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Regarding Learning Disorders
Information for Parents

Research and Theory

Specific learning disabilities (LD) can arise for a numberof different reasons. For example, not all cognitive abilities develop concurrently;some lag behind, such that a child is developing certain abilities moreslowly than her peers. However, learning disabilities may also be due toperceptual-motor problems arising from physiological or neurological difficulties.Or the learning disability may stem from the child's cognitive style, whichcauses her to respond more impulsively in learning situations.

Thus, some disabilities are attributable to developmental lag, which occurswhen a child of elementary-school age has not developed certain skills thatare typical for her age. Another common problem that stems from a developmentallag is inability to pay attention. A sixth grader who is as distractibleas a third grader would be said to have an attention-deficit disorder. Attention-deficitHyperactivity Disorder (ADHD) is a severe form of this problem and is characterizedby developmentally inappropriate levels of impulsiveness, overactivity,and inattention. There is a high correlation between ADHD and learning disabilities.Finally, perceptual-motor disabilities (e.g., dyslexia), many of which appearto have some kind of organic cause, also affect learning. For instance,a child who has difficulty following oral instructions may have a defectin auditory processing; her brain may have difficulty translating instructionsinto a behavioral response, or her inattentiveness may cause her to forgetthe beginning of the instructions by the time she hears the last of them.

According to most estimates, between 5% and 15% of school-age children havelearning disabilities. Males tend to outnumber females by 2:1 or even 5:1.Although LD problems have been linked to a variety of cognitive and neurobiologicaldeficits and to family histories of learning disabilities, the exact causesof learning disabilities are largely unknown.

Assesment

This will vary from state to state, although every state is expectedto adhere to federal standards. One method that some diagnosticians useis to examine differences between verbal and nonverbal intelligence on testssuch as the Wechsler Intelligence Scale for Children-Third Edition (WISC-III).On the WISC-III, this would mean comparing the Verbal IQ with the PerformanceIQ. One problem with this approach is that Dr. Wechsler and his followersnever intended the Verbal and Performance scales to be measuring separateand discriminable aspects of intelligence. They are both different manifestationsof general intelligence. The distinction between verbal and nonverbal istherefore rather arbitrary and is not even theory-driven.

Another method of evaluating LD problems is to examine subtest "scatter"(i.e., differences in subtest scores) on tests like the WISC-III. This iswrong headed for several reasons. Among them:

  1. IQ tests presumably measure cognitive ability, not academic prowess;
  2. subtest scatter is common and "statistically significant" differences in scores may not have any practical relevance;
  3. the DSM-III-R requires a more thorough evaluation of cognitive AND academic functioning; etc.

The most accepted practice is to compare IQ scores with standard scoreson individually administered achievement tests such as the Wechsler IndividualAchievement Test (WIAT). Certain states will apply the LD diagnosis whena particular achievement test score is 1.25 standard deviations units lowerthan the IQ score (a standard deviation is usually 15 points). Thus, a childwhose basic reading score is 75, but whose IQ is 98, would be regarded asLD, provided that the reading problem is not secondary to generalized mentalimpairment (e.g., Mental Retardation), sensory disorders, emotional disturbance,or lack of academic opportunity.

But the state of the art method for diagnosing learning disabilities isto use sophisticated psychometric properties of tests such as the WIAT inorder to derive predicted (expected) achievement scores based on the IQscore. The test manual will tell you, for example, that a child with anIQ of 92 is predicted (expected) to receive certain scores on each of theachievement tests. You then compare the child's ACTUAL achievement scoreswith her PREDICTED scores on each of the tests. This is the method favoredby the DSM-III-R, which stipulates that the academic skill, "as measuredby a standardized, individually administered test," is "markedlybelow the expected level, given the person's schooling and intellectualcapacity (as determined by an individually administered IQ test)."The diagnostician would still have to rule out the possible causes of theLD problem which were listed previously, and that skill deficit must behaving a demonstrable impact on the child's schoolwork.

