What are sources of information and support?
Imagine having important needs and ideas to
communicate, but being unable to express them. Perhaps feeling bombarded by
sights and sounds, unable to focus your attention. Or trying to read or add
but not being able to make sense of the letters or numbers.
You may not need to imagine. You may be the
parent or teacher of a child experiencing academic problems, or have someone
in your family diagnosed as learning disabled. Or possibly as a child you
were told you had a reading problem called dyslexia or some other learning
handicap.
Although different from person to person,
these difficulties make up the common daily experiences of many learning
disabled children, adolescents, and adults. A person with a learning
disability may experience a cycle of academic failure and lowered
self-esteem. Having these handicaps--or living with someone who has
them--can bring overwhelming frustration.
But the prospects are hopeful. It is
important to remember that a person with a learning disability can learn.
The disability usually only affects certain limited areas of a child's
development. In fact, rarely are learning disabilities severe enough to
impair a person's potential to live a happy, normal life.
This booklet is provided by the National
Institute of Mental Health (NIMH), the Federal agency that supports research
nationwide on the brain, mental illnesses, and mental health. Scientists
supported by NIMH are dedicated to understanding the workings and
interrelationships of the various regions of the brain, and to finding
preventions and treatments to overcome brain dysfunctions that handicap
people in school, work, and play.
The booklet provides up--to-date information
on learning disabilities and the role of NIMH-sponsored research in
discovering underlying causes and effective treatments. It describes
treatment options, strategies for coping, and sources of information and
support. Among these sources are doctors, special education teachers, and
mental health professionals who can help identify learning disabilities and
recommend the right combination of medical, psychosocial, and educational
treatment.
In this booklet, you'll also read the
stories of Susan, Wallace, and Dennis, three people who have learning
disabilities. Although each had a rough start, with help they learned to
cope with their handicaps. You'll see their early frustrations, their steps
toward getting help, and their hopes for the future.
The stories of Susan, Wallace, and Dennis
are representative of people with learning disabilities, but the characters
are not real. Of course, people with learning disabilities are not all
alike, so these stories may not fit any particular individual.
Susan
At age 14, Susan still tends to be quiet.
Ever since she was a child, she was so withdrawn that people sometimes
forgot she was there. She seemed to drift into a world of her own. When she
did talk, she often called objects by the wrong names. She had few friends
and mostly played with dolls or her little sister. In school, Susan hated
reading and math because none of the letters, numbers or "+" and "-" signs
made any sense. She felt awful about herself. She'd been told--and was
convinced--that she was retarded.
Wallace
Wallace has lived 46 years, and still has
trouble understanding what people say. Even as a boy, many words sounded
alike. His father patiently said things over and over. But whenever his
mother was drunk, she flew into a rage and spanked him for not listening.
Wallace's speech also came out funny. He had such problems saying words that
in school his teacher sometimes couldn't understand him. When classmates
called him a "dummy," his fists just seemed to take over.
Dennis
Dennis is 23 years old and still seems to
have too much energy. But he had always been an overactive boy, sometimes
jumping on the sofa for hours until he collapsed with exhaustion. In grade
school, he never sat still. He interrupted lessons. But he was a friendly,
well-meaning kid, so adults didn't get too angry. His academic problems
became evident in third grade, when his teacher realized that Dennis could
only recognize a few words and wrote like a first grader. She recommended
that Dennis repeat third grade, to give him time to "catch up." After
another full year, his behavior was still out of control, and his reading
and writing had not improved.
Unlike other disabilities, such as paralysis
or blindness, a learning disability (LD) is a hidden handicap. A learning
disability doesn't disfigure or leave visible signs that would invite others
to be understanding or offer support. A woman once blurted to Wallace, "You
seem so intelligent--you don't look handicapped!"
LD is a disorder that affects people's
ability to either interpret what they see and hear or to link information
from different parts of the brain. These limitations can show up in many
ways--as specific difficulties with spoken and written language,
coordination, self-control, or attention. Such difficulties extend to
schoolwork and can impede learning to read or write, or to do math.
Learning disabilities can be lifelong
conditions that, in some cases, affect many parts of a person's life: school
or work, daily routines, family life, and sometimes even friendships and
play. In some people, many overlapping learning disabilities may be
apparent. Other people may have a single, isolated learning problem that has
little impact on other areas of their lives.
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"Learning disability" is not a diagnosis in
the same sense as "chickenpox" or "mumps." Chickenpox and mumps imply a
single, known cause with a predictable set of symptoms. Rather, LD is a
broad term that covers a pool of possible causes, symptoms, treatments, and
outcomes. Partly because learning disabilities can show up in so many forms,
it is difficult to diagnose or to pinpoint the causes. And no one knows of a
pill or remedy that will cure them.
