LEARNING DISABILITIES
LEARNING DISABILITIES
Imagine having important needs and ideas to communicate, but being
unable to express them. Perhaps feeling bombarded by sights and sounds,
unable to focus your attention. Or trying to read or add but not being
able to make sense of the letters or numbers.
- You may not need to imagine. You may be the parent or teacher of a
child experiencing academic problems, or have someone in your family
diagnosed as learning disabled. Or possibly as a child you were told you
had a reading problem called dyslexia or some other learning handicap.
- Although different from person to person, these difficulties make up
the common daily experiences of many learning disabled children,
adolescents, and adults. A person with a learning disability may
experience a cycle of academic failure and lowered self-esteem. Having
these handicaps--or living with someone who has them--can bring
overwhelming frustration.
- But the prospects are hopeful. It is important to remember that a
person with a learning disability can learn. The disability
usually only affects certain limited areas of a child's development. In
fact, rarely are learning disabilities severe enough to impair a
person's potential to live a happy, normal life.
- This booklet is provided by the National Institute of Mental Health
(NIMH), the Federal agency that supports research nationwide on the
brain, mental illnesses, and mental health. Scientists supported by NIMH
are dedicated to understanding the workings and interrelationships of
the various regions of the brain, and to finding preventions and
treatments to overcome brain dysfunctions that handicap people in
school, work, and play.
- The booklet provides up--to-date information on learning disabilities
and the role of NIMH-sponsored research in discovering underlying causes
and effective treatments. It describes treatment options, strategies for
coping, and sources of information and support. Among these sources are
doctors, special education teachers, and mental health professionals who
can help identify learning disabilities and recommend the right
combination of medical, psychosocial, and educational treatment.
- In this booklet, you'll also read the stories of Susan, Wallace, and
Dennis, three people who have learning disabilities. Although each had a
rough start, with help they learned to cope with their handicaps. You'll
see their early frustrations, their steps toward getting help, and their
hopes for the future.
- The stories of Susan, Wallace, and Dennis are representative of
people with learning disabilities, but the characters are not real. Of
course, people with learning disabilities are not all alike, so these
stories may not fit any particular individual.
Susan
At age 14, Susan still tends to be quiet. Ever since she was a child,
she was so withdrawn that people sometimes forgot she was there. She
seemed to drift into a world of her own. When she did talk, she often
called objects by the wrong names. She had few friends and mostly played
with dolls or her little sister. In school, Susan hated reading and math
because none of the letters, numbers or "+" and "-"
signs made any sense. She felt awful about herself. She'd been told--and
was convinced--that she was retarded.
Wallace
Wallace has lived 46 years, and still has trouble understanding what
people say. Even as a boy, many words sounded alike. His father patiently
said things over and over. But whenever his mother was drunk, she flew
into a rage and spanked him for not listening. Wallace's speech also came
out funny. He had such problems saying words that in school his teacher
sometimes couldn't understand him. When classmates called him a "dummy,"
his fists just seemed to take over.
Dennis
Dennis is 23 years old and still seems to have too much energy. But he
had always been an overactive boy, sometimes jumping on the sofa for hours
until he collapsed with exhaustion. In grade school, he never sat still.
He interrupted lessons. But he was a friendly, well-meaning kid, so adults
didn't get too angry. His academic problems became evident in third grade,
when his teacher realized that Dennis could only recognize a few words and
wrote like a first grader. She recommended that Dennis repeat third grade,
to give him time to "catch up." After another full year, his
behavior was still out of control, and his reading and writing had not
improved.
Unlike other disabilities, such as paralysis or blindness, a learning
disability (LD) is a hidden handicap. A learning disability doesn't
disfigure or leave visible signs that would invite others to be
understanding or offer support. A woman once blurted to Wallace, "You
seem so intelligent--you don't look handicapped!"
- LD is a disorder that affects people's ability to either interpret
what they see and hear or to link information from different parts of
the brain. These limitations can show up in many ways--as specific
difficulties with spoken and written language, coordination,
self-control, or attention. Such difficulties extend to schoolwork and
can impede learning to read or write, or to do math.
