Children's Voice Mar/Apr 2006

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Exceptional Children: Navigating Learning Disabilities and Special Education

Effective Communication Is the Best Medicine
Medical professionals can help ensure school success for children with learning disabilities.

By Sheldon H. Horowitz

Creating safe, stable, and nurturing opportunities for children to learn is a gargantuan task, and the list of potential--and in some cases, essential--ingredients that contribute to children's educational well-being is virtually endless. Attending to these needs can be especially challenging for children in foster care. Medical professionals should be recruited as active partners in ensuring that learning and behavioral needs are addressed at home and in the school community.

Why Doctors?

Society views members of the medical community with great respect, and schools have long depended on physicians to ensure the health and safety of children throughout the school year. Nevertheless, a sort of tension exists between the educational and medical communities, perhaps because of their perceived separateness and the different types of authority bestowed on their respective members.

Think about the child who is "having trouble paying attention in class." At a certain point--hopefully after first providing explicit and carefully documented remedial instruction--teachers and school support personnel may turn to special education to design an effective instructional program for the child. At the same time, the child might be viewed as a candidate for medical evaluation, with careful attention to whether ADHD or other medical concerns are contributing to poor school performance.

Armed with good information, and working in partnership, educators and doctors can be extraordinarily powerful in advocating for and delivering effective services to children with learning disabilities (LD) and related disorders of learning and behavior.

What All Children Need

Here are some of the essential ingredients that contribute to a child's well-being. Although the context here is educational, they certainly apply to a child's family and community life as well. These issues should be discussed with medical providers, and their comments and recommendations should be included in reports and conversation with adult care providers and school personnel.

Children need
  • school environments that allow them to feel safe and free to ask questions and seek advice;

  • classrooms where they have opportunities for explicit and well-targeted instruction, practice and corrective feedback, and the assurance that honest effort will reap rewards;

  • a sense of belonging and inclusiveness, even when they are pulled out of the general education classroom for remedial or special educational services;

  • adults (parents, medical professionals, and educators, administrators, and related services providers) who are committed to establishing and maintaining direct and ongoing communication;

  • help coping with transitions--both expected and unexpected--and, to the extent possible, opportunities to participate in the decision-making process so they learn how to be flexible and effective self-advocates;

  • positive role models--adults and peers--in school, at home, and in the community;

  • coordination of educational and medical care, where all members of the treatment team have easy access to meaningful information (written in ways that everyone can understand); and

  • an accurate, meaningful record (more than just copies of report cards and lists of standardized scores) of school progress, perhaps including work samples, photos, and annotated notes about what teaching and learning strategies seemed to have worked best over time, and even which teachers were most effective, and why.
Action Items for the Treatment Team

Here are ways to join with medical providers and ensure learning success for children with learning disabilities: 1

Help dispel the stubborn mythology that surrounds specific learning disabilities. This is an ideal role for physicians. Ask them to explain how LD is not about seeing letters upside down or reversed, and that dyslexia is just one type of learning disability that affects reading speed and accuracy, vocabulary, comprehension, spelling, and written expression.

Convey the message that learning disabilities are real. No medical tests can diagnose learning disabilities, but that doesn't mean they're not real. Neurobiological and genetic research in this area is far from complete, but we do know learning disabilities often run in families, and their effects can be lifelong.

Ask physicians to help children and families understand that learning disabilities can affect an individual's ability to function at different times and in different ways across the person's lifespan. Let them articulate that learning disabilities aren't limited to any one skill area, such as reading, math, or listening, and that learning disabilities do not result from educational impoverishment or physical, sensory, or motor impairments; that they're as likely to appear in boys as in girls; and that they don't result from a lack of motivation or effort on the part of the individual.

Better understand the similarities and differences between different disorders. Although disorders of learning, attention, mood, and anxiety often have overlapping characteristics and co-occur with some frequency, each has recommended treatment approaches, and each demands unique evaluation protocols to determine what will work best and how to monitor improvement over time.

Take LD and ADHD. The public is well aware that a number of medicines have proven effective in helping children with ADHD stay focused. There is, however, no recommended medical treatment for LD. We've also discovered that LD and ADHD co-occur in as many as one-third of children with these disorders. Medical professionals can help avoid confusion and misunderstanding about how the features of these two different disorders overlap, explain the necessary assessments to determine the presence of LD or ADHD (or both), and explain what different types of treatments and interventions are available.

