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Head On Talks: ​Learning Differently 

by Joel D. Lazaro, M.D. (MAGIS, 06/08/19) 

COURSE OBJECTIVES: 1. Warm parent-child relationship


1. To review the normal developmental tasks of 2. Models of achievement
the school age child and the factors that 3. Models of reading, intellectual interest
affect learning 4. Expectation of educational achievement
2. To present the red flags of learning difficulty 5. Involvement in school
and identify the common developmental 6. Parental monitoring, standards, discipline
disorders that affect learning 7. Structured and well organized home life
3. To present the essential elements of
assessment done for a child with LD and the ● Parenting is the primary influence in child
role of Educators dev’p
4. To present the factors that affect the ● Together with good nutrition (pre-natal and
outcome of children with learning difficulty post-natal), experiences that are:
REPEATED
School Age Child CONSISTENT
● Industry vs. Inferiority PREDICTABLE
● Achievement → Self-concept NURTURING
● Sense of competence largely influenced by are important in expressing the underlying
ability to succeed in school genetic potential and optimizing brain dev’p
and function
Developmental Expectations:
● Every child learns at his/her own Good parenting practices:
developmental pace 1. Reading to children
● Learning comes naturally in children--even 2. Using complex language
in the most trying/challenging situations 3. Responsiveness
● Some children experience Delays in 4. Warmth in interaction
development, some are even born with
Developmental disorders ● Children are born ready to learn and best
● Children bring to school a set of unique learning happens in a nurturing relationship.
characteristics and experiences that affect They learn through being engaged and
how they respond to school experiences, doing, watching and copying
relate to others and learn ● Lack of positive relationship, inadequate
supervision and involvement with children
Lesson in Neurodiversity are associated with increased risk of
● The whole picture matters behavioral, developmental and even
● Neurodiversity Strengths Checklist (Thomas learning problems
Armstrong, PhD):
www.institute4learning.com Learning - The Teacher and School
thomas@institute4learning.com ● To teach effectively, educators must always
keep in mind the dynamics and needs of the
Learning - The Family class as well as the individual
Family processes which promote academic characteristics and needs of each student in
success: the class

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Head On Talks: ​Learning Differently 
by Joel D. Lazaro, M.D. (MAGIS, 06/08/19) 

Family processes which promote academic


Learning Disability 7-10%
success:
1. Developmentally appropriate curriculum Attention 5-10%
2. Teacher preparation, attendance, attitude Deficit/Hyperactivity
3. Conducive and safe classrooms Disorder
4. Good teaching facilities
5. Expectations and rewards for attainment Mental Health 10-20%
6. Extracurricular activities Disorders (anxiety,
depression, mood
School Infrastructure - Philippine Set-up disorder)
● 1 of every 8 schools have a T:P ratio of 1:60
and up Chronic illness 5%
● 1 of every 7 pupils do not have a classroom
Ill-defined factors ?
● 1 of every 5 pupils do not have a desk
● 1 of every 3 pupils do not have a textbook

Philippine Education in a Bind The Red Flags - Cognitive & Behavior Red
● Only 6 of every 1000 grade 6 students are Flags ​(Heward, 2006)
prepared to enter high school 1. Memory / Retention - requires more time to
● Only 2 of every 100 4th year HS grad are fit automatically recall information and have
for college more difficulty handling larger amount of
● Filipino youth ranked 41st in Science and cognitive information at one time
42nd in Math among 45 countries Typical concerns:
a. “Ituro mo ngayon mamaya lang limot na”
Obsolescence of Education in the Digital Age b. “Malilimutin sa mga gamit at mga bilin”
● The most endangered jobs are those that c. “Hindi matandaan kapag sunod-sunod
don’t involve any deep, substantive na utos”
interaction with people
● Today’s youth must become champions at 2. Learning rate - number of practice or
skills of human interaction -- empathy, instructional trials needed before a student
social sensitivity, collaboration, solving can respond correctly without prompts or
problems together, building relationships, assistance (e.g. 2-3x for non LD vs. 20-30x
even spirituality LD child)
Typical concerns:
CAVEAT: Schools must make sure they are not a. “Mabagal matuto at maka-intindi”
the one killing the passion of children to learn. b. “Kelangan pang mag-tutor para matuto”
c. “Kelangan ng paulit-ulit na turo”
Learning Difficulty
● 1 in 25 school age kids 3. Attention - difficulty attending to relevant
features of a learning task and instead may
focus on distracting irrelevant stimuli;
Etiologic Causes Prevalence
difficulty sustaining attention to learning
Intellectual Disability 2-3% tasks

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Head On Talks: ​Learning Differently 
by Joel D. Lazaro, M.D. (MAGIS, 06/08/19) 

Typical concerns: 4. Internalizing behaviors - fear/anxiety,


a. “Hindi nakikinig sa guro kapag nasa sadness
klase” 5. Failure to achieve age/grade level expected
b. “Kung ano-ano ang ginagawa imbes na tasks
makinig”
c. “Hindi natatapos/kumpleto and trabaho Inferiority: Dysfunctional Coping Strategies
sa school” 1. School avoidance/truancy
2. Bullying/aggression
4. Poor motivation 3. Acting like a clown
● Develop ​learned helplessness ​- a 4. Acting out to get thrown out
condition in which a person who has 5. Joining peers who don’t achieve (gang
experienced repeated failures comes to mentality)
expect failure regardless of his efforts; 6. Dulling the pain with drugs and alcohol
quickly gives up and turn to or wait for 7. Self-injurious/suicidal behavior
others to assist/help them
● They easily acquire a problem solving Assessment
approach called ​outer-directedness,​ in Historical Data
which they seem to distrust their own ● Comes from multiple sources and
responses and rely on others for perspectives
assistance and solutions ● Look for recurring and consistent themes

