Learning and Cognitive Disorders

• Cognitive disorders are a group of neurological (brain-related) disorders that interfere with taking in, understanding, and remembering information.
• Learning disorders are a group of neurological (brain-related) disorders characterized by problems with learning, sorting, and storing information.
• People with learning disorders may have difficulty with one or more core skills, such as listening, speaking, reading, writing, math, or reasoning.
  • Specific types of learning disorders include reading ( Dyslexia ), writing ( Dysgraphia ), math ( Dyscalculia ), and others.
  • Difficulties in any of these areas may hinder employment, academic performance, achievement, and/or daily living activities.
• Learning disorders may overlap with other environmental issues or other disorders.
  • High-risk populations include people with traumatic brain injuries (TBIs) and individuals who were prenatally exposed to alcohol or drugs.
  • One third of children with learning disorders also have Attention Deficit Hyperactivity Disorder (ADHD). For more information, see Chapter D-13: Hyperactivity and Problems with Attention.

Specialized Services

• An individual showing symptoms of severe learning disability or cognitive delay will significantly benefit from a Medicaid waiver.
  • This waiver is an approval for support services money for the individual.
  • These services can take place in the home or in the community.
• A formal diagnosis may qualify children younger than three for an Individualized Family Service Plan. Consult with your supervisor to see if there is a local Infant Learning Program to provide an assessment for the child and access to eligible services.
• A school-aged child may need an Individualized Education Plan (IEP) or a 504 plan. IEPs are provided for under the Individuals with Disabilities Education Act of 2004, while 504 plans are provided under Section 504 of the Rehabilitation Act of 1973. The school district evaluates the child for need and establishes the IEP or 504, which provides specific services to address the areas of need. Parents, teachers, administrators, and district personnel may all be members of the IEP or 504 team.
• Adults may be eligible for work training through the Alaska Division of Vocational Rehabilitation (DVR).

• When you suspect a learning or cognitive delay, ask your supervisor about referring the client for an evaluation or additional services, including tutoring or assessments.
• Be considerate of cultural and environmental factors. For example, people who speak English as a second language are often incorrectly flagged as having learning or cognitive challenges.
• Children who are diagnosed early and receive early intervention have significantly better lifelong outcomes. Intervention is usually a team effort involving the family, school district, behavioral health professional, and medical provider.
• Learning disorders and other conditions such as ADHD or autism often occur at the same time, but they are not the same condition.
• Children with cognitive and learning issues are more likely to experience child abuse and neglect.
  • Supporting and educating the child and family can reduce this risk.
  • See Chapter D-3: Abuse and Neglect for more information.

When you work with clients who have learning or cognitive disorders, keep these things in mind:

• There can be much stigma associated with learning disorders. Whenever possible, you should adapt the environment or task to the client's current developmental level.
• A learning disorder is not a problem with intelligence or motivation, and people with learning disorders are not “lazy” or “dumb." They may need your help dealing with others' perceptions, and family members may need to learn how to relate to their loved one in healthy and supportive ways.
• People with learning disorders hear, see, and receive information differently.
  • This can lead to problems with learning new information.
  • They need to be counseled in ways that match their unique styles.
• Children with cognitive or learning disorders may present as defiant or oppositional. This may be due to their frustration with feeling behind all the time or may be their way of distracting others from their real challenges. You can help by accepting them for who they are and helping them get to the root of their frustrations.

Referral information, including reports from medical providers, school staff, clinicians, or other sources regarding the client's wellbeing.

Releases of Information ( ROIs ) that are current or updated before getting information about the client from other sources.

Client history related to past traumas, academic performance, work performance, and past interventions.

Treatment Plan, including a history of presenting problem and recommended course of treatment. Review the DSM-5 for criteria on Learning Disorders.

See Chapter C-1: Development Across the Lifespan for typical developmental milestones.

