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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Many normed assessments can be used in evaluating skills in the primary academic domains: reading, including word recognition, fluency, and comprehension; mathematics, including computation and problem solving; and written expression, including handwriting, spelling and composition.
The most commonly used comprehensive achievement tests include the Woodcock-Johnson IV (WJ IV), Wechsler Individual Achievement Test II (WIAT II), the Wide Range Achievement Test III (WRAT III), and the Stanford Achievement Test–10th edition. These tests include measures of many academic domains that are reliable in identifying areas of difficulty.
In the reading domain, there are also specialized tests that can be used to obtain details about specific reading deficits. Assessments that measure multiple domains of reading include Gray's Diagnostic Reading Tests–2nd edition (GDRT II) and the Stanford Diagnostic Reading Assessment. Assessments that measure reading subskills include the Gray Oral Reading Test IV – Fourth Edition (GORT IV), Gray Silent Reading Test, Comprehensive Test of Phonological Processing (CTOPP), Tests of Oral Reading and Comprehension Skills (TORCS), Test of Reading Comprehension 3 (TORC-3), Test of Word Reading Efficiency (TOWRE), and the Test of Reading Fluency. A more comprehensive list of reading assessments may be obtained from the Southwest Educational Development Laboratory.
The purpose of assessment is to determine what is needed for intervention, which also requires consideration of contextual variables and whether there are comorbid disorders that must also be identified and treated, such as behavioral issues or language delays. These contextual variables are often assessed using parent and teacher questionnaire forms that rate the students' behaviors and compares them to standardized norms.
However, caution should be made when suspecting the person with a learning disability may also have dementia, especially as people with Down's syndrome may have the neuroanatomical profile but not the associated clinical signs and symptoms. Examination can be carried out of executive functioning as well as social and cognitive abilities but may need adaptation of standardized tests to take account of special needs.
Assessments for developmental coordination disorder typically require a developmental history, detailing ages at which significant developmental milestones, such as crawling and walking, occurred. Motor skills screening includes activities designed to indicate developmental coordination disorder, including balancing, physical sequencing, touch sensitivity, and variations on walking activities.
The American Psychiatric Association has four primary inclusive diagnostic criteria for determining if a child has developmental coordination disorder.
The criteria are as follows:
1. Motor Coordination will be greatly reduced, although the intelligence of the child is normal for the age.
2. The difficulties the child experiences with motor coordination or planning interfere with the child's daily life.
3. The difficulties with coordination are not due to any other medical condition
4. If the child does also experience comorbidities such as mental retardation; motor coordination is still disproportionally affected.
Screening tests which can be used to assess developmental coordination disorder include:-
- Movement Assessment Battery for Children (Movement-ABC – Movement-ABC 2)
- Peabody Developmental Motor Scales- Second Edition (PDMS-2)
- Bruininks-Oseretsky Test of Motor Proficiency (BOTMP-BOT-2)
- Motoriktest für vier- bis sechsjährige Kinder (MOT 4-6)
- Körperkoordinationtest für Kinder (KTK)
- Test of Gross Motor Development, Second Edition (TGMD-2)
- Maastrichtse Motoriek Test (MMT)
- Wechsler Adult Intelligence Scale (WAIS-IV)
- Wechsler Individual Achievement Test (WAIT-II)
- Test of Word Reading Efficiency (TOWRE-2)
- Developmental Coordination Disorder Questionnaire (DCD-Q)
- Children's Self-Perceptions of Adequacy in, and Predilection for Physical Activity (CSAPPA)
Currently there is no single gold standard assessment test.
A baseline motor assessment establishes the starting point for developmental intervention programs. Comparing children to normal rates of development may help to establish areas of significant difficulty.
However, research in the "British Journal of Special Education" has shown that knowledge is severely limited in many who should be trained to recognise and respond to various difficulties, including developmental coordination disorder, dyslexia and deficits in attention, motor control and perception (DAMP). The earlier that difficulties are noted and timely assessments occur, the quicker intervention can begin. A teacher or GP could miss a diagnosis if they are only applying a cursory knowledge.