5. Behavior excesses and challenging Past School History


behaviors ○ History of school transfers, grade
a. Poor self-control: hyperactive, retention, summer remedial class
aggressive ○ School attendance pattern
b. Poor self-regulation: impulsive, impatient ○ Guidance/counseling office records
c. Inappropriate behaviors: lying, stealing ○ Past educational testing
d. Bizarre behaviors: ○ Special school services provisions
obsessive-compulsive, self-injurious ○ School clinic visits
behaviors
e. Avoidance behavior: malingering, school Past Medical History
phobia ○ Birth and maternal history
○ History of relevant illness
The more severe the degree of learning ○ Family history of similar problems
difficulty, the higher the incidence of behavior ○ Developmental milestones
problems ○ Socio-environmental history

Evidence of Inferiority Physical Examination


1. Teacher expressing worry, disappointment ○ General system exam
and/or frustration ○ Vision and hearing
2. Parents becoming anxious, critical and ○ Neurologic exam
frustrated ○ Dysmorphism
3. Teased/bullied by classmates ○ Laboratory testing - not routinely done
unless proper indications exist
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Head On Talks: ​Learning Differently 
by Joel D. Lazaro, M.D. (MAGIS, 06/08/19) 

Formal Testing 3. Legal: RA 7277 Magna Carta for the


● Developmental assessment (0-8 years) - Disabled
done by developmental pediatrician 4. Medical: Identify early, prevent
○ Gesell Developmental Test complications
○ Griffith’s Developmental Test 5. Ethical/Moral: Because we care!
● Psychometric test - done by psychologist
○ Stanford-Binet IQ Test Obstacles and Barriers
○ Wechsler Intelligence Scale 1. Inadequate knowledge/skills to detect the
● Psychoeducational test and problem
neuropsychological test - done by 2. Lack of resources
psychologist or SPED specialist 3. Hesitancy to inform parents
○ Academic achievement test 4. Uncooperative parents
○ Learning disability test 5. Afterwards, what’s next? (Why rock the
○ Executive skills evaluation boat?)

Mitigating Factors of Learning Difficulty How to tell parents?


1. Intelligence AVOID:
2. Self-esteem 1. Hiding the problem
3. Early identification and intervention 2. Surprising parents later (i.e. end of grading
problems period or the school year)
4. Family support 3. Lack of due process
5. Teacher/school assistance 4. Character assassination
5. Labeling
Role of Educators / Administrators 6. Trade-offs
1. Help in early detection of suspected cases 7. Mass promotion
2. Gather relevant information from teachers, 8. Forcing parents to seek MD’s without
guidance office, school officials explanation why
3. Inform parents and guide them on what to 9. Coming off as judgmental
do (Tip: Be prompt, be proper!)
4. Make appropriate and timely referrals (Tip: Characteristics of a Good Disclosure to
Establish referral network) Parents:
5. Help in management of cases 1. Objective/direct to the point
a. Medication efficacy monitoring 2. Consistent
b. Child/family counseling 3. Timely
c. Collaborate with medical and allied 4. Professional
medical professionals 5. Balanced
6. Compassionate
The Art of Referral 7. Non-judgmental
Why the need to refer? 8. Non-blaming
1. Technical: To uncover the underlying cause
of the problem
2. Practical: Two or three heads are better
than one!

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Head On Talks: ​Learning Differently 
by Joel D. Lazaro, M.D. (MAGIS, 06/08/19) 

Whom to refer and for what reason? the values of the culture to which you
1. Internalizing/externalizing behaviors - child belong.
psychiatrist ● Timely ​intervention as well as opportunities
2. IQ testing/academic achievement testing provided will be the game changers.
and counseling - child psychologist
3. Disability diagnosis and treatment - What is needed for meaningful learning?
developmental pediatrician ● Feeling valued
4. Educational evaluation, tutorials - SPED ● High interest active learning
specialist ● The big picture before the detail
5. Speech and language evaluation and ● Visual and verbal concepts
therapy - speech pathologist ● Multisensory learning environments to
6. Work behavior and skills training - enable meaningful experiences
occupational therapist ● Meaningful feedback about what you’re
doing well and how to do it better
Elements of a Good Referral
1. Specific reason WHY child is being referred Intervention
2. Description of the problem (specifics) ● Don’t just retain in grade! Find the reason
3. Steps taken to help the child why the child failed to learn
4. Good and positive points of the child ● June is the best time to establish behavioral
5. Identity/position of referee control
● Decrease total workload, or
What to expect from MD’s consultation? ● Give smaller quotas of work at a time
1. Developmental skills profile ● Target productivity first, accuracy later
2. Behavior observation during testing ● Reduce homework
3. Medical concerns ○ Overall correlation with achievement is
4. Diagnosis just 0.15-0.25 (just 2-6% of variance in
5. Plan of management and intervention achievement) across all grades and
options weaker in elementary grades (Cooper,
Robinson, & Patall, 2006)
Neurodiversity: Paradigm Shift ○ For high school, best amount was 1.5 -
2.5 hours per night; more hours had no
further benefit
Disability Neurodiversity
Model Model
What is equity?
Message You are You are unique. It is the absence of avoidance, unfair, or
disabled. remediable differences among groups of
people, whether those groups are defined
Goal Fix the Observe, Learn, socially, economically, demographically, or
problem. Optimize geographically or by any other means of
stratification -- like their learning ability or
● Our strengths or weaknesses may be disability
manifested at different life stages and
contexts. Human competence is defined by