Not all learning problems are necessarily
learning disabilities. Many children are simply slower in developing certain
skills. Because children show natural differences in their rate of
development, sometimes what seems to be a learning disability may simply be
a delay in maturation. To be diagnosed as a learning disability, specific
criteria must be met.
The criteria and characteristics for
diagnosing learning disabilities appear in a reference book called the DSM
(short for the Diagnostic and Statistical Manual of Mental Disorders).
The DSM diagnosis is commonly used when applying for health insurance
coverage of diagnostic and treatment services.
- Learning disabilities can be divided
into three broad categories:
- Developmental speech and language
disorders
- Academic skills disorders
- "Other," a catch-all that includes
certain coordination disorders and learning handicaps not covered by
the other terms
Each of these categories includes a number
of more specific disorders.
Developmental Speech and Language
Disorders
Speech and language problems are often the
earliest indicators of a learning disability. People with developmental
speech and language disorders have difficulty producing speech sounds, using
spoken language to communicate, or understanding what other people say.
Depending on the problem, the specific diagnosis may be:
-
- Developmental articulation disorder
- Developmental expressive language
disorder
- Developmental receptive language
disorder
Developmental Articulation Disorder
-- Children with this disorder may have trouble controlling their rate of
speech. Or they may lag behind playmates in learning to make speech sounds.
For example, Wallace at age 6 still said "wabbit" instead of "rabbit" and
"thwim" for "swim." Developmental articulation disorders are common. They
appear in at least 10 percent of children younger than age 8. Fortunately,
articulation disorders can often be outgrown or successfully treated with
speech therapy.
Developmental Expressive Language
Disorder -- Some children with language impairments have problems
expressing themselves in speech. Their disorder is called, therefore, a
developmental expressive language disorder. Susan, who often calls objects
by the wrong names, has an expressive language disorder. Of course, an
expressive language disorder can take other forms. A 4-year-old who speaks
only in two-word phrases and a 6-year-old who can't answer simple questions
also have an expressive language disability.
Developmental Receptive Language
Disorder -- Some people have trouble understanding certain aspects
of speech. It's as if their brains are set to a different frequency and the
reception is poor. There's the toddler who doesn't respond to his name, a
preschooler who hands you a bell when you asked for a ball, or the worker
who consistently can't follow simple directions. Their hearing is fine, but
they can't make sense of certain sounds, words, or sentences they hear. They
may even seem inattentive. These people have a receptive language disorder.
Because using and understanding speech are strongly related, many people
with receptive language disorders also have an expressive language
disability.
Of course, in preschoolers, some misuse of
sounds, words, or grammar is a normal part of learning to speak. It's only
when these problems persist that there is any cause for concern.
Academic Skills Disorders
Students with academic skills disorders are
often years behind their classmates in developing reading, writing, or
arithmetic skills. The diagnoses in this category include:
-
- Developmental reading disorder
- Developmental writing disorder
- Developmental arithmetic disorder
Developmental Reading Disorder
-- This type of disorder, also known as dyslexia, is quite widespread. In
fact, reading disabilities affect 2 to 8 percent of elementary school
children.
When you think of what is involved in the
"three R's"--reading, 'riting, and 'rithmetic--it's astounding that most of
us do learn them. Consider that to read, you must simultaneously:
-
- Focus attention on the printed
marks and control eye movements across the page
- Recognize the sounds associated
with letters
- Understand words and grammar
- Build ideas and images
- Compare new ideas to what you
already know
- Store ideas in memory
Such mental juggling requires a rich, intact
network of nerve cells that connect the brain's centers of vision, language,
and memory.
A person can have problems in any of the
tasks involved in reading. However, scientists found that a significant
number of people with dyslexia share an inability to distinguish or separate
the sounds in spoken words. Dennis, for example, can't identify the word
"bat" by sounding out the individual letters, b-a-t. Other children with
dyslexia may have trouble with rhyming games, such as rhyming "cat" with
"bat." Yet scientists have found these skills fundamental to learning to
read. Fortunately, remedial reading specialists have developed techniques
that can help many children with dyslexia acquire these skills.
However, there is more to reading than
recognizing words. If the brain is unable to form images or relate new ideas
to those stored in memory, the reader can't understand or remember the new
concepts. So other types of reading disabilities can appear in the upper
grades when the focus of reading shifts from word identification to
comprehension.
Developmental Writing Disorder
-- Writing, too, involves several brain areas and functions. The brain
networks for vocabulary, grammar, hand movement, and memory must all be in
good working order. So a developmental writing disorder may result from
problems in any of these areas. For example, Dennis, who was unable to
distinguish the sequence of sounds in a word, had problems with spelling. A
child with a writing disability, particularly an expressive language
disorder, might be unable to compose complete, grammatical sentences.