"Teachers will not be able to recognise or accommodate the child with learning difficulties in class if their knowledge is limited. Similarly GPs will find it difficult to detect and appropriately refer children with learning difficulties."
Although disorder for written expressions skills can be difficult and an enduring problem all throughout childhood into adulthood, different types of treatment and support can help individuals who have this disorder to employ strategies and skills in the home and school environment. This includes remedial education tailored to improve specific skills, providing special academic services in the learning environment, and addressing concurrent health and mental issues. It is sometimes necessary to foster motivational techniques to maintain motivation and minimize negative thoughts or feelings. Using whatever modifications are necessary to overcome fears of failure in the early stages of writing mediation is strongly encouraged because children with learning disabilities often experience low self-esteem and confidence, which may further interfere with learning and academic success.
Developmental coordination disorder is a lifelong neurological condition that is more common in males than in females, with a ratio of approximately four males to every female. The exact proportion of people with the disorder is unknown since the disorder can be difficult to detect due to a lack of specific laboratory tests, thus making diagnosis of the condition one of elimination of all other possible causes/diseases. Approximately 5–6% of children are affected by this condition.
Interventions include:
- Mastery model:
- Learners work at their own level of mastery.
- Practice
- Gain fundamental skills before moving onto the next level
- Note: this approach is most likely to be used with adult learners or outside the mainstream school system.
- Direct instruction:
- Emphasizes carefully planned lessons for small learning increments
- Scripted lesson plans
- Rapid-paced interaction between teacher and students
- Correcting mistakes immediately
- Achievement-based grouping
- Frequent progress assessments
- Classroom adjustments:
- Special seating assignments
- Alternative or modified assignments
- Modified testing procedures
- Quiet environment
- Special equipment:
- Word processors with spell checkers and dictionaries
- Text-to-speech and speech-to-text programs
- Talking calculators
- Books on tape
- Computer-based activities
- Classroom assistants:
- Note-takers
- Readers
- Proofreaders
- Scribes
- Special education:
- Prescribed hours in a resource room
- Placement in a resource room
- Enrollment in a special school for learning disabled students
- Individual education plan (IEP)
- Educational therapy
Sternberg has argued that early remediation can greatly reduce the number of children meeting diagnostic criteria for learning disabilities. He has also suggested that the focus on learning disabilities and the provision of accommodations in school fails to acknowledge that people have a range of strengths and weaknesses, and places undue emphasis on academic success by insisting that people should receive additional support in this arena but not in music or sports. Other research has pinpointed the use of resource rooms as an important—yet often politicized component of educating students with learning disabilities.
Specific causes of this disorder are unknown. The interaction of physical, psychological, and environmental factors is thought to contribute to the disorder of written expression. In neuropsychological and neurobiological research, some studies show evidence that abnormally high testosterone levels and abnormalities in cognitive processes (visual-motor, linguistic, attentional, and memory) are thought to play a role in learning disorder cases. The impact of brain injuries in both children and adults can impair any of these cognitive processes.
There are tests that can indicate with high probability whether a person is a dyslexic. If diagnostic testing indicates that a person may be dyslexic, such tests are often followed up with a full diagnostic assessment to determine the extent and nature of the disorder. Tests can be administered by a teacher or computer. Some test results indicate how to carry out teaching strategies.
According to the DSM-IV-TR, communication disorders are usually first diagnosed in childhood or adolescence though they are not limited as childhood disorders and may persist into adulthood. They may also occur with other disorders.
Diagnosis involves testing and evaluation during which it is determined if the scores/performance are "substantially below" developmental expectations and if they "significantly" interfere with academic achievement, social interactions and daily living. This assessment may also determine if the characteristic is deviant or delayed. Therefore, it may be possible for an individual to have communication challenges but not meet the criteria of being "substantially below" criteria of the DSM IV-TR.
