1. “Walk A Mile In My Shoes”
An interactive workshop
on learning disabilities
Melissa Rowbotham, M.Ed
Copyright © 2010 by Integra Foundation
MP to start
Our goal for the training:
To get some receptivity to the idea that behavior may not just reflect disobedience
- to convey respect and openness to any of their concerns about security (we get that these kids can be hard – but we don’t know what that’s like): start a relationship with them/ begin to engage
Take home message for the day:
Can’t Do vs Won’t Do (also support vs. punishment)
Figure out what might be going on in behavior
It is hard to do things that are hard – when faced with that – behaviors & emotions
Change to include our audience

2. _ to _% of children/youth have a LD
___% of children who have an LD also have a social, emotional or behavioural problem
_ to _ % of kids with ADHD also have a LD
___% of children with ADHD who also have anxiety
1 in __ children and youth in Canada have a mental health disorder (which includes anxiety and depression)
Co-morbid – explain term “roommates”
ADHD has a lot of room mates (Behaviour and LDs most common)
ADHD most likely suggested by teachers as an issue – because it is BEHAVIOURAL and can be observed.
Not always the full story – teacher/school staff are in the best position to observe and watch for changes in behaviour, mood, trauma especially if there is a relationship however teachers need more info and training.
You don’t need to solve/fix/diagnose. Need to observe, suggest and support.

3. “Walk A Mile In My Shoes”
Learning Objectives:
To introduce the concepts of Learning Disabilities (LDs)
To experience what it might feel like to have LDs
To talk about resources around anxiety and depression
Brief introductions (recognition of their expertise in residential treatment); we have done this workshop for … but new to residential. Help us to understand what the kids day looks like, recognize that security is key
Eliciting problem behaviors: What are the behaviors that are problematic / that wears you out/down?
Want to elicit typical problems rather than horror stories
Looking for top 10
Examples – telling a kid 10 times to their chores; not finishing the stuff they start;

4. What are learning disabilities?
Neurologically based disorders
Affect the ability to take in,
understand, remember or express information.
Specific, not global impairments
Found in individuals who possess average to above average thinking and reasoning skills
Lifelong disorders

5. What are learning disabilities?
LDs reflect neurobiological factors, including genetics, congenital or acquired conditions
LDs are not due to differences in culture, language, SES, motivation

6. What are learning disabilities?
Impairments in one or more of the following psychological processes:
Language processing
Phonological processing
Visual-spatial processing
Processing Speed
Memory & attention
Executive functioning
Self disclosure
Lingo is fluid – words – but meanings change, people use terms differently,
Process – what is that word?
Talk about phonol processing – what does this mean?
Our experience like LD – read and may not get meaning – level of language is so dense – tackle it together
And giving you a cheat sheet – use with clients, will go back to it
Demonstrate this is our knowledge – not belonging to psychologists only in a report
Talk about first 3 today – and next three in context of lD/ADHD
For each one – activity first, discussion, info: terms, why NB in general, why for your kids? (what are implications/strategies)

7. What are learning disabilities?
Impairments may affect learning in the areas of:
Reading
Oral language
Written language
Math
Dx of LD made when have average intelligence but problem with one of those processes we just listed. And the problem affects school skills – can be in one or more than one of these areas.
As we go through the processes, we’ll try to show why the processes get in the way of reading or writing or math, for example.

8. What Do LDs Affect?
LDs come in many forms & affect everyone differently
Possible problems in social situations:
Understanding sarcasm
Figuring out how someone is feeling from their body language or facial expressions
Understanding the unwritten social rules
Participating in groups
Marjory to lead

9. If a large solid-hoofed mammal becomes available to you without compensation, refrain from casting your faculty for seeing into the oral cavity of such a creature.
Melissa to lead

10. Demystifying Processes
Term
Description
Application
Verbal Reasoning
Verbal Comprehension
General Verbal Ability
Ability to think through problems using words
Ability to understand words and connected language
Understanding instructions, lessons, stories
Logical thinking and problem-solving
Understanding word meanings
Expressing ideas in words MP
Link to exercise to underscore the following concepts:
Need integration of processes to work out the answer – including:
vocabulary (long-term memory),
Logical Reasoning / strategies – how did you figure out how to start the problem? E.g., look for words you know, like mammal = animal
Abstract reasoning – understanding metaphors & words with multiple meanings, eg even if figure out each word separately, may not have meaning
Culture – age, context – how many don’t recognize the proverb? Anyone know of a similar saying in another language or culture?

