Dr. MJ Bazos MD,
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
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.
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.
Understanding the Problem
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 Ever since she was a child, she was so withdrawn that people sometimes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 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 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.
What Is a Learning Disability?
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 lay. 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.
Are the Types of Learning Disabilities?
"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.
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
•Academic skills disorders
•"Other," a catch-all that includes
certain coordination disorders and learning handicaps not covered by the other
Each of these categories includes a
number of more specific disorders.
Developmental Speech and Language
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
•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
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
•Understand words and grammar
•Build ideas and images
•Compare new ideas to what you already
•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.
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
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.
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
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.
What Causes Learning Disabilities?
Understandably, one of the first
questions parents ask when they learn their child has a learning disorder is
"Why? What went wrong?"
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
Errors in Fetal Brain
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
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
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
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
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
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.
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.
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.
Are Learning Disabilities Related
to Differences in the Brain?
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.
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.
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.
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.
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 First Identified?
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.
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.
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.
How Are Learning
Disabilities Formally Diagnosed?
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
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
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.
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.
Are the Education Options?
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.
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.
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
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.
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 rugs, 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.
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
have not proven effective in treating the majority of children with learning
disabilities or attention disorders:
•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.
How Do Families Learn to Cope?
The effects of learning disabilities
can ripple outward from the disabled child or adult to family, friends, and
peers at school or work.
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
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.
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
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.
Susan is now in ninth grade and enjoys
learning. She no longer believes she's retarded, and her use of words has
improved. Susan has become a talented craftsperson and loves making clothes and
furniture for her sister's dolls. Although she's still in a special education
program, she is making slow but steady progress in reading and math.
Over the years, Wallace found he liked
tinkering with cars and singing in the church choir. At church, he met a woman
who knew about learning disabilities. She told him he could get help through his
county social services office. Since then, Wallace has been working with a
speech therapist, learning to articulate and notice differences in speech
sounds. When he complains that he's too old to learn, his therapist reminds him,
"It's never too late to work your good brain!" His state vocational
rehabilitation office recently referred him to a job-training program. Today, at
age 46, Wallace is starting night school to become an auto mechanic. He likes it
because it's a hands-on program where he can learn by doing.
Dennis is now age 23. As he walks into
the college job placement office, he smiles and shakes hands confidently. After
shuffling through a messy stack of papers, he finally hands his counselor a
neatly typed resume. Although Dennis jiggles his foot and interrupts
occasionally, he's clearly enthusiastic. He explains that because tape-recorded
books and lectures got him through college, he'd like to sell electronics.
Dennis says he'll also be getting married next year. He and his fiancee are
concerned that their children also will have LD. "But we'll just have to watch
and get help early—a lot earlier than I did!"
Can Learning Disabilities Be
Outgrown or Cured?
Even though most
people don't outgrow their brain dysfunction, people do learn to adapt and live
fulfilling lives. Dennis, Susan, and Wallace made a life for
themselves—not by being cured, but by developing their personal strengths.
Like Dennis' tape-recorded books and lectures, or Wallace's hands-on auto
mechanics class, they found alternative ways to learn. And like Susan's crafts
or Wallace's singing, they found ways to enjoy their other talents.
Even though a learning disability
doesn't disappear, given the right types of educational experiences, people have
a remarkable ability to learn. The brain's flexibility to learn new skills is
probably greatest in young children and may diminish somewhat after puberty.
This is why early intervention is so important. Nevertheless, we retain the
ability to learn throughout our lives.
Even though learning disabilities
can't be cured, there is still cause for hope. Because certain learning problems
reflect delayed development, many children do eventually catch up. Of the speech
and language disorders, children who have an articulation or an expressive
language disorder are the least likely to have long-term problems. Despite
initial delays, most children do learn to speak.
For people with dyslexia, the outlook
is mixed. But an appropriate remedial reading program can help learners make
With age, and
appropriate help from parents and clinicians, children with ADHD become better
able to suppress their hyperactivity and to channel it into more socially
acceptable behaviors. As with Dennis, the problem may take less disruptive
forms, such as fidgeting.
Can an adult
be helped? For example, can an adult with dyslexia still learn to read? In many
cases, the answer is yes. It may not come as easily as for a child. It may take
more time and more repetition, and it may even take more diverse teaching
methods. But we know more about reading and about adult learning than ever
before. We know that adults have a wealth of life experience to build on as they
learn. And because adults choose to learn, they do so with a determination that
most children don't have. A variety of literacy and adult education programs
sponsored by libraries, public schools, and community colleges are available to
help adults develop skills in reading, writing, and math. Some of these
programs, as well as private and nonprofit tutoring and learning centers,
provide appropriate programs for adults with LD.
What Aid Does the Government Offer?
As of 1981, people with learning
disabilities came under the protection of laws originally designed to protect
the rights of people with mobility handicaps. More recent Federal laws
specifically guarantee equal opportunity and raise the level of services to
people with disabilities. Once a learning disability is identified, children are
guaranteed a free public education specifically designed around their individual
needs. Adolescents with disabilities can receive practical assistance and extra
training to help make the transition to jobs and independent living. Adults have
access to job training and technology that open new doors of opportunity.
