THE "LEARNING DISABLED" CHILD
Robert J. Doman, M.D.
Twenty-five years ago, special education was in its infancy. It was virtually impossible for the parents of children with severe problems to obtain any services from their school systems. With the recent development of special education and the passing of legislation providing for children with special needs, funds are now available through state and federal governments to supplement the education of these children. An effort is being made to evaluate and place more and more children, and as a result, the numbers of "special" programs have increased, and many children are being inappropriately labeled and placed in special classes.
SPECIAL EDUCATION CLASSIFICATION & PLACEMENT
Children are being labeled as learning disabled, hyperactive, neurologically impaired, etc., and are being assigned special class placement, while proper programs are still not available for children with severe problems. Each year, new classifications arise for those individuals who do not "fit" into the regular, "normal" classroom. In some areas, as many as 40 percent of the school population is currently pigeon-holed to fit into one of these categories.
Fortunately for most of us, we were attending school during a period when these classifications did not exist. If they had, a large percentage of us would have been placed in special classrooms, attached with special labels.
STIGMAS OF LABELIZATION
It is important to note that the classifications are administrative ones and they are not a diagnosis, for there is no such disease as hyperkinesis, hyperactivity, learning disabled, etc. These are merely symptoms of a problem, and they are not the problem itself. Children who are placed in these special-education categories become stigmatized by the label because they are segregated and thrust into an abnormal environment that makes it virtually impossible for them to learn normal, appropriate behaviors. Obviously, a child is incapable of learning normal behavior in an abnormal environment. Accordingly, these children, instead of having a great opportunity to succeed, have even less of a chance.
THE USE OF DRUGS
Sadly, many of these labeled children are also placed on drugs in an effort to quiet and calm them down. Estimates of the number of "learning disabled" or "hyperactive" children on drugs go as high as 3 million children in this country today. It is amazing that the education-medical establishment can rationalize the placement of such a large group of children on amphetamines and other drugs during a period when we hear through various media of a public outcry denouncing the usage of drugs in our society by children.
IDENTIFICATION OF PROBLEMS
The youth of today often exhibit difficulties in various facets of education such as reading, mathematics, etc. Not long ago, I lectured to a group of parents in a community where the most popular labels attached to children were neurologically impaired and communicationally handicapped. The parents pressed me to identify the terms I would use to label such children. My response was, "I call these children easy." When one of these children would walk into my office, I usually would think, "Here comes one that is easy" or "there's an easy one." Why? Because the problems of these children are easy to identify and generally easy to remediate, as the children are often found to be what is termed neurologically dysorganized.
A child who is found to be lacking in complete neurological organization is, to some degree, neurologically dysorganized. To a large extent, this is an environmental problem or an inherited problem, as opposed to organic dysorganization such as would be found in a child who is suffering from a brain injury.
The first step in detecting neurological dysorganization is to evaluate the child against the developmental profile and to have him tested to rule out the possibility of an organic problem.
EVALUATION OF DYSORGANIZATION
NACD's evaluation of these children begins by determining the organization at the brain level of the pons. This is ascertained while viewing the child's ability to crawl on his stomach. The child should be able to crawl on his stomach in what is termed a "cross pattern" without receiving specific instruction. Cross-pattern crawling is forward movement where the child extends his right arm and pulls up his left leg, pushing and pulling with the right arm and left leg. He then alternates his movement so that he is pushing and pulling with the left arm and right leg. If the child crawls in what is called a homolateral pattern (which is pushing and pulling with the right arm and right leg, and then the left arm and left leg) he is exhibiting a degree of dysorganization at that level. If the child crawls without a pattern or in a manner where he is extending both arms forward and pulling both legs up, he is also reflecting dysorganization in the pons area of the brain.
Advancing to the mid-brain, organization or dysorganization can be assessed by examining the child's ability to creep on his hands and knees. Remember, you crawl before you creep. Crawling is on the stomach, and creeping is on the hands and knees. The child should also creep in a cross pattern. Properly, the child's hands should be extended flat on the floor with fingers pointing forward. Ideally, the child should be looking forward at the extended hand. Again, if the child creeps in a homologous (bunny hop) or a homolateral pattern (right arm and right leg) he is exhibiting a degree of dysorganization. In assessing your child's ability to creep, it is necessary that you have him creep at various speeds, with varied amounts of starting and stopping. A child properly organized at this level should never go into the homolateral pattern or homologous pattern.