11. Demystifying Processes
Term
Description
Application
Perceptual processing
Visual-spatial
Ability to make sense of what one sees
Putting together visual information
Noticing & understanding facial expressions
Understanding a chart or graph
Reading a map

14. Demystifying Processes
Term
Description
Application
Non-Verbal Reasoning
Perceptual reasoning
Visual-spatial
Perceptual-organizational
Performance
Visual problem-solving
Ability to organize, put together or orient visual information
Ability to form and mentally manipulate images
Understanding concept words related to time, space
Building according to a plan or model
Judging space and distance
Math (geometry, shapes, measurement)
Following sewing patterns, IKEA instructions

15. What symbol has to come next in the sequence of the five symbols on the left? Can you sketch this sixth figure?
Answer is back-to-back 6
Cover up one side of each mirrored figure – elicit discussion about problem solving strategies. 15

16. What symbol has to come next in the sequence of the five symbols on the left? Can you sketch this sixth figure?
MP to lead if time

17. Kids with LDs and other disabilities are at risk – why?
Frustration at not being able to do what child knows he/she should be able to do
Feelings about having a “disability”
Sense that others’ expectations are not being met (parents, teachers)
Peers’ responses
Lack of others’ understanding/responses
Responses to others’ feelings & anxieties

18. Invisible Disabilities
Neurobiological impairments are invisible.
Mental Health Issues are invisible
Behaviour may be are only clue.
Where else can we look?
OSR, past reports, grades, parents, teachers and kids
OSR Ontario School Record – what is your equivalent?

19. What is Anxiety/worry?
Diffuse uncomfortable sense of apprehension, often accompanied by autonomic symptoms” (Barlow, 2002)
Basic human emotion
Part of normal development
Can be adaptive
Lots of definitions of anxiety, depending on who you read. I like Barlow’s because it captures the uncomfortable nature of anxiety
One of the basic human emotions – we all experience anxiety at some times, or at some stages of our lives. e.g., public speaking – one of the most common anxiety-producing experiences,
Part of normal development – dependency to autonomy – exposed to new situations and learn to master your fear e.g. sleeping with light off as kid, starting new school, first day of high school, job interview
Also has an important function – we need anxiety:
Safety mechanism – hard-wired response to perceived danger – when we perceive threat, there is an increase in autonomic nervous system reactions – palms sweat, breath faster or more shallowly, feel butterflies in stomach – that works as an early warning mechanism – tells us something is up
Cave man times – fight or flight

20. What is an Anxiety Disorder?
Symptoms interfere with the youth’s ability to function in everyday life
Persistent
Intensity of reactions is severe
Anxiety disorders are relatively common in childhood: Prevalence rate of >10%
Can look like skipping, lack of motivation, withdrawal, externalizing behaviour, “aggressive avoidance”
So if anxiety is normal and we all have it, how do you know when it is a problem, especially a problem for your child or teen?
Short answer:
When it seriously interferes with the child’s ability to do the tasks of everyday life – e.g., restricts their ability to go to school or hang out with friends at the mall, or interferes with their concentration – can’t think about school work, can’t sleep
When it is persistent – not just a period of time when a big change is happening – like child not sleeping well & distracted in grade eight, worrying about starting high school
When the intensity of the child’s responses are outside the norm – when doing an assessment and making a diagnosis, we usually try to get information about the child from a variety of sources – the parents, school, sometimes extended family, watching the child in the assessment – often, people will notice something
Research into anxiety disorders suggests that some of the anxiety disorders start fairly early , put a child vulnerable to developing other psychiatric problems, and if untreated, can persist into adulthood.

21. Types of Anxiety Disorders in Childhood
Generalized Anxiety Disorder (GAD)
Social Phobia
Specific Phobia
Post-traumatic Stress Disorder (PTSD)
Panic Disorder
Obsessive-Compulsive Disorder (OCD)
Separation Anxiety Disorder (SAD)
TGeneralized Anxiety Disorder (GAS) %
Obsessive-Compulsive Disorder (OCD) 1-3%
Panic Attacks
Rare in children, unless part of another anxiety disorder but more common in adolescents with specific phobias, Social phobia, SAD or GAD
Posttraumatic Stress Disorder 1% of adults, unknown in children
Separation Anxiety % of children under 7
These are the Anxiety Disorders in the Diagnostic and Statistical Manual (DSM) system – psychologists, psychiatrists use criteria to make a diagnosis.
Diagnosis can be helpful for a couple of reasons:
Short hand way of communicating information –
Research – group kids with particular cluster of symptoms together – can do careful studies and learn what symptoms are part of the disorder and what are unique to the child – predict what to watch out for; and most importantly, to learn how to help these kids – what works and what doesn’t work
Also – diagnosis is not the end point, though. Usually, understanding a child from a broader perspective – issues /stresses, how does a child feel; how do they cope?
Bio-psycho-social model useful
hese are the Anxiety Disorders in the Diagnostic and Statistical Manual (DSM) system – psychologists, psychiatrists use criteria to make a diagnosis.

