13.11: Neurodivergence and Special Education

This is the term used to describe the wide range of differences we might see in the ways children develop. The Diagnostic and Statistical Manual of Mental Disorders (2013) lists a section of neurodevelopmental disorders that includes intellectual disabilities, autism spectrum disorder, learning disabilities, communication disorders, and AD/HD.

Autism spectrum disorder

Sometimes children’s brains work differently. One form of this neurodiversity is Autism spectrum disorder.

Autism: Defining Spectrum Disorder

Autism spectrum disorder (ASD) describes a range of conditions classified as neuro-developmental disorders in the fifth revision of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The DSM-5, published in 2013, redefined the autism spectrum to encompass the previous (DSM-IV-TR) diagnoses of autism, Asperger syndrome, pervasive developmental disorder not otherwise specified (PDD-NOS), and childhood disintegrative disorder. These disorders are characterized by social deficits and communication difficulties, repetitive behaviors and interests, sensory issues, and in some cases, cognitive delays.

Asperger syndrome was distinguished from autism in the earlier DSM-IV by the lack of delay or deviance in early language development. Additionally, individuals diagnosed with Asperger syndrome did not have significant cognitive delays. PDD-NOS was considered "subthreshold autism" and "atypical autism" because it was often characterized by milder symptoms of autism or symptoms in only one domain (such as social difficulties). In the DSM-5, both of these diagnoses have been subsumed into autism spectrum disorder.

Autism spectrum disorders are considered to be on a spectrum because each individual with ASD expresses the disorder uniquely and has varying degrees of functionality. Many have above-average intellectual abilities and excel in visual skills, music, math, and the arts, while others have significant disabilities and are unable to live independently. About 25 percent of individuals with ASD are nonverbal; however, they may learn to communicate using other means.

Social Communication Symptoms

Social impairments in children with autism can be characterized by a distinctive lack of intuition about others. Unusual social development becomes apparent early in childhood. Infants with ASD show less attention to social stimuli, smile and look at others less often, and respond less to their own name. Toddlers with ASD differ more strikingly from social norms; for example, they may show less eye contact and turn-taking and may not have the ability to use simple movements to express themselves. Individuals with severe forms of ASD do not develop enough natural speech to meet their daily communication needs.

Restricted and Repetitive Behaviors

Children with ASD may exhibit repetitive or restricted behavior, including:

• Stereotypy—repetitive movement, such as hand flapping, head rolling, or body rocking.
• Compulsive behavior—exhibiting intention to follow rules, such as arranging objects in stacks or lines.
• Sameness—resistance to change; for example, insisting that the furniture not be moved or sticking to an unvarying pattern of daily activities.
• Restricted behavior—limits in focus, interest, or activity, such as preoccupation with a single television program, toy, or game.
• Self-injury—movements that injure or can injure the person, such as eye poking, skin picking, hand biting, and head banging.

Figure \(\PageIndex{1}\): Repetitive behavior can be one of the symptoms of autism spectrum disorder.[1]

Etiology

While specific causes of ASD have yet to be found, many risk factors have been identified in the research literature that may contribute to its development. These risk factors include genetics, prenatal and perinatal factors, neuroanatomical abnormalities, and environmental factors. It is possible to identify general risk factors, but much more difficult to pinpoint specific factors.

Genetics

ASD affects information processing in the brain by altering how nerve cells and their synapses connect and organize; thus, it is categorized as a neuro-developmental disorder. The results of family and twin studies suggest that genetic factors play a role in the etiology of ASD and other pervasive developmental disorders. Studies have consistently found that the prevalence of ASD in siblings of children with ASD is approximately 15 to 30 times greater than the rate in the general population. In addition, research suggests that there is a much higher concordance rate among monozygotic (identical) twins compared to dizygotic (fraternal) twins. It appears that there is no single gene that can account for ASD; instead, there seem to be multiple genes involved, each of which is a risk factor for part of the autism syndrome through various groups. It is unclear whether ASD is explained more by rare mutations or by combinations of common genetic variants.

