Articles

Reprinted by permission from the author Dr. Saul Greenberg

Learning disabilities (LD) is a term that refers to a varied group of disorders that is manifested as significant difficulties in the acquisition and use of listening, speaking, reading, spelling, writing, reasoning, or mathematical abilities. These disorders are intrinsic to the individual and are presumed to be due to central nervous system dysfunction. The term does not include children who have learning problems which are primarily the result of visual, hearing, or motor handicaps, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage. Children with LD have average or above average intelligence. Currently the most accepted approach to defining a learning disability is one in which there is a significant discrepancy between a child's potential for learning and his/her achievement. Children with LD have difficulties learning in the traditional way at the accepted rate for their age group. For some reason their channels for learning do not process stimuli in the usual way. As a result, input and expression can be affected. The Learning Disabilities Association of Canada says 10% of Canadians have a learning disability serious enough to require some form of therapy. Learning disabilities affect boys and girls equally, although more boys are referred for help, perhaps because they are more disruptive to parents and teachers.

Types & Manifestations

Learning problems can be divided into two main groups:

1. Involvement of auditory-visual processes, resulting in reading disorders (dyslexia) and other language-based learning problems.
2. Involvement of visual and motor processes, resulting in poor handwriting (dysgraphia), problems with mathematics (dyscalculia) and deficits in social skills.

Dyslexia and Language-Based Learning Disabilities

Dyslexia is the most common of the learning disabilities and the one that causes most long-term problems. It is not caused by any visual acuity problem but is actually due to impaired language-processing skills. Dyslexics have a problem with decoding "phonemes", the individual speech sounds in the alphabet, and have difficulty with "phonics", the ability to sound out words. One must be able to decode letters quickly and automatically in order to concentrate on the meaning of the words.

Dyslexics also have a problem with verbal short-term memory and therefore have problems recalling letters, words, phrases, names, dates, phone numbers, addresses, and other rote facts. Besides having problems with understanding written material, many children with auditory processing problems have difficulty with understanding what they hear. Distinguishing similar sounds in words such as "dog" vs. "log" may be an additional problem, especially in a noisy environment. Following verbal directions at home and in school may be confusing to some children with LD.

One needs phonics to be able to read and spell words properly, which is often a problem for dyslexics. Another problem for dyslexics is mathematics because they have difficulty memorizing basic math facts and remembering sequences of steps for computation. They often reverse or mislabel numbers, e.g. 13 for 30, and often have difficulty with understanding word problems. Dyslexics often have a history of delayed speech and mispronouncing words, because certain sounds are omitted, substituted or distorted.

Nonverbal Learning Disabilities (NLD)

Problems with arithmetic and handwriting, and deficits in social awareness and social judgment are associated with NLD. These comprise about 1% to 10% of learning disabilities. The right side of the brain processes nonverbal information and deals with spatial awareness, recognition of visual patterns, and coordination of visual information with motor processeses (visual-motor integration).

Children with NLD can have psychomotor and tactile-perceptual deficits and may be poorly coordinated in gross and fine motor skills. As a result, they are delayed at tying shoes, holding a pencil, catching a ball, riding a bike, and assembling puzzles. They have visual-perceptual-organizational deficits and have problems with eye-hand coordination such as difficulties with handwriting, drawing, and copying from the blackboard.

The specific problem these children have with mathematics is that they have problems understanding fundamental concepts or what approach is required to solve a problem. They do, however, have strong psycholinguistic skills such as rote verbal learning, word recognition and spelling.

These children are often described as being socially isolated, with few close friends and limited social activity. They have problems understanding jokes, strategies of games, motives of others, and social conventions. They often lack insight into their own future, strengths and weaknesses. Possible reasons for these social problems include poor social comprehension, inability to take the perspective of others, misinterpretation of body language, impulsivity, and being easily led.

Coexisting Conditions

Attention-Deficit Hyperactivity Disorder

ADHD occurs in 26%-41% of children with learning disabilities. This combination may be due to the fact that ADHD children are inattentive and learn poorly, or perhaps 'tune out'. Children with LD experience frustration and may be unable to sustain attention because the academic demands are too hard. Studies suggest that ADHD and LD are not genetically linked.

