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From Kindergarten to
College
Learning Disabilities
With Dr. Larry B. Silver
Child and Adolescent Psychiatrist
Wednesday, Sep. 5, 2001; 1 p.m. EDT
What causes learning disabilities? How can I determine if my child has one? What should I do once a disability has been identified? Are doctors becoming too quick to diagnose and medicate children with learning disabilities as some have criticized?
Child and Adolescent Psychiatrist Dr. Larry B. Silver will be online Wednesday, Sep. 5 at 1 p.m. EDT to answer questions about learning disabilities and attention deficit disorder.
Dr. Silver is author of "The Misunderstood Child: A Guide for Parents of Children with Learning Disabilities" and "Dr. Larry Silver's Advice to Parents on Attention Deficit Hyperactivity Disorder" and President of the Learning Disabilities Association of America. He currently practices in the Washington, D.C. area.
The transcript follows.
Editor's Note: Washingtonpost.com moderators retain editorial control
over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Kensington, Md.:
What role do you think anxiety/mental blocks play in what are usually perceived as symptoms of Attention Deficit Disorder (without the hyperactivity)? For example, if a child is not able to concentrate or answer simple questions about something they just learned -- is it inattention or is it freezing up and can you tell the difference?
Dr. Larry Silver: You ask a good question. Part of the thinking that goes into making the diagnosis of ADD is to clarify if the distractibility is due to anxiety or to ADD. If it is due to anxiety, it will occur at certain times or certain places. For example, only happens in school or when doing homework but never in other settings. Only happens when work requires writing. If it is due to ADD, something one is born with, the behaviors will be chronic and pervasive. Chronic in that you have heard these comments year after year from teachers and others. Pervasive in that it occurs in school, at home, and possibly in other settings and not just when doing school work.
Washington, D.C.:
Regarding dyslexia, the International Dyslexia Association seems to recommend intensive one-on-one instruction -- which of course, would benefit any student -- and at the same time suggests that a very large percentage of Americans have this disorder. In view of the fact that individual tutoring for every student isn't possible, are you aware of any progress in developing classroom techniques for dealing with dyslexia, or progress in diagnosing this disorder early enough to channel these students into a different teaching methodology? Where could I learn more about these classroom strategies, if they exist?
Dr. Larry Silver: You put your finger on the key problems faced by special education. We do not have enough trained people and the work is very labor intensive. The answer? First is early identification. For example, we know that if we give intensive help with reading during grades 1 - 3, we can make significant progress. And this can be done in class by general education teachers who know how to teach reading. For more details, write to the IDA. They can help.
Harbor Springs, Mich.:
Dr. Silver,
My 2 1/2 year-old son was recently diagnosed as being mildly to moderately autistic. His primary development challenge is the inability to speak at an age appropriate level. He is presently enrolled in a special needs class in our community. What can I (we) do to most effectively help him control or overcome his disability.
Thank you.
George Kampstra
Dr. Larry Silver: The topic for this program is not autism. To answer would take much time and space. May I suggest that you speak to the professionals who work with your child or contact a parent support group to get information.
Bethesda, Md.:
My son, a college freshman, has a moderate learning disability -- attention deficit. He is not hyperactive or taking medications. Any advice on the transition to college?
Dr. Larry Silver: Wow! He has two problems - a learning disability and Attention Deficit Disorder. Each requires interventiion. I would have hoped that he has received services for each prior to this and that the college he attends knows of each disability and what to do. For the LD, he may need special tutors plus accommodations. For the ADD, he should be on medication. I hope neither is a new concept for you or for him. If they are, you need to discuss your questions with the professionals who made these diagnoses.
Columbia, Md.:
My daughter was diagnosed with dyslexia and dysgraphia five years ago by Dr. Saunders. She studied Orton Gillingham approximately one year. She is now a junior at The Seton Keough High School. Her grades are excellent (especially in Math and Science) but English and Social Studies are more difficult. We are now preparing for SAT's and would like your opinion on the best way to go about preparation? And as a high school student how can we be sure she is having her needs met in the classroom?
