Learning problems can often be managed very successfully, even though they cannot be cured. The goal of therapy is to enable youngsters to live with their limitations as productively as possible. Treatment is usually waged on four fronts:
- Psycho-social-behavioral therapies: teaching children strategies for maximizing their strengths and compensating for their weaknesses.
- Other interventions: Specialized language instruction, taught by a teacher or therapist who has received special training, is used to teach dyslexic teenagers to read, write and spell. Comparable programs exist for children with dysgraphia and dyscalculia.
- Medication therapy: using medications to improve concentration problems and other conditions such as depression.
- Special education: a school environment tailored to the unique needs of each child with a learning disability. Until such time as it is determined that a teen no longer needs special services, once a year the school and parents work together on formulating an appropriate individualized education plan, or IEP, for the following academic year.
With so many differences among adolescents who have learning deficits, treatment must be individually tailored. Anticipate frequent lane changes on the road to improvement, as one medication gets substituted for another or you switch therapies midstream because the behavioral technique you were hoping would help your son or daughter fell short of expectations. This is a field where even the experts freely admit that no one has all the answers.
Like rest stops on the interstate, useful advice and tips come along sporadically, assembled from physicians, therapists, special-ed teachers, other moms and dads, support groups, on-line chat rooms and so on. The members of your team may include the pediatrician, a private pediatric psychologist or psychiatrist, and the school psychologist or social worker. Whomever you choose, make sure that they treat children with your teenager’s disability on a regular basis. You want people who have a broad and long-term overview of your child’s ongoing saga.
- Cognitive-behavioral therapy: teaches children techniques to change their behavior. For example, children may be taught to place their hands on their stomach and relax when they feel upset, or be taught to think through tasks step by step when problem solving.
- Behavior modification: a technique for modifying behavior through reinforcement. Desirable behaviors are explained to the youngster, as are the small rewards for complying and the mild penalties for when he doesn’t. If this sounds like the method of discipline described in other places, you’re right, only boys and girls with learning difficulties may need more frequent reinforcement.
- Social skills training: teaches youngsters fundamental social skills such as making eye contact when talking to someone else and how to read people’s facial expressions. Typically held in a group setting.
- Psychotherapy: is talk therapy intended to help patients reverse defeatist attitudes and also to understand and accept their disabilities.
- Support groups: gatherings of adolescents who have learning disorders or their parents. Support groups bring together people in similar circumstances to share their experiences and feelings in a supportive, nonjudgmental atmosphere. Meetings, typically sponsored by patient-support organizations, hospitals and other health-related agencies, are often more productive when they’re led by a social worker, nurse or other health-care professional. Members take away the knowledge that they are not alone—always comforting—as well as practical advice, referrals to specialists and local services, and other valuable information.
- Family counseling: Destructive family patterns can become so deeply ingrained that they persist even after a youngster with a learning deficiency begins to make progress. Family counseling can be a useful forum for airing interfamily conflicts, reexamining issues through the eyes of an impartial third party and discovering new solutions for breaking an unhealthy cycle.
Stimulants are the most widely used pharmaceutical treatment for attention deficit hyperactivity disorder. At least 1.5 million young people take the stimulants three or four times a day. “Stimulant medication can have a very dramatic effect,” concludes Dr. Wolraich. “Most kids benefit from being on it.” Why, then, have stimulants sometimes received a black eye in the popular press? Several criticisms have been leveled against the drugs: They are irresponsibly prescribed as a performance enhancer, a by-product of our success obsessed culture; they are likely to be abused by the same teens they are supposed to help; they stunt growth and may produce other unwanted long-term side effects. Not true.
The American Medical Association publicly repudiated the claim that doctors were overwriting prescriptions, while studies show that teens that use stimulants to manage their ADHD are less likely to engage in substance abuse and other risky behaviors. As for side effects, says Dr. Wolraich, “I usually tell parents that stimulants have fewer side effects than aspirin and no known severe long-term consequences.”
Having a learning problem doesn’t by itself qualify a student for specialeducation services. It’s the gap between her current school performance and her academic and intellectual potential, as determined by the testing, that decides eligibility. A significant discrepancy between the two would warrant special services. Now the question is, which services?
One of the cornerstones of the Individuals with Disabilities Act is that students with disabilities be educated alongside their nondisabled peers to the maximum extent possible. By that standard, the ideal situation is inclusion: being taught in a regular classroom in the regular school building, but with additional services provided as needed. One teen’s schedule might include weekly speech therapy and time in a resource room; another might require sessions with a school psychologist.
In general, fewer options exist in junior high and high school than at the elementary-school level, where special education often takes place in separate, self-contained classrooms. As early as kindergarten, a student may spend one or two periods in a regular classroom, with an eye toward full mainstreaming before going on to middle school. In U.S. public schools, four in five youngsters with learning disabilities and nearly two in five boys and girls who are mentally retarded are taught in regular classes.
By the time of junior high, only those adolescents who have been diagnosed with severe learning problems are likely to be placed in alternative sites, which typically offer small class sizes and a curriculum that blends both academic and vocational skills. Students with mild or moderate disabilities are almost always mainstreamed. However, they may receive special accommodations in classroom environment or instruction to help them learn, depending on their needs. Below are some examples of special measures that might be implemented in a regular classroom:
- Having the student sit front center, near the teacher’s desk and away from windows, doors, air conditioners, radiators and other potential distractions.
- Simplifying instructions and avoiding multiple commands.
- Allowing the student to take exams in a small, quiet room.
- Allowing the student extra time to finish tests and other classroom assignments.
- Reviewing test instructions or homework assignments on the blackboard.
- Allowing a student with an auditory-processing problem to wear earplugs, to block out extraneous noise. Or alternately, having her wear a wireless device that transmits the teacher’s voice directly to an earpiece while blocking out ambient noise.
- Ordering a second set of books to keep at home, in the event that a student leaves his books in his locker—a not-uncommon occurrence.
- For dyslexic, dysgraphic students who have difficulty spelling and poor penmanship, grading papers primarily on content rather than on spelling and neatness.
- Allowing students with learning disabilities to use word processors, calculators, audiobooks, tape recorders, spellers and other assistive technology.