Developmental Arithmetic Disorder
-- If you doubt that arithmetic is a complex process, think of the steps you
take to solve this simple problem: 25 divided by 3 equals ?
Arithmetic involves recognizing numbers and
symbols, memorizing facts such as the multiplication table, aligning
numbers, and understanding abstract concepts like place value and fractions.
Any of these may be difficult for children with developmental arithmetic
disorders. Problems with numbers or basic concepts are likely to show up
early. Disabilities that appear in the later grades are more often tied to
problems in reasoning.
Many aspects of speaking, listening,
reading, writing, and arithmetic overlap and build on the same brain
capabilities. So it's not surprising that people can be diagnosed as having
more than one area of learning disability. For example, the ability to
understand language underlies learning speak. Therefore, any disorder that
hinders the ability to understand language will also interfere with the
development of speech, which in turn hinders learning to read and write. A
single gap in the brain's operation can disrupt many types of activity.
"Other" Learning Disabilities
The DSM also lists additional categories,
such as "motor skills disorders" and "specific developmental disorders not
otherwise specified." These diagnoses include delays in acquiring language,
academic, and motor skills that can affect the ability to learn, but do not
meet the criteria for a specific learning disability. Also included are
coordination disorders that can lead to poor penmanship, as well as certain
spelling and memory disorders.
Attention Disorders
Nearly 4 million school-age children have
learning disabilities. Of these, at least 20 percent have a type of disorder
that leaves them unable to focus their attention.
Some children and adults who have attention
disorders appear to daydream excessively. And once you get their attention,
they're often easily distracted. Susan, for example, tends to mentally drift
off into a world of her own. Children like Susan may have a number of
learning difficulties. If, like Susan, they are quiet and don't cause
problems, their problems may go unnoticed. They may be passed along from
grade to grade, without getting the special assistance they need.
In a large proportion of affected
children--mostly boys--the attention deficit is accompanied by
hyperactivity. Dennis is an example of a person with attention deficit
hyperactivity disorder--ADHD. They act impulsively, running into traffic or
toppling desks. Like young Dennis, who jumped on the sofa to exhaustion,
hyperactive children can't sit still. They blurt out answers and interrupt.
In games, they can't wait their turn. These children's problems are usually
hard to miss. Because of their constant motion and explosive energy,
hyperactive children often get into trouble with parents, teachers, and
peers.
By adolescence, physical hyperactivity
usually subsides into fidgeting and restlessness. But the problems with
attention and concentration often continue into adulthood. At work, adults
with ADHD often have trouble organizing tasks or completing their work. They
don't seem to listen to or follow directions. Their work may be messy and
appear careless.
Attention disorders, with or without
hyperactivity, are not considered learning disabilities in themselves.
However, because attention problems can seriously interfere with school
performance, they often accompany academic skills disorders.
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Understandably, one of the first questions
parents ask when they learn their child has a learning disorder is "Why?
What went wrong?"
Mental health professionals stress that
since no one knows what causes learning disabilities, it doesn't help
parents to look backward to search for possible reasons. There are too many
possibilities to pin down the cause of the disability with certainty. It is
far more important for the family to move forward in finding ways to get the
fight help.
Scientists, however, do need to study causes
in an effort to identify ways to prevent learning disabilities.
Once, scientists thought that all learning
disabilities were caused by a single neurological problem. But research
supported by NIMH has helped us see that the causes are more diverse and
complex. New evidence seems to show that most learning disabilities do not
stem from a single, specific area of the brain, but from difficulties in
bringing together information from various brain regions.
Today, a leading theory is that learning
disabilities stem from subtle disturbances in brain structures and
functions. Some scientists believe that, in many cases, the disturbance
begins before birth.
Errors in Fetal Brain Development
Throughout pregnancy, the fetal brain
develops from a few all-purpose cells into a complex organ made of billions
of specialized, interconnected nerve cells called neurons. During this
amazing evolution, things can go wrong that may alter how the neurons form
or interconnect.
In the early stages of pregnancy, the brain
stem forms. It controls basic life functions such as breathing and
digestion. Later, a deep ridge divides the cerebrum--the thinking part of
the brain--into two halves, a right and left hemisphere. Finally, the areas
involved with processing sight, sound, and other senses develop, as well as
the areas associated with attention, thinking, and emotion.
As new cells form, they move into place to
create various brain structures. Nerve cells rapidly grow to form networks
with other parts of the brain. These networks are what allow information to
be shared among various regions of the brain.
Throughout pregnancy, this brain development
is vulnerable to disruptions. If the disruption occurs early, the fetus may
die, or the infant may be born with widespread disabilities and possibly
mental retardation. If the disruption occurs later, when the cells are
becoming specialized and moving into place, it may leave errors in the cell
makeup, location, or connections. Some scientists believe that these errors
may later show up as learning disorders.
