Six-year-old David's favorite part of the day is story time. He loves it when Mom reads to him, and he has no trouble remembering what he hears. But David has a problem. He cannot read for himself. In fact, any task that requires visual skill frustrates him.
Sarah is in her third year of school, yet her writing is unusually sloppy. Her letters are poorly formed, and some of them are written backward. Adding to her parents' concern is the fact that Sarah has trouble even writing her own name.
Josh, a young teen, does well in every subject at school except math. The concept of numerical values completely baffles him. Just looking at numbers makes Josh angry, and when he sits down to do his math homework, his disposition rapidly deteriorates.
WHAT is wrong with David, Sarah, and Josh? Are they simply lazy, stubborn, perhaps slow-witted? Not at all. Each of these children is of normal to above-average intelligence. Yet, each one is also hampered by a learning disability. David suffers from dyslexia, a term that is applied to a number of reading problems. Sarah's extreme difficulty with writing is called dysgraphia. And Josh's inability to grasp the basic concepts of math is known as dyscalculia. These are just three learning disabilities. There are many more, and some experts estimate that altogether they affect at least 10 percent of the children in the United States.
Defining Learning Disabilities
Granted, at times most youths find learning to be a challenge. Usually, though, this does not indicate a learning disability. Instead, it simply demonstrates that all children have learning strengths and weaknesses. Some have strong hearing skills; they can absorb information quite well by listening. Others are more visually oriented; they learn better by reading. In school, however, students are clustered into a classroom and all are expected to learn regardless of the teaching method used. Hence, it is inevitable that some will have learning problems.
According to some authorities, however, there is a difference between simple learning problems and learning disabilities. It is explained that learning problems can be overcome with patience and effort. In contrast, learning disabilities are said to be more deep-rooted. "The learning disabled child's brain seems to perceive, process, or remember certain kinds of mental tasks in a faulty manner," write Drs. Paul and Esther Wender.
Still, a learning disability does not necessarily mean that a child is mentally handicapped. To explain this, the Wenders draw an analogy with tone-deaf people, who cannot distinguish differences in musical pitch. "Tone deaf people are not brain-damaged and there is nothing wrong with their hearing," Wenders write. "Nobody would suggest that tone deafness is due to laziness, poor teaching, or poor motivation." It is the same, they say, with those who are learning disabled. Often, the difficulty focuses on one particular aspect of learning.
This explains why many children with learning disabilities have average to above-average intelligence; indeed, some are extremely bright. It is this paradox that often alerts doctors to the possible presence of a learning disability. The book Why Is My Child Having Trouble at School? explains: "A child with a learning disability is functioning two or more years below the expected level for his age and his assessed IQ." In other words, the problem is not simply that the child has trouble keeping up with his peers. Rather, his performance is not on par with his own potential.
Providing Needed Help
The emotional effects of a learning disability often compound the problem. When children who are learning disabled do poorly in school, they may be seen as failures by their teachers and peers, perhaps even by their own family. Sadly, many such children develop a negative self-image that can persist as they grow. This is a valid concern, since learning disabilities generally do not go away. "Learning disabilities are life disabilities," writes Dr. Larry B. Silver. "The same disabilities that interfere with reading, writing, and arithmetic also will interfere with sports and other activities, family life, and getting along with friends."
It is essential, therefore, that children with learning disabilities receive parental support. "Children who know that their parents are strong advocates for them have a basis for developing a sense of competency and self-esteem," says the book Parenting a Child With a Learning Disability.
But to be advocates, parents must first examine their own feelings. Some parents feel guilty, as if they were somehow to blame for their child's condition. Others panic, feeling overwhelmed by the challenges set before them. Both of these reactions are unhelpful. They keep the parents immobilized and prevent the child from getting the help he needs.
So if a skilled specialist determines that your child has a learning disability, do not despair. Remember that children with learning disabilities just need extra support in a specific learning skill. Take the time to become familiar with any programs that may be available in your area for children who are learning disabled. Many schools are better equipped to deal with such situations than they were years ago.
Experts emphasize that you should praise your child for any accomplishments, no matter how small. Be generous with commendation. At the same time, do not neglect discipline. Children need structure, and this is all the more true of those who are learning disabled. Let your child know what you expect, and hold to the standards you set.
Finally, learn to view your situation realistically. The book Parenting a Child With a Learning Disability illustrates it this way: "Imagine going to your favorite restaurant and ordering veal scallopini. When the waiter puts the plate in front of you, you discover rack of lamb. They're both delicious dishes, but you were prepared for the veal. Many parents need to make a mental shift in their thinking. You might not have been prepared for the lamb, but you find it's wonderful. So it is when you raise children with special needs."