- Learning disabilities can be lifelong conditions that, in some cases,
affect many parts of a person's life: school or work, daily routines,
family life, and sometimes even friendships and lay. In some people,
many overlapping learning disabilities may be apparent. Other people may
have a single, isolated learning problem that has little impact on other
areas of their lives.
"Learning disability" is not a diagnosis in the same sense as
"chickenpox" or "mumps." Chickenpox and mumps imply a
single, known cause with a predictable set of symptoms. Rather, LD is a
broad term that covers a pool of possible causes, symptoms, treatments,
and outcomes. Partly because learning disabilities can show up in so many
forms, it is difficult to diagnose or to pinpoint the causes. And no one
knows of a pill or remedy that will cure them.
- Not all learning problems are necessarily learning disabilities. Many
children are simply slower in developing certain skills. Because
children show natural differences in their rate of development,
sometimes what seems to be a learning disability may simply be a delay
in maturation. To be diagnosed as a learning disability, specific
criteria must be met.
- The criteria and characteristics for diagnosing learning disabilities
appear in a reference book called the DSM (short for the Diagnostic
and Statistical Manual of Mental Disorders). The DSM diagnosis is
commonly used when applying for health insurance coverage of diagnostic
and treatment services.
- Learning disabilities can be divided into three broad categories:
- Developmental speech and language disorders
- Academic skills disorders
- "Other," a catch-all that includes certain
coordination disorders and learning handicaps not covered by the
other terms
- Each of these categories includes a number of more specific
disorders.
Developmental Speech and Language Disorders
Speech and language problems are often the earliest indicators of a
learning disability. People with developmental speech and language
disorders have difficulty producing speech sounds, using spoken
language to communicate, or understanding what other people say.
Depending on the problem, the specific diagnosis may be:
- Developmental articulation disorder
- Developmental expressive language disorder
- Developmental receptive language disorder
- Developmental Articulation Disorder -- Children with
this disorder may have trouble controlling their rate of speech. Or they
may lag behind playmates in learning to make speech sounds. For example,
Wallace at age 6 still said "wabbit" instead of "rabbit"
and "thwim" for "swim." Developmental articulation
disorders are common. They appear in at least 10 percent of children
younger than age 8. Fortunately, articulation disorders can often be
outgrown or successfully treated with speech therapy.
- Developmental Expressive Language Disorder -- Some
children with language impairments have problems expressing themselves
in speech. Their disorder is called, therefore, a developmental
expressive language disorder. Susan, who often calls objects by the
wrong names, has an expressive language disorder. Of course, an
expressive language disorder can take other forms. A 4-year-old who
speaks only in two-word phrases and a 6-year-old who can't answer simple
questions also have an expressive language disability.
- Developmental Receptive Language Disorder -- Some
people have trouble understanding certain aspects of speech. It's as if
their brains are set to a different frequency and the reception is poor.
There's the toddler who doesn't respond to his name, a preschooler who
hands you a bell when you asked for a ball, or the worker who
consistently can't follow simple directions. Their hearing is fine, but
they can't make sense of certain sounds, words, or sentences they hear.
They may even seem inattentive. These people have a receptive language
disorder. Because using and understanding speech are strongly related,
many people with receptive language disorders also have an expressive
language disability.
- Of course, in preschoolers, some misuse of sounds, words, or grammar
is a normal part of learning to speak. It's only when these problems
persist that there is any cause for concern.
Academic Skills Disorders
Students with academic skills disorders are often years behind
their classmates in developing reading, writing, or arithmetic skills.
The diagnoses in this category include:
- Developmental reading disorder
- Developmental writing disorder
- Developmental arithmetic disorder
- Developmental Reading Disorder -- This type of
disorder, also known as dyslexia, is quite widespread. In fact, reading
disabilities affect 2 to 8 percent of elementary school children.
- When you think of what is involved in the "three R's"--reading,
'riting, and 'rithmetic--it's astounding that most of us do learn them.
