What does a diagnosis really tell you? What do the labels Specific Learning Disability, Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) actually mean? How are parents to know which classification is the best fit for their child and will result in the greatest progress?
As a school neuropsychologist, I’m often approached by parents and students after they’ve been mislabeled and misunderstood. Many of the children have been through years of testing and diagnoses, sometimes showing little, if any, improvement. This has resulted in critical lost years of academic instruction. Compounding the issue is that the experience can lead to decreased self-esteem, which may result in additional emotional and behavioral problems. Children often do not fit into neat diagnostic categories. There are complex interplays between biological and psychological factors that must be addressed. There are unique brain-processing strengths and weaknesses that need to be factored in when assessing and treating a child.
Take the hypothetical case of David, a sophomore in a private high school. David was evaluated by the Child Study Team, but wasn’t found eligible for special education because, although underperforming, he was not failing his courses. He was diagnosed with ADHD by a neurologist and placed on medication. However, David continued to struggle in school, often obtaining Ds on his exams. He became increasingly depressed and isolated, calling himself a “loser.” Detailed neuropsychological testing of this otherwise bright and capable teen revealed a learning disability in a very specific subtype of written language and math, as well as difficulties in executive functioning. Once David’s strengths and weaknesses were understood, and modifications and accommodations were implemented in school, his performance improved. In addition, David’s negative self-talk and depression lifted as he now began to feel he could keep up with the work. This is an example of how a detailed assessment uncovered specific underlying learning issues, leading to a proper diagnosis and a very real change.
Another example of the importance of understanding a child’s unique strengths and weaknesses relates to the diagnosis of Autism Spectrum Disorder (ASD). An alarming number of students with ASD are misdiagnosed and mislabeled with alternate disorders for years before receiving the correct diagnoses. Some have additional disorders as well. ASD is a particular diagnosis that can be easily misunderstood. It is assigned when there are found to be difficulties in two areas—social communication and restricted, repetitive behavior or interests. These challenges must have been present from early childhood. Symptoms can range from mild to more severe. Students with ASD or other disorders sometimes have sensory challenges as well. They can either be oversensitive or undersensitive to temperature, texture, smell or sound. It is important to evaluate students as part of a neuropsychological assessment for sensorimotor input and output before measuring higher-order functioning such as intelligence or attention. This ensures that findings are interpreted correctly.
A second hypothetical example involves Michael. He had a similar profile to David, and was also diagnosed with ADHD, low self-esteem and decreasing grades. However, Michael was in special education since kindergarten under the classification of “Other Health Impaired” due to his early diagnosis of ADHD. His parents noticed Michael’s increased frustration, but neither they nor the school knew what to do. A thorough neuropsychological evaluation was conducted. It was discovered that Michael met the criteria for ASD based on his social communication difficulties and restricted interests. A sensory-motor battery revealed various difficulties, including oversensitivity to hallway noise during classroom changes. This resulted in an inability to gather materials for the next class. Interventions for ASD were implemented, including pragmatic speech and language therapy, social-skills groups, individual therapy and a behavior intervention plan. Michael’s locker was also moved to a quieter area. Michael became less frustrated as his needs were finally being met.
What is learned is that it is essential to examine underlying symptoms and root causes of what is bothering the child. Sometimes it is not readily apparent. Neuropsychological testing enables the caregiver to look beyond the surface into how the brain is operating to understand an array of strengths and weaknesses. In this manner, one is better able to understand and help the child. After all, isn’t that what the Individualized Education Plan is all about—to design a program around the individual’s strengths and weaknesses?
Practical Guidelines for Assessment and Intervention for A Child With Learning Difficulties
I am often asked by parents for assistance in accessing help for their children who they believe may require special education, or have already been placed in special education but continue to struggle in school.
How to Ask Your School System for a Neuropsychological Assessment
There are times when your child’s school does not understand or properly address his/her disability. This may occur because of a lack of progress in school. This may also happen if you, as a parent, do not agree with an evaluation that was performed by the school. You may feel that some areas of concern were not addressed. Parents are part of the process and can request that an Independent Evaluation be conducted at the school’s expense. This assessment may be conducted by an outside evaluator and can include a neuropsychological assessment.
The Importance of Identifying the “Specific” in Specific Learning Disability
By Dr. Leah Isler
It is not enough to know that your child has a Specific Learning Disability. The term “Specific” needs to be defined. Dyslexia is an example of a Specific Learning Disability. It is a neurodevelopmental disorder that hinders the acquisition of reading abilities. It cannot otherwise be explained by deficits in general intelligence, academic learning opportunities, overall motivation or sensory acuity problems. It is not only important to know if your child has dyslexia, but what type of dyslexia your child has, to properly plan for early and specific interventions. There also needs to be an awareness that there are different types of writing and math disorders. The specific type of disorder, which is pinpointed in a school neuropsychological assessment, often makes a huge difference regarding which types of interventions and accommodations are needed.
Leah Isler is a school psychologist who has a private practice in school neuropsychology. Her website is childneuropsychevals.com. She can be reached at [email protected].