Prenatal and Perinatal Factors

A number of prenatal and perinatal complications have been reported as possible risk factors for ASD. These risk factors include maternal gestational diabetes, maternal and paternal age over 30, bleeding after first trimester, use of prescription medication (such as valproate) during pregnancy, and meconium (the earliest stool of an infant) in the amniotic fluid. While research is not conclusive on the relation of these factors to ASD, each of these factors has been identified more frequently in children with ASD than in developing youth without ASD.

Environmental Factors

Evidence for environmental causes is anecdotal and has not been confirmed by reliable studies. In the last few decades, controversy surrounded the idea that vaccinations may be the cause for many cases of autism; however, these theories lack scientific evidence and are biologically implausible. Even still, parental concern about a potential vaccine link with autism has led to lower rates of childhood immunizations, outbreaks of previously controlled childhood diseases in some countries, and the preventable deaths of several children.

Treatment

There is no known cure for ASD, and treatment tends to focus on management of symptoms. The main goals when treating children with ASD are to lessen associated deficits and family distress and to increase quality of life and functional independence.[2] Treatment for ASD should begin as soon as possible after diagnosis. Early treatment for ASD is important as proper care can reduce individuals’ difficulties while helping them learn new skills and make the most of their strengths.

Figure \(\PageIndex{2}\): Applied Behavior Analysis takes place at the client’s home or school where a trained individual works one on one with the child using specific techniques.[5]

There has been increasing attention to the development of evidenced-based interventions for young children with ASD. Although evidence-based interventions for children with ASD vary in their methods, many adopt a psychoeducational approach to enhancing cognitive, communication, and social skills while minimizing behaviors that are thought to be problematic.[6]

COVID 19 pandemic, mask wearing has affected the social cognition of children with ASD further (Tamon et al, 2022).

The Diversity of the Autism Spectrum

The rainbow-colored infinity symbol represents the diversity of the autism spectrum as well as the greater neurodiversity movement. The neurodiversity movement suggests that diverse neurological conditions appear as a result of normal variations in the human genome. It challenges the idea that such neurological differences are inherently pathological, instead asserting that differences should be recognized and respected as a social category on a par with gender, ethnicity, sexual orientation, or disability status.

Figure \(\PageIndex{3}\): A symbol of the autism spectrum – worldwide there has been growing awareness of the disorder.[7]

Learning Disorders

When children don’t seem to be developing or learning in the typical pattern one might be assessed for a disorder or disability. What is a learning disorder or disability? In the next section we’ll learn about the spectrum of disorders and how they may impact many areas of the child's life.

• A learning disorder is a classification of disorders in which a person has difficulty learning in a typical manner within one of several domains. Types of learning disorders include difficulties in reading (dyslexia), mathematics (dyscalculia), and writing (dysgraphia). These disorders are diagnosed with certain criteria.
• A learning disability has problems in a specific area or with a specific task or type of activity related to education.

Children with learning challenges are usually identified in school because this is when their academic abilities are being tested, compared, and measured. In the Diagnostic and Statistical Manual of Mental Disorders -DSM-5, a qualified person will make a diagnosis, identified causes, and will make a treatment plan for disorders and disabilities. The diagnosis of specific learning disorder was added to the DSM-5 in 2013.

The DSM does not require that a single domain of difficulty (such as reading, mathematics, or written expression) be identified—instead, it is a single diagnosis that describes a collection of potential difficulties with general academic skills, simply including detailed specifies for the areas of reading, mathematics, and writing. Academic performance must be below average in at least one of these fields, and the symptoms may also interfere with daily life or work. In addition, the learning difficulties cannot be attributed to other sensory, motor, developmental, or neurological disorders.[8]

The following is an example of the DSM-5 - learning disorders.