Consider that to read, you must simultaneously:
- Focus attention on the printed marks and control eye movements
across the page
- Recognize the sounds associated with letters
- Understand words and grammar
- Build ideas and images
- Compare new ideas to what you already know
- Store ideas in memory
- Such mental juggling requires a rich, intact network of nerve cells
that connect the brain's centers of vision, language, and memory.
- A person can have problems in any of the tasks involved in reading.
However, scientists found that a significant number of people with
dyslexia share an inability to distinguish or separate the sounds in
spoken words. Dennis, for example, can't identify the word "bat"
by sounding out the individual letters, b-a-t. Other children with
dyslexia may have trouble with rhyming games, such as rhyming "cat"
with "bat." Yet scientists have found these skills fundamental
to learning to read. Fortunately, remedial reading specialists have
developed techniques that can help many children with dyslexia acquire
these skills.
- However, there is more to reading than recognizing words. If the
brain is unable to form images or relate new ideas to those stored in
memory, the reader can't understand or remember the new concepts. So
other types of reading disabilities can appear in the upper grades when
the focus of reading shifts from word identification to comprehension.
- Developmental Writing Disorder -- Writing, too,
involves several brain areas and functions. The brain networks for
vocabulary, grammar, hand movement, and memory must all be in good
working order. So a developmental writing disorder may result from
problems in any of these areas. For example, Dennis, who was unable to
distinguish the sequence of sounds in a word, had problems with
spelling. A child with a writing disability, particularly an expressive
language disorder, might be unable to compose complete, grammatical
sentences.
- Developmental Arithmetic Disorder -- If you doubt
that arithmetic is a complex process, think of the steps you take to
solve this simple problem: 25 divided by 3 equals ?
- Arithmetic involves recognizing numbers and symbols, memorizing facts
such as the multiplication table, aligning numbers, and understanding
abstract concepts like place value and fractions. Any of these may be
difficult for children with developmental arithmetic disorders. Problems
with numbers or basic concepts are likely to show up early. Disabilities
that appear in the later grades are more often tied to problems in
reasoning.
- Many aspects of speaking, listening, reading, writing, and arithmetic
overlap and build on the same brain capabilities. So it's not surprising
that people can be diagnosed as having more than one area of learning
disability. For example, the ability to understand language underlies
learning speak. Therefore, any disorder that hinders the ability to
understand language will also interfere with the development of speech,
which in turn hinders learning to read and write. A single gap in the
brain's operation can disrupt many types of activity.
"Other" Learning Disabilities
The DSM also lists additional categories, such as "motor
skills disorders" and "specific developmental disorders not
otherwise specified." These diagnoses include delays in acquiring
language, academic, and motor skills that can affect the ability to
learn, but do not meet the criteria for a specific learning
disability. Also included are coordination disorders that can lead to
poor penmanship, as well as certain spelling and memory disorders.
Attention Disorders
Nearly 4 million school-age children have learning disabilities. Of
these, at least 20 percent have a type of disorder that leaves them
unable to focus their attention.
- Some children and adults who have attention disorders appear to
daydream excessively. And once you get their attention, they're often
easily distracted. Susan, for example, tends to mentally drift off into
a world of her own. Children like Susan may have a number of learning
difficulties. If, like Susan, they are quiet and don't cause problems,
their problems may go unnoticed. They may be passed along from grade to
grade, without getting the special assistance they need.
- In a large proportion of affected children--mostly boys--the
attention deficit is accompanied by hyperactivity. Dennis is an example
of a person with attention deficit hyperactivity disorder--ADHD. They
act impulsively, running into traffic or toppling desks. Like young
Dennis, who jumped on the sofa to exhaustion, hyperactive children can't
sit still. They blurt out answers and interrupt. In games, they can't
wait their turn. These children's problems are usually hard to miss.
Because of their constant motion and explosive energy, hyperactive
children often get into trouble with parents, teachers, and peers.
- By adolescence, physical hyperactivity usually subsides into
fidgeting and restlessness. But the problems with attention and
concentration often continue into adulthood. At work, adults with ADHD
often have trouble organizing tasks or completing their work. They don't
seem to listen to or follow directions. Their work may be messy and
appear careless.