Thank you.
Beverly Prosen
Dr. Larry Silver: I'm pleased that her problems were picked up early and that you found her the right help. Her progress is a reflection of your efforts. It may be that she needs additional help now with her reading comprehension and written language. That is, she can read and write; however, each takes longer to do and requires extra effort. She might need another round of help. Concerning the SATs, if she has documented learning disabilities, she should be able to get extended time on the test. She might need to take a review course with someone who knows learning disabilities instead of or along with a regular SAT review couse. You and she have come so far. Keep up the good work. It will pay off.
Herndon, Va.:
I have an 11-year-old daughter (entering 6th grade) who has ADHD. She takes Concerta and it helps her a lot.
She has always been a bit behind on her reading skills and is a very reluctant recreational reader. However, she thoroughly enjoys stories when I read them to her. Recently she remarked that books make more sense when they are read to her. Could this be an attention-related issue, i.e. because reading is sort of hard for her she loses interest and doesn't fully grasp the storyline?
Dr. Larry Silver: About 30 to 50 percent of children with ADHD also have a learning disability. The Concerta helps her ADHD. It sounds as if she might also have a learning disability involving reading (and, I will guess, spelling). Arrange through her school or privately to have testing done to clarify if she has LD. If so, there is much that can be done to help her.
Arlington, Va.:
A friend who is a special education teacher had a boy put in her class who had extreme behavioral problems. He misbehaved in her class, was removed, and placed in a regular class where he is supposedly fine. Is it possible that kids with behavioral problems are being diagnosed as learning disabled as a quick fix?
Dr. Larry Silver: I hope not. To diagnose someone with LD in the school system requires formal psychological and educational testing, showing significant discrepancy between ability and performance. I do not have enough details to answer why this boy did what he did.
McLean, Va.:
Hello Dr. Silver - I greatly enjoyed your book, "The Misunderstood Child." I have a 10 year old girl who has been tested as Dyslexic and ADD. I have read widely on the subject and have sent my daughter to specific programs that have helped her, but I don't see local schools focusing on some tried and true research -- the use of phonemic awareness techniques (such as Lindamood-Bell) to help these children. Any idea why?
Dr. Larry Silver: Thank you for your kind comments about my book. I can only agree with you. We now know so much about the importance of phonemic awareness in reading and written language. But, too many general education teachers were not taught this during their training. The U.S. Department of Education is aware of the problem and working on it. The Learning Disabilities Association of America is also tring to improve teacher education as well as better in-service training for teachers already out of school. Keep up the good work with your daughter.
Washington, D.C.:
What Web site resources do you recommend for parents of children with learning disabilities? I know of LD OnLine (www.ldonline.org) which I think is an excellent site.
Dr. Larry Silver: LDonline is the best. Since I am President of the Learning Disabilities Association of America, I must mention their web site as well. ldanatl@usaor.net.
Washington, D.C.:
I have a question regarding funding for special needs programs in public schools. Specifically, do you think it's right that school districts pay inordinate amounts of money for individualized attention for those with ADD/learning disabilities but rarely do anything special for those students who are significantly above average, i.e., gifted? It seems that we should be providing encouragement at both ends of the spectrum.
Dr. Larry Silver: I could not agree with you more. General education, including special programs for those who are gifted and those who may be less than average, and programs for students with special needs should be funded full. If you agree, write to your Senators and your Congressperson now. Congress is in the middle of discussing and deciding on education budgets this very week.
Lahore, Pakistan:
What are the main causes of dyslexia?
What remedial measures do you suggest?
What techniques do you recommend for the teaching these types of student?
Dr. Larry Silver: Your questions would take a text book and I have a few lines. May I suggest that you write to the Learning Disabilities Association of America, 4156 Library Road, Pittsburgh, PA 15234, USA. They will send you information on the questions you ask.
Sterling:
I was wondering if procrastination is considered to be a learning disability as well. If so, where can adults who suffer from it seek counseling/training in the D.C. area? Please comment.
