Charlie looks around his first grade classroom when it’s reading time. He needs frequent reminders to get back to work. His teachers and his parents are puzzled why such a bright boy is having trouble in school. Could it be an attention deficit causing the problem? Could a learning problem cause the inattention? How can they help Charlie succeed?
Learning and attention problems are common and can range from mild to severe. From five to 10 percent of school-age children are identified with learning disabilities (LD). At least five to eight percent are diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). Many of these children have both. Although the studies vary, 25 to 70 percent of children with ADHD have a learning disability and from 15 to 35 percent of children with LD have ADHD. There are many children who have milder learning or attentional problems but the additive effects can be significant. Even mild dysfunctions in these critical brain functions can create problems as demands increase in secondary school, college and in life.
Attention and learning are related brain processes, separate but dependent on each other for successful functioning. “Learning” is the way the brain uses and remembers information like a factory taking in raw materials, storing parts and then manufacturing and shipping a finished product. “Attention” involves brain controls which regulate what information gets selected as important and gets acted on. The attention/behavior control system acts like the executives at the factory distributing the “brain energy” budget, setting priorities, deciding what to produce and monitoring quality control. Late shipments or poor quality products could be the result of any number of “glitches” in either system. Minor problems in one system can be compensated for but when both systems are affected failure looms. Sorting out the breakdown points is critical but can be complicated.
Evaluation: Look Beyond Symptoms
Comprehensive assessment is needed as some of the symptoms of learning and attention problems may look similar, at least on the surface. A child may be “distractible” because weak attention controls are unable to filter out unimportant sights or sounds. However, if reading is too difficult the child may look around because it doesn’t make sense. A child might be “disruptive” because their behavior controls are weak and they impulsively call out or annoy others. Some children with learning problems may act-up out of frustration or embarrassment. They would rather be considered “bad” than dumb. Other difficulties that can occur with either learning or attention problems might be:
Underachievement despite good potential
Difficulty with time-limited tasks
Problems with starting/completing work
Messy writing or disorganized papers
Problems with peer relations
Secondary emotional problems due to repeated failure and frustration
Evaluation includes a careful review of a child’s history (medical, developmental, behavioral, educational), family situation, current functioning and appropriate testing. Information is gathered from parents, school records, school staff, medical providers, other professionals and the child. Testing for learning disabilities includes cognitive (IQ) and achievement testing with speech/language, motor skill and other evaluations as needed. Medical consultation with a primary care provider, developmental-behavioral pediatrician, child psychiatrist or neurologist is often needed, especially when attentional, medical, developmental or emotional issues are present. Rating scales are often used to assess behavior or emotional functioning.
Learning Disabilities: Looking for Processing Problems
As learning disabilities reflect the brain’s difficulty in processing certain kinds of information, the evaluation process looks for historical clues and evidence of specific patterns of strengths and weaknesses. Children with learning disabilities are more likely to show:
history of developmental delays
family history of learning problems
normal medical evaluation but can have motor coordination issues
language delays that may include mixing up sounds in words (e.g., aminal for animal)
a lot of knowledge but difficulty in expressing ideas clearly
slowness with learning academic readiness skills (e.g., letter identification)
difficulty applying learned skills rapidly and automatically resulting in labored reading and poor reading comprehension
report cards and tests that show consistent pattern of difficulty in one area
individual testing shows distinctive patterns, such as deficits in phonological processing (pulling apart sounds in words) and delays in reading words.
behavioral issues occur when processing weakness are stressed (e.g., too many instructions given at once when deficits in language processing are present).
social problems because language processing impacts negotiation skills or visual-spatial problems result in standing too close to others.
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