Progressing up into the lower cortex area of the brain, you may evaluate organization by viewing the child's ability to walk. Instruct the child to walk across the room while he points at his feet, and assess whether he is walking in a homolateral pattern or a cross pattern. You may wish to demonstrate to the child what you intend him to do, then have him mimic your actions. Have the child follow your instructions while starting and stopping his movement several times. Any hesitation he displays about which hand to point is an indication of dysorganization. He should be pointing opposite hand to opposite foot, and should not walk in a homolateral pattern. There are many children who lack this cross-pattern function, and they reflect coordination problems to a certain extent. Coordinated gross motor action culminates in a cross pattern whether it's bowling, doing a basketball lay-up, or throwing a baseball pitch. A child who lacks complete organization will display a loss of coordination to some degree. Interestingly, there is the rare child who is neurologically dysorganized but has good coordination. Such children generally have other inefficiencies, particularly mixed dominance.
CORTICAL HEMISPHERIC DOMINANCE
Neurological organization culminates at the top cortical level of the brain. This organization is the establishment of cortical-hemispheric dominance. This is the establishment of a dominant hemisphere, or side. A completely organized child should be right-handed, right-footed, right-eared, and right-eyed, or left-handed, left-footed, and so on.
ASSESSMENT OF DOMINANCE
To assess your child's dominance, begin by evaluating the function of his hands. You can find out if he has a dominant hand, as this will be the hand he writes with, throws a ball with, etc. These functions should all be done with the same hand. If a child writes with one hand and throws a ball with the opposite hand, he obviously is displaying mixed dominance. Assessment of foot dominance is essentially done by using the same method, observing which foot the child kicks with, hops with, etc.
To assess auditory dominance, have the child put his ear next to the door and attempt to listen to conversation that is emanating from the other side. Speak very softly so that the child leans toward you. The child will turn his head to either the right or left so that the dominant ear is closest to the source of the sound.
Assessment of visual dominance is accomplished at what is called near point and far point, using vision as close as three feet and at a further distance. To assess the child at a distance, have him point his finger toward your finger while you extend your arm and point your finger toward the child. If you sight along your finger to his finger, you can find out which eye he is using. You may wish to have him alternate his extended arm from right to left to double check your findings. Also have the child look into a telescope or kaleidoscope, as he will invariably use the dominant eye.
At near point place a one-eighth inch dot on a piece of paper and put another paper with a one-eighth inch hole in the center on top. Line up the hole with the dot so that the child can see the dot by looking through the hole on the top piece of paper. Have the child grasp the paper with the hole in both hands and slowly move the paper up to his eye, watching the dot the entire time. Again, watch which eye the child brings the paper to, as it will invariably be the dominant eye.
A completely organized child will have a dominant hand, foot, ear, and eye, which will be all on the same side. If the child lacks complete dominance in any area or does not exhibit dominance on the same side, it's a reflection of a degree of neurological dysorganization.
HOW DYSORGANIZATION AFFECTS FUNCTION
If the child lacks a controlling hemisphere of the brain organization is lacking because the influx of information to the brain is not occurring correctly. For instance, a child may take visual information through his right eye and store it in his left hemisphere. When a child neglects to take in information from one side and place it in one hemisphere he is not establishing firm pathways into the brain. The child cannot efficiently process that information. You might view the dysorganization as a room filled with filing cabinets. If he is properly organized all of the files are in alphabetical order and he can place a piece of information in and extract it efficiently. A dysorganized child's files are not alphabetized, and he may absorb the information but when he attempts to retrieve it he may be unable to do so. These children are classically the ones who study for a test one night, only to fail when they go in to take it. They took in the information but lost it when they attempted to retrieve it. When you place these children under any type of stress, the system immediately begins falling apart, and their function diminishes. Often these children neglect to remember a homework assignment from the previous night, yet they can remember what color dress mother wore on Christmas two years previously. These individuals are not lacking innate intelligence. They just cannot properly take in information, assimilate it, process it, and bring it back out again.
CATEGORIZATION AND CLASSIFICATION
Categories and classifications depend to a large extent on the particular school system or district that the child is placed in. In one school district the child may be labeled as learning disabled, while in another he may be categorized as hyperactive. This is the same child with the same problem, but for the most part there are some differences in the symptoms of the children that are placed in these various categories.