Dr. Larry Silver: There are many reasons for procrastination ranging from one's personality style to an emotional problem to learning disabilities to ADHD or mixtures of any of the above. There are professionals called "coaches" who are trained to work with adults who have this problem. To get a list of coaches in your area, go on the internet at Americoach.com
Silver Spring, Md.:
My daughter was diagnosed in 3rd grade with ADD. Now that she is 12, we've found out that she has early onset bipolar disorder. Every professional we've worked with has a different opinion of whether or not she still has, or ever had, ADD. What do you suggest?
Dr. Larry Silver: Statistically, about 50 percent of children with Bipolar Disorder will also have ADHD. The ADHD might be present from preschool; whereas, the Bipolar might not be apparent enough to diagnose until ages 8 - 12. So, she might have both. I suggest you work with a good Child and Adolescent Psychiatrist to clarify what is going on. A good book that discusses this for parents is: "The Bipolar Child" by Papolos ande Papolos (Broadway Books, NY)
Sterling, Va.:
After years and years and test after test I have yet to be told whether or not my son is ADHD. I continue to get from his teachers that he is a very smart child if only he could stay on task. From the doctors I get there is not enough concrete evidence to diagnose ADHD. What do I do? He is now in 6th grade?
Dr. Larry Silver: I share your frustration. If he has had psychological, educational, and ADHD testing and everyone is still unclear what is causing the problems, I am puzzled. Maybe you need to see a new mental health professional who knows ADHD to rethink the question. If, after this assessment, no ADHD is found, it will be important to figure out what else is going on and how to address it.
Hampton, Va.:
My grandson has been diagnosed as ADHD, bi-polar and also has Tourret's syndrome. With such a mix of disabilities it's hard to get the proper medication as he tends to want to nap after his medication is administered. This makes it nearly an impossible situation at school for the teacher. Any suggestions on how to handle all of this for him to be alert for class in order to be educated?
Dr. Larry Silver: I'm sorry your grandson is struggling so. Unfortunately, the three problems you mention can be found in the same child. And, the treatment is tricky. You need to try to get each under control without making the other worse or causing side effects. Be sure he is under the care of a good Child and Adolescent Psychiatrist who knows these disorders. Until they are under control, he might be less than available for school. Keep faith. He can be helped.
Reston, Va.:
Any relation between ADHD/ADD and later alcoholism? I ask because there seem to be more ADD/ADHD people, including me, in AA than in the general population.
Dr. Larry Silver: Research shows that ADHD does not lead to a higher incidence of substance abuse. However, having ADHD and not being diagnosed or treated or treated inadequately can lead to frustrations, failures and low self-esteem. The result might be using subsances. The people in 12 step programs that I work with usually have years of stories about behavioral problems or school failures before thier substance problem.
Falls Church, Va.:
My 13 year old son is LD and doing pretty well in public school with appropriate assistance (using an Alphasmart, e.g.). But I'm worried about what will happen when he gets to the local high school next year, with the large classes, students "getting lost," etc. Do you have any general advice on the public/private school decision? I'm not familiar with any of the local private schools here in the D.C. area.
Dr. Larry Silver: I share your concerns. It will be important that your school professionals plan ahead. If he has an IEP, be sure that it covers all of his needs for next year. Maybe you could seek a private educational consultant to advise you on these needs. A private school may not help, especially if this school is more demanding than public school and is less than cooporative about accommodations. You are right to start thinking ahead now so that by the time he gets to high school he will be read.
Washington, D.C.:
Who would have a list of local tutors for dyslexic kids just beginning to read? Clearly they need more than a motivated teenager but I haven't found but one or two names for the entire District. Are we really that far behind the curve in training teachers how to deal with this disorder?
Dr. Larry Silver: I don't like to recommend one source since there are many to contact. Two places to call to get special education tutors are: The Lab School at 202 333-0191 and the Kingsbury Center at 202 232-5878. (My apologies to those I have offended by not listing you.)
Clifton, Va.:
What suggestions or ideas might you have to convince school systems to help children with severe writing and reading language problems to verbally "test" these children rather than require written work which is used to give them a passing or failing grade in a course?