It should also be noted that the DSM diagnoses do not comprise a complete list of all communication disorders, for example, auditory processing disorder is not classified under the DSM or ICD-10.
The following diagnoses are included in the communication disorders:
- Expressive language disorder – Characterized by difficulty expressing oneself beyond simple sentences and a limited vocabulary. An individual understands language better than their ability to use it; they may have a lot to say but have difficulties organizing and retrieving the words to get an idea across beyond what is expected for their developmental stage.
- Mixed receptive-expressive language disorder – problems comprehending the commands of others.
- Stuttering – a speech disorder characterized by a break in fluency, where sounds, syllables or words may be repeated or prolonged.
- Phonological disorder – a speech sound disorder characterized by problems in making patterns of sound errors, i.e. "dat" for "that".
- Communication disorder NOS (not otherwise specified) – the DSM-IV diagnosis in which disorders that do not meet the specific criteria for the disorder listed above may be classified.
LBLD can be an enduring problem. Some people might experience overlapping learning disabilities that make improvement problematic. Others with single disabilities often show more improvement. Most subjects can achieve literacy via coping mechanisms and education.
Dyslexic children require special instruction for word analysis and spelling from an early age. While there are fonts that may help people with dyslexia better understand writing, this might simply be due to the added spacing between words. The prognosis, generally speaking, is positive for individuals who are identified in childhood and receive support from friends and family.
Special education classes are the primary treatment. These classes focus on activities that sustain growth in language skills. The foundation of this treatment is repetition of oral, reading and writing activities. Usually the SLP, psychologist and the teacher work together with the children in small groups in the class room.
Another treatment is looking at a child's needs through the Individual Education Plan (IEP). In this program teachers and parents work together to monitor the progress of the child's comprehensive, verbal, written, social, and motor skills in school and in the home. Then the child goes through different assessments to determine his/her level. The level that the child is placed in will determine the class size, number of teachers, and the need for therapy.
Disorders and tendencies included and excluded under the category of communication disorders may vary by source. For example, the definitions offered by the American Speech–Language–Hearing Association differ from that of the Diagnostic Statistical Manual 4th edition (DSM-IV).
Gleanson (2001) defines a communication disorder as a speech and language disorder which refers to problems in communication and in related areas such as oral motor function. The delays and disorders can range from simple sound substitution to the inability to understand or use their native language.
In general, communications disorders commonly refer to problems in speech (comprehension and/or expression) that significantly interfere with an individual’s achievement and/or quality of life. Knowing the operational definition of the agency performing an assessment or giving a diagnosis may help.
Persons who speak more than one language or are considered to have an accent in their location of residence do not have speech disorders if they are speaking in a manner consistent with their home environment or a blending of their home and foreign environment.
Treatment for dysgraphia varies and may include treatment for motor disorders to help control writing movements. The use of occupational therapy can be effective in the school setting, and teachers should be well informed about dysgraphia to aid in carry-over of the occupational therapist's interventions. Treatments may address impaired memory or other neurological problems. Some physicians recommend that individuals with dysgraphia use computers to avoid the problems of handwriting. Dysgraphia can sometimes be partially overcome with appropriate and conscious effort and training. The International Dyslexia Association suggests the use of kinesthetic memory through early training by having the child overlearn how to write letters and to later practice writing with their eyes closed or averted to reinforce the feel of the letters being written. They also suggest teaching the students cursive writing as it has fewer reversible letters and can help lessen spacing problems, at least within words, because cursive letters are generally attached within a word.
Diagnosing dysgraphia can be challenging but can be done at facilities specializing in learning disabilities. It is suggested that those who believe they may have dysgraphia seek a qualified clinician to be tested. Clinicians will have the client self-generate written sentences and paragraphs, and copy age-appropriate text. They will assess the output of writing, as well as observe the client's posture while writing, their grip on the writing instrument, and will ask the client to either tap their finger or turn their wrists repeatedly to assess fine motor skills.
