ABC's of Learning Disorders - Clinical Psychology Associates N.C. Florida, P.A.

THE ABC’s of Learning Disorder .pdf version

by Ernest J. Bordini, Ph.D.
Clinical Psychology Associates of North Central Florida, P.A. CPANCF.COM (352) 336-2888 Gainesville - Ocala
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The term “Learning Disorder” or “LD” is the most recently used term for children who suffer significant difficulties an acquiring basic academic skills. This is the less technical term for what was previously termed as “Academic Skills Disorders” or dyslexia, dyscalculia, dysgraphia, etc. The actual term for a particular learning disorder consists of the area of academic difficulty. Mathematics Disorder and Disorder of Written Expression usually co-exist with Reading Disorders, but sometimes are diagnosed alone. In addition to the above Approximately 2 to 10 out of 100 children will be diagnosed with a learning disorder.

The Diagnostic and Statistical Manual -IV (APA, 1994) classifies Learning Disorders as conditions usually first diagnosed in infancy, childhood, or adolescence. Children who have early developmental difficulties with speech, such as not saying their first words by 12-14 months or two-word sentences by approximately two years may be prone to reading disorders. Children who suffer developmental coordination difficulties such as difficulties in eye-hand coordination or learning to walk may also be at increased risk for these disorders.

DSM-IV estimates that one out of ten to one out of four children with disruptive behavior disorders such as Conduct Disorder, Oppositional Defiant Disorder or Attention-deficit Hyperactivity Disorder or may suffer from depressive disorders may also suffer from LD. Perinatal injuries, medical disorders, lead poisoning, fetal alcohol syndrome, and chromosomal abnormalities have also been associated with learning disorders. The most common risk factor, however, is heredity.

Reading disorders, which may effect 4% of school children may be diagnosed as early as Kindergarten but often may not be diagnosed until formal reading instruction in first grade. Brighter children may not be diagnosed until demands increase in fourth grade or later.

DSM-IV notes that the prevalance of Disorder of Written Expression is more difficult to estimate. Difficulty in writing, handwriting, difficulty remembering letter sequences of common words may appear as early as first grade but may not be diagnosed until writing demands increase towards the end of the year. It usually is identifiable by second grade.

Mathematics disorder is less frequent than reading disorders, effecting approximately 1% of school children. It is particularly important to rule out mathematics anxiety or attention difficulties since these can interfere with accuracy of calculation skills and cognitive flexibility. It often may not be diagnosed until 3rd or 4th grade, or sometimes later.

The impact of learning disorders on emotional adjustment and achievement has to be understood to appreciate the seriousness of these academic difficulties. Deficits in social skills and self-esteem are not uncommon, and nearly 40% of children with LD may drop out before graduating high school and may go on to have difficulties with employment.

Learning disorders are likely due to very subtle brain difficulties in processing visual and/or auditory material. While the difficulties may be subtle and require special testing by a licensed psychologist, school psychologist or sometimes a speech and language pathologist, these subtle difficulties can impact severely on writing and on reading speed, accuracy, and comprehension.

Children with reading difficulties may have difficulty in the phonological or “sounding out” aspects of reading. Children with combinations of both or multiple difficulties often exhibit the most severe reading difficulties.

Diagnosis is usually made by a licensed psychologist or school psychologists as the diagnosis is based on patterns of strengths and weaknesses in cognitive abilities and achievement. This is accomplished by administration of standardized psychological tests such as the Wechsler or Woodcock-Johnson Tests. These are administered individually to the student and are time consuming. Unfortunately due to limited school resources, there is a trend to user briefer or short form tests, which tend to have a higher risk of mis-diagnosis. In some cases more extensive neuropsychological testing may be necessary or helpful to identify underlying skills such as auditory or visual memory which may contribute to the disorder or co-existing conditions such as behavior problems, depression, coordination disorders or sensory-motor integration difficulties.

Educational testing may be performed throught the school psychological services department, though often waits are long and such evaluations tend to vary quite a bit accross counties in Florida and the country. Educational testing is usually not covered by health insurance.

The diagnosis of a learning disorder entitles the child to special services. Dr. Mel Levine, a developmental pediatrician, has stressed the importance of early help for learning disorders while establishing “islands of competence.” He recommended encouraging and developing the child’s natural strengths and interests to bolster self-esteem and reduce frustration when tackling new tasks.

Once diagnosis is made an Individual Education Plan (IEP) is created for the child. The IEP is subject to approval by the parents. Special services are geared to provide a “free and appropriate education” in the “least restrictive” environment. Schools have a list of rights that parents and children have in relationship to this diagnosis and placement.

The common misconception that a child is simply “behind”, will “catch up” or “grow out of it” on their own is unfortunate because specialized remediation is often needed. Children who do master material may later encounter new difficult challenges as they encounter new academic demands and concepts. Adults with Learning Disorders often experience social and occupational difficulties.

Children may receive extra assistance and instruction by a learning specialist, speech and language therapy if necessary, use of a resource class, or in more severe cases full-time placement in a resource class. In later grades and college some of these children may qualify to have tests read to them, extra time for reading assignments, take oral instead of written exams, substitute class requirements, or may be able to utilize books on tape. Some colleges specialize in educating children with various learning disabilities. Locally, the University of Florida and Sante Fe Community College are experienced and helpful in assisting with guidance and necessary accommodations.

Since learning disorders are common and persistent problems, beware of false promises and magical cures. The axiom of “if it seems to good to be true, it probably is” applies to these treatments as well. Effective programs often involve intensive individual assessment, therapy, and individual and small group instruction. Area multi-disciplinary programs include the Ross-Mercer Clinic at the University of Florida and the Morris Developmental Center in Gainesville. Some children with milder reading difficulties find programs such as those offered through private learning centers helpful. Educators, family physicians, and pediatricians often can provide the names of psychologists or other providers who have expertise in providing evaluations and remediation.

References:

American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition. 1994

Levine, Melvin Educational Care. A System for Understanding and Helping Children with Learning Problems at Home and in School Educators Publishing Service, Cambridge, Mass. 1994

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