Dr. Larry Silver: Alas, isn't it a shame that will all of our knowledge of the brain and of learning disabilities, we still have school professionals who do not understand. Do not tolerate it. First, the reading and writing disabilities must be documented. Then, the school must set up a plan for helping. Then, you go to the classroom for accommodations. If all of this is beyond your ability at this time, seek out an educational consultant who can advise you about a specific program. One last thought. It is easier for teachers to accommodate for visible problems, such as blindness, deafness, cerebral palsy. It is sometimes hard to understand that LD may be invisible to the outside but that it is just as debilitating a disability and must be addressed.
Virginia:
My son has LD. He learned sign language and it helped him a lot.
Dr. Larry Silver: I'm pleased that it healped. I am not sure I would recommend it for most students with LD. The question is whether he improved with his reading, writing, math skills or he found an alternative way to communicate.
Arlington, Va.:
Do you have any advice for parents where one sibling is "normal" and the other has CAPD, says hurtful things without thinking, and senses offense in verbal communications where none is in fact meant? One child is always angry and one is always hurt and neither has done wrong. I feel bad for the LD one, but the "normal" one is hurting as well.
Dr. Larry Silver: I do not know what "CAPD" means. But, you do have a problem. May I suggest you seek family counseling to address the sibling conflicts.
Fairfax, Va.:
We've just signed on with a coach to help our 11-year-old daughter who had ADHD. Any thoughts on what we can do to help ensure that the coaching process is successful?
Dr. Larry Silver: Coaching is excellent for 11 year olds with ADHD who have problems with organization or executive function. Your clue that it is helping is that she improves in this area. Coaching will not help the hyperactivity, distractibility, or impulsivity. These require medications. (Also, watch that she does not also have a learning disability and may need more than coaching.)
LaPlata, Md.:
I have two children that I have recently started taking to a psychologist for emotional problems due to a divorce. I was told that one son was ADD and the other was ADHD. Is it possible to have two brothers have the same yet different disorders? My children have always been like night and day I just chalked it up to genes. Neither can remember or choose not to do what we call morning or bedtime chores and these are the same things we have been saying since they were able to handle the task. Brush hair, brush teeth, wash face, Do they really not remember or is this part of the ADD/ADHD
Thank you
Dr. Larry Silver: There is only one disorder, it is called Attention Deficit Hyperactivity Disorder (ADHD). Individuals with this problem might be hyperactive might be distractible with a short attention span or might be impulsive. Or, he/she might have two or all three of these behaviors. Some professionals refer to children with only distractibility as Attention Deficit Disorder (ADD); thus, your confusion. They both have the same disorder, only each reflects it differently. In about 50 percent of the cases, it is a familial problem, probably due to a genetic theme. Since both have it, I would guess that one of the parents or siblings of the parents have the same problem.
New Market, Md.:
My 9 year old son was diagnosed with dyslexia last year, and has been in the Fred. Co. public school's alpha phonics program for dyslexics. The strange thing is that he is a pretty good reader, and enjoys reading, although he tends to read aloud words that aren't there, or skip over groups of words, but he gets the main idea of the stories. He is very cooperative in school and at home -- no discipline problems. Are there different degrees of dyslexia? (He has a lot of difficulty with basic math and spelling.)
Dr. Larry Silver: Dyslexia refers to difficulty putting letters and sounds together and blending into words. Your son may be reading words; however, your examples suggest that he is not consistently decoding and coming up with the correct word. The alpha phonics program used is a good one and should help.
Silver Spring, Md.:
I am trying to better understand my 13 year old daughters' behavior. She has ADHD and mild learning disabilities which are being addressed at school and with medication. However, she is so irritable and angry with us that it is hard to live with her. I know 13 is a very difficult age, but she is often irritable and refuses to interact with the family. Could this be a side effect of the Concerta she takes for ADHD? Any suggestions on how to help her manage her anger? Thank you!
