Learning Disabilities in Children: Where and How to Get Help for your Child

Learning Disabilities | Pediatrician Dr. Marta Katalenas | Austin, TX

Are you worried that your child might be struggling in school because of learning disabilities? This overwhelming thought has daunted thousands of parents whose children may show signs of learning disabilities. Despite any sneaking suspicions or tell-tale signs, a board certified pediatrician can help determine the specific learning needs of your child.

To help parents just like you understand learning disabilities and how to help children cope with them, Dr. Marta Katalenas sat down for an in-depth conversation with Dr. Anna Masbad, the Founder and Director of Vesper’s Psychological Services in Round Rock, Texas.

Dr. Katalenas (Dr.K): Dr. Masbad, please tell us what Learning Disabilities are and which ones you see frequently in children.

Dr. Masbad (Dr. M):  Learning Disabilities are usually diagnosed in a child when his or her achievement on individually administered standardized reading, writing or mathematics tests are substantially below the expected level, dependent upon their age, education level and measured intelligence, or IQ.

“Substantially Below” is considered a discrepancy of more than one standard deviation between the child’s performance and IQ. Also, the learning problems significantly interfere with academic achievements or activities of daily living that require math, reading and writing. In our practice the common learning disabilities we see are reading disorder, math disorder, and disorder of written expression or writing ability.

Dr. K: Who can officially do the testing and who can suspect there is a problem? Who would be the first person to raise the red flag?

Dr. M: Typically the parents and the teacher of the child are usually the first ones to suspect a learning disability and perhaps see some common signs of learning disabilities. A professional who can diagnose learning disabilities includes an educational diagnostician in the school system, school psychologist or a clinical psychologist in a private setting.

Common signs of learning disabilities that I’ve seen in my practice and based on teacher feedback are kids that are slow to learn new skills, rely heavily on memorization, may have unstable pencil grip, have difficulty remembering facts, confuse basic words and that are slow to learn connections between letters and sounds. Perhaps transposing and confusing arithmetic signs. These children also typically have deficits in social skills and avoid writing assignments, have difficulties making friends, trouble with word problems and things of that nature. Parents and teachers often identify the red flags at the outset when the symptoms are evident.

Dr. K: I understand that learning disabilities can impact the child’s family life.

Dr. M: Also their ability to make friends because they sometimes have trouble understanding body language and facial expression. For example, we see in our clinic when children with learning disabilities misconstrue the intent of the verbal and nonverbal language and they run into difficulties making friends and they don’t understand why.

Dr. K: These are signs the parents can detect at home because when a child is doing homework and the parents are helping with that and get involved sometimes they can detect those problems. Some parents say “I don’t want my child labeled” or “I don’t want the teacher or the school to label my child with learning disabilities.”

Do you think that this kind of “labeling” is a negative impact to the child in the long run?

Dr. M: Yes, but it is paramount to address the parents fears of their child being labeled. Accurate information and education about what learning disabilities are, implications for learning and prognosis, and future functioning as an adult is important information that must be conveyed to the parents. Typically, a lot parents’ fears are alleviated when informed guidance is given.

Dr. K: I get the impression that some parents think that if their child is labeled as “learning disabled” it commits him or her to retardation. Once that connection is made, parents might say “Oh, no. My child is smart”, and they are as far as IQ. What would you say to those parents? Do you see this parental behavior in your practice of parents being afraid of that kind of connection being made?

Dr. M: Typically, parents will misconstrue learning disabilities as a mental retardation. These are actually distinct diagnosis and they can cross over, but they are different and it is important that parents understand being diagnosed with a learning disability doesn’t mean your child has a sub-average intellectual capacity. On the contrary, children with learning disabilities typically have average or above average intelligence and there is no generalized impairment in their adaptive functioning which is more often associated with mental retardation.

In mental retardation, or to be considered as such, the child’s IQ is typically seventy percent or less. Concurrent impairments for deficits in a least two areas of adaptive functioning (e.g., being able to handle the demands of daily living such as self-help, safety, self-direction, communication, etc.) may also be present in children with mental retardation, not those with learning disabilities.

Dr. K: I think you made a very good point about parents getting their child tested for an IQ number.

Dr. M: Absolutely! It is also a way to empower the parents with their strengths and weaknesses, in different domains of their child’s functioning. It is quite informative – they can glean information about the child’s capacity in reading, reading fluency, math fluency, social skills and so forth.

Dr. K: Where can parents get these neuropsychological evaluations done and where do they go to request them? Do they go to the school, to you or to me?