Other Factors That Affect Brain
Development
Through experiments with animals, scientists
at NIMH and other research facilities are tracking clues to determine what
disrupts brain development. By studying the normal processes of brain
development, scientists can better understand what can go wrong. Some of
these studies are examining how genes, substance abuse, pregnancy problems,
and toxins may affect the developing brain.
Genetic Factors -- The fact
that learning disabilities tend to run in families indicates that there may
be a genetic link. For example, children who lack some of the skills needed
for reading, such as hearing the separate sounds of words, are likely to
have a parent with a related problem. However, a parent's learning
disability may take a slightly different form in the child. A parent who has
a writing disorder may have a child with an expressive language disorder.
For this reason, it seems unlikely that specific learning disorders are
inherited directly. Possibly, what is inherited is a subtle brain
dysfunction that can in turn lead to a learning disability.
There may be an alternative explanation for
why LD might seem to run in families. Some learning difficulties may
actually stem from the family environment. For example, parents who have
expressive language disorders might talk less to their children, or the
language they use may be distorted. In such cases, the child lacks a good
model for acquiring language and therefore, may seem to be learning
disabled.
Tobacco, Alcohol, and Other Drug Use
-- Many drugs taken by the mother pass directly to the fetus. Research shows
that a mother's use of cigarettes, alcohol, or other drugs during pregnancy
may have damaging effects on the unborn child. Therefore, to prevent
potential harm to developing babies, the U.S. Public Health Service supports
efforts to make people aware of the possible dangers of smoking, drinking,
and using drugs.
Scientists have found that mothers who smoke
during pregnancy may be more likely to bear smaller babies. This is a
concern because small newborns, usually those weighing less than 5 pounds,
tend to be at risk for a variety of problems, including learning disorders.
Alcohol also may be dangerous to the fetus'
developing brain. It appears that alcohol may distort the developing
neurons. Heavy alcohol use during pregnancy has been linked to fetal alcohol
syndrome, a condition that can lead to low birth weigh, intellectual
impairment, hyperactivity, and certain physical defects. Any alcohol use
during pregnancy, however, may influence the child's development and lead to
problems with learning, attention, memory, or problem solving. Because
scientists have not yet identified "safe" levels, alcohol should be used
cautiously by women who are pregnant or who may soon become pregnant.
Drugs such as cocaine--especially in its
smokable form known as crack--seem to affect the normal development of brain
receptors. These brain cell parts help to transmit incoming signals from our
skin, eyes, and ears, and help regulate our physical response to the
environment. Because children with certain learning disabilities have
difficulty understanding speech sounds or letters, some researchers believe
that learning disabilities, as well as ADHD, may be related to faulty
receptors. Current research points to drug abuse as a possible cause of
receptor damage.
Problems During Pregnancy or Delivery
-- Other possible causes of learning disabilities involve complications
during pregnancy. In some cases, the mother's immune system reacts to the
ferns and attacks it as if it were an infection. This type of disruption
seems to cause newly formed brain cells to settle in the wrong part of the
brain. Or during delivery, the umbilical cord may become twisted and
temporarily cut off oxygen to the fetus. This, too, can impair brain
functions and lead to LD.
Toxins in the Child's Environment
-- New brain cells and neural networks continue to be produced for a year or
so after the child is born. These cells are vulnerable to certain
disruptions, also.
Researchers are looking into environmental
toxins that may lead to learning disabilities, possibly by disrupting
childhood brain development or brain processes. Cadmium and lead, both
prevalent in the environment, are becoming a leading focus of neurological
research. Cadmium, used in making some steel products, can get into the
soil, then into the foods we eat. Lead was once common in paint and
gasoline, and is still present in some water pipes. A study of animals
sponsored by the National Institutes of Health showed a connection between
exposure to lead and learning difficulties. In the study, rats exposed to
lead experienced changes in their brainwaves, slowing their ability to
learn. The learning problems lasted for weeks, long after the rats were no
longer exposed to lead.
In addition, there is growing evidence that
learning problems may develop in children with cancer who had been treated
with chemotherapy or radiation at an early age. This seems particularly true
of children with brain tumors who received radiation to the skull.
In comparing people with and without
learning disabilities, scientists have observed certain differences in the
structure and functioning of the brain. For example, new research indicates
that there may be variations in the brain structure called the planum
temporale, a language-related area found in both sides of the brain. In
people with dyslexia, the two structures were found to be equal in size. In
people who are not dyslexic, however, the left planum temporale was
noticeably larger. Some scientists believe reading problems may be related
to such differences.
With more research, scientists hope to learn
precisely how differences in the structures and processes of the brain
contribute to learning disabilities, and how these differences might be
treated or prevented.
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Next: Getting Help.
