A Look At Learning Disabilities In Children And Youth

by Larry B. Silver, M.D.
Reprinted with permission from the Learning Disability Association of Montgomery County, Inc., in Maryland

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National Information Center
for Children and Youth with Disabilities

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Children and adolescents perform poorly in school for various reasons. Some have emotional or family problems; for others, the source of trouble is the community, the school, or peers; and some are simply below average intellectually. But 10 to 20 percent have a neurologically-based disorder of the type called a learning disability. According to the definition used by the federal government, these children are of at least average intelligence (many are far above average), and their academic problems are not caused by an emotional disturbance, by social or cultural conditions, or by a primary visual, hearing, or motor disability. Instead, the reason for their learning problems seems to be that their brains are "wired" in a way slightly different from the average person's. About 20 percent of children with learning disabilities also have a related problem, attention deficit disorder (ADD) or attention deficit hyperactivity disorder (ADHD). Its symptoms include hyperactivity, distractibility, and impulsiveness. ADD or ADHD must be evaluated and treated separately from the learning disability.

Learning disabilities are lifelong conditions that may require special understanding and help throughout grade school, high school, and beyond. They are also life disabilities that have important effects outside of the classroom, interfering not only with academic work but also with children's games, daily activities, and even friendships. Therefore, help for these children means more than classroom special education.

Types of Learning Disabilities

By the late 1960s, the present model of learning disabilities was established. This model distinguishes four stages of information processing used in learning: input, integration, memory, and output. Input is the process of recording in the brain information that comes from the senses. Integration is the process of interpreting this information. Memory is its storage for later retrieval. Output of information is achieved through language or motor (muscular) activity. Learning disabilities can be classified by their effects at one or more of these stages. Each child has individual strengths and weaknesses at each stage.

Input. The first major type of problem at the input stage is a visual perception disability. Some students have difficulty in recognizing the position and shape of what they see. Letters may be reversed or rotated; for example, the letters d, b, p, q, and g might be confused. The child might also have difficulty distinguishing a significant form from its background. People with this disability often have reading problems. They may jump over words, read the same line twice, or skip lines. Other students have poor depth perception or poor distance judgement. They might bump into things, fall over chairs, or knock over drinks.

The other major input disability is in auditory perception. Students may have difficulty understanding because they do not distinguish subtle differences in sounds. They confuse words and phrases that sound alike -- or example, "blue" with "blow" or "ball" with "bell." Some children find it hard to pick out an auditory figure from its background; they may not respond to the sound of a parent's or teacher's voice, and it may seem that they are not listening or paying attention. Others process sound slowly and therefore cannot keep up with the flow of conversation, inside or outside the classroom. Suppose a parent says, "It's getting late. Go upstairs, wash your face, and get into your pajamas. Then come back down for a snack." A child with this disability might hear only the first part and stay upstairs.

Integration. Integration disabilities take several forms, corresponding to the three stages of sequencing, abstraction, and organization.

A student with a sequencing disability might recount a story by starting in the middle, going to the beginning, and then proceeding to the end. The child might also reverse the order of letters in words, seeing "dog" and reading "god." Such children are often unable to use single units of a memorized sequence correctly. If asked what comes after Wednesday, they have to start counting from Sunday to get the answer. In using a dictionary, they must start with "A" each time.

The second type of integration disability involves abstraction. Students with this problem have difficulty in inferring meaning. They may read a story but not be able to generalize from it. They may confuse different meanings of the same word used in different ways. They find it difficult to understand jokes, puns, or idioms.

Once recorded, sequenced, and understood, information must be organized -- integrated into a constant flow and related to what has previously been learned. Students with an organization disability find it difficult to make bits of information cohere into concepts. They may learn a series of facts without being able to answer general questions that require the use of these facts. Their lives in and outside of the classroom reflect this disorganization.

Memory. Disabilities also develop at the third stage of information processing, memory. Short-term memory retains information briefly while we attend to it or concentrate upon it. For example, most of us can retain the 10 digits of a long distance telephone number long enough to dial, but we forget it if we are interrupted. When information is repeated often enough, it enters long-term memory, where it is stored and can be retrieved later. Most memory disabilities affect short-term memory only; students with these disabilities need many more repetitions than usual to retain information.

Output. At the fourth stage, output, there are both language and motor disabilities. Language disabilities almost always involve what is called "demand language" rather than spontaneous language. Spontaneous language occurs when we initiate speaking -- select the subject, organize our thoughts, and find the correct words before opening our mouths. Demand language occurs when someone else creates the circumstances in which communication is required. A question is asked, and we must simultaneously organize our thoughts, find the right words, and answer. A child with a language disability may speak normally when initiating conversation but respond hesitantly in demand situations -- pause, ask for the question to be repeated, give a confused answer, or fail to find the right words.

