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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Next:
Sustaining Hope
