Sarah is in the second grade and has received D’s and F’s on her report card all year. Her parents had taken her to a neurologist who ruled out a medical cause, including attention deficit hyperactivity disorder (ADHD). Suspecting a learning disability, they contact her district’s child study team for a psychoeducational evaluation. After anxiously awaiting results, they are told, “We have great news! There is no significant discrepancy between her overall IQ and her achievement scores, which means she has no learning disability.”
Sarah’s parents leave the meeting bewildered. If she’s putting in the effort and still receiving failing grades, something isn’t right. Why does she need to have a “discrepancy” to be labeled as having a learning disability? What Sarah’s parents encountered was the original and still widely used model for evaluating children with learning disabilities, which examines certain relationships while ignoring many other processes that can help explain why a child is struggling.
According to the US Department of Education, close to three million children receive special education, with Specific Learning Disability as their primary category designation. A learning disability is a neurological disorder that can make a basic task like reading, writing, organizing information or computing math more difficult than usual. The federal Individuals with Disabilities Education Act (IDEA) states that all schools are obligated to help identify children with learning disabilities and have them assessed with parental consent. Learning disabilities are difficult to diagnose as many factors are involved. That is why an update to the law was enacted that allows for a neuropsychological approach in addition to the discrepancy model. Many parents are still unaware of the changes in federal law and their right to request the newer evaluation model when appropriate.
The Neuropsychological or “Strengths and Weaknesses” Model
Sarah’s parents eventually learned of the neuropsychological approach, which can reveal their daughter’s unique strengths and weaknesses through a series of evaluations. A battery of neuropsychological tests began with a detailed medical and educational history, followed by an assessment of Sarah’s sensorimotor capabilities.
Sarah’s executive functioning, the part of the brain that controls attention, organization, planning and problems solving, was evaluated next. She performed poorly on this assessment. Although she wasn’t diagnosed with ADHD, Sarah was found to have difficulty on specific tests of attention. She had working memory challenges as well, an inability to hold information in short-term memory while manipulating it. All of these cognitive processes affected her overall classroom performance. Academic testing revealed specific difficulties with math calculation and written language tasks, which are often found in children who have difficulties with working memory, attention and executive functioning. After comprehensive testing was completed, followed by an analysis of her strengths and weaknesses, Sarah was classified with a Specific Learning Disability in the areas of written language and mathematics. There are four different subtypes of written language and mathematics disorders. Specific interventions were implemented according to the particular areas of challenge.
In summary, unlike the discrepancy model, which tends to be limited in its approach, the neuropsychological model delves far more deeply into a child’s unique makeup, and, as a result, reveals a more specific diagnosis. This allows for tailor-made remedies to be brought into play.
Dyslexia
David is in first grade in a school for those with behavioral disabilities. He cannot read and does not even know all of his letter sounds. He doesn’t pay attention in school, refusing to focus. When pushed to learn, he instead crumples his work and throws it on the floor. His school evaluation reveals an IQ in the average range, but with very low scores in all of his achievement tests, demonstrating that he is not making much progress in school. Consider these facts:
• Eighty percent of children with learning disabilities have problems with reading.
• Approximately one out of every five children struggles with dyslexia.
• Dyslexia is neurological in origin.
• Dyslexia falls under the special education code of Specific Learning
• Disability. If someone waits until a discrepancy appears, the critical period
• of reading intervention has often passed.
• Included among the many notable people with dyslexia are Leonardo da Vinci, Thomas Edison, Albert Einstein, Steve Jobs, Jay Leno and Steven Spielberg.
There is more than one type of dyslexia. Although many students with reading problems have difficulties in phonological (letter-sound) awareness, some have challenges recognizing sight words that cannot simply be sounded out, have poor reading fluency or struggle with reading comprehension and/or working memory. A neuropsychological evaluation can better determine which form of a reading disorder exists so that more accurate and timely interventions can be implemented.
David’s neuropsychological evaluation revealed that he had two types of dyslexia, which understandably caused major frustrations. Interventions were initiated for his specific dyslexia and learning difficulties. This led to a decrease in his negative behaviors and allowed him to transition out of the behavioral program and into a mainstream resource setting not long afterwards.
Sarah’s and David’s situations are but two examples of how, through the usage of neuropsychological techniques in schools, learning disabilities and dyslexia can now be identified earlier, followed by appropriate interventions. The ability to address the unique strengths and weaknesses of each child during his/her critical time of learning and brain development is indeed a breakthrough that should be considered by any parent whose child is facing classroom challenges.
Leah Isler is a school psychologist who also has a private practice in child neuropsychology. She can be reached at [email protected].