• Dyslexia - Reading
• Dyscalculia – Mathematics
• Dyspraxia - Motor Coordination
• Dysgraphia - Writing
• Auditory Processing Disorder - Hearing
• Visual Processing Disorder - Visual

Dyslexia

Dyslexia, sometimes called “reading disorder,” is the most common learning disability; of all students with specific learning disabilities, 70%–80% have deficits in reading. The term "developmental dyslexia" is often used as a catchall term, but researchers assert that dyslexia is just one of several types of reading disabilities. A reading disability can affect any part of the reading process, including word recognition, word decoding, reading speed, prosody (oral reading with expression), and reading comprehension.

Dyscalculia

Dyscalculia is a form of math-related disability that involves difficulties with learning math-related concepts (such as quantity, place value, and time), memorizing math-related facts, organizing numbers, and understanding how problems are organized on the page. Dyscalculics are often referred to as having poor "number sense."

Dyspraxia

Children who have motor skills substantially below what is expected for their age are diagnosed with dyspraxia – or developmental coordination disorder (DCD) as it is more formally known. They are not lazy, clumsy or unintelligent – in fact, their intellectual ability is in line with the general population – but they do struggle with everyday tasks that require coordination.

Figure \(\PageIndex{4}\): Children with learning challenges are usually identified in school because this is when their academic abilities are being tested, compared, and measured.[9]

Dysgraphia

The term dysgraphia is often used as an overarching term for all disorders of written expression. Individuals with dysgraphia typically show multiple writing-related deficiencies, such as grammatical and punctuation errors within sentences, poor paragraph organization, multiple spelling errors, and excessively poor penmanship.[10]

Auditory Processing Disorder

A processing deficit in the auditory modality that spans multiple processes is auditory processing disorder (APD). To date, APD diagnosis is mostly based on the utilization of speech material. Unfortunately, acceptable non-speech tests that allow differentiation between an actual central hearing disorder and related disorders such as specific language impairments are still not adequately available.

Visual Processing Disorder

Difficulty processing or interpreting visual information is referred to as visual processing disorder (VPD). Kids with visual processing issues may have difficulty telling the difference between two shapes or finding a specific piece of information on a page.[11]

Table \(\PageIndex{1}\): - Summary of Learning Disabilities[12]

Disability	Difficulties	Effects
Dyslexia	Difficulty with reading	Problems reading, writing, spelling
Dyscalculia	Difficulty with math	Problems doing math problems, understanding time, using money
Dyspraxia (Sensory Integration Disorder)	Difficulty with fine motor skills	Problems with hand-eye coordination, balance manual dexterity
Dysgraphia	Difficulty with writing	Problems with handwriting, spelling, organizing ideas
Auditory Processing Disorder	Difficulty hearing difference between sounds	Problems with reading, comprehension, language
Visual Processing Disorder	Difficulty interpreting visual information	Problems with reading, math, maps, charts, symbols, pictures

Legislation for Children with Disabilities

Since the 1970s political and social attitudes have moved increasingly toward including people with disabilities into a wide variety of “regular” activities. In the United States, the shift is illustrated clearly in the Federal legislation that was enacted during this time. Three major laws were passed that guaranteed the rights of persons with disabilities, and of children and students with disabilities in particular. The third law has had the biggest impact on education.

The Rehabilitation Act of 1973, Section 504

This law, the first of its kind, required that individuals with disabilities be accommodated in any program or activity that receives Federal funding (PL93-112, 1973). Although this law was not intended specifically for education, in practice it has protected students' rights in some extra-curricular activities (for older students) and in some childcare or after-school care programs (for younger students). If those programs receive Federal funding of any kind, the programs are not allowed to exclude children or youths with disabilities, and they have to find reasonable ways to accommodate the individuals' disabilities.

Americans with Disabilities Act of 1990 (or ADA)

This legislation also prohibited discrimination on the basis of disability, just as Section 504 of the Rehabilitation Act had done (PL 101-336, 1990). Although the ADA also applies to all people (not just to students), its provisions are more specific and “stronger” than those of Section 504. In particular, ADA extends to all employment and jobs, not just those receiving Federal funding. It also specifically requires accommodations to be made in public facilities such as with buses, restrooms, and telephones. ADA legislation is therefore responsible for some of the “minor” renovations in schools that you may have noticed in recent years, like wheelchair-accessible doors, ramps, and restrooms, and public telephones with volume controls.