Dr. Larry Silver: There are too many questions I would need to clarify before I could answer. Brifly, yes, life should not be as difficult as you describe for you or for her. You might find my book, "The Misunderstood Child. A Guide for Parents of Children with Learning Disabilities" (Times Books, NY) helpful. Or, you might need family counseling.
Denver, Colo.:
So are you saying that if you have ADD/ADHD you need medication?
Dr. Larry Silver: It is difficult to answer in a brief time/space. Let me try. Over forty years of research consistently has shown that ADHD is a neurochemical disorder and is caused by a deficiency of a specific neurotransmitter in the brain. This research also shows that using specific medications that increase the production of this transmitter in the brain can improve the problem, resulting in a decrease in hyperactivity, distractibility, and/or impulsivity.
Washington, D.C.:
Thanks for this chat. I just realized my IEP was too long ago to qualify for submitting materials for accommodated testing for the LSAT. Since I am no longer in school (previous testing was done through school system), where can I find professionals who can re-test me and submit materials for accommodated testing? Also what is the going rate?
Dr. Larry Silver: There are many excellent diagnosticians in this area. The testing takes about 5 hours and the average fee is about $1500. I would rather not give specific names. Call the professionals you knew at high school and ask for people to consider.
Arlington, Va.:
As I understand it, CAPD is Central Auditor Processing Disorder and it results in a person who has normal hearing not "getting" the subtleties of language (e.g., can't make sense of sarcasm, nuances, etc.). The person speaking is not heard, the listener isn't understanding it, etc. Here, the CAPD listener gets angry and blames the "normal" speaker. It is frustrating for all of us.
Dr. Larry Silver: People with central auditory processing problems do have difficulty quickly processing what is heard. Some have difficulty distinquishing the subtle differences in sounds (called phonemes). Some have difficulty processing these sounds quickly enough. Some have both. It is frustrating for the individual and for the people trying to communicate. Fortunately, a speech-language theapist knowledgable about this disorder can be of help. With improvement both the speaker and the individual struggling to undersatnd will be less frustrated. There are also accommodations that can be learned to facilitate communications.
Arlington, Va.:
Dr. Silver,
Is there any evidence to suggest learning disabilities are inherited? I have some sort of LD pertaining to Math, (it has never actually been named) and I am concerned about my children having the same problem. A psychologist once told me the disability is similar to dyslexia but I haven't been able to find many books on disabilities related to Math. Most publications focus on ADD, dyslexia, etc.
Thank you.
Dr. Larry Silver: The studies with LD and with ADHD suggest that as many as 50 percent of individuals with these problems probably inherited it. That is, it runs in families. Thus, it is not uncommon to find that a parent or a member of the parent's family has the same problems.
Burke, Va.:
Could you please give a reason for Fairfax County School District's increase of learning disabled students being more than 10 percent a year when the total enrollment increased by less than 3 percent?
Dr. Larry Silver: I can not. I have not seen these statistics. You would have to ask your Assistant Superintendent for Special Education.
Reston, Va.:
Approximately 15 years ago I was told by a doctor that a cup of black coffee administered to a child without sugar and cream would have the same effect as Ritalin.
It worked for my child.
Would you happen to know why this method succeeded and why more doctors don't suggest it rather than medication that may over the long run harm a child?
Dr. Larry Silver: I am sorry to say that your family doctor is not correct. The amount of caffine in a cup of coffee is not adequate to help. I'm pleased that it helped your child; however, I can not recommend this treatment.
Ft. Washington, Md.:
This is my son's first year of high school. After three very bad years in the public school system, I've decided to home school. We are both unsure what to expect, but he is willing to try anything than to go back to public school. Things were so bad at the school that he is now on prescription Zantax. He was diagnosed with mild ADD and his therapist recommended behavior modifications in the classes. Teachers were too busy to give him the needed structure. Do have any comments for home schooling?
Dr. Larry Silver: It sounds as if you and he have had some frustrating years. I can not be specific without more information. Does he have learning disabilities? Does he have ADHD. (Zantec is not a treatment for ADHD.) I'd like to help but do not have enough details.