Increased Services, Equal Opportunity
The Individuals with Disabilities
Education Act of 1990 assures a public education to school-aged children with
diagnosed learning disabilities. Under this act, public schools are required to
design and implement an Individualized Educational Program tailored to each
child's specific needs. The 1991 Individuals with Disabilities Education Act
extended services to developmentally delayed children down to age 5. This law
makes it possible for young children to receive help even before they begin
Another law, the Americans
with Disabilities Act of 1990, guarantees equal employment opportunity for
people with learning disabilities and protects disabled workers against job
discrimination. Employers may not consider the learning disability when
selecting among job applicants. Employers must also make "reasonable
accommodations" to help workers who have handicaps do their job. Such
accommodations may include shifting job responsibilities, modifying equipment,
or adjusting work schedules.
publicly funded colleges and universities must also remove barriers that keep
out disabled students. As a result, many colleges now recruit and work with
students with learning disabilities to make it possible for them to attend.
Depending on the student's areas of difficulty, this help may include providing
recorded books and lectures, providing an isolated area to take tests, or
allowing a student to tape record rather than write reports. Students with
learning disabilities can arrange to take college entrance exams orally or in
isolated rooms free from distraction. Many colleges are creating special
programs to specifically accommodate these students.
Programs like these made it possible
for Dennis to attend and succeed in college. The HEATH Resource Center,
sponsored by the American Council on Education, assists students with learning
disabilities to identify appropriate colleges and universities. Information on
the HEATH center and related organizations appears at the end of this brochure.
Public Agency Support
Effective service agencies are also in
place to assist people of all ages. Each state department of education can help
parents identify the requirements and the process for getting special education
services for their child. Other agencies serve disabled infants and preschool
children. Still others offer mental health and counseling services. The National
Information Center for Children and Youth can provide referrals to appropriate
local resources and state agencies.
Counselors at each state department of
vocational rehabilitation serve the employment needs of adolescents and adults
with learning disabilities. They can refer adults to free or subsidized health
care, counseling, and high school equivalence (GED) programs. They can assist in
arranging for job training that sidesteps the disability. For example, a
vocational counselor helped Wallace identify his aptitude for car repair. To
work around Wallace's language problems, the counselor helped locate a
job-training program that teaches through demonstrations and active practice
rather than lectures.
State departments of
vocational rehabilitation can also assist in finding special equipment that can
make it possible for disabled individuals to receive training, retain a job, or
live on their own. For example, because Dennis couldn't read the electronics
manuals in his new job, a vocational rehabilitation counselor helped him locate
and purchase a special computer that reads books aloud.
Finally, state-run protection and advocacy
agencies and client assistance programs serve to protect these fights. As
experts on the laws, they offer legal assistance, as well as information about
local health, housing, and social services.
What Hope Does Research Offer?
Sophisticated brain imaging technology
is now making it possible to directly observe the brain at work and to detect
subtle malfunctions that could never be seen before. Other techniques allow
scientists to study the points of contact among brain cells and the ways signals
are transmitted from cell to cell.
this array of technology, NIMH is conducting research to identify which parts of
the brain are used during certain activities, such as reading. For example,
researchers are comparing the brain processes of people with and without
dyslexia as they read. Research of this kind may eventually associate portions
of the brain with different reading problems.
Clinical research also continues to amass
data on the causes of learning disorders. NIMH grantees at Yale are examining
the brain structures of children with different combinations of learning
disabilities. Such research will help identify differences in the nervous system
of children with these related disorders. Eventually, scientists will know, for
example, whether children who have both dyslexia and an attention disorder will
benefit from the same treatment as dyslexic children without an attention
Studies of identical and
fraternal twins are also being conducted. Identical twins have the same genetic
makeup, while fraternal twins do not. By studying if learning disabilities are
more likely to be shared by identical twins than fraternal twins, researchers
hope to determine whether these disorders are influenced more by genetic or by
environmental factors. One such study is being conducted by scientists funded by
the National Institute of Child Health and Human Development. So far, the
research indicates that genes may, in fact, influence the ability to sound out
Animal studies also are adding to
our knowledge of learning disabilities in humans. Animal subjects make it
possible to study some of the possible causes of LD in ways that can't be
studied in humans. One NIMH grantee is researching the effects of barbiturates
and other drugs that are sometimes prescribed during pregnancy. Another
researcher discovered through animal studies that certain prenatal viruses can
affect future learning. Research of this kind may someday pinpoint prenatal
problems that can trigger specific disabilities and tell us how they can be
Animal research also allows the
safety and effectiveness of experimental new drugs to be tested long before they
can be tried on humans. One NIH-sponsored team is studying dogs to learn how new
stimulant drugs that are similar to Ritalin act on the brain. Another is using
mice to test a chemical that may counter memory loss.
This accumulation of data sets the stage
for applied research. In the coming years, NIMH-sponsored research will focus on
identifying the conditions that are required for learning and the best
combination of instructional approaches for each child.
Piece by piece, using a myriad of research
techniques and technologies, scientists are beginning to solve the puzzle. As
research deepens our understanding, we approach a future where we can prevent
certain brain and mental disorders, make valid diagnoses, and treat each
effectively. This is the hope, mission, and vision of the National Institute of