Motor disabilities are of two types: poor coordination of large muscle groups, which is called gross motor disability; and poor coordination of small muscle groups, which is called fine motor disability. Gross motor disabilities make children clumsy. They stumble, fall, and bump into things; they may have difficulty in running, climbing, riding a bicycle, buttoning shirts, or tying shoelaces. The most common type of fine motor disability is difficulty in coordinating the muscles needed for writing. Children with this problem write slowly, and their handwriting is often unreadable. They may also make spelling, grammar, and punctuation errors.

Detecting a Learning Disability in Children

There are several early clues to the presence of a learning disability. In preschool children we look for failure to use language in communication by age three, or inadequate motor skills (buttoning, tying, climbing) by age five. In school-age children, we observe whether they are learning the skills appropriate to their grade. Schools and families should always consider the possibility of a learning disability before assuming that a child who has been doing poorly in school is lazy or emotionally disturbed. The Individuals with Disabilities Education Act (IDEA), Public Law (P.L.) 102-119 -- formerly known as the Education for All Handicapped Children Act (EHA), P.L. 94-142 -- requires public school systems to evaluate children who are at risk for a learning disability. Evaluations can also be performed by professionals in private practice, beginning with family doctors. Attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), and other problems should always be considered as well and evaluated by qualified professionals with expertise with these conditions. It is important to distinguish between emotional, social, and family problems that are causes and those that are consequences of academic difficulties, because they require different treatments.

The psychological assessment may include a neuropsychological or a clinical psychological evaluation. The intelligence of the child should be determined to learn whether the child is performing below potential. Discrepancies in performance between different sections of the IQ (intelligence quotient) test will help to clarify learning strengths and weaknesses. Other tests may be used to assess perception, cognition, memory, and language abilities. Current academic skills are judged by achievement tests. Both IQ and achievement tests help to clarify discrepancies between potential and actual ability. There are also specific tests that help to uncover learning disabilities. A speech pathologist, occupational therapist, or other professional may contribute further information, as can parents.

Treatment of Learning Disabilities in Children

Special education is the treatment of choice for learning disabilities in school. The Individuals with Disabilities Education Act requires that the school, in conjunction with the parents and relevant professionals, develop an individualized education plan (IEP) for each student with learning disabilities. This plan is revised every year to take into account each eligible student's present skills and learning disabilities and abilities. The specific instruction students receive will vary depending upon their needs and capabilities. Some students attend special education classes full time. Others spend most of their time in a regular class and go to a resource room for part of each day, or spend most of the day in special education and the rest in a regular class. The regular classroom teacher must build on the child's strengths while helping to compensate for weaknesses. The special education teacher consults with the classroom teacher and provides specific interventions, called academic therapy, to overcome or compensate for learning disabilities. Some children need remedial work to learn basic skills such as reading, writing, and arithmetic. Others also need special intervention to fill gaps; for example, students might have difficulty writing a composition in high school because they did not learn punctuation in an earlier grade. Strategies for learning appropriate to a given student's strengths and weaknesses can be taught. Some children need specific related services: a notetaker (for a student with a fine motor disability), word processors, laptop computers, books on tape, or extra time for tests. The IDEA requires schools to provide these special education and related services at no cost to families.

Parents must also try to understand the nature of their children's problems. Like classroom teachers, they must build on the child's strengths while compensating for or adjusting to the weaknesses without exposing them unnecessarily. A child with a visual motor disability, for example, might find it hard to load a dishwasher but could carry out the trash. The same child might have difficulty catching or throwing a ball, but no trouble swimming. Parents must think ahead about these matters to minimize their child's stress and to maximize his or her chance to experience success, make friends, and develop self-esteem. Treatment that affects only school work will not succeed, because learning disabilities are life disabilities.

It is essential to recognize learning disabilities and related problems as early as possible. Without recognition and help, children may become increasingly frustrated and distressed as they persistently fail. By the time they reach high school, they may give up. On the other hand, children whose problems are recognized early and treated appropriately can overcome or learn to compensate for their disabilities.

(NICHCY thanks Dr. Larry Silver and the Learning Disability Association of Montgomery County, Inc., for permission to reprint Dr. Silver's article, which appeared in their November 1991 newsletter. The Learning Disability Association of Montgomery County, Inc., is a local chapter of the Learning Disabilities Association of America. You can contact LDAMC, Inc. by writing P.O. Box 623, Rockville, MD 20848-0623.)