Dyslexia is defined as difficulty reading. When children are learning to read and write in kindergarten and first grade, it is not uncommon for them to misinterpret a “b” as a “d,” a “6” as a “9,” the word on as no and so forth. An important distinction is that this is not a vision problem; rather, the brain is reversing, inverting or missequencing the information it receives from the eyes. Most kids outgrow this condition by age seven or so. For dyslexic youngsters, however, the reading problems persist.
In another form of dyslexia, the mind accurately identifies a word it “sees” but is slow to connect a meaning to it. These teenagers read extremely slowly and may have to reread material several times before they understand it. Other tasks of communication may pose difficulties as well, such as comprehending spoken language and expressing themselves orally and in writing.
Dysgraphia is defined as difficulty writing, as a result of dyslexia, poor motor coordination or problems understanding space. How it is manifested depends upon the cause. A report written by an adolescent with dysgraphia due to dyslexia will contain many illegible and/or misspelled words, whereas motor clumsiness or defective visual-spatial perception affects only handwriting, not spelling.
Dyscalculia is defined as difficulty performing mathematical calculations. Math is problematic for many students, but dyscalculia may prevent a teenager from grasping even basic math concepts.
Auditory Memory and Processing Disabilities
Auditory memory and processing disabilities include difficulty understanding and remembering words or sounds. A teen may hear normally yet not remember key facts because her memory is not storing and deciphering them correctly. Or she may hear a phrase but not be able to process it, especially if the language is complex, lengthy or spoken rapidly, or if there is background noise. For youngsters with central auditory-processing disorders (CAPD), the hum of a fan or the routine sounds of the classroom may interfere with learning.
Attention Deficit/Hyperactivity Disorder (ADHD)
The American Academy of Pediatrics (AAP) has published recommendations on guidelines for the diagnosis and treatment of ADHD. The guidelines, developed by a panel of medical, mental health and educational experts, are intended for primary-care physicians (and parents as well) to help better understand how to recognize and treat ADHD, the most common childhood neurobehavioral disorder.
Between 4 and 12 percent of all school-age children have ADHD. The first step, diagnosing the condition, cannot usually be done successfully until a child is about age six.
The AAP guidelines include the following for diagnosis:
- ADHD evaluations should be initiated by the primary-care clinician for children who show signs of school difficulties, academic underachievement, troublesome relationships with teachers, family members and peers and other behavioral problems. Questions to parents, either directly or through a pre-visit questionnaire regarding school and behavioral issues, may help alert physicians to possible ADHD.
- In diagnosing ADHD, physicians should use DSM-IV criteria developed by the American Psychiatric Association (symptoms include distractibility, hyperactivity and impulsivity). These guidelines require that ADHD symptoms be present in two or more of a child’s settings, and that the symptoms adversely affect the child’s academic or social functioning for at least six months.
- The assessment of ADHD should include information obtained directly from parents or caregivers, as well as a classroom teacher or other school professional, regarding the core symptoms of ADHD in various settings, the age of onset, duration of symptoms and degree of functional impairment.
- Evaluation of a child with ADHD should also include assessment for coexisting conditions: learning and language problems, aggression, disruptive behavior, depression or anxiety. As many as one-third of children diagnosed with ADHD also have a coexisting condition.
Treatment guidelines include the following recommendations:
- Primary-care clinicians should establish a treatment program that recognizes ADHD as a chronic condition. This implies the need for education about the condition and a sustained monitoring system to track the effects of treatment and developmental changes in behavior.
- The treating clinician, parents and child, in collaboration with school personnel, should specify appropriate goals to guide management. Goals should relate to the specific problems of the individual child, such as school performance, difficulty finishing tasks and problems with interactions with schoolmates.
- If appropriate, the clinician should recommend behavior therapy and/or stimulant medication to improve specific symptoms in children with ADHD. The guideline provides a review of the scientific evidence for recommending medication and behavior therapy.
- When the treatment for a child with ADHD has not met its goals, clinicians should reevaluate the original diagnosis, all appropriate treatments, adherence to the treatment plan and coexisting conditions, including learning disabilities and mental health conditions.