Communicate the message that there is no "cure" for learning disabilities. This is a critical role for medical personnel. Proven treatments for specific learning disabilities alone rarely involve medicine, diet, or other nonbehavioral approaches. Medical providers should reassure parents and educators that the best way to address learning disabilities is through a well-targeted, intensive program of instruction and support, coupled with careful, ongoing observation and monitoring of progress.

Include physicians in the feedback loop when evaluating progress during periods of focused instruction, documenting the child's response to intervention and making needed adjustments.

Demand accountability from each other and from the systems that support students' health and learning. Medical professionals often see children at different times during the school year and should be encouraged to discuss educational concerns as part of their routine intake interview. As experts in child development, they can encourage early screening efforts to ensure students don't have to wait to fail before being identified as at risk of learning failure.

Medical professionals can also be effective in expediting referrals for special education evaluations by empowering parents, foster parents, and other caregivers to be proactive in sharing concerns with school personnel and apprising them of their due process rights so that they can be effective advocates for their children. See NCLD's series of Parent Guides and Parent Briefs, and share them with all members of the treatment team. 2

Remember to consider the multidimensional nature of learning disabilities. "A learning disability is what you have, not who you are." Be sure those providing any type and level of care acknowledge the importance of addressing the medical, behavioral, and social and emotional needs of these children in addition to their unique instructional challenges.

Be outspoken advocates for students with learning disabilities. Medical practitioners can have a strong positive impact in local school communities and at the district, state, and federal levels. As respected professionals, their voices can often penetrate unintended bureaucratic barriers; as advocates, they can often influence policy in support of improved services for students who struggle with learning. They are, perhaps most importantly, valuable members of the treatment teams that deliberate about the very services and supports that can have an immediate positive effect on school success. Invite them to participate in these meetings in writing, by phone, or in person.

Discourage a wait-and-see approach to decision making about learning disabilities. We're all guilty of waiting too long--to see the doctor about a persistent pain, to finish a project that has taken over the living room floor, or to ask how our children are performing in school. When school problems arise, parents and other caregivers often are eager to dismiss concerns about learning disabilities as premature, or even place blame on external factors (he's tired, she lost her notebook, he was absent) and shy away from thinking about the possibility of LD. In fact, survey data suggest that even parents who admit to suspecting learning disabilities in their children will wait almost a year before seeking help.

Educators are often similarly predisposed to attribute students' struggles to immaturity or lack of effort. Join forces with medical professionals and send the strong message that sooner is better when it comes to investigating the possibility of LD.

Open and maintain effective, ongoing dialogue. Too often we assume information about a child is readily shared among parents and other caregivers, educators and other professionals, and related service providers. This is rarely the case.

For example, an elementary school-age child may see her primary care physician for managing her ADHD medication. In addition to her assorted subject area and specialty teachers, she also works with a special educator in a resource room program, and she has an afterschool tutor for math. Her parents daily oversee homework and studying for examinations, and she attends religious training classes each week led by a lay member of her faith community. These individuals will not know how to communicate with each other about their goals, expectations, and contributions to her success unless all of them make a concerted decision to do so. Establish a systematic approach to gathering and sharing feedback, perhaps facilitated by questionnaires, conference calls, or e-mail.

Help students be effective self-advocates. Longitudinal studies, following children over 20 years, have shown that successful individuals with learning disabilities share key attributes:
  • the ability to be an effective self-advocate and to identify and seek out needed services and supports,

  • the ability to articulate specific details about their learning and behavioral needs,

  • having a well-established network of people to whom to turn for support, and

  • thinking ahead and being proactive in arranging for needed accommodations and modifications.
Medical professionals, educators, and parents, foster parents, and other caregivers should work together to ensure that students learn and rehearse self-advocacy skills from an early age and that, whenever appropriate, students are included in the development of educational and treatment plans.

Sheldon Horowitz EdD is Director of Professional Services, National Center for Learning Disabilities (www.LD.org), New York, New York. NCLD provides essential information to parents, professionals, and individuals with learning disabilities; promotes research and programs to foster effective learning; and advocates for policies that protect and strengthen education rights and opportunities. For permission to reproduce this article, or to contact Dr. Horowitz, e-mail him at help@ncld.org. © 2006 National Center for Learning Disabilities. All rights reserved. Used with permission.

  1. Adapted from Sheldon H. Horowitz. (2004, October). From Research-to-Policy-to-Practice: A prescription for success for students with learning disabilities. Journal of Child Neurology, 19(10). Available Onlineback

  2. For copies of NCLD's Parent Guides, Parent Briefs, and fact sheets on learning disabilities, visit NCLD's websiteback


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