"Sit Still and Pay Attention!"
Living With Attention Deficit Hyperactivity Disorder
"All along, Jim had said that Cal was just spoiled and that if we—meaning me—cracked down on him, he'd shape up. Now here was this doctor telling us that it wasn't me, it wasn't us, it wasn't Cal's teachers: something really was wrong with our little boy."
CAL suffers from Attention Deficit Hyperactivity Disorder (ADHD), a condition characterized by inattentiveness, impulsive behavior, and hyperactivity. The disorder is estimated to affect from 3 to 5 percent of all school-age children. "Their minds are like TV sets with faulty channel selectors," says learning specialist Priscilla L. Vail. "One thought leads to another, with no structure or discipline."
Let us briefly consider three major symptoms of ADHD.
Inattentiveness: The child with ADHD cannot filter out unimportant detail and focus on one topic. Thus, he is easily distracted by extraneous sights, sounds, and smells. He is paying attention, but no single feature in his environment stands out. He cannot determine which one deserves his primary concentration.
Impulsive behavior: The ADHD child acts before he thinks, without considering the consequences. He shows poor planning and judgment, and at times his actions are dangerous. "He rushes into the street, onto the ledge, up the tree," writes Dr. Paul Wender. "As a result he receives more than his share of cuts, bruises, abrasions, and trips to the doctor."
Hyperactivity: Hyperactive children are constantly fidgeting. They cannot sit still. "Even when they are older," Dr. Gordon Serfontein writes in his book The Hidden Handicap, "careful observation will reveal some form of continuous movement involving the legs, feet, arms, hands, lips or tongue."
Yet, some children who are inattentive and impulsive are not hyperactive. Their disorder is sometimes referred to simply as Attention Deficit Disorder, or ADD. Dr. Ronald Goldberg explains that ADD "can occur without any hyperactivity at all. Or it can occur with any degree of hyperactivity—from barely noticeable, through rather annoying, to highly disabling."
What Causes ADHD?
Over the years, attention problems have been blamed on everything from bad parenting to fluorescent lighting. It is now thought that ADHD is associated with disturbances in certain brain functions. In 1990 the National Institute of Mental Health tested 25 adults with ADHD symptoms and found that they metabolized glucose more slowly in the very areas of the brain that control movement and attention. In about 40 percent of ADHD cases, the individual's genetic makeup seems to play a role. According to The Hyperactive Child Book, other factors that may be associated with ADHD are the use of alcohol or drugs by the mother during pregnancy, lead poisoning, and, in isolated cases, diet.
The ADHD Adolescent and Adult
In recent years doctors have found that ADHD is not just a childhood condition. "Typically," says Dr. Larry Silver, "parents will bring in a child for treatment and say, 'I was the same when I was a kid.' Then they'll admit they still have problems waiting in line, sitting through meetings, getting things done." It is now believed that about half of all children with ADHD carry at least some of their symptoms into adolescence and adulthood.
During adolescence, those with ADHD may shift from risky behavior to delinquency. "I used to worry that he wouldn't get into college," says the mother of an ADHD adolescent. "Now I just pray that he stays out of jail." That such fears may be valid is shown by a study comparing 103 hyperactive youths with a control group of 100 children who did not have the disorder. "By their early 20s," reports Newsweek, "the kids from the hyperactive group were twice as likely to have arrest records, five times as likely to have felony convictions and nine times as likely to have served time in prison."
For an adult, ADHD poses a unique set of problems. Dr. Edna Copeland says: "The hyperactive boy may turn into an adult who changes jobs frequently, gets fired a lot, fiddles all day and is restless." When the cause is not understood, these symptoms can strain a marriage. "In simple conversations," says the wife of a man with ADHD, "he wouldn't even hear everything I said. It's like he was always somewhere else."
Of course, these traits are common to many people—at least to a degree. "You have to ask if the symptoms have always been there," says Dr. George Dorry. For example, he notes that if a man has been forgetful only since he lost his job or since his wife gave birth, that's not a disorder.
Furthermore, if one truly has ADHD, the symptoms are pervasive—that is, they affect almost every aspect of the person's life. Such was the case with 38-year-old Gary, an intelligent, energetic man who could not seem to complete a single task without being distracted. He has already held more than 120 jobs. "I had just accepted the fact that I couldn't succeed at all," he said. But Gary and many others—children, adolescents, and adults—have been helped to cope with ADHD. How?
