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Implications  of  Turner Implications  of  Turner

Implications of Turner - PowerPoint Presentation

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Implications of Turner - PPT Presentation

Syndrome Challenges in the School Suzanne Bousquet PhD Executive Director School of Psychology Kean University Turner syndrome affects approximately 1 out of every 2000 female live births worldwide ID: 710144

turner girls cognitive syndrome girls turner syndrome cognitive verbal weaknesses provide visual social memory implications school difficulty classroom test

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Slide1

Implications of Turner Syndrome: Challenges in the School

Suzanne

Bousquet

,

Ph.D.

Executive Director, School of Psychology

Kean UniversitySlide2

Turner syndrome affects approximately 1 out of every 2,000 female live births worldwide. Each year 800 new cases are diagnosed in the United States alone.

At least 60,000 American females have Turner Syndrome.

If the average classroom size is 24, and if 12 of the 24 students are girls, then there will be one girl with Turner Syndrome (diagnosed or undiagnosed) in every 160 classrooms at any one time.

Turner Syndrome StatisticsSlide3

Just as there is great diversity in the physical implications of Turner Syndrome (e.g., the presence of cardiac problems), there is great diversity in the cognitive issues related to TS.

Due to varied cognitive issues, girls with Turner Syndrome easily “fly beneath the radar” of educators.

Diverse Cognitive ProfilesSlide4

The hallmark cognitive phenotype of TS is significantly higher Verbal IQ scores than Performance IQ scores (aka Nonverbal Learning Disorder).

However, not all girls with TS show this cognitive

phenotype.Moreover, not all girls with TS who have this profile have comparable degrees of verbal strengths and non-verbal weaknesses.

Turner Syndrome Cognitive PhenotypeSlide5

Neuroimaging studies have reported both anatomical and functional differences between girls with TS and age-matched controls in the following areas: Parietal Cortices

Dorsolateral Prefrontal Cortices

Superior Temporal GyrusHippocampal FormationAmygdalaTemporal Lobes

Turner Syndrome: Brain Development Slide6

Specific brain involvement is further supported by the distinct neurocognitive profile found in girls with TS:Unlike many chromosomal disorders, Turner Syndrome is not associated with mental retardation.

Normal Verbal Abilities

Impaired Visual Spatial AbilitiesImpaired Working MemoryImpaired Executive FunctionsImpaired Attentional Focus

Turner Syndrome: Cognitive Functioning Slide7

The Verbal-Performance IQ split does not provide sufficient specific information about the cognitive strengths and weaknesses.Many of which researchers still do not fully understand.

Interestingly, the variation in full scale IQ scores among girls with TS parallels the variation seen in their own mothers (who do not have TS).

Verbal IQ at same level or higher than mothersPerformance IQ always lower than mothersThis means that mother’s IQ partially predict daughter’s IQ scores.

Implications of Cognitive Phenotype and Brain Functions?Slide8

Girls with TS:perform at par or above peers in word recognition, reading and spelling; some girls are described as avid readers.

have well-developed phonological processing skills, word knowledge, verbal comprehension and verbal reasoning.

relative strength in simple arithmetic, number comprehension and productivity, number comparison, and estimation accuracy.

Cognitive Strengths in Turner SyndromeSlide9

Girls with TS are often diagnosed with Math Learning Disorder.Difficulties are not related to poor number sense or calculation accuracy and are independent of spatial skills.Exactly what is the issue with Math?

Processing Speed

Girls with TS are slower on arithmetic fact retrieval and response times on calculation and estimation problems.

Cognitive Weaknesses in Turner

Syndrome: MathematicsSlide10

One Minute Test Name __________________      Test 1 Sums to 106 + 2 = _____ 5 + 2 = _____ 7 + 1 = _____

1 + 9 = _____ 5 + 5 = _____ 2 + 4 = _____

7 + 2 = _____ 9 + 0 = _____ 8 + 2 = _____ 7 + 3 = _____ 4 + 6 = _____ 1 + 5 = _____ 2 + 3 = _____ 3 + 3 = _____ 5 + 3 = _____ 4 + 4 = _____ 4 + 2 = _____ 5 + 4 = _____

3 + 4 = _____ 8 + 1 = _____ 9 + 8 = _____

Speeded Math

Test ExampleSlide11

Girls with TS have difficulty with:visuoperceptual, and

visuoconstructional

tasks visual-motor integrationcopying from the chalkboardVisuoperception

deficits are apparent on object identification and location identification tasks.

Visuoconstructional

deficits are apparent on tasks that involve visual working memory, as well as processing speed.

Cognitive Weaknesses in Turner Syndrome:

Visuospatial

DeficitsSlide12

Mental Rotation TaskSlide13

Girls with TS have difficulty with:Both working memory and long-term visual memory.

Difficulty recognizing and recalling shapes and sequences.

