What are sources of information and support?
Susan
Susan was promoted to the sixth grade but still couldn't do basic math. So, her mother brought her to a private clinic for testing. The clinician observed that Susan had trouble associating symbols with their meaning, and this was holding back her language, reading, and math development. Susan called objects by the wrong words and she could not associate sounds with letters or recognize math symbols. However, an IQ of 128 meant that Susan was quite bright. In addition to developing an Individualized Education Plan, the clinician recommended that Susan receive counseling for her low self-esteem and depression.
Wallace
In the early 1960s, at the request of his ninth grade teacher, Wallace was examined by a doctor to see why he didn't speak or listen well. The doctor tested his vocal cords, vision, and hearing. They were all fine. The teacher concluded that Wallace must have "brain damage," so not much could be done. Wallace kept failing in school and was suspended several times for fighting. He finally dropped out after tenth grade. He spent the next 25 years working as a janitor. Because LD frequently went undiagnosed at the time when Wallace was young, the needed help was not available to him.
Dennis
In fifth grade, Dennis' teacher sent him to the school psychologist for testing. Dennis was diagnosed as having developmental reading and developmental writing disorders. He was also identified as having an attention disorder with hyperactivity. He was placed in an all-day special education program, where he could work on his particular deficits and get individual attention. His family doctor prescribed the medication Ritalin to reduce his hyperactivity and distractibility. Along with working to improve his reading, the special education teacher helped him improve his listening skills. Since his handwriting was still poor, he learned to type homework and reports on a computer. At age 19, Dennis graduated from high school and was accepted by a college that gives special assistance to students with learning disabilities.
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The first step in solving any problem is realizing there is one. Wallace, sadly, was a product of his time, when learning disabilities were more of a mystery and often went unrecognized. Today, professionals would know how to help Wallace. Dennis and Susan were able to get help because someone saw the problem and referred them for help.
When a baby is born, the parents eagerly wait for the baby's first step, first word, a myriad of other "firsts." During routine checkups, the pediatrician, too, watches for more subtle signs of development. The parents and doctor are watching for the child to achieve developmental milestones. The developmental milestones chart (omitted here; see page 18 of brochure) lists a few of these markers and the ages and grades that they typically appear.
Parents are usually the first to notice obvious delays in their child reaching early milestones. The pediatrician may observe more subtle signs of minor neurological damage, such as a lack of coordination. But the classroom teacher, in fact, may be the first to notice the child's persistent difficulties in reading, writing, or arithmetic. As school tasks become more complex, a child with a learning disability may have problems mentally juggling more information.
The learning problems of children who are quiet and polite in school may go unnoticed. Children with above average intelligence, who manage to maintain passing grades despite their disability, are even less likely to be identified. Children with hyperactivity, on the other hand, will be identified quickly by their impulsive behavior and excessive movement. Hyperactivity usually begins before age 4 but may not be recognized until the child enters school.
What should parents, doctors, and teachers do if critical developmental milestones haven't appeared by the usual age? Sometimes it's best to allow a little more time, simply for the brain to mature a bit. But if a milestone is already long delayed, if there's a history of learning disabilities in the family, or if there are several delayed kills, the child should be professionally evaluated as soon as possible. An educator or a doctor who treats children can suggest where to go for help.
By law, learning disability is defined as a significant gap between a person's intelligence and the skills the person has achieved at each age. This means that a severely retarded 10-year-old who speaks like a 6-year-old probably doesn't have a language or speech disability. He has mastered language up to the limits of his intelligence. On the other hand, a fifth grader with an IQ of 100 who can't write a simple sentence probably does have LD.
Learning disorders may be informally flagged by observing significant delays in the child's skill development. A 2-year delay in the primary grades is usually considered significant. For older students, such a delay is not as debilitating, so learning disabilities aren't usually suspected unless there is more than a 2-year delay. Actual diagnosis of learning disabilities, however, is made using standardized tests that compare the child's level of ability to what is considered normal development for a person of that age and intelligence.
For example, as late as fifth grade, Susan couldn't add two numbers, even though she rarely missed school and was good in other subjects. Her mother took her to a clinician, who observed Susan's behavior and administered standardized math and intelligence tests. The test results showed that Susan's math skills were several years behind, given her mental capacity for learning. Once other possible causes like lack of motivation and vision problems were ruled out, Susan's math problem was formally diagnosed as a specific learning disability.
Test outcomes depend not only on the child's actual abilities, but on the reliability of the test and the child's ability to pay attention and understand the questions. Children like Dennis, with poor attention or hyperactivity, may score several points below their true level of ability. Testing a child in an isolated room can sometimes help the child concentrate and score higher.