Dr. M: Parents can approach the school counselor or administrator to institute a referral for a formal evaluation. It is important that parents familiarize themselves with the key federal education law that serves students with learning disabilities. This is called IDEA, or Individual with Disabilities Education Act. It grants parents the right to request a formal evaluation at no cost. Prior to that, the school might initiate a pre-referral intervention, whereby different interventions have been identified before going into a more formal evaluation.

Certainly, parents may approach their family pediatrician who typically refers them to a clinical psychologist. Sometimes, parents go directly to a mental health professional and inquire about Section 504 testing along with different types of testing.

Dr. K: You are talking about what is called Section 504?

Dr. M: Yes. Typically what happens is that the teacher, parents and perhaps a school counselor might meet and come up with informal intervention for the child. If after a certain period of time the evaluation doesn’t glean adequate profit in the child, more formal evaluation may be requested. The parents can typically go to the school counselor and he or she can guide the parents to the Section 504 or Special Education Services. Section 504 is typically for students who are primarily served in the general educational setting but have impairments that impede their functioning. Section 504 is a good avenue to try first before going into Special Education because it’s the least restrictive route. If Section 504 doesn’t yield results then Special Education support may be warranted for the child.

Dr. K: Once all the evaluation is done and the child is diagnosed, does the child then pass on to Special Education?

Dr. M: The school might try for a 2-4 hour psycho-educational evaluation first. In Round Rock, Texas it is called “Full Individual Evaluation”, where psychological factors affecting the child (e.g., language, medical conditions, etc.) are identified and taken into consideration. An IQ test is administered, or general intelligence is measured, along with achievement measurements. A psychological or emotional screening may also be done. All of this is done in a school setting.

A neuropsychological evaluation is typically conducted in a private setting and is more extensive. A neuropsychological evaluation may require 6-12 hours of testing because it provides a more complete picture of cognitive functioning of the child.

For example, in depth assessment of memory and executive functioning such as planning, organization, and problem solving skills of the child are assessed. A more thorough assessment of attention sensory motor skills is also assessed. These kinds of tests are not typically conducted in a school setting.

Dr. K: Neuropsychological evaluations would be done by an individual such as you, a neuropsychologist or a clinical psychologist in a private setting. If the parent wants these evaluations done at the school they have to go through the school counselor and that would be the first contact for the parents.

Dr. M: The counselor usually is the person we have close contact with. In our practice we work in close collaboration with the counselor and different systems. The counselor, as well as psychiatrists, will have excellent resources and information for referrals.

Dr. K: Parent can contact the school for a primary assessment before they even come to see you or me. Sometimes, parents are secretive about assessments, as they don’t want the whole world to know even if they are suspecting learning disabilities within their child. As a parent, I do empathize. If they decide to tell someone at school about their child’s possible learning disability, so that person can keep an eye on the child or intervene, would that person be the school counselor?

Dr. M: Yes, the school counselor or administrator but it doesn’t have to be a linear pattern. They certainly do not have to go to the school. They can go to a clinical psychologist in private practice.

In our practice, we have several instances where we do the evaluation first because parents usually approach us first and sometimes they are reticent in approaching the school staff because, as you said, they may not want the whole world to know. Certainly they can approach a mental health clinic, or a clinical psychologist, and we can initiate the testing in a private setting.

Dr. K: For parents that want to be want assurance and choose to keep things between their family and health care providers, can the school take that evaluation and act upon it to decide if the child needs an individual school administered evaluation?

Dr. M: Sometimes the school may, once we take the professional clinical psychologist report. That is certainly taken into consideration for http://www.ncld.org/students-disabilities/iep-504-plan/what-is-iep IEP planning, accommodating IEP individualized educational plans and accommodations that might better serve the child.

Dr. K: I know we are talking about locally now and this opinion may not affect the rest of the world, but here in Round Rock, Texas do you think they are good at listening to what you have to say?

Dr. M: Absolutely. In my experience with the local school districts here, they integrate the reports that we furnish to them. In fact, they’ve been very good in collaborating to meet the best needs of the child. In my experience, I can go ahead and recommend instructional studies for the child and so forth. The committees have been wonderful in taking into consideration and the recommendation by our clinic.

Dr. K: Going back to the parent who wants to tell the school who will be the parent or student advocate, is that the school counselor you mentioned before?

Dr. M: There is a parent liaison. Your local school counselor can guide the parents; that is a good avenue. Parents are encouraged to stay in close contact with resources that can provide them with accurate and up to date information.

In the state of Texas, there are parent training and information centers that might be available to them. Again, a good resource is the school counselor and Special Education Department. In Round Rock, the Special Education Department keeps parent resource materials where there is a library of books, tapes, video tapes and other readily available things for the parents.