General areas of concern:

• Listening skills
• Language skills (including speaking, reading or writing)
• Mathematical operations

Difficulties in preschool:

• Pronouncing words
• Finding the right word
• Rhyming
• Learning the alphabet, numbers, colors, shapes, and days of the week
• Following directions or following routines
• Controlling crayons, pencils, and scissors or coloring within the lines
• Doing buttons, zippers, and snaps, and learning to tie shoes

Difficulties in grades K-4:

• Learning the connection between letters and sounds
• Blending sounds to make words
• Reading basic words
• Misspellings words or making frequent reading errors
• With basic math concepts
• Telling time and remembering sequences
• Learning new skills

Difficulties in grades 5-8:

• Reading and comprehension
• Math skills
• Open-ended test questions or word problems
• Writing or reading in front of others
• Spelling
• Organizational skills (e.g., bedroom, homework, or desk areas are messy and disorganized)
• Following classroom discussions and expressing thoughts out loud
• Writing legibly

Difficulties in high school:

• Attention span
• Memory
• Following directions
• Discriminating between or among letters, numerals or sounds
• Reading or writing
• Hand-eye coordination
• Organization
• Sensory integration
• Math
• Writing legibly
• Processing sensory information
• Language skills
• Age-appropriate verbal and written communications

Difficulties in adulthood:

• Short attention span
• Poor memory
• Difficulty following directions
• Poor reading and/or writing ability
• Poor hand-eye coordination
• Difficulties with planning and/or sequencing
• Disorganization

General concerns

• What concerns do your parents, school, medical providers, or others have about your ability to learn?
• What difficulties do you have at work? Does your employer have specific areas of concern with your performance?
• Has anyone in your family ever been diagnosed with a:
  • Developmental disorder?
  • Learning disorder?
  • Genetic or chromosomal disorder?

Does the 3-month-old child:

• Make eye contact?
• Follow moving objects with his eyes?
• Respond to loud noises with surprise?
• Make cooing sounds like “ooh” or “aah”?

Does the 6- to 9-month-old child:

• Recognize familiar faces?
• Turn her head turn towards sounds?
• Laugh?
• Look for fallen objects?
• Transfer toys from hand to hand?
• Roll from back to tummy?
• Use gestures, like pointing or reaching?
• Enjoy interactive playing?
• Shake head for “no?”
• Sit without support?
• Crawl on her hands and knees?

Does the 12-month-old child:

• Wave “hi” or “bye bye” or use similar greetings in his language?
• Understand simple directions?
• Pick up small objects with his thumb and finger?

Does the 18-month-old child:

• Follow simple directions?
• Use 20-30 words?
• Point and name objects?
• Hold and drink from a cup?
• Stack blocks or objects?
• Walk alone?

Does the 24- to 36-month-old child:

• Understand simple questions?
• Use more than 50 words?
• Run smoothly and easily?
• Understand descriptive words like “hot/cold” or similar words in her own language?
• Use 3- to 5-word sentences?
• Match colors and shapes?
• Dress and undress herself?

Does the 4- to 6-year-old child:

• Know some letters and short words?
• Understand what "morning" means?
• Count to 20 by memory?
• Speak so you can understand him?
• Know his first and last name?
• Show some concern for others in pain?
• Have best friends?
• Have some control over emotions?

Does the 7- to 12-year-old child:

• Learn letter or sound connections?
• Display appropriate coordination and balance?
• Pay attention?
• Know how to read and write at or near grade level?
• Understand what she hears or reads?
• Engage in class discussions or interactions?
• Complete word problems?
• Feel consumed or frustrated by her homework?

Does the 12- to 18-year-old child:

• Read slowly and accurately?
• Comprehend what he has read?
• Write?
• Complete multiple choice tests?
• Have a weak memory?
• Complete homework or other projects?

Does the adult:

• Keep his attention on the task at hand?
• Have problems with memory?
• Have difficulty reading and/or writing?
• Seem disorganized?
• Have difficulty navigating new situations?
• Struggle with problem solving, planning ahead, or sequencing activities?

Routinely review Chapter C-4: BHA/P Services and Common Interventions for how to prepare for and conduct interventions during appointments and for information on the levels of service available throughout Alaska.

Specifically, if you suspect a client of any age has a learning or cognitive disorder, your first step is to share your observations with your clinical supervisor and/or the client's clinician. It will be important to explain to the clinician why you think they may have a cognitive or learning disorder and what area it may be in (e.g., reading, writing, math).

When a client does have a specific cognitive or learning disorder, you may be asked to provide interventions identified on their treatment plan, 504 plan, or IEP. Some of these may include:

• Scheduling
• Time management
• Personal hygiene
• Study skills

Be sure you are familiar with the information in Chapter B-5: Mandatory Reporting and Duty to Warn and Chapter B-8: Documentation and Billing. Report instances of the following, consistent with your organization's policies and procedures:

• Child abuse or neglect.
• Suicidal thoughts or plans.
• Intentions to cause harm or injury to the self or others.