Each type of LD is diagnosed in slightly different ways. To diagnose speech and language disorders, a speech therapist tests the child's pronunciation, vocabulary, and grammar and compares them to the developmental abilities seen in most children that age. A psychologist tests the child's intelligence. A physician checks for any ear infections, and an audiologist may be consulted to rule out auditory problems. If the problem involves articulation, a doctor examines the child's vocal cords and throat.
In the case of academic skills disorders, academic development in reading, writing, and math is evaluated using standardized tests. In addition, vision and hearing are tested to be sure the student can see words clearly and can hear adequately. The specialist also checks if the child has missed much school. It's important to rule out these other possible factors. After all, treatment for a learning disability is very different from the remedy for poor vision or missing school.
ADHD is diagnosed by checking for the long-term presence of specific behaviors, such as considerable fidgeting, losing things, interrupting, and talking excessively. Other signs include an inability to remain seated, stay on task, or take turns. A diagnosis of ADHD is made only if the child shows such behaviors substantially more than other children of the same age.
If the school fails to notice a learning delay, parents can request an outside evaluation. In Susan's case, her mother chose to bring Susan to a clinic for testing. She then brought documentation of the disability back to the school. After confirming the diagnosis, the public school was obligated to provide the kind of instructional program that Susan needed.
Parents should stay abreast of each step of the school's evaluation. Parents also need to know that they may appeal the school's decision if they disagree with the findings of the diagnostic team. And like Susan's mother, who brought Susan to a clinic, parents always have the option of getting a second opinion.
Some parents feel alone and confused when talking to learning specialists. Such parents may find it helpful to ask someone they like and trust to go with them to school meetings. The person may be the child's clinician or caseworker, or even a neighbor. It can help to have someone along who knows the child and can help understand the child's test scores or learning problems.
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Although obtaining a diagnosis is important, even more important is creating a plan for getting the right help. Because LD can affect the child and family in so many ways, help may be needed on a variety of fronts: educational, medical, emotional, and practical.
In most ways, children with learning disabilities are no different from children without these disabilities. At school, they eat together and share sports, games, and after-school activities. But since children with learning disabilities do have specific learning needs, most public schools provide special programs.
Schools typically provide special education programs either in a separate all-day classroom or as a special education class that the student attends for several hours each week. Some parents hire trained tutors to work with their child after school. If the problems are severe, some parents choose to place their child in a special school for the learning disabled.
If parents choose to get help outside the public schools, they should select a learning specialist carefully. The specialist should be able to explain things in terms that the parents can understand. Whenever possible, the specialist should have professional certification and experience with the learner's specific age group and type of disability. Some of the support groups listed at the end of this booklet can provide references to qualified special education programs.
Planning a special education program begins with systematically identifying what the student can and cannot do. The specialist looks for patterns in the child's gaps. For example, if the child fails to hear the separate sounds in words, are there other sound discrimination problems? If there's a problem with handwriting, are there other motor delays? Are there any consistent problems with memory?
Special education teachers also identify the types of tasks the child can do and the senses that function well. By using the senses that are intact and bypassing the disabilities, many children can develop needed skills. These strengths offer alternative ways the child can learn.
After assessing the child's strengths and weaknesses, the special education teacher designs an Individualized Educational Program (IEP). The IEP outlines the specific skills the child needs to develop as well as appropriate learning activities that build on the child's strengths. Many effective learning activities engage several skills and senses. For example, in learning to spell and recognize words, a student may be asked to see, say, write, and spell each new word. The student may also write the words in sand, which engages the sense of touch. Many experts believe that the more senses children use in learning a skill, the more likely they are to retain it.
An individualized, skill-based approach--like the approach used by speech and language therapists--often succeeds in helping where regular classroom instruction fails. Therapy for speech and language disorders focuses on providing a stimulating but structured environment for heating and practicing language patterns. For example, the therapist may help a child who has an articulation disorder to produce specific speech sounds. During an engaging activity, the therapist may talk about the toys, then encourage the child to use the same sounds or words. In addition, the child may watch the therapist make the sound, feel the vibration in the therapist's throat, then practice making the sounds before a mirror.
Researchers are also investigating nonstandard teaching methods. Some create artificial learning conditions that may help the brain receive information in nonstandard ways. For example, in some language disorders, the brain seems abnormally slow to process verbal information. Scientists are testing whether computers that talk can help teach children to process spoken sounds more quickly. The computer starts slowly, pronouncing one sound at a time. As the child gets better at recognizing the sounds and heating them as words, the sounds are gradually speeded up to a normal rate of speech.