Dr. K: I have to say how lucky we are here in the United States. I don’t know about other states, but in Texas the system does work and coming from a country where none of that connection, between psychological needs and learning disability needs exists this is a blessing and helps young people become successful adults. Holding on to what parents see at home, does maturity influence these symptoms of learning disabilities? Kids that are six or seven years old might reverse numbers and letters. Does maturity play a role in how the parents know if this immaturity is going to go away or if it is a learning disability?

Dr. M: It definitely plays a role. That is why it is important to try the informal intervention first and to observe the child. After a period of unsuccessful evaluation which doesn’t mitigate positive results, then a move to more formal measures is indicated.

Dr. K: What about family history? If the parents or any other member of the family has learning disabilities is that a concern?

Dr. M: Yes. Learning disabilities often run families. Family history is considered a risk factor for development of learning disabilities.

For example, there is a research finding that states twenty-five to sixty percent of parents of children who have reading problems show reading difficulties. So definitely that is taken into consideration and when you do the clinical interview during the assessment with the parents, that is a red flag to take into consideration

Dr. K: I know from the medical side there are certain medical conditions, such as premature babies that may have a little bit of an issue with learning. What other conditions are learning disabilities associated with and can you name a few that you see in your practice?

Dr. M: In our practice, children with learning disabilities are at risk for internalizing and externalizing problems.

Internalizing problems are depressive symptoms, withdrawal and anxiety. Externalizing problems are aggression, ADHD and oppositional defiance.

Dr. K: Is there a treatment for learning disabilities, and does it require an ongoing therapy into adulthood?

Dr. M: Yes, it does require an ongoing treatment. For learning disabilities, special education planning or Section 504 services would be a good step.

For example, an IEP or accommodation can be set up for the child. Appropriate instructional setting such as resource support and inclusion content mastery can be mobilized for the child. Parental training, education sessions are critical.

As we spoke of earlier, the strengths and weaknesses of the child’s profile are important and they are an empowering source of information for the parents. Strategies for behavior management in the home are also important and that is why we implement parental training as well.

Therapy is also an important component for children with learning disabilities that may suffer from internalizing concerns such as depression and anxiety and also have poor social skills. Therapy might help enhance their coping, self esteem, self monitoring and problem solving and so forth. Collaboration with the psychiatrist or the physician is also very critical because we typically collaborate to understand the child’s symptoms better.

Medications are sometimes indicated for attention, increased attention and concentration, as well as alleviation of some of the depressive and anxious symptoms that are seen or some of the aggressive behaviors manifested.

Really, I can’t over emphasize enough the importance of collaboration among professionals with all the assistance affecting the child. By that I mean the school, the home, the psychologist and the psychiatrist. In our practice, we work with occupational therapists and they typically work on enhancing the child’s activities of daily living and their refinement of motor skills. We also work with speech and language pathologist. There are different treatments and modality that can be tried and implemented for the child. The key here is that it has to be individualized for the child’s need.

Dr. K: You will teach them learning strategies to deal with life emotionally and socially?

Dr. M: Yes. Social skills are an important component: how to monitor their feelings, their actions in important study strategies which enhance their success. These actions include time management, organization skills, appropriate study skills, appropriate homework skills and all the things that are empowering to the child, so it enhances their sense of mastery.

Dr. K: In reading your brochures, I see you offer parenting classes. You don’t know how many times in the week I get requests for those type of classes in general, not just children with learning disabilities. Do you have classes just for regular parenting classes or do you have to have a diagnosis to go to your office?

Dr. M: In our clinical practice, we provide free initial consultation, which is a critical component. With individual step-by-step plans we can mobilize with the parents.

In addition to our practice, we urge parents to attend parent information sessions in their child’s school – the school counselor as a resource for that.

Dr. K: So, the first step would be to call your practice and make the first appointment to see what you can offer? What are your suggestions to parents after the first visit?

Dr. M: How we best work in tandem with the school is typically in after school programs and daycare programs and so forth. We can definitely offer assistance.

Dr. K: When my kids were in school, I attended a few educational sessions and they were excellent. They caused questions to come to your mind and it really helped me to consider if my child needed help with particular aspects of learning. I really encourage parents to attend these sessions and to give your practice a call if they feel their child has a problem.

Dr. Masbad how can the parents contact you?

Dr. M: You can call our office by dialing (512) 535-1967 or send us an email at info@vespers-pc.com. Our website address is www.vespers-pc.com.

About the Author

Dr. Katalenas

Dr. Katalenas is a pediatrician and owner of The Pediatric Center of Round Rock and the author of the book "The Step Up Diet: From Scratch… The Quality, Quantity, and Timing Solution to Childhood Obesity", a guide to healthy cooking and eating for busy families.