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Clinical Reference Systems: Pediatric Advisor 10.0
Learning Disabilities
What are learning disabilities?
If a child has average or above-average intelligence and is
performing very poorly at school, he or she may have a
learning disability (LD). It is a type of handicap probably
caused by the makeup or function of a person's brain and may
last throughout life.
The definition of learning disability used for educational
purposes may vary from state to state. The National
Committee for Learning Disabilities includes several
disorders under the general category of learning disability.
These disorders involve difficulties with listening,
speaking, reading, writing, reasoning, or solving math
problems.
What are the characteristics of an LD?
Learning disabilities have a wide range of characteristics
and various degrees of severity. However, all
learning-disabled children have poor or uneven academic
achievement even though they have normal or above-normal
intelligence. These children may show difficulties in one
or many of the following areas:
- Attention
Focusing attention is by far the most common difficulty
children with LDs have. As a result, these children may
often perform poorly in the classroom, on tests, or at
home. Impulsiveness may affect their ability to give
thoughtful responses to questions or to stop
inappropriate behaviors. They may seem to be lazy or
disinterested because they have trouble focusing on
details and get tired easily when they try to
concentrate.
- Language
Children may have difficulties with receptive language
or with expressive language.
Children who often ask to have things repeated or have
trouble following multiple instructions may have
difficulties in receptive language.
Children who cannot express themselves clearly may have
expressive language difficulties. They may often use
the wrong words or mix their words up. They may not be
able to tell a story without getting the events mixed
up. (This type of difficulty should not be confused
with the problems of a child who does not know English.)
- Temporal-spatial orientation
A child with problems in this area may have trouble
understanding the difference between tomorrow and next
week. Or he may have difficulty with directions and
often get lost. He may be the last to learn the way to
the bus or the bathroom.
- Visual-perceptual processing
Many children seem to see letters or words backwards.
For example, they may confuse b's and d's or read "was"
for "saw" even after they have finished the 3rd grade.
They may also have difficulty learning to write and get
poor marks in penmanship.
- Auditory-perceptual processing
Children who have this kind of problem have difficulty
focusing on important sounds in the classroom instead of
background noise. For example, they may have difficulty
listening to the teacher. They may appear inattentive
and have trouble following spoken instructions.
- Memory
Many children may have trouble remembering basic
information like their addresses and phone numbers.
They may find it hard to remember multiplication tables
or days of the week. They may also have trouble with
short-term memory and forget classroom instructions or
where they are in telling a story or in conversation.
- Fine motor control
Children who have trouble with fine motor control have
poor handwriting and turn in messy papers. They may be
slow in copying work from the blackboard. It may be
hard for them to produce good work because writing is so
difficult. They become ashamed of their work.
- Gross motor control
Children with an LD may at times appear to be clumsy and
awkward. They may drop things and bump into desks more
often than other children. As a result, their peers may
tease and reject them.
What causes an LD?
Learning disabilities seem to be caused by the brain, but
the exact causes are not yet known. Learning disability has
been related to many biological factors including:
- heredity
- various conditions that the mother may have had during
her pregnancy with the child, such as infections during
the early months of pregnancy or use of drugs or alcohol
- prematurity, low birth weight, or birth trauma or
distress
- certain conditions after birth (such as metabolic
imbalances or infections)
- chronic medical illnesses, such as asthma or diabetes
- head injuries
- poor nutrition.
A child who has a learning disability may have other
handicaps, such as hearing problems or serious emotional
disturbance. However, LDs are not caused by these
conditions, nor are they caused by environmental influences
such as cultural differences or inappropriate instruction.
What are the consequences of an LD?
Children who are not doing well in school may not feel good
about themselves. If they feel they can't cope with the
demands of the people around them, they may withdraw from
their friends and social activities. Some experts believe
that the loss of self-esteem may cause learning-disabled
children to spend time with others who view themselves as
losers and may contribute to juvenile delinquency. The
children may lose motivation and drop out of school. It is
important not to overlook poor self-esteem in LD children.
Children need to receive counseling and change expectations
about themselves.
What is the treatment?
