseness, a lump in the throat, trouble falling asleep, and difficulty concentrating. It is very hard for a person with generalized anxiety just to be still and relax. A person with generalized anxiety disorder may have experienced panic attacks in the past and been agoraphobic.
Obsessive Compulsive Disorder (OCD) is an anxiety disorder characterized by recurrent obsessions or thoughts associated with a sense of alarm or threat, and compulsive behaviours which relate to escape from the perceived threat. Thoughts may involve a perceived threat of harm to oneself or someone else or may involve a metaphysical or spiritual threat. Obsessive thinking related to contamination from germs, disease, or dirt commonly involve escape rituals related to cleaning, such as excessive hand washing and chronic cleaning. Obsessions related to having failed to complete some important task may lead to compulsive checking behaviours, where a person checks and rechecks door locks, light switches, faucets, or stoves. A person can check items ten or even a hundred times, with an overwhelming impulse to recheck until he or she experiences a reduction in tension. There are various forms of OCD, all of which are more or less disruptive to learning and living. Insight into the fact that a thought is irrational or unreasonable provides no relief, and reassurance from someone else has little lasting positive effect.
Today, the prognosis for most anxiety problems is good to excellent. Group, individual, or family based psychological treatment or medical treatment or some combination of these is often very helpful.
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Post-Traumatic Stress Disorder
Post-traumatic stress disorder (PTSD) is a stress-related mental health condition in which a person has experienced one or more events as traumatic and the sufferer re-experiences the event(s) persistently and experiences certain other types of symptoms. A traumatic event may be something experienced directly by the sufferer, or witnessed, or may involve learning that someone close to them has experienced trauma, and first responders (e.g. police personnel, firefighters, paramedics) are often exposed to terrible events in the course of their work. In PTSD, a person may re-experience the traumatic event(s) as intrusive recollections, nightmares, flashbacks, or in other ways, and shows significant avoidance of trauma-related stimuli, experiences persistent negative thoughts or feelings that start or worsen after the trauma. A person with PTSD experiences changed in arousal and reactivity after the trauma—for example, irritability or aggression, hypervigilance, difficulty concentrating, difficulty sleeping. A person with PTSD may or may not experience dissociation and, while symptoms sometimes develop immediately after the traumatic event(s), onset is sometimes delayed until well after the event. PTSD can affect people of all ages; DSM-5 describes a preschool subtype of PTSD.
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Adjustment Disorders
Adjustment Disorders are conditions that sometimes develop when a person has unusual difficulty coping with a stressor. With Adjustment Disorder, emotional or behavioral symptoms develop in response to one or more identifiable stressors within 3 months of the onset of the stressors. Symptoms may involve depressed mood, anxiety, disturbance of conduct, or a combination of these, and a sufferer’s distress is clearly more than would be expected in response to the stressor. The symptoms cause marked distress and impair functioning. Adjustment disorder can be difficult to diagnose because there’s considerable overlap with other conditions.
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Giftedness
Giftedness refers to performance in one or more domains. When a person is gifted academically or intellectually, in music, art, or athletics, they are operating at the highest level in that domain—higher even than other people functioning at a high level in the area. Age and developmental level are relevant: in earlier stages of development or at a young age, potential is the thing to consider, whereas achievement is most important later.
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Kindergarten Readiness
We are able to provide an assessment to help you and your school division determine whether your child is prepared to enter Kindergarten. This type of assessment can be particularly helpful for children who are born in the latter months of the year, or for children who may be ready to enter Kindergarten early. For this assessment, we will examine your child's cognitive and academic development, social and emotional functioning, motor coordination, and other areas that are relevant to school readiness. With this information, you and your child's school division will be able to make an informed decision about readiness to begin Kindergarten.
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Social Skills problems
Some children learn social skills naturally through their daily interactions. Others require direct teaching to be able to learn appropriate skills. Social skills training involves teaching children to make more effective use of interpersonal communication strategies, learn social problem solving techniques and rules for appropriate social behaviour. Children have difficulty developing social skills for a variety of reasons. Some developmental difficulties-ADHD, Asperger's Syndrome-are often associated with social difficulties. Depression or anxiety can reduce social skills, and the lack of exposure to role-models may delay development of social skills. When social skill deficits are severe or the child has particular learning needs, teaching often begins in a one-on-one setting with a teacher or mentor. For example, preschool age children with Autism Spectrum Disorder often begin by being directly taught to look in their teacher's eyes when speaking. Later in the day, during free play, this child may be prompted by the teacher to ask a classmate to play or to begin a discussion with a peer about a favourite topic. He or she may require practice and prompting in several settings over a period of time in order to develop appropriate social skills. Some children benefit from a small group learning in social skills. This may take the form of a therapy group designed to give children a forum in which to discuss, learn, and practice skills helpful in dealing with current social issues, with the guidance of a trained counsellor. One advantage of the group format is that it provides a safe environment in which children can practice newly acquired skills through role-playing with other group members.
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Addictions
Abuse of alcohol, prescription and non-prescription drugs, or gambling can lead to serious difficulties in all aspects of life. In seeking help with one's use of substances or gambling, it is not necessary that large life problems exist, although this is frequently what leads people to seek treatment. Addiction is characterized by frequent use of a substance or gambling, preoccupation with the activity when not engaged with it, and interference of the activity with daily living. Often family members and close friends are the first to notice that an individual is struggling with substance abuse or gambling. At other times, family members are the last to know. Treatment for substance abuse and gambling can be beneficial for the individual, as well as his or her family. Substance abuse affects an individual, not only during the activity, but also afterward. Alcohol and drugs stay in the human system for varying amounts of time, and impact performance on learning, working, relating to others, and other activities.
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Fetal Alcohol Spectrum Disorders (FASD)
Fetal alcohol spectrum disorder (FASD) is a term describing a range of symptoms caused by prenatal alcohol exposure. FASD With Sentinel Facial Features, and FASD Without Sentinel Facial Features are subtypes. The terms, At Risk for Neurodevelopmental Disorder, and FASD, associated with prenatal alcohol exposure are not diagnoses, but may be used to describe situations where a person is known to have been exposed to alcohol prenatally but where assessment findings are not conclusive.
Diagnosis of FASD generally requires the participation of a multidisciplinary team made up of Pediatricians, Child development specialists, Speech-Language Pathologists, Physiotherapists, Occupational Therapists, in addition to Psychologists.
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Sleep Disorders
Sometimes daytime problems—with learning, behaviour, mood, immune functioning—are the result of poor or inadequate sleep. To live and learn well, we must sleep well. But even as poor sleep can threaten the physical, emotional, and intellectual health of children, youth, and adults, professionals and parents too often overlook its importance. Click the “Articles” link for a primer of behavioural and medical sleep disorders, and pieces about the resemblance of sleep deprivation and ADHD in children, how some families are getting rid of their televisions for the sake of their kidsʼ sleep, and how children and teens can lose the equivalent of a month's worth of sleep over a year to TV, video games, messaging late into the night.
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