Studies have failed to find clear evidence that language delay can be prevented by training or educating health care professionals in the subject. Overall, some of the reviews show positive results regarding interventions in language delay, but are not curative. (Commentary - Early Identification of Language Delays, 2005)
Since this syndrome is very rare, it takes a multidisciplinary team to evaluate the syndrome and diagnose it, including speech-language pathologists, neurolinguists, neurologists, neuropsychologists, and psychologists. In 2010, Verhoeven and Mariën identified several subtypes of Foreign Accent Syndrome. They described a neurogenic, developmental, psychogenic and mixed variant. Neurogenic FAS is the term used when FAS occurs after central nervous system damage. Developmental FAS is used when the accent is perceptible as of an early age, e.g. children who have always spoken with an accent. Psychogenic FAS is used when FAS is psychologically induced, associated with psychiatric disorder or clear psychiatric traits. The term mixed FAS is used when patients develop the disorder after neurological damage, but the accent change has such a profound impact on the self-perception and identity that they will modify or enhance the accent to make it fit with the new persona. Hence, there is a psychological component.
Diagnosis, up until today, is generally purely perceptually based. However, in order to find out what subtype the patient is suffering from, complementary investigations are necessary. This differentiation is necessary for the clinician to allow for correct therapeutic guidance. Psychological evaluations may be performed in order to rule out any psychiatric condition that may be causing the change in speech, as well as tests to assess reading, writing, and language comprehension in order to identify comorbid disorders often co-occurring with the disorder. One of the symptoms of this syndrome is that the patient moves their tongue or jaw differently while speaking, which creates a different sound, so a recording is done of the speech pattern in order to analyze it. Often images of the brain are taken with either MRI, CT, SPECT or PET scans. This is done in order to see if there is structural and or functional damage in the areas of the brain that control speech and/or rhythm and melody of speech. EEG is sometimes performed to investigate whether there are disturbances at the electrophysiological level.
An expressive language disability or delay in kindergarten age children is classified as a Communication Disability/Delay under a Code 30. If there is no marked improvement in the child's ability to express themselves verbally once the student enters Grade 1, a child can be given a Code 57 for a Communication Disability. This diagnosis must be given from a Speech-Language Pathologist in order for the child to receive continued special education funding.
Children who demonstrate deficiencies early in their speech and language development are at risk for continued speech and language issues throughout later childhood. Similarly, even if these speech and language problems have been resolved, children with early language delay are more at risk for difficulties in phonological awareness, reading, and writing throughout their lives. Children with mixed receptive-expressive language disorder are often likely to have long-term implications for language development, literacy, behavior, social development, and even mental health problems. If suspected of having a mixed receptive-expressive language disorder, treatment is available from a speech therapist or pathologist. Most treatments are short term, and rely upon accommodations made within the environment, in order to minimize interfering with work or school. Programs that involve intervention planning that link verbal short term memory with visual/non-verbal information may be helpful for these children. In addition, approaches such as parent training for language stimulation and monitoring language through the "watch and see" method are recommended. The watch-and-see technique advises children with mixed receptive-expressive language disorder who come from stable, middle-class homes without any other behavioral, medical, or hearing problems should be vigilantly monitored rather than receive intervention. It is often the case that children do not meet the eligibility criteria established through a comprehensive oral language evaluation; and as a result, are not best suited for early intervention programs and require a different approach besides the "one size fits all" model.
A consortium of academic clinicians and scientists was convened in 2013 to develop more defined diagnostic guidelines for this disorder in anticipation of furthering research, clinical trials, and clinical care for this patient subgroup. A second consortium meeting was convened at NIMH in 2014 to develop preliminary treatment guidelines. The following are the members of the PRC
At the time of first PANS presentation, note any family history of pharyngitis, impetigo, perianal dermatitis, and GAS infections. If possible, family members should have a throat swab cultured for GAS. Ongoing vigilance against GAS infections in any of the patient’s close contacts is important, as symptom exacerbations have been reported following exposure to a sibling with GAS (even when the PANDAS patient had no evidence of infection). Prompt medical attention to symptoms suggestive of streptococcal infection is important not only to protect the patient, but also siblings, who may be at an increased genetic risk for PANS.
