Clinics and Departments

Learning Disabilities 

Everyone agreed Billy was ready for kindergarten. All through his preschool years, nursery school teachers, parents, relatives and friends described him as a bright, curious, and creative child. Billy had acquired a wealth of knowledge about the world around him, and was particularly interested in the workings of electronic devices. At the age of four he could disassemble a radio or watch and could reassemble it with no difficulty. He also was a mild-mannered, well-behaved child, and his parents’ expectations for his school performance were indeed very high. Their comment to family and friends was “this is a child who will thrive in school.”  

However, after several months of direct instruction in readiness skills—such as learning the letters of the alphabet or learning numbers—Billy began to struggle. Sometimes he could not recall the exact names of the letters or numbers, and sometimes he could not recall the sounds the letters made. Sometimes he printed letters or numbers backward, and sometimes they were inverted. When it came to remembering actual words, he was at a loss.  

At the spring parent conference, teachers voiced concerns over Billy’s academic achievement, but assured parents this was probably a matter of maturation, and he would “catch up in first grade.” As many parents would feel, Billy’s parents were concerned but did not want to “overreact.” They began to ask pertinent questions, and began to wonder whether their son was “at risk” for having learning disabilities.  

What is a learning disability? Is it easy to identify?

These two questions must be asked simultaneously. There are “indicators” of potential learning disabilities. On the other hand, all children are unique, differing from one another intellectually, emotionally, socially and physically. Given this uniqueness, however, most students learn in regular classrooms and are taught successfully with traditional methods of instruction.  

However, all children do not follow this pattern. Some children struggle due to specific “learning disabilities,” and require individualized instruction. These children, known as children with “learning disabilities,” may have problems in one or several of the academic areas (such as reading, arithmetic, language or spelling). Often their estimated intellectual ability differs markedly from their actual achievement. Some of these students may exhibit wide spans between the skills they excel in and those that are problem areas. Some may have only one problem area, such as reading comprehension, whereas others may have a combination of learning problems.

Therefore, to diagnose a learning disability, it is important to consider the following: 

  • Has this child been thoroughly evaluated for both hearing and vision?
  • Are there other health issues?
  • Have other developmental milestones (such as age of walking, age of first words and intelligible speech, age of toilet training, development of “small/ large motor skills” and development of socialization skills) been within average parameters? 

After addressing these questions, keep in mind that learning disabilities are not diagnosed in the same sense as “chickenpox.” There is no absolute or predictable set of symptoms. Parents and pre-school teachers may suspect a potential learning disability by observing of development. But children differ in their rate of development, and sometimes what seems to be a potential learning disability may simply be a delay in maturation. Not all learning problems are necessarily learning disabilities. 

Proper diagnosis is crucial. Making a diagnosis is a complex task. There are “red flags” for potential learning disabilities, and research has stressed the importance of early identification of children who are “at risk” for learning disabilities. On the other hand, children develop at various rates, so parents are encouraged to “not over-react.  

Risk factors to monitor 

There may be a learning disability if this child: 

  • has a history of chronic ear infections during pre-school years
  • has difficulty copying basic geometric shapes
  • does not recall names and sounds of letters or numbers
  • has difficulty copying and recalling the formation of letters and numbers when a sample is not provided
  • has difficulty associating sounds with written symbols (e.g. “b” sounds like “b-b-b.”)
  • does not recognize rhymes
  • has difficulty with letters or numbers which are easily reversed or inverted
  • has difficulty with “automatic” recall of letters and numbers
  • has little experience with the idea of written words conveying meaning 

These and other risk factors should be closely monitored during the beginning elementary years, as early identification of difficulties has significant implications for long-term outcomes. 

Moving from observations to formal assessments 

While children can be informally identified as being “at risk” for having learning disabilities, actual diagnosis 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. 

In other words, specific criteria must be met to be diagnosed with a learning disability. The Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition (DSM-IV) contains the criteria and characteristics for diagnosing learning disabilities. The manual provides specific criteria professionals use to determine whether a formal diagnosis of a learning disability can be made. For example, the diagnostic criteria from the DSM-IV identify a learning disability in the area of reading based on the following: 

1.      Reading achievement, as measured by individually administered standardized tests of reading accuracy or comprehension, is substantially below that expected given the person’s chronological age, measured intelligence, and age-appropriate education. 

2.      The disturbance in Criterion 1 significantly interferes with academic achievement or activities of daily living that require reading skills. 

3.      If a sensory deficit is present, the reading difficulties are in excess of those usually associated with it. 

Assessments for possible learning disabilities are completed by professionals such as School Psychologists, Clinical Psychologists and/or Educational Specialists, and teachers certified in Special Education.  

Federal definition of a learning disability 

The federal definition of a learning disability comes into play if the need for Special Education is a possibility. This definition is more precise than the DSM-IV definition, and it is the one schools and Special Education personnel most often use. It is as follows: 

  • A condition within the individual affecting learning, relative to potential. A specific learning disability is manifested by interference with the acquisition, organization, storage, retrieval, manipulation, or expression of information so that the individual does not learn at an adequate rate when provided with the usual developmental opportunities and instruction from a regular school environment. 
  • A specific learning disability is demonstrated by a significant discrepancy (which is determined by a statistical formula) between a pupil’s general intellectual ability and academic achievement. This formula tends to be quite rigid, although school districts demonstrate varying amounts of flexibility in their interpretation. 
  • A specific learning disability is demonstrated primarily in academic functioning, but may also affect self-esteem, career development, and life adjustment skills.  
  • A specific learning disability may occur with, but cannot be primarily the result of: visual, hearing, or motor impairment; mental impairment; emotional disorders; or environmental, cultural, economic influences, or a history of an inconsistent education program. 