Somewhere, USA:
What methods do you suggest to remove learning disabilities at the childhood level?
What are the reasons for learning disabilities among children?
Dr. Larry Silver: Your questions are too broad to answer in the space provided. May I suggest that you write for information on these questions to the Learning Disabilities Association of America. 4156 Library Road, Pittsburgh, PA 15234.
Herndon, Va.:
Dr. Silver,
What do you do to assist your child in retaining what is being taught? My son, who is now 14, struggles with this and has for sometime now. I believe if he could just retain what was given to him during class and homework, he would be able to apply this towards getting good grades. This is frustrating for him and he breaks down and cries. It is not ass if he is not trying -- he is. Please advise.
Dr. Larry Silver: The real question is why he is having difficulty retaining material. Speak to your school professionals. Perhaps formal testing is needed. Find out why and then the approach to use will become clear.
Washington, D.C.:
My 5-year old was diagnosed as probable ADHD at 3 1/2. He is going to get re-evaluated at the end of this month and might possibly be put on medication -- not for attention, but for impulsivity and hyperactivity. This seems to be his greatest problem, even in a special education setting. The only thing consistent about his behavior is his inconsistencies. My question is, if he has the attention but his impulsive and hyperactive behavior are the biggest problem in school -- and somewhat at home -- is this still considered ADHD? His teacher at a special education camp said that once she finally got him to sit down and do his work, he would stay on task and complete it correctly and that he has a great memory. I am starting to worry because I have worked hard to accept the ADHD diagnosis but now it sounds like he has other problems or a combination of problems. Thanks.
Dr. Larry Silver: A child with ADHD might have one or more of three behaviors or might have all three: hyperactivity, distractibility, impulsivity. Discuss this with the professional making the diagnosis. If you want to read more about this, you might read my book, "Dr. Larry Silver's Advice to Parents on ADHD." (Times Books, NY.
Sterling, Va.:
It has been my contention that children who have not been properly taught to read or learn primary math by their first, second or third grade teachers are frequently placed into classes for learning disabled students. Also, some students are placed in learning disabled classes because they arrived speaking another language, yet they are labeled as though their brain doesn't function correctly.
This is incorrect placement. Why should the child be labeled as having a learning disability because the teacher failed? Yet this is happening everyday in some school systems.
Dr. Larry Silver: Although you might be correct in some cases, I do not think this is the pattern. To be identified with LD, the school must do comprehensive testing and show a clear discrepancy between intellectual level and performance. Poor teaching, lack of teaching, bilingual or bicultural issues are taken into account. So, I hope what you describe is not the case.
Silver Spring, Md.:
Dr. Silver,
I registered my 5-year-old daughter in kindergarten in a standard Montgomery County school, but I did not reveal that she had an IEP (Individual Education Plan), because I do not want the new school she is attending to pigeon-hole her as a special ed kid. Public schools do not have a great reputation for handling special ed children, especially "minorities."
I want the new teachers to have the highest expectations of my child, whether she has learning challenges or not. Several months have passed since she "graduated" from PEP. Her language delay is almost gone. I want her to be mainstreamed.
If the new school detects a need for certain special ed services for my daughter -- and I will ask that they evaluate her -- they can take required steps.
My question is this: Am I handling this thing in the right way? One of the intake forms asked whether she had an IEP. I indicated she did not. (Obviously, I lied.) I am very worried that she might be pigeon-holed or discriminated against for a past delay.
I figure that the worse that could happen, now that the new school does not know about the IEP, is that they will find out later and take needed action. Again, I need to know what you think. Thanks.
Dr. Larry Silver: If she was identified in a PEP program and had an IEP, this should be known to her Kindergarten teacher, even if you did not tell the teacher. For her to have been in a special preschool program suggests that she is struggling with developmental issues. Please watch closely. If she is not doing well, you must do something.
San Ramon, Calif.:
How can you remediate a visual processing problem? Are there computer programs that can help for a young child?
Dr. Larry Silver: Your question is too technical for me to answer in this format. Seek out a professional who works in this area and ask your questions.
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