THE HYPERACTIVE CHILD
A child who is severely hyperactive is possibly a child with an organic problem, such as a slight brain injury or metabolic problem. Many of these children may be helped through dietary restrictions or medical intervention. A large percentage of the children labeled as hyperactive are those who the teacher feels move around too much, are easily distracted, and/or exhibit a short attention span. There are many bright children who display these same characteristics. It is amazing that often a child who has been thus labeled can sit in front of a television set for an hour straight without losing interest.
ABNORMAL LEARNING ENVIRONMENTS
Some children are placed in a learning environment that is inappropriate for them. The pace is too slow, the material covered is below their intellectual level, etc. Such a child needs to be challenged and stimulated, and he is not receiving this in his present learning environment. Young children are much brighter and quicker than we often assume, and we may assess a learning environment as appropriate for them when in reality the pace is too slow. As an example, I reflect back to when my son was in kindergarten. I received a call from the school saying my son possibly had a problem in that he seemed slightly hyperactive and had a short attention span. This characterized itself during story time. I went in to observe as the teacher arranged the class in a semi-circle and began reading a story. Sure enough, during the reading my son got up and went to the rear of the classroom where the books were stored and picked one out and began reading. After the teacher finished her reading, she came over to me and said, "Look! See what I mean? He has a short attention span and is unable to sit quietly while I read the story." I told her that I would have been disappointed if he had remained seated, because he had read that book over a year ago.
He was not hyperactive and he did not have a short attention span. He was merely bored. The teacher was reading material that he was already familiar with, and it was below his present intellectual level. It follows that a large percentage of the children diagnosed as hyperactive or hyperkinetic are in reality children who are bright but are bored at their school's slow pace.
LEARNING DISABLED CHILD
The child with this label usually is a child who is a classic example of neurological dysorganization. However, some children who are diagnosed as learning disabled have no problem at all, other than being situated in a learning environment that incorporates an inappropriate program. For instance, when you place a child who is a visual learner in a classroom atmosphere with an auditory approach to reading such as phonics, the child will often fail, not because he is incapable of learning to read but because he is a visual learner and has been placed in an auditory program. On numerous occasions, parents have brought their children into our offices claiming that they were failing first or second grade. Often it was the type of learning environment that actually played the key role in the problem. Often it was discovered that the children not only could read, but actually were reading above their grade level. These were children who for the most part had been instructed in kindergarten or nursery school to read by sight and were being tested on their grasp of phonics rather than their individual ability to read.
A child who is heavily visual or auditory does need some remediation in terms of developing the other modality. Such a child can be situated in a home program to strengthen his ability to assimilate and process visual or auditory information, depending upon which function was found lacking.
THE EFFECTS OF DYSORGANIZATION
One of the effects of dysorganization and lack of a dominant hemisphere is often a problem with language-related activities, such as verbal language and reading. Language is a function of the dominant hemisphere, and if the child is dysorganized, he often has a handicap in terms of his language function. Interestingly, children who lack cortical-hemispheric dominance often have good musical abilities. Music is a function of the sub-dominant hemisphere. To clarify this, reflect on someone who has experienced a stroke. If the stroke occurred in the dominant hemisphere of the brain, the person quite possibly could have lost the ability to speak. If the same individual who could not speak were asked to sing, he quite possibly could do so, since music is not in the dominant hemisphere that was affected by the stroke.
The average child does not generally establish dominance until the end of first grade, although a child's development can be accelerated to the point where dominance may be realized at the age of 2 or 3 years. However, placing children in a musical environment prior to establishment of dominance acts to reinforce the sub-dominant hemisphere, thus delaying the establishment of dominance. In many cases, without specific remediation we are making that child neurologically dysorganized in such a fashion that he may never become properly organized. Once the child exceeds the age of 6, he has become fixed in his method of accomplishing acts in a particular mode, such as writing with the left hand, kicking with the right food, etc. He will not naturally alter organization to become properly dominant. Specific remediation must take place if we are to correct the organization dysfunction.
The child who is labeled as having a communication handicap is one who lacks dominance, since language functions in the dominant hemisphere. This is the same type of problem experienced by individuals who stutter. We are able to listen to the stuttering child jump from hemisphere to hemisphere in an attempt to communicate.