Treatment for learning disabilities  

It is important to get help once a learning disability has been diagnosed. In order to receive Special Education services through the public school system, specific criteria must be met to qualify for various services. As suggested previously, the following steps must be completed in order to receive Special Education services for a learning disability.

  • A formal assessment is completed and indicates a significant discrepancy (or difference) between intelligence and academic skill development. For example, if the Intelligence score (or Full Scale IQ) is 100, then the reading achievement score must be 79 or below in order to qualify for services. 
  • A “processing disorder” (which may include difficulty with areas such as memory, attention, or understanding of language) must be evident. 
  • There must be evidence of severe underachievement in the classroom.

 

What are alternatives to special education services? 

Children may obtain scores indicating they are struggling with academic skill development, but the scores are not discrepant enough for them to receive Special Education services. In these cases it is sometimes possible to qualify for other sources of support, such as Title I, Chapter I or Assurance of Mastery, which are federally funded programs for children in regular education who do not qualify for Special Education in the public schools.  

In addition to these services, parents sometimes hire tutors to work with their children to strengthen skills and to provide support with work completion. This is not an optimal solution, however, as the cost of tutoring is not covered by insurance, nor is it compensated by the school. 

What causes learning disabilities? 

Often one of the first questions parents ask when they learn their child has a learning disability is “Why? How did this happen?” In spite of years of research, professionals have made few gains in answering this question. Recent studies suggest that learning disabilities appear to run in families and therefore, the possibility of a genetic link has been explored. In addition, with the development of Positron Emission Topography, or PET scans, it has been possible to compare brain structures of people with and without learning disabilities. In these studies, results have identified tiny differences in brain structures and functioning. This has led to further research into the physiological aspect of learning disabilities. 

Other “causes” of learning disabilities are more related to factors in the environment. Problems during pregnancy or delivery, effects of tobacco, alcohol and other drug use, and toxins in the child’s environment also are contributory factors.

 

Can learning disabilities be outgrown? 

Perhaps the best answer is to re-phrase the question, and ask, “Can learning disabilities be managed?” Can a person develop strategies to work around the disability and acquire skills needed for a successful and productive life? The answer to these questions is certainly “yes.” In fact, countless individuals across cultures with reported learning disabilities, have made enormous achievements in science, politics, athletics, and the arts. speak for themselves. It is thought that Albert Einstein, Thomas Edison, Winston Churchill, Nelson Rockefeller, George Patton, Walt Disney, Tom Cruise, and Cher have had some form of learning disability. 

How to “work around” a learning disability

What interventions or accommodations help? The professionals working with individuals with learning disabilities have found that a multi-sensory, structured, systematic, and repetitious instructional approach has been most effective. There are dozens of publications based on the studies and writings of Dr. Samuel T. Orton and Psychologist Anna Gillingham. In the 1920’s the two collaborated to develop an effective approach for teaching reading and written language skills to people with learning disabilities. Today, this approach is viewed as the most effective in working with individuals with these difficulties. The purpose of the Orton-Gillingham approach and related materials is to remediate skills. 

In addition to remediation of skills, however, it is necessary to make accommodations. The following are commonly used and accepted by professionals and educators: 

  • Use tape-recorded textbooks. The student either solely listens to the tape, or attempts to follow in his/her textbook as he/she listens. 
  • Use instructor’s lecture notes. The student attempts to take his/her own notes during class, but is also provided with a complete copy of the instructor’s notes. The rationale is that unless this is a class in “notetaking” the student with learning disabilities should not be penalized for having difficulty getting the critical information down on paper while listening. 
  • Use a proofreader. Often a Special Education teacher, tutor, parent, or peer-tutor reads and corrects mechanical errors in written language (e.g. spelling, capitalization, and punctuation). Again, emphasis is placed in the knowledge and skills the student has acquired, not on the “means” of acquiring or communicating this knowledge. 
  • Alternative assignments. An instructor may accept a shorter written report along with a “hands on” project in lieu of a lengthy written report. For example, a student may draw or build a model of the Globe Theatre along with a shortened report on the life of Shakespeare. 
  • Testing accommodations. Students may receive extended time during tests due to slow rate of task completion in academic areas. Tests also may be given in distraction-free settings when attention is part of the learning disability. In many instances, types of tests are altered. For a student with a learning disability in written expression, it may be preferable to use an objective test rather than an essay test. The goal of testing should be to determine whether the student acquired the knowledge and skill level of the course (not whether he/she can write quickly and efficiently within a given time period). 
  • Other accommodations are included in a student’s IEP (Individualized Educational Plan) according to their specific learning needs. The IEP team (consisting of administrators, teachers and parents) agree on the particular accommodations needed for each student. 

Sources of information and support 

Learning Disabilities Association of America
4156 Library Road
Pittsburgh, PA 15234
(412) 341-8077
www.ldanatl.org 

Library of Congress
National Library Service for the Blind and Physically Handicapped
1291 Taylor Street NW
Washington, DC 20542
(202) 707-5100

Talking Books and Reading Disabilities, a fact sheet outlining eligibility requirements for borrowing talking books. 

National Information Center for Children and Youth with Disabilities
PO Box 1492
Washington, DC 20013
(800) 695-0285
www.ncld.org 

National Institute of Mental Health
www.nimh.nih.gov 

International Dyslexia Association
Chester Building, Suite 382
Baltimore, MD 21286
(410) 296-0232
www.interdys.org 

To arrange for special college entrance testing for LD adults, contact:

ACT Special Testing (319) 337-1332
SAT Scholastic Aptitude Test (609) 771-7137
GED (202) 939-9490