Learning Disabilities and Learning Disorders
part 3

The difficulty in diagnosing learning disorders and disabilities is with the testing.  First of all, it is not easy or cheap.  It takes about 4-8 hours to test and at least as much to score and prepare a report.  Our clinic contracts out this service to private psychologists.  It costs about 700-800 dollars to do the testing on one child.  Parts of this can be done by a special education teacher or aide.  There is usually about one testing school psychologist to 5-15 schools.  If the psychologist just did testing every day, he or she could never test everyone with a learning disorder.  Our clinic has a budget for testing about 10-20 children a year.  That is about 10% of the children who actually come in with a learning disability.

Secondly, it isn't always accurate, partly because of co-morbidity with ADHD.  If people have ADHD, they have a hard time paying attention to boring things.  Testing is sort of boring and totally inflexible.  I have seen many children with marked ADHD who I was sure had a learning disability.  Sure, that is, until we treated the ADHD and the learning disability disappeared!

Therefore, testing is usually reserved for more complicated cases and for those who can convince the schools to do it or pay for it themselves.  I don't think this is a big problem.  A clinical examination as noted above, along with a careful history, can pick up the vast majority of learning disabilities and disorders.

Most parents want to know, will my son ever read?  Will he ever learn math?  Will he every write legibly?  The answer is dependent on the age of the child when the learning disability is identified and what is done about it.  With early intervention (ages 4-7) and vigorous treatment of the learning disability and any co-morbid condition, people can usually overcome their learning disorders to an extent that they are no longer disabling.  Children are more liley to improve markedly if their disability is less servere, if they are diagnosed early, have higher Iqs, and if they come from higher socioeconomic status and lack comorbid neuropsychiatric disorders.  On the other hand, if a learning disability is first identified at age 10 and nothing is done about it and other neuropsychiatric disorders are left untreated, the future is bleak indeed.

At this moment in the history of mankind, no skill is as important as reading.  The learning disabilities which cause this learning disorder are usually language related and not visually related.  Reading disorders come in three types, depending on if decoding and/or comprehension is affected.

Decoding is the ability to read accurately aloud or to yourself.  You must translate the characters on the page into language.

Comprehension is the ability to make sense of the language which you read.

Some people decode fine, but do not comprehend.  That is, they can read to you just fine but can not answer any questions about what they have just accurately read to you.  This is relatively rare.

Other people have a hard time decoding, but have good comprehension.  That is, they have a hard time reading to you, but once they do read it correctly, they understand it.  This is the most common.

Others have both problems.  They can 't decode well and they can't understand it well once they finally do read it correctly.  This is more likely the case with multiple learning disabilities or mental retardation.

If you can't read, usually you can't spell. They usually go together.

The number of different ways that this learning disorder can present is very great.  To start with, some children reverse numbers and can not align them properly.  Math requires great attention to doing things in a specific order and an ability to work abstractly with no real - life context at all.  Some people have great problems with understanding the relationship between different shapes and the concepts that go with them.  Most math is now taught using concepts like halves (of objects), area for teaching multiplication, and parts of a whole for teaching adding and subtracting.  with this learning disorder, this can be baffling.  Later on the application of the basic operations to real world math problems is very difficult.  Flexibility in teaching is more likely to be beneficial in this disorder than the others.

There are two main ways this presents.  Some children have very bad coordination of the small muscles of their hand.  It is hard to make the letters and they are slow at it.  They are also bad with scissors, coloring, drawing, and other handiwork.  Others have normal fine motor control, but have a great deal of problem with the rules of writing.  Spelling, Grammar, punctuation, capitalization, and composition are very difficult.  In a normal writer, these skills come nearly as automatically as speaking.  In this disorder, the person is having to consciously recall these rules at all times.  This makes writing slow, painful, and of poor quality.  This disorder often is related to reading problems.

These children are clumsy.  They are always falling, tripping. and they do badly in most sports, but especially those involving catching and throwing.  Things like swimming and biking and less affected.  It is a horrible blow to a child's self esteem, especially boys.  In a recent Swedish Study, this was a quite common condition.  About 5-8% of children had significant problems with coordination.  Boys are about seven times more likely to have this problem than girls.  ADHD is quite common in children with Developmental Coordination disorders.  At least 20% of children with Developmental Coordination disorders have ADHD.  Children with Developmental Coordination disorders also have evidence of other learning disorders and language disorders, especially problems with reading.

In my experience, this problem can lead to very poor self esteem in boys when present with ADHD and learning problems.  It certain warrants an aggressive intervention.