Children identified as having a behavior problem are generally easy to remediate, with appropriate treatment and management. The problem, however, can be a severe handicap for the child. The dysorganized but otherwise bright child, who is presently not functioning at the same level as his peers, questions his own intelligence and dwells upon what is wrong and why he is different. A large portion of these children eventually (at approximately the third grade level) develop behavior problems. These behavioral problems can originate as a self-defense mechanism, one that the child formulates in an effort to protect his battered ego. If a child tries and fails, he generally is left with only one recourse, which is to internalize the belief that he is of below normal intelligence. Therefore, it is safer in the terms of his ego protection to not try at all or to act out. He then can blame his failure on the fact that he did not try, which is much easier for him to live with.
Children labeled as behavior problems will develop a poor self-image, particularly if they are placed in a special class. Every child attending school knows who is placed in a special classroom, and the child becomes an object of taunting and ridicule by his peers, which only serves to strengthen his poor self- image. He is segregated at the school and in the neighborhood, which correspondingly alters the child's behavior to produce feelings of despondency that force the child to withdraw and be come introverted and often aggressive. These children seem to be always getting into fights, and very often it is they who initiate the quarrel.
The problems of hyperactivity, learning disability, etc., are more commonly attributed to boys than they are to girls. The primary cause of this disparity between the sexes is a matter of motivation and getting a proper start in life. Before children enter a classroom environment, little girls are in the house playing school while their male counterparts are outside rough-housing and playing in the dirt.
A friend called one day in hysterics, stating that her son in kindergarten received a report from his teacher stating that he had flunked paper-cutting. The mother was at a loss to explain why her son had failed, and she desired to know what this failure entailed. There was absolutely nothing wrong with the child. He was very active and bright. He just had not received prior experience in cutting, which is a problem you would rarely find in a girl as they are continually cutting out paper dolls and making dresses for them, etc. Girls have the advantage of starting school on the right foot, since they play school at an early age and are interested in reading quietly in their mothers' laps and listening to stories, thereby internalizing various words and phrases spoken. As a result of this prior knowledge, they generally succeed in the early stages of school. That is not to say that females do not exist who fall into the various categories of learning disabled and hyperkinetic. However, the ratio within these categories is three boys to every one girl.
DIFFICULTIES IN THE CLASSROOM
One of the great tragedies of this era is that many children are being classified and labeled, restricted in their opportunities and being denied the opportunities of reaching their potentials. A child who has been placed in a special-education classroom rarely ever leaves the classroom. Since the curriculum in the special classroom is geared below that of the normal class, no matter how well the child progresses each year, he inevitably falls behind his peers in their regular classroom. In addition to this problem, he also has been labeled, which provides not only a social stigma but destroys the child's own self-image. If data were available, it is quite possible that we would discover adolescent suicides are much higher among those children who have been labeled and classified compared to those who have not.
As the school systems develop these programs, they are placing labels on the children at earlier and earlier ages. Within the next few years we will see more and more schools taking responsibility for children at ages 2 or 3. One of the initial steps the school will develop is to test and evaluate the child. The children are no longer attached with relatively harmless labels such a being lazy or full of beans or he is all boy. Now the child is learning-disabled, hyperactive, or behavioral disordered. There's a potential for great danger in this, in that millions of children run the risk of being permanently disabled through the process of having these labels thrust upon them.
GOALS OF HOME PROGRAMS
When we work on home programs with children with mild dysorganization on the pons, mid-brain, and cortical levels, we can often alleviate these minor problems within a six-month period. If the child has a more severe problem, therapeutical measures would take a longer amount of time for complete remediation. We set home-program goals for children with minor problems as high as advancing academically in reading and math at a rate of one year's growth within every three-month period.
Rapid advancement is not as difficult as it may sound, because concurrently we are improving the child's neurological functions, enabling him to absorb information and process it at a much faster rate. We also design the academic program to fit the needs of each individual child. Quite often we only require thirty minutes a day for the child's instruction, for both the neurological and academic portions of the program.
The future can be bright for these children if the problem itself is treated and not the symptoms. We must also avoid the labels, stigma, and destruction of the child's self-image.
Reprinted from the Journal of the National Academy for Child Development
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