Tarnow Articles

Learning Disabilities: Diagnosis and Treatment 

Children who experience difficulty learning, particularly in the classroom, are a constant challenge to their teachers and parents. These difficulties are not secondary to deprivation, primary emotional problems or poor visual or auditory acuity. Often, teachers and parents attribute these difficulties to poor motivation. We have all heard comments like, "If only he cared more, and tried harder." If we stop to think why someone who is proud of his/her achievements, and values the praise of teachers and parents would choose the punishing path of failure, it would make no sense. However, lack of motivation often reflects an attempt to avoid failure and anxiety. It is easier to be thought of as someone who "will not," rather than someone who "cannot." In spite of attempts to learn and do well, grades do not improve. It is no wonder that the student begins to doubt his own judgement and ability.

In keeping with the Center's belief that "good diagnosis leads to good treatment," it is important to understand the specific nature of the learning difference so that appropriate interventions can be implemented. It should be established whether an attention deficit disorder is interfering with the acquisition of information or the ability to demonstrate what has been learned. Learning disabilities can occur with or without ADD. In fact,approximately 40% of individuals who struggle with ADD are also affected with a learning disability. ADD results in "incomplete" learning. It is easy to forget what has only been partially learned. Inconsistent performance results lead teachers to make comments such as, "I know he can do it when he tries."

Successful learning depends on many cognitive abilities working together. Information must be received and understood, integrated and then expressed in a way that demonstrates the learning that has occurred. Interference with this process at any level can result in academic failure. The evaluation process must identify where the interference occurs.

Learning occurs through all of our senses, but in the classroom, we depend primarily on our visual and auditory processing. Hearing and vision should always be tested to rule out poor acuity. Visual perception and visual motor skills are important in the development of academic abilities, and must be evaluated during the assessment of school failure.

Oral language skills cannot be emphasized enough as a contributing factor to the success or failure in the classroom. Whether language arts or mathematics is being taught, instruction occurs through the spoken word. Poor oral language skills results in poor written language skills. Language is a complicated symbol system. Often, we think that because someone can converse fairly adequately, that the entire language system is intact. However, the "language of the classroom" is often more complicated. Language is divided into subsystems of sounds (phonology), grammar and syntax, vocabulary and meaning (semantics), and the ability to use language in different contexts (pragmatics). A break down in any one of these systems can result in significant difficulty being experienced in learning.

Current research indicates that individuals with language disorders have difficulty processing sounds at the necessary speed. Pathways in the brain which allows this rapid processing have not been established. While this theoretical concept has been understood for some years, it has been difficult to remediate it effectively. We are fortunate that new tools are becoming available which allow us to slow down the auditory signal electronically so that these pathways can be established.

One of these methods is the Fast ForWord Program that is being made available through the Scientific Learning Corporation. Children ages 4-14 years play highly motivating video games during which they learn to process information upon which language development depends. Because of the plasticity of the brain, new pathways are established. Exposure to this therapy, therefore, treats the underlying cause of the language learning difficulty rather than treating the symptoms, which often include reading, behavior, and attention problems. This program has been thoroughly researched and the results have been astounding. "Fast ForWord enabled more than 90 percent of the children in our large-scale field trial to overcome the fundamental speech reception problems that underlie their language-learning impairments," states Sheryle Bolton, SLC's chief executive officer.

At the Tarnow Center we are proud to offer this exciting and innovative program to our patients. We currently have 15 children enrolled in the Fast ForWord Program. Two of them have recently graduated. The children, their families, and I have been delighted by the progress that has been made. One young man has made four grade levels reading progress. All this in four to six weeks! In addition to the direct gains observed in reading and learning, I have observed the children taking responsibility and learning to self-manage better. "The impact of Fast ForWord on children with language-learning impairments is profound," states Dr. Michael Merzenich, a leading authority on brain plasticity from the University of California and co-founder of SLC. He also states,

"It's similar to what children with vision impairments experience when they first put on a new pair of glasses. This program is like glasses for the ears."

The games must be played intensively, five days a week for a period of four to six weeks. Some children "play" at home, others at their schools, and another group comes into the office daily. When Fast ForWord is completed, re-evaluation of reading and oral language is done, so that progress can be documented, new goals set, and further intervention planned as necessary.