Figure \(\PageIndex{5}\): President George H. W. Bush Signs the Americans with Disabilities Act, 07/26/1990.[13]

Individuals with Disabilities Education Act (or IDEA)

As its name implied this legislation was more focused on education than either Section 504 or ADA. It was first passed in 1975 and has been amended several times since, including most recently in 2004 (PL 108-446, 2004). In its current form, the law guarantees the following rights related to education for anyone with a disability from birth to age 21.

The first two rights influence schooling in general, but the last three affect the work of classroom teachers rather directly:

• Free, appropriate education: An individual or an individual's family should not have to pay for education simply because the individual has a disability, and the educational program should be truly educational; i.e., not merely caretaking or babysitting.
• Due process: In case of disagreements between an individual with a disability and the schools or other professionals, there must be procedures for resolving the disagreements that are fair and accessible to all parties, including the person himself or herself or the person's representative.
• Fair evaluation of performance in spite of disability: Tests or other evaluations should not assume test taking skills that a person with a disability cannot reasonably be expected to have, such as holding a pencil, hearing or seeing questions, working quickly, or understanding and speaking orally. Evaluation procedures should be modified to allow for these differences. This provision of the law applies both to evaluations made by teachers and to school-wide or “high-stakes” testing programs.
• Education in the “least restrictive environment”: Education for someone with a disability should provide as many educational opportunities and options for the person as possible, both in the short term and in the long term. In practice, this requirement has meant including students in regular classrooms and school activities as much as possible.
• An Individualized Educational Plan (IEP): Given that every disability is unique, instructional planning for a person with a disability should be unique or individualized as well. In practice, this provision has led to classroom teachers planning individualized programs jointly with other professionals (like reading specialists, psychologists, or medical personnel) as part of a team.[14]

Special Education Process

Figure \(\PageIndex{6}\):The special education process includes evaluation, eligibility, IEP, placement, instruction, annual review and evaluation again.[15]

References:

Tamon, H., Itahashi, T., Yamaguchi, S. et al. Autistic children and adolescents with frequent restricted interest and repetitive behavior showed more difficulty in social cognition during mask-wearing during the COVID-19 pandemic: a multisite survey. BMC Psychiatry 22, 608 (2022). https://doi.org/10.1186/s12888-022-04249-8

Attributions:

Child Growth and Development by Jennifer Paris, Antoinette Ricardo, and Dawn Rymond, 2019, is licensed under CC BY 4.0 (adapted by Bhadha, 2023)

[1] Image by Countincr is licensed under CC BY-SA 3.0

[2] Children’s Development by Ana R. Leon is licensed under CC BY 4.0

[3] Autism Spectrum Disorder by the National Institute of Mental Health is in the public domain

[4] Children’s Development by Ana R. Leon is licensed under CC BY 4.0

[5] Image by Edwards Air Force Base is in the public domain

[6] Children’s Development by Ana R. Leon is licensed under CC BY 4.0

[7] Image is in the public domain

[8] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

[9] Image by pan xiaozhen on Unsplash

[10] Dyspraxi by The Conversation is licensed under CC BY-ND 4.0

[11] Ludwig, A. A., Fuchs, M., Kruse, E., Uhlig, B., Kotz, S. A., & Rübsamen, R. (2014). Auditory processing disorders with and without central auditory discrimination deficits. Journal of the Association for Research in Otolaryngology: JARO, 15(3), 441-64.

Child Development – Unit 6: Language Development references Psychology.by Boundless, licensed under CC BY-SA 4.0

[12] Dyspraxi by The Conversation is licensed under CC BY-ND 4.0

[13] Image is in the public domain

[14] Lifespan Development: A Psychological Perspective by Martha Lally and Suzanne Valentine-French is licensed under CC BY-NC-SA 3.0

[15] Image by Ian Joslin is licensed under CC BY 4.0