A Word of Caution to Parents
VIRTUALLY all children are at times inattentive, impulsive, and overactive. The presence of these traits does not always indicate ADHD. In his book Before It's Too Late, Dr. Stanton E. Samenow notes: "I have seen innumerable cases where a child who does not want to do something is excused because he is thought to suffer from a handicap or condition that is not his fault."
Dr. Richard Bromfield also sees a need for caution. "Certainly, some people diagnosed with ADHD are neurologically impaired and need medication," he writes. "But the disorder is also being named as the culprit for all sorts of abuses, hypocrisies, neglects and other societal ills that in most cases have nothing to do with ADHD. In fact, the lack of values in modern life—random violence, drug abuse and, less horrifically, unstructured and overstimulating homes—are more apt to foster ADHD-like restlessness than any neurological deficit."
It is thus with good reason that Dr. Ronald Goldberg warns against using ADHD as "a catchall concept." His advice is to "make sure no important diagnostic stone is left unturned." Symptoms that resemble ADHD may indicate any one of many physical or emotional problems. The assistance of an experienced doctor is therefore essential in making an accurate diagnosis.
Even if a diagnosis is made, parents would do well to weigh the pros and cons of medication. Ritalin can eliminate undesirable symptoms, but it can also have unpleasant side effects, such as insomnia, increased anxiety, and nervousness. Thus, Dr. Richard Bromfield cautions against being too quick to medicate a child simply to eliminate his symptoms. "Too many children, and more and more adults, are being given Ritalin inappropriately," he says. "In my experience, Ritalin use seems to depend largely on parents' and teachers' ability to tolerate children's behavior. I know of kids who have been given it more to subdue them than to meet their needs."
Parents should therefore not be too quick to label their children as having ADHD or a learning disability. Rather, they should weigh the evidence carefully, with the help of a skilled professional. If it is determined that a child has a learning disorder or ADHD, parents should take the time to become well-informed about the problem so that they can act in the best interests of their children.
Meeting The Challenge
OVER the years several treatments have been proposed for ADHD. Some of these have focused on diet. However, some studies suggest that food additives do not usually cause hyperactivity and that nutritional solutions are often ineffective. Other methods of treating ADHD are medication, behavior modification, and cognitive training.*
Medication. Since ADHD apparently involves a brain malfunction, medication for restoring the proper chemical balance has proved helpful to many.# However, medication does not take the place of learning. It merely helps the child focus his attention, giving him a foundation upon which to learn new skills.
Many adults with ADHD have likewise been aided by medication. However, caution is in order—with youths and adults—since some stimulant medication used to treat ADHD can be addictive.
Behavior modification. A child's ADHD does not absolve parents from the obligation to discipline. Though the child may have special needs in this regard, the Bible admonishes parents: "Train up a boy according to the way for him; even when he grows old he will not turn aside from it." (Proverbs 22:6) In her book Your Hyperactive Child, Barbara Ingersoll notes: "The parent who simply gives up and lets his hyperactive child 'run wild' does the child no favor. Just like any other child, the hyperactive child needs consistent discipline coupled with respect for the child as a person. This means clear limits and appropriate rewards and penalties."
It is therefore important that parents provide solid structure. Furthermore, there should be a strict routine in daily activities. Parents may wish to give the child some latitude in making up this schedule, including a time for homework, study, bath, and so forth. Then be consistent in following through. Make sure that the daily routine is adhered to. Phi Delta Kappan notes: "Physicians, psychologists, school officials, and teachers have an obligation to the child and the child's parents to explain that the classification of ADD or ADHD is not a license to get away with anything, but rather an explanation that may lead to legitimate help for the child in question."
Cognitive training. This includes helping the child to change his view of himself and his disorder. "People with attention-deficit disorder feel 'ugly, stupid, and bad' even if they are attractive, intelligent, and good-hearted," observes Dr. Ronald Goldberg. Therefore, the child with ADD or ADHD needs to have a proper view of his worth, and he needs to know that his attention difficulties can be managed. This is especially important during adolescence. By the time a person with ADHD reaches the teenage years, he may have experienced much criticism from peers, teachers, siblings, and perhaps even from parents. He now needs to set realistic goals and to judge himself fairly rather than harshly.
The above approaches to treatment can also be pursued by adults with ADHD. "Modifications are necessary based on age," writes Dr. Goldberg, "but the underpinnings of treatment—medication where appropriate, behavior modification, and cognitive [training]—remain valid approaches throughout the life cycle."
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