Students diagnosed with an expressive language disability usually qualify for extra educational supports and assistance in school.
Mixed receptive-expressive language disorder (DSM-IV 315.32) is a communication disorder in which both the receptive and expressive areas of communication may be affected in any degree, from mild to severe. Children with this disorder have difficulty understanding words and sentences. This impairment is classified by deficiencies in expressive and receptive language development that is not attributed to sensory deficits, nonverbal intellectual deficits, a neurological condition, environmental deprivation or psychiatric impairments. Research illustrates that 2% to 4% of 5 year olds have mixed receptive-expressive language disorder. This distinction is made when children have issues in expressive language skills, the production of language, and when children also have issues in receptive language skills, the understanding of language. Those with mixed receptive-language disorder have a normal left-right anatomical asymmetry of the planum temporale and parietale. This is attributed to a reduced left hemisphere functional specialization for language. Taken from a measure of cerebral blood flow (SPECT) in phonemic discrimination tasks, children with mixed receptive-expressive language disorder do not exhibit the expected predominant left hemisphere activation. Mixed receptive-expressive language disorder is also known as receptive-expressive language impairment (RELI) or receptive language disorder.
There are some common problems not related to dysgraphia but often associated with dysgraphia, the most common of which is stress. Often children (and adults) with dysgraphia will become extremely frustrated with the task of writing (and spelling); younger children may cry, pout, or refuse to complete written assignments. This frustration can cause the child (or adult) a great deal of stress and can lead to stress-related illnesses. This can be a result of any symptom of dysgraphia.
Diagnosis may be clinical if associated with dementia and other etiologies. In cases caused by stroke, MRI will show a corresponding stroke in the inferior parietal lobule. In the acute stage, this will be bright (restricted diffusion) on the DWI sequence and dark at the corresponding area on the ADC sequence.
Sensory processing sensitivity (SPS), a personality trait, a high measure of which defines a highly sensitive person (HSP), has been described as having hypersensitivity to external stimuli, a greater depth of cognitive processing, and high emotional reactivity. The terms SPS and HSP were coined in the mid-1990s by psychologists Elaine Aron and husband Arthur Aron, with SPS being measured by Aron's Highly Sensitive Person Scale (HSPS) questionnaire. Other researchers have applied various other terms to denote this responsiveness to stimuli that is evidenced in humans and other species.
According to the Arons and colleagues, people with high SPS comprise about 15–20% of the population and are thought to process sensory data more deeply due to the nature of their central nervous system. Although many researchers consistently related high SPS to negative outcomes, Aron and colleagues state that high SPS is a personality trait and not a disorder; other researchers have associated it with increased responsiveness to both positive and negative influences.
Speech therapy is usually the most common treatment for asemia. Speech therapy allows the patient to be able to improve their speaking, comprehension, and writing skills. These patients have to learn all of these skills again since they are unable to understand or express anything. It usually depends on how long it takes for the speech therapy to work. If the condition is less severe, it will take less time, such as perhaps a couple of months to years. If the condition is more severe, it may take many years. The way speech therapy works is through speech practice as well as using special computer programs which let the patient practice their communication skills. By using simple and short sentences or writing down these phrases can aid the patients while going through therapy. Giving them enough time to communicate with their friends, family, or therapist will help them increase their skills and be able to manage them.
Complete success is usually achieved with treatment. However, sometimes only partial success is achieved and the patient cannot fully comprehend everything. With the partial restoration of some skills, the speech therapist may only focus on the skills which can be restored. In other cases, the therapist may work on the skills which may not retrieved and teach the patient how to handle those.