- The clinician should provide a periodic and systematic follow-up for the child with ADHD. Monitoring should be directed to the child’s individual goals and any adverse effects of treatment, with information gathered from parents, teachers and the child. The guidelines recommend areas for future research in treatment options, long-term outcomes and other areas in the management of children with ADHD.
Although ADHD often appears to subside during puberty, “We now know that isn’t true,” says Dr. Suzanne Boulter, a pediatrician from Concord, New Hampshire. “In reality, hyperactivity may decrease, but the inattention and impulsivity remain unchanged. As these young people navigate their way through high school and college, these problems may stand as their biggest obstacle to academic success.”
Autistic Spectrum Disorder (ASD)/Pervasive Developmental Disorder (PDD)
Autism is a disorder with a variety of symptoms that range from mild to severe. Labels such as classic autism, Asperger’s syndrome and pervasive developmental disorder not otherwise specified are often confusing, because youngsters with these conditions share many of the same characteristics, such as deficient social skills, hypersensitivity to sights and sounds, difficulties adapting to change and other idiosyncratic interests. The difference between one child and another is frequently a matter of degree. As a result, all of these diagnoses are part of autistic spectrum disorder.
Asperger’s and autism occupy opposite ends of the spectrum; in fact, AS is sometimes referred to as “mild” autism. Whereas most children with AS are of average or above-average intelligence, four in five autistic boys and girls exhibit some degree of an intellectual disability. Another key difference involves speech. Children with autism are frequently speech-delayed; kids with Asperger’s syndrome, on the other hand, tend to be verbally precocious. And once they begin talking, it can seem as if a dam has given way. Dr. Hans Asperger, the Austrian pediatrician who discovered the disorder, called his patients “little professors,” on account of their penchant for pontificating.
“They’re very dependent on their language skills to get by,” observes Dr. William Lord Coleman of Duke University Medical Center and the University of North Carolina School of Medicine, “and so they use them excessively, which can overwhelm people.” This plays a large part in their difficulties interacting with their peers. Adolescents with Asperger’s syndrome spend an inordinate amount of time in their own world—even for teenagers—but they’re often lonely and want to make friends. The problem is, they’re not sure how to act in social settings. Between that and their eccentricities, they may become victims of teasing and bullying. Parents of a child with AS, or any other disorder, should try their best to stay attuned to their youngster’s moods. Rates of anxiety, depression and suicide are unusually high in this group.
To distinguish classic autism from Asperger’s syndrome, pediatricians and pediatric specialists rely on the diagnostic guidelines from the Diagnostic and Statistical Manual of Mental Disorders. Most children fall somewhere in the middle of the spectrum. Only about one in one thousand youngsters is diagnosed with classic autism. The incidence of Asperger’s is believed to be double and possibly triple that.
There are about half a million adolescents with an intellectual disability in the United States. Nine in ten are classified as having a mild intellectual disability, 1 with an intellectual-functioning level, or IQ, between 50 and 69—some fifty-five points below average. (An IQ of 35 to 49 places a person in the category of a moderate intellectual disability; 20 to 34, a severe intellectual disability; and under 20, a profound intellectual disability.)
Cognitively, many boys and girls with a mild intellectual disability function not that far below their non-disabled classmates. They absorb new information and skills, only more slowly. The problems they do have may be related to memory, problem solving skills, logical thought, perception and attention span.
Like parents of other adolescents with special needs, mothers and fathers are probably as concerned about their child’s social development as they are with his academic progress. Adolescence, of course, is a time when being different can set one up as an object of teasing. Youngsters who have an intellectual disability, in addition to their intellectual limitations, may possess physical and/or mental health problems that also make them stand out. They are often keenly aware of feeling set apart from their peers without learning deficits. Understandably, they are susceptible to feelings of frustration and depression.
A diagnosis of an intellectual disability is based on IQ and two other standards:
- Significant limitations in two or more essential skills of daily living (communication, self-care, reading, writing and so on)
- The condition must be present before the age of eighteen.