- Attention disorders, with or without hyperactivity, are not
considered learning disabilities in themselves. However, because
attention problems can seriously interfere with school performance, they
often accompany academic skills disorders.
Understandably, one of the first questions parents ask when they learn
their child has a learning disorder is "Why? What went wrong?"
- Mental health professionals stress that since no one knows what
causes learning disabilities, it doesn't help parents to look backward
to search for possible reasons. There are too many possibilities to pin
down the cause of the disability with certainty. It is far more
important for the family to move forward in finding ways to get the
fight help.
- Scientists, however, do need to study causes in an effort to identify
ways to prevent learning disabilities.
- Once, scientists thought that all learning disabilities were caused
by a single neurological problem. But research supported by NIMH has
helped us see that the causes are more diverse and complex. New evidence
seems to show that most learning disabilities do not stem from a single,
specific area of the brain, but from difficulties in bringing together
information from various brain regions.
- Today, a leading theory is that learning disabilities stem from
subtle disturbances in brain structures and functions. Some scientists
believe that, in many cases, the disturbance begins before birth.
Errors in Fetal Brain Development
Throughout pregnancy, the fetal brain develops from a few
all-purpose cells into a complex organ made of billions of
specialized, interconnected nerve cells called neurons. During this
amazing evolution, things can go wrong that may alter how the neurons
form or interconnect.
- In the early stages of pregnancy, the brain stem forms. It controls
basic life functions such as breathing and digestion. Later, a deep
ridge divides the cerebrum--the thinking part of the brain--into two
halves, a right and left hemisphere. Finally, the areas involved with
processing sight, sound, and other senses develop, as well as the areas
associated with attention, thinking, and emotion.
- As new cells form, they move into place to create various brain
structures. Nerve cells rapidly grow to form networks with other parts
of the brain. These networks are what allow information to be shared
among various regions of the brain.
- Throughout pregnancy, this brain development is vulnerable to
disruptions. If the disruption occurs early, the fetus may die, or the
infant may be born with widespread disabilities and possibly mental
retardation. If the disruption occurs later, when the cells are becoming
specialized and moving into place, it may leave errors in the cell
makeup, location, or connections. Some scientists believe that these
errors may later show up as learning disorders.
- (Graphic Omitted. Shows brain development for
stages 4-, 6-, and 8-month-old fetus; birth; and adult.)
Other Factors That Affect Brain Development
Through experiments with animals, scientists at NIMH and other
research facilities are tracking clues to determine what disrupts
brain development. By studying the normal processes of brain
development, scientists can better understand what can go wrong. Some
of these studies are examining how genes, substance abuse, pregnancy
problems, and toxins may affect the developing brain.
- Genetic Factors -- The fact that learning
disabilities tend to run in families indicates that there may be a
genetic link. For example, children who lack some of the skills needed
for reading, such as hearing the separate sounds of words, are likely to
have a parent with a related problem. However, a parent's learning
disability may take a slightly different form in the child. A parent who
has a writing disorder may have a child with an expressive language
disorder. For this reason, it seems unlikely that specific learning
disorders are inherited directly. Possibly, what is inherited is a
subtle brain dysfunction that can in turn lead to a learning disability.
- There may be an alternative explanation for why LD might seem to run
in families. Some learning difficulties may actually stem from the
family environment. For example, parents who have expressive language
disorders might talk less to their children, or the language they use
may be distorted. In such cases, the child lacks a good model for
acquiring language and therefore, may seem to be learning disabled.
- Tobacco, Alcohol, and Other Drug Use -- Many drugs
taken by the mother pass directly to the fetus. Research shows that a
mother's use of cigarettes, alcohol, or other drugs during pregnancy may
have damaging effects on the unborn child. Therefore, to prevent
potential harm to developing babies, the U.S. Public Health Service
supports efforts to make people aware of the possible dangers of
smoking, drinking, and using drugs.
- Scientists have found that mothers who smoke during pregnancy may be
more likely to bear smaller babies. This is a concern because small
newborns, usually those weighing less than 5 pounds, tend to be at risk
for a variety of problems, including learning disorders.