Psychological Disturbances

Depression and anxiety disorders occur in one-third of learning-disabled (LD) children, especially in those with nonverbal learning disabilities. It is not surprising since these children often have very low levels of self-esteem, following years of experiencing failure at school and being labeled "dumb" by peers. Conduct disorder and ADHD occur in about one third of LD children, especially in those with language-based reading disabilities.

Causes

Heredity is a primary factor in language-based learning disabilities. 35%-40% of close relatives of dyslexics have similar difficulties. As with ADHD, there is a link between learning disabilities and maternal abuse of alcohol and cocaine during pregnancy. Dyslexia is associated with left-brain dysfunction, the side of the brain that is specialized for language. Researchers have found that an area in the left hemisphere, known as the planum temporale , which is normally larger on the left side than the right, is either the same size or smaller in dyslexics. Nonverbal learning disabilities have been found in children with severe head injuries, hydrocephalus and radiation treatment of the head. Since these conditions involve destruction of white matter in the right hemisphere, it is felt that nonverbal learning disabilities are caused by early damage to white matter in the right hemisphere.

Diagnosis

Early diagnosis is the central focus of treatment. It is important that a diagnosis be made before skill levels and self-esteem slip to dangerous lows. The child's physician should look for any neurologic dysfunction and assess hearing, and vision to rule out any sensory or neurological problem affecting learning. He/she should take a history of developmental milestones to rule out mental retardation or autism, and inquire about behaviour and attention span. Medications such as antihistamines, anticonvulsants, tranquillizers, and asthma medications may affect attention and learning. Formal assessment, by a psychologist, of intelligence and educational achievement is occasionally necessary. Reports from teachers and/or IQ tests can give information about cognitive strengths and weaknesses and help define how well the child processes information. Some of the more frequently used intelligence tests for school-aged children are the Wechsler Intelligence Scale for Children (WISC-III) and the Stanford Binet Intelligence Scale. Academic achievement can be assessed by tests such as the Peabody Individual Achievement Test-Revised (PIAT-R), Woodcock-Johnson Tests of Achievement-Revised (WJ-R) and the Wide Range Achievement Test-Revised (WRAT-R).

Treatment

Educational Therapy

The cornerstone of treatment of learning disabilities is educational therapy. This must be tailored to the individual needs, and depends on the child's learning strengths and weaknesses. There are many programs to teach reading skills, including intensive phonetic teaching programs. There is no evidence, however, that any one reading technique is better than another.

Besides remedial reading techniques, some have tried teaching LD children learning strategies . There has been some success to instructing them to improve the way they approach new tasks, memorize new information (e.g. using mnemonics), and organize information (e.g. using rhymes or visual images to link specific bits of information together.) One successful strategy is the "write-say" method which involves the student rewrite incorrectly spelled words several times while spelling the word out loud. A variant of this method has also proved successful in teaching multiplication tables.

Other methods to help LD children include the use of other children in the class or school acting as tutors, as well as computer-assisted instruction methods. Children with writing disorders, may be helped by using classmate's notes, homework buddies, oral testing, and being taught keyboarding.

Other Therapies

Social skills training, psychological counseling, and behaviour management techniques are often used therapies, but have not been shown to be consistently helpful. In the child with LD and ADHD, stimulant medications have been shown to improve classroom performance, not only through improved attentiveness, but also in the way the central nervous system processes information. In reading tasks, this effect is seen in improved word-finding abilities.

Most Boards of Education are required by law to provide specialized education for LD children. This may mean special classes, special teachers, or even a special school. There is evidence, though, that teaching LD students in regular classes, using highly motivated, well-trained teachers, and teachers' aides, can lead to improvements in academics, behaviour, and self-esteem.

One of the most valuable supports for parents is the Association for Children with Learning Disabilities (ACLD). It provides parents with information about local services and new discoveries and offers support groups in which parents can compare notes and provide encouragement.

Prognosis

The outcome in children with LD is better for those who are of higher intelligence, have a less severe disability, are in a higher socioeconomic class, attend private school, are not hyperactive, and have no neurologic findings. Most children with reading disability can compensate and attain literacy, but as adults they do less well in areas of work and social and psychological adjustment. However, with the right support systems, many people with LD can achieve high academic and professional success, e.g. Winston Churchill and Thomas Edison.