Teasing Out Learning Disabilities

To all of you Dads out there, happy belated Father’s Day. Here’s hoping that you enjoyed some quality time with the children who mean the most to you — and that you got a special glimpse of how much you mean to them.

I get calls from parents from time to time, asking where they can find more information on various pediatric conditions. They are referred to me through a few daycare centers I know, and these referrals usually have less to do with me being a medical writer than with my child being a human magnet for common medical conditions. And a few weeks ago, I was called by a father who was struggling with the idea of putting his 6 year-old son on medication for ADHD. It seems that the boy had a history of not paying attention at school, his reading and spelling were woefully behind, and his teachers’ patience was running thin. They wanted intervention, and his pediatrician had suggested that perhaps medical therapy would be helpful.

To his credit, the pediatrician reviewed the boy’s psychoeducational report carefully, and while the clinical psychologist who performed the evaluation could not provide a diagnosis of ADHD, telling signs were noted. During the evaluation, the child had trouble sitting still and had difficulty staying on task. His Working Memory Composite was low average, suggesting that he was having some challenges with concentration. These things were all apparently consistent with teacher observations.

The problem was, these observations were 180 degrees from his father’s experience of his son at home. With the TV off, the boy was able to sit at a table unsupervised and do his homework. And despite his inability to complete work at school, the boy had been able to stay on grade level with outside tutoring. Not exactly an ADHD poster child. And his parents understandably didn’t want to put him on medication before understanding what they were dealing with. Who could blame them? Maybe they weren’t dealing with ADHD. Maybe their child had a learning disability.

Unfortunately, this is not an uncommon scenario. According to the CDC, approximately 16% of boys and 8% of girls aged 5 - 17 years had ever had diagnoses of ADHD or a learning disability. As we well know, sometimes these conditions occur together. But how do we know for sure when they don’t?

A few years ago, I was faced with the same kind of dilemma. My daughter wasn’t paying attention in group activities in school, and would instead wander off (mentally, sometimes physically) and begin to do her own thing. The teachers’ opinion was ADD and the results of psychoeducational assessment were anything but clear. Our pediatrician offered to let us try medication. But we held out until she was old enough for an auditory evaluation for central processing disorder, and we found out that she couldn’t hear well. The perforations in her eardrums after tubes apparently never healed, and at the age of 7, she had simply learned to make herself busy when the room was too noisy for her to make out words. There was also evidence of an integration deficit.

There are a multitude of learning disabilities, some of which may show up in delayed developmental milestones before the child enters a classroom, many which may not. Regardless, parents often turn to the pediatrician with their concerns when a child does begin to struggle in school, and getting to the bottom of the symptoms is not a simple — or quick – task. And even when a firm diagnosis is reached, parents may not know what to do with the information.

Here are some poignant questions that I’ve heard from parents over the last year:

“Will medicine for ADHD interfere in my child’s development?”

“My child’s private school doesn’t provide intervention for learning disabilities. How do I find a school that can address her specific needs?”

“Why should I spend extra money for auditory testing? If the diagnosis is auditory processing disorder, there’s nothing I can do about it anyway.”

“If my child has dyscalculia, how do I keep him motivated to learn math?”

While there are no definitive solutions to questions like these, I think that good answers are possible when you consider the individual child. What would your answers be? Are you familiar with the Individuals with Disabilities Education Improvement Act of 2004 and the policy of public schools in your area? How about specialty private schools, educational/child psychologists? This kind of information and resources may be helpful to worried parents.