- Alcohol also may be dangerous to the fetus' developing brain. It
appears that alcohol may distort the developing neurons. Heavy alcohol
use during pregnancy has been linked to fetal alcohol syndrome, a
condition that can lead to low birth weigh, intellectual impairment,
hyperactivity, and certain physical defects. Any alcohol use during
pregnancy, however, may influence the child's development and lead to
problems with learning, attention, memory, or problem solving. Because
scientists have not yet identified "safe" levels, alcohol
should be used cautiously by women who are pregnant or who may soon
become pregnant.
- Drugs such as cocaine--especially in its smokable form known as
crack--seem to affect the normal development of brain receptors. These
brain cell parts help to transmit incoming signals from our skin, eyes,
and ears, and help regulate our physical response to the environment.
Because children with certain learning disabilities have difficulty
understanding speech sounds or letters, some researchers believe that
learning disabilities, as well as ADHD, may be related to faulty
receptors. Current research points to drug abuse as a possible cause of
receptor damage.
- Problems During Pregnancy or Delivery -- Other
possible causes of learning disabilities involve complications during
pregnancy. In some cases, the mother's immune system reacts to the ferns
and attacks it as if it were an infection. This type of disruption seems
to cause newly formed brain cells to settle in the wrong part of the
brain. Or during delivery, the umbilical cord may become twisted and
temporarily cut off oxygen to the fetus. This, too, can impair brain
functions and lead to LD.
- Toxins in the Child's Environment -- New brain cells
and neural networks continue to be produced for a year or so after the
child is born. These cells are vulnerable to certain disruptions, also.
- Researchers are looking into environmental toxins that may lead to
learning disabilities, possibly by disrupting childhood brain
development or brain processes. Cadmium and lead, both prevalent in the
environment, are becoming a leading focus of neurological research.
Cadmium, used in making some steel products, can get into the soil, then
into the foods we eat. Lead was once common in paint and gasoline, and
is still present in some water pipes. A study of animals sponsored by
the National Institutes of Health showed a connection between exposure
to lead and learning difficulties. In the study, rats exposed to lead
experienced changes in their brainwaves, slowing their ability to learn.
The learning problems lasted for weeks, long after the rats were no
longer exposed to lead.
- In addition, there is growing evidence that learning problems may
develop in children with cancer who had been treated with chemotherapy
or radiation at an early age. This seems particularly true of children
with brain tumors who received radiation to the skull.
In comparing people with and without learning disabilities, scientists
have observed certain differences in the structure and functioning of the
brain. For example, new research indicates that there may be variations in
the brain structure called the planum temporale, a language-related area
found in both sides of the brain. In people with dyslexia, the two
structures were found to be equal in size. In people who are not dyslexic,
however, the left planum temporale was noticeably larger. Some scientists
believe reading problems may be related to such differences.
- With more research, scientists hope to learn precisely how
differences in the structures and processes of the brain contribute to
learning disabilities, and how these differences might be treated or
prevented.
Susan
>Susan was promoted to the sixth grade but still couldn't do basic
math. So, her mother brought her to a private clinic for testing. The
clinician observed that Susan had trouble associating symbols with their
meaning, and this was holding back her language, reading, and math
development. Susan called objects by the wrong words and she could not
associate sounds with letters or recognize math symbols. However, an IQ of
128 meant that Susan was quite bright. In addition to developing an
Individualized Education Plan, the clinician recommended that Susan
receive counseling for her low self-esteem and depression.
Wallace
In the early 1960s, at the request of his ninth grade teacher, Wallace
was examined by a doctor to see why he didn't speak or listen well. The
doctor tested his vocal cords, vision, and hearing. They were all fine.
The teacher concluded that Wallace must have "brain damage," so
not much could be done. Wallace kept failing in school and was suspended
several times for fighting. He finally dropped out after tenth grade. He
spent the next 25 years working as a janitor. Because LD frequently went
undiagnosed at the time when Wallace was young, the needed help was not
available to him.
Dennis