Girls with TS perform better on tasks involving visual working memory when they “talk themselves” through the task.Cognitive Weaknesses in Turner Syndrome: MemorySlide14

Types of stimuli used to test

visual working memorySlide15

Presentation 1Slide16

Presentation 2Slide17
Slide18
Slide19

Girls with TS have weaknesses in:Their ability to plan, organize, monitor and execute multi-step problem-solving

Managing materials

Following directionsInitiating tasksCognitive flexibilityThey do have the ability to plan and organize steps toward a goal, however, their poor search strategies, speed of responding, and cognitive inflexibility interfere with reaching the goal.

Cognitive Weaknesses in Turner Syndrome: Executive FunctionSlide20

In one minute, name as many animals as you can think of?In one minute, state as many words you can think of that start with the letter “S”?

Note: Girls with TS are noted to have difficult with verbal fluency tasks

Quick and Easy Executive Function TestSlide21

There is an increased incidence of attention-deficit/hyperactivity disorder (ADHD) among girls with TS versus children in the general population.Remains to be seen if cognitive profiles and treatment response patterns in TS are similar to typical ADHD

(i.e. treatment implications are complicated in TS by growth disturbances).

Some researchers propose that increased incidence of ADHD Combined Type, which is mostly reported in boys versus girls in the general population, may be attributed to both girls with TS and boys only having one X chromosome. Cognitive Weaknesses in Turner Syndrome:

Attentional

FocusSlide22

Trail Making Test ExampleSlide23

Girls with TS may show difficulty interacting with their peers. Some research has shown that there are specific deficits in immediate memory for faces. It may take longer to encode a face and interpret facial emotions. This can impact everyday social communication.Some researchers argue that girls with TS have difficulty reading facial expressions that connote emotions, especially fear.

Because of deficits in visual attention, subtle social cues may escape the notice of a girl with TS.

Cognitive Weaknesses in Turner Syndrome: Social CognitionSlide24

Girls with TS appear physically younger than their age mates. A contemporary phenomenon, called “Grow Older Younger,” as exemplified in fashion, and cultural icons, may mean that girls with TS are seen as less desirable for friend selection. Adolescent girls with TS begin dating later than other adolescents. Sexual activity also begins later for girls with TS.

Some may struggle with low self-esteem and higher rate of lifetime depression.

Possible physical differences associated with TS may compound these issues.Social Cognition ContinuedSlide25

Prepare student for the daily routine and changes immediately when entering the school. Give parents the next day’s routine prior to coming to school.Place in small group math class or provide support for large classroom instruction and assignments.

Introduce new activities one step at a time to minimize frustration.

Provide opportunities for cooperative work with good role models.Allow student to work on the floor when appropriate.Classroom Implications and Recommendations for Younger ChildrenSlide26

Provide assignment notebook and assist with completion.Instruct with specific verbal cues and written reminders.Provide a copy of material and notes from the chalkboard.

Provide binder with dividers or multi-colored folders for each subject.

Verbally point out individual objects and how they relate to the whole.Limit amount of problems or questions on a page and use consistent format. Classroom Implications and Recommendations for Older ChildrenSlide27

Teach memory and comprehension strategies.Reinforce verbal strengths with class discussion and cooperative group activities.Encourage use of word processor for writing.

Allow extra time for work completion and test taking.

Placement in more functional academic programs instead of higher level courses.Be sensitive to the tendency of feeling “overloaded”.

Classroom Implications and Recommendations for Older ChildrenSlide28

Provide opportunities to “shine” in strength areas in the classroom.

Verbally explain humor and commonly misinterpreted sayings.

Provide non-threatening interaction with peers.Involve school counselor or social worker to provide direct instruction in social skills and problem solving.

Encourage positive peer interaction in and outside of school.

Overall, focus on the child’s strengths, but acknowledge areas of growth needed.

Classroom Implications and Recommendations for SocializationSlide29

Girls with Turner Syndrome have:normal intelligence.

Impairments in motor skills, visual-motor coordination, and visualizing objects in relation to each other. This type of impairment is termed nonverbal learning disability (NVLD), which is manifested by a discrepancy between verbal and performance IQ scores with verbal scores being higher.

difficulty with mathematics, tasks requiring manual dexterity, and poor directional sense (i.e., difficulty with left and right). understanding social and nonverbal cues which may lead to social immaturity.

Summary of Cognitive FunctioningSlide30

There is need for a COLLABORATIVE INTERDISCIPLINARY approach TO identify TS girls and to PROVIDE EFFECTIVE INTERVENTIONS

Teachers – General Ed and Special Ed

School NursesSchool PsychologistsSpeech Pathologists, Audiologists

Playground Aids, Girl Scout Leaders, and Others Who Interact Regularly with GirlsSlide31

These patterns of cognitive strengths and weaknesses are seen in a high percentage of Turner Syndrome. Consequently, it may be beneficial for girls to have academic and psychological testing early on so parents and teachers can help girls compensate.

Clearly these young women face many challenges in living with such a disorder. Though they may have increased health risks and face some learning difficulties, with proper treatments and counseling, all evidence suggests these girls can live full, healthy lives.

Early diagnosis is critical for these girls to develop to their full potential.

Conclusion