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REGARDING LEARNING DISABILITIES
(INFORMATION FOR PARENTS)

cont.

TREATMENT

As many people already know, the medical response to Attention-deficit Hyperactivity Disorder (ADHD) is a psychostimulant such as Ritalin or Cylert. The fact that 80% or more of ADHD children respond positively to stimulants would appear to favor an organic cause of this disorder; however, studies have shown that non-ADHD school children also show a similar pattern of reduced activity level and less distractibility when administered stimulants. The effects of stimulants tend to be dose-dependent, with improvements in attention being associated with low doses and reductions in overactivity being associated with higher doses. There is also some evidence that social behaviors continue to improve with increasing dosage level, while performance on cognitive tasks is better at lower doses than higher doses. Parents and teachers should be aware that stimulants do not "cure" ADHD; once their use is discontinued, symptoms usually return.

It should be noted that the use of stimulant drugs as a treatment for ADHD has been criticized on several grounds. First, stimulants are not associated with long-term improvements in social, emotional, or academic functioning. Second, stimulants can have a number of adverse side-effects including insomnia, loss of appetite, irritability, increased heart rate and blood pressure, and a temporary suppression of height and weight. Third, stimulants are effective for only about 75% of hyperactive youth and appear to be least beneficial for children or adolescents with signs of minimal brain damage. Note, however, that concern regarding the possibility that stimulant drugs lead to subsequent drug abuse has not been confirmed. Because there are side-effects with virtually all drugs, it is necessary to weigh and balance the benefits of the medication with the unpleasant side effects. There is no perfect medium and some uncomfortableness may need to be tolerated. It is also crucial to find a physician (or preferably, a child psychiatrist) who is willing to adjust dosages over time, rather than taking the child off medication as soon as the initial dosage proves ineffective. There are other, nonstimulant medications, such as Imipramine, that have proven effective in helping some children with ADHD.

There are many behavioral and cognitive approaches to teaching LD children how to compensate for their disabilities. Current theories of learning disability emphasize difficulties in the self-regulation of planful behaviors. Research has shown, for example, that children who demonstrate use of inadequate task strategies are helped by mild prompts or direct instruction in strategy usage. Studies have also shown that, in contrast to the problem-solving strategies of non-LD children, those with LD problems produce more task-irrelevant speech. Therefore, a major objective of many remedial programs is to teach LD children more effective problem-solving skills. One method for teaching these skills is called "self-instruction" in which an instructor verbalizes the problem-solving process while solving an actual problem, which is very much like "thinking aloud." Then the child is encouraged to solve a similar problem while verbalizing the necessary steps and receives coaching from the instructor. Then the instructor "fades out" her coaching and ultimately the child "fades out" the self-talk and solves the problem without any unnecessary verbalizations.

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A very useful and inexpensive guidebook for parents and teachers of LD students is "Helping the LD Student with Homework," by Suzanne H. Stevens, published by LDTV, 1001 S. Marshall St., Suite 37, Winston-Salem, North Carolina 27101. Ms. Stevens recommends conferences with the teacher, parent, and LD specialist attending, to work out a plan of action early in the school year. She also stresses the need to be realistic about the child's capabilities.

It can take five to ten minutes for a child just to get organized for studying one homework assignment, and she will need time to reorganize before tackling each assignment. Because LD students have "memories that leak" it is crucial that homework assignments be written down exactly as the teacher expects. The child should be taught to record every assignment in a notebook. Each assignment should be accompanied by at least two examples of how to do the assigned work; e.g., the LD may be able to carry in addition while at school, yet completely forget how this is done by the time she gets home.

The child's homework should cover only those topics that the child has already showed some mastery of in class. Subjects that are new or that the child is struggling with should not be included in homework assignments. Because LD children do their best work under structured conditions, their homework activities should be "routinized." The child should receive some sort of immediate positive feedback when homework is turned in. The parent's role in homework is more of facilitator, offering support and sympathy, but not getting deeply involved in helping the child complete the assignments. (My clinical experience has shown that LD children often get their parents to do the lion's share of the homework, because the parents get tired of re-explaining how to do things or listening to the child's litany of complaints.) Another helpful book by Ms. Stevens is "The Learning-Disabled Child: Ways That Parents Can Help," published by John F. Blair.

Parents need to remember that discipline in the home is a form of education, and a learning disability that interferes with schoolwork will often interfere with the child's ability to profit from traditional forms of discipline. Parents and teachers should be sensitive to the impact that LD problems can have on the child's self-concept, mood, and social skills. Treatment strategies should remain flexible enough to comprehensively deal with the child's problems. Children with legitimate learning difficulties should not be shamed or punished into performing better in their studies, nor should unrealistic demands be placed upon them. It is a sad fact that LD problems are strongly correlated with conduct disorders, and this often occurs because the LD child must look to other underachieving, disenfranchised youth in order to develop a sense of success and belongingness ("I can't be a successful student, but maybe I can be a successful delinquent."). Accommodating to the child's patterns of strengths and weaknesses reduces frustration and maximizes opportunities to learn. It is important to use interventions that are age-appropriate, as any self-respecting sixth grader would take offense at receiving the same instructional techniques used with third graders, just because that happens to be her current reading level.

Other useful texts include: "The Parent's Guide: Solutions to Today's Most Common Behavior Problems in the Home," by Stephen B. McCarney, and Angela M. Bauer, published by Hawthorne Educational Services, 800 Gray Oak Drive, Columbia, MO 65201; and "Your Hyperactive Child: A Parent's Guide to Coping with Attention Deficit Disorder," by Barbara Ingersoll, published by Main Street Books, 666 Fifth Avenue, New York, New York 10103.

A FINAL WORD

Some school districts will inform parents that, even though they suspect their child has an LD problem, or hyperactivity, etc., the school district does not provide these assessments. A local school district has been telling parents that they only have resources for evaluating dyslexia. Federal laws, such as PL 94-142 and 504, require school districts to evaluate any child who is suspected of having problems. If the parent disagrees with the opinion of school officials, the parent has the right to ask for a hearing to resolve the issue. At the hearing, a school which does not want to do appropriate testing must explain why such testing in unnecessary--which is almost impossible for them to do without doing an evaluation! Probably all states have advocacy groups that help parents negotiate the trials and tribulations of our public school system and parents who feel that their child is being undeserved by their school district should avail themselves of this valuable resource.

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