For nearly six decades, many children with attention disorders have benefited from being treated with medication. Three drugs, Ritalin (methylphenidate), Dexedrine (dextroamphetamine), and Cylert (pemoline), have been used successfully. Although these drugs are stimulants in the same category as "speed" and "diet pills," they seldom make children "high" or more jittery. Rather, they temporarily improve children's attention and ability to focus. They also help children control their impulsiveness and other hyperactive behaviors.
The effects of medication are most dramatic in children with ADHD. Shortly after taking the medication, they become more able to focus their attention. They become more ready to learn. Studies by NIMH scientists and other researchers have shown that at least 90 percent of hyperactive children can be helped by either Ritalin or Dexedrine. If one medication does not help a hyperactive child to calm down and pay attention in school, the other medication might.
The drugs are effective for 3 to 4 hours and move out of the body within 12 hours. The child's doctor or a psychiatrist works closely with the family and child to carefully adjust the dosage and medication schedule for the best effect. Typically, the child takes the medication so that the drug is active during peak school hours, such as when reading and math are taught.
In the past few years, researchers have tested these drugs on adults who have attention disorders. Just as in children, the results show that low doses of these medications can help reduce distractibility and impulsivity in adults. Use of these medications has made it possible for many severely disordered adults to organize their lives, hold jobs, and care for themselves.
In trying to do everything possible to help their children, many parents have been quick to try new treatments. Most of these treatments sound scientific and reasonable, but a few are pure quackery. Many are developed by reputable doctors or specialists--but when tested scientifically, cannot be proven to help. Following are types of therapy that havenot proven effective in treating the majority of children with learning disabilities or attention disorders:
- Megavitamins
- Colored lenses
- Special diets
- Sugar-free diets
- Body stimulation or manipulation
Although scientists hope that brain research will lead to new medical interventions and drugs, at present there are no medicines for speech, language, or academic disabilities.
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The effects of learning disabilities can ripple outward from the disabled child or adult to family, friends, and peers at school or work.
Children with LD often absorb what others thoughtlessly say about them. They may define themselves in light of their disabilities, as "behind," "slow," or "different."
Sometimes they don't know how they're different, but they know how awful they feel. Their tension or shame can lead them to act out in various ways--from withdrawal to belligerence. Like Wallace, they may get into fights. They may stop trying to learn and achieve and eventually drop out of school. Or, like Susan, they may become isolated and depressed.
Children with learning disabilities and attention disorders may have trouble making friends with peers. For children with ADHD, this may be due to their impulsive, hostile, or withdrawn behavior. Some children with delays may be more comfortable with younger children who play at their level. Social problems may also be a product of their disability. Some people with LD seem unable to interpret tone of voice or facial expressions. Misunderstanding the situation, they act inappropriately, turning people away.
Without professional help, the situation can spiral out of control. The more that children or teenagers fail, the more they may act out their frustration and damage their self-esteem. The more they act out, the more trouble and punishment it brings, further lowering their self-esteem. Wallace, who lashed out when teased about his poor pronunciation and was repeatedly suspended from school, shows how harmful this cycle can be.
Having a child with a learning disability may also be an emotional burden for the family. Parents often sweep through a range of emotions: denial, guilt, blame, frustration, anger, and despair. Brothers and sisters may be annoyed or embarrassed by their sibling, or jealous of all the attention the child with LD gets.
Counseling can be very helpful to people with LD and their families. Counseling can help affected children, teenagers, and adults develop greater self-control and a more positive attitude toward their own abilities. Talking with a counselor or psychologist also allows family members to air their feelings as well as get support and reassurance.
Many parents find that joining a support group also makes a difference. Support groups can be a source of information, practical suggestions, and mutual understanding. Self-help books written by educators and mental health professionals can also be helpful. A number of references and support groups are listed at the end of this booklet.
Behavior modification also seems to help many children with hyperactivity and LD. In behavior modification, children receive immediate, tangible rewards when they act appropriately. Receiving an immediate reward can help children learn to control their own actions, both at home and in class. A school or private counselor can explain behavior modification and help parents and teachers set up appropriate rewards for the child.
Parents and teachers can help by structuring tasks and environments for the child in ways that allow the child to succeed. They can find ways to help children build on their strengths and work around their disabilities. This may mean deliberately making eye contact before speaking to a child with an attention disorder. For a teenager with a language problem, it may mean providing pictures and diagrams for performing a task. For students like Dennis with handwriting or spelling problems, a solution may be to provide a word processor and software that checks spelling. A counselor or school psychologist can help identify practical solutions that make it easier for the child and family to cope day by day.
Every child needs to grow up feeling competent and loved. When children have learning disabilities, parents may need to work harder at developing their children's self-esteem and relationship-building skills. But self-esteem and good relationships are as worth developing as any academic skill.
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