Treatment

As many people already know, the medical response to Attention-deficitHyperactivity Disorder (ADHD) is a psychostimulant such as Ritalin or Cylert.The fact that 80% or more of ADHD children respond positively to stimulantswould appear to favor an organic cause of this disorder; however, studieshave shown that non-ADHD school children also show a similar pattern ofreduced activity level and less distractibility when administered stimulants.The effects of stimulants tend to be dose-dependent, with improvements inattention being associated with low doses and reductions in overactivitybeing associated with higher doses. There is also some evidence that socialbehaviors continue to improve with increasing dosage level, while performanceon cognitive tasks is better at lower doses than higher doses. Parents andteachers should be aware that stimulants do not "cure" ADHD; oncetheir use is discontinued, symptoms usually return.

It should be noted that the use of stimulant drugs as a treatment for ADHDhas been criticized on several grounds. First, stimulants are not associatedwith long-term improvements in social, emotional, or academic functioning.Second, stimulants can have a number of adverse side-effects including insomnia,loss of appetite, irritability, increased heart rate and blood pressure,and a temporary suppression of height and weight. Third, stimulants areeffective for only about 75% of hyperactive youth and appear to be leastbeneficial for children or adolescents with signs of minimal brain damage.Note, however, that concern regarding the possibility that stimulant drugslead to subsequent drug abuse has not been confirmed. Because there areside-effects with virtually all drugs, it is necessary to weigh and balancethe benefits of the medication with the unpleasant side effects. There isno perfect medium and some uncomfortableness may need to be tolerated. Itis also crucial to find a physician (or preferably, a child psychiatrist)who is willing to adjust dosages over time, rather than taking the childoff medication as soon as the initial dosage proves ineffective. There areother, nonstimulant medications, such as Imipramine, that have proven effectivein helping some children with ADHD.

There are many behavioral and cognitive approaches to teaching LD childrenhow to compensate for their disabilities. Current theories of learning disabilityemphasize difficulties in the self-regulation of planful behaviors. Researchhas shown, for example, that children who demonstrate use of inadequatetask strategies are helped by mild prompts or direct instruction in strategyusage. Studies have also shown that, in contrast to the problem-solvingstrategies of non-LD children, those with LD problems produce more task-irrelevantspeech. Therefore, a major objective of many remedial programs is to teachLD children more effective problem-solving skills. One method for teachingthese skills is called "self-instruction" in which an instructorverbalizes the problem-solving process while solving an actual problem,which is very much like "thinking aloud." Then the child is encouragedto solve a similar problem while verbalizing the necessary steps and receivescoaching from the instructor. Then the instructor "fades out"her coaching and ultimately the child "fades out" the self-talkand solves the problem without any unnecessary verbalizations.

A very useful and inexpensive guidebook for parents and teachers of LD studentsis "Helping the LD Student with Homework," by Suzanne H. Stevens,published by LDTV, 1001 S. Marshall St., Suite 37, Winston-Salem, NorthCarolina 27101. Ms. Stevens recommends conferences with the teacher, parent,and LD specialist attending, to work out a plan of action early in the schoolyear. She also stresses the need to be realistic about the child's capabilities.

It can take five to ten minutes for a child just to get organized for studyingone homework assignment, and she will need time to reorganize before tacklingeach assignment. Because LD students have "memories that leak"it is crucial that homework assignments be written down exactly as the teacherexpects. The child should be taught to record every assignment in a notebook.Each assignment should be accompanied by at least two examples of how todo the assigned work; e.g., the LD may be able to carry in addition whileat school, yet completely forget how this is done by the time she gets home.

The child's homework should cover only those topics that the child has alreadyshowed some mastery of in class. Subjects that are new or that the childis struggling with should not be included in homework assignments. BecauseLD children do their best work under structured conditions, their homeworkactivities should be "routinized." The child should receive somesort of immediate positive feedback when homework is turned in. The parent'srole in homework is more of facilitator, offering support and sympathy,but not getting deeply involved in helping the child complete the assignments.(My clinical experience has shown that LD children often get their parentsto do the lion's share of the homework, because the parents get tired ofre-explaining how to do things or listening to the child's litany of complaints.)Another helpful book by Ms. Stevens is "The Learning-Disabled Child:Ways That Parents Can Help," published by John F. Blair.