22. What is Distress/sadness
Always associated with a trigger, event or situation
Will improve with environmental accommodation or removal of stressor
Functional impairment usually mild
Professional psychiatric treatment not usually necessary
Counselling and therapy will often help
Social supports (friendships and family) will often help
Medications would not be normally used

23. What is Depression? Referred to as Major Depressive Disorder -MDD
Characterized by:
Feelings of hopelessness, sadness
Loss of interest in activities
Vegetative signs: change in eating or sleeping, low energy or fatigue
Poor concentration, difficulty making decisions
Persistent
Interferes with daily living
Rare in children under 12 years old -

24. Depression in Childhood
Diagnosis of Depression is often overlooked in childhood:
Some symptoms are more typical of children than of adults (e.g., irritability)
High co-occurence with other disorders (such as ADHD & behavioual issues) may mask the symptoms
Certain features of Depression are more typical at different ages
Perception that kids don’t get depressed.
Also – really hard to diagnose accurately.
What it looks like changes over time. - e.g., depressed mood – feeling sad or hopeless & looking tearful for younger kids, often is manifest as irritable mood.
Loss of interest in activities – may not be in all activities with kids. Can have a kid who still plays his DS every day but does not want to play with other kids or may not take pride in his ability to get to the next level, eg.

25. When to ask for more help
When you are concerned about safety or well being of student
Watch for obvious indicators of mood issues:
Crying, shaking, avoidance
Freezing in classroom situations
Angry Outbursts & Increased Irritation
Physical Evidence of Self-Harm or Decline
Watch for changes:
In behaviour
In Hygiene
In peer interactions
In interactions with teachers and school staff
When

26. What would help worry/distress at school?
Involve student in problem-solving process (they have great ideas!)
Acknowledge effort even if output is weak
Encourage & support accountability
Address barriers caused by LD, ADHD, OT,
Note taking
Scheduling
Planning & Organizing (Support Self-Reliance)

27. What would help worry/distress at school?
Make sure learning style is understood
Are accommodations appropriate and sufficient?
Watch for bullying or peer difficulties
Teach pro-social skills to entire class and be clear about classroom expectations
Discuss Fair versus Equal

28. What would help worry/distress at school?
Find out what is overwhelming them in the school setting & accommodate
Set up student for success and mastery to build self-esteem
Watch for activities/subjects/projects that are “too hard”
Empower them by encouraging and being receptive to attempts at self-advocacy

29. Support & Listen Reach Out - Ask student if they’re alright
Ask about any changes in their life
Check in with other teachers, peers, their family
Be Real about limits of confidentiality
Always encourage parental involvement
May chose to state policy outright
Never promise you won’t tell anyone

30. Suggest Help In school support
School Team (rule out learning issues, bullying, or situation within class)
Social Workers
Guidance
Special Education
Administrators

31. Suggest a Referral Inform family and student of your concern
Enlist the help of your team
Encourage a thorough assessment
Be open to school involvement in treatment
Outside Referral for Assessment & Treatment:
Hospital Clinic or Program
Children’s Mental Health Clinic GP

32. Resources GP’s will know local referral sources: Hospital Clinics
Children’s Mental Health Clinics
Specialty Clinics (Integra, Sick Kids Anxiety Groups, CAMH First Episode Clinic)
Pediatricians and specializing psychiatrists and psychologists
Private practitioners (play therapists, social workers, therapists) – only after a thorough assessment

33. Resources – Websites & Books
Sick Kids – Information and Resources – “Trusted Answers”
Information on Referral Sources
Resources for Teachers
TeachADHD
The ABCs of Mental Health – A Teacher Resource
Orientation to Children’s Mental Heath – Teachers Guide
Learning Disability Association of ON