- Complete evaluation
A team of professionals will gather information about
your child to determine the nature and degree of the
learning disability and the child's educational needs.
The evaluation includes testing and input from teachers
and parents.
The evaluation may begin several ways. A teacher or
your pediatrician may suggest your child needs
evaluation. The school may ask your permission to
evaluate your child. You may ask for an evaluation of
your child by the school. You may take your child to a
private facility for evaluation.
The team of professionals may include the following:
- social worker
- learning disability specialist or special educator
- speech/language pathologist
- audiologist (hearing specialist)
- physical therapist
- school occupational therapist
- pediatrician trained in assessing a child's
neurological development
- child psychiatrist.
This approach is needed to define the severity of the
disability and decide on treatment. It is also
important to make sure there is no medical problem
underlying the child's condition. Parents are of utmost
importance in the evaluation. The professionals rely
heavily on the parents' perspectives of the problems to
make meaningful recommendations.
- Preparation of treatment at school
The results of the evaluation help determine whether
your child is eligible to receive special education
services. The results are also used to develop an
Individualized Educational Plan (IEP). Parents must
help write the IEP. The IEP must outline the following:
- your child's present performance
- specific special education services and who will
provide them
- short-term objectives and yearly goals
- objective criteria and evaluation procedures to
measure your child's progress toward these goals on
at least an annual basis.
To get the most appropriate services for your child, you
must work closely with the other team members. If you
hear something surprising about your child or strongly
disagree with the conclusions of the evaluation,
services, or therapies offered, voice your concerns at
the IEP meeting. Signing the IEP means that you agree
to the services, goals, and other matters listed in it.
If you disagree and a compromise cannot be reached, the
school must inform you of the procedures for challenging
the IEP.
- Specific treatments
There are a several ways in which special educators can
help learning-disabled children. Some schools have
special classes for children with particular learning
disabilities. For children with less severe problems,
time with a special educator for several hours a week
may be all that is needed. Sessions with a language
therapist or other specialist may also be helpful.
If your child has attention deficit disorder (ADD), your
pediatrician may prescribe medication. Coordination
among the parents, teachers, behavior therapists, and
your doctor is necessary to monitor the effects of
the medicine.
What can I do to help?
- Provide support, sensitivity, and acceptance. Your
child needs you to accept his condition and to give
unconditional love and support. You can build up your
child's self-esteem and confidence by constantly
reminding him of his strengths.
- Help your child understand his problem and talk about
it. Then he won't feel as strongly that he is a problem
and can focus on coping skills.
- Provide an educationally nurturing home environment.
Provide an organized place and time for study. In
addition, a balanced diet, enough rest, play activities,
and family outings strengthen a child's body and mind.
- Maintain communication with the school. Stay in close
touch with your child's teachers, therapists, and other
caregivers. Let your child's teacher(s) know that you
want to play an active role in your child's education.
Ask how you can reinforce and expand on what is taking
place in the classroom, both behaviorally and
academically.
- Seek professional counseling for yourself as well as
your child if you feel the need for extra help to cope.
Most parents find advice on handling difficult behavior
and feelings extremely valuable.
- Join LD associations and support groups. These will
help keep you up to date with the latest information on
LD and put you in touch with parents who have children
with similar problems.
- Be cautious of nontraditional treatments. Be sure to
check with your pediatrician before adding nonstandard
therapies to the treatment plan. Discuss all ideas
freely with your pediatrician.
RESOURCES FOR PARENTS
Organizations
Council for Learning Learning Disabilities Assn.
Disabilities (CLD) of America (LDA)
P.O. Box 40303 4156 Library Rd.
Overland Park, KS 66204 Pittsburgh, PA 15234
(913) 492-8755 (412) 341-8077
National Center for National Network of Learning
Learning Disabilities Disabled Adults (NNLDA)
99 Park Ave. 808 North 82nd Street #F2
New York, NY 10016 Scottsdale, AZ 85257
(212) 687-7211 (602) 941-5112
The Orton Dyslexia Society
724 York Road
Baltimore, MD 21204
(800) 222-03123
Suggested Reading
See:
Learning Disabilities: Book List
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