Parents need to remember that discipline in the home is a form of education,and a learning disability that interferes with schoolwork will often interferewith the child's ability to profit from traditional forms of discipline.Parents and teachers should be sensitive to the impact that LD problemscan have on the child's self-concept, mood, and social skills. Treatmentstrategies should remain flexible enough to comprehensively deal with thechild's problems. Children with legitimate learning difficulties shouldnot be shamed or punished into performing better in their studies, nor shouldunrealistic demands be placed upon them. It is a sad fact that LD problemsare strongly correlated with conduct disorders, and this often occurs becausethe LD child must look to other underachieving, disenfranchised youth inorder to develop a sense of success and belongingness ("I can't bea successful student, but maybe I can be a successful delinquent.").Accommodating to the child's patterns of strengths and weaknesses reducesfrustration and maximizes opportunities to learn. It is important to useinterventions that are age-appropriate, as any self-respecting sixth graderwould take offense at receiving the same instructional techniques used withthird graders, just because that happens to be her current reading level.

Other useful texts include: "The Parent's Guide: Solutions to Today'sMost Common Behavior Problems in the Home," by Stephen B. McCarney,and Angela M. Bauer, published by Hawthorne Educational Services, 800 GrayOak Drive, Columbia, MO 65201; and "Your Hyperactive Child: A Parent'sGuide to Coping with Attention Deficit Disorder," by Barbara Ingersoll,published by Main Street Books, 666 Fifth Avenue, New York, New York 10103.

Diagnostic Considerations

One important issue in the assessment of learning disabilities is "who"is doing the assessing? My perspective is that of a clinical psychologist,rather than a school psychologist, educational diagnostician, etc. My diagnosesare based exclusively on the revised third edition of the Diagnostic andStatistical Manual of Mental Disorders (DSM-III-R), published by the AmericanPsychiatric Association. Using this nomenclature, learning disabilitiesare currently referred to as Specific Developmental Disorders (e.g., DevelopmentalArithmetic Disorder), in order to distinguish them from more global developmentaldisorders such as Mental Retardation and Autism. However, within a few monthsthe next version of the DSM will be published, DSM-IV. Specific DevelopmentalDisorders will then be referred to as Learning Disorders.

Disabled learners may be no less intelligent than their peers, but overallLD children have somewhat lower-than-average IQs than their non-LD counterparts.Their academic skills deficits are focal. Learning disorders are characterizedby inadequate development of specific academic skills that are not due toMental Retardation or deficient educational opportunities. If a sensorydeficit (e.g., hearing impairment) is present, the learning difficultiesare in excess of those usually associated with it. The diagnosis is madeonly if the learning disorder significantly interferes with academic achievementor with activities of daily living that require those particular skills.

Federal guidelines stipulate that the learning difficulties should not beprimarily due to visual, hearing, or motor disabilities, orthopedic problems,or emotional disability. Furthermore, there should be the assurance thatlearning difficulties are not primarily the result of 1) inadequate instructionor curriculum for the child's age and/or ability level; 2) lack of educationalopportunity; 3) emotional stress at home or school; 4) a temporary crisissituation; 5) environmental, cultural, or economic disadvantage; or 6) lackof motivation. It is generally recommended that the diagnostician reviewexamples of classwork (e.g., a writing sample) that exhibit the learningdisability. The areas of learning disability specified in the Educationfor All Handicapped Children Act (Public Law 94-142) include: oral expression,listening comprehension, written expression, basic reading skill, readingcomprehension, mathematics calculation, and mathematics reasoning.

A Final Word

Some school districts will inform parents that, even though they suspecttheir child has an LD problem, or hyperactivity, etc., the school districtdoes not provide these assessments. A local school district has been tellingparents that they only have resources for evaluating dyslexia. Federal laws,such as PL 94-142 and 504, require school districts to evaluate any childwho is suspected of having problems. If the parent disagrees with the opinionof school officials, the parent has the right to ask for a hearing to resolvethe issue. At the hearing, a school which does not want to do appropriatetesting must explain why such testing in unnecessary--which is almost impossiblefor them to do without doing an evaluation! Probably all states have advocacygroups that help parents negotiate the trials and tribulations of our publicschool system and parents who feel that their child is being undeservedby their school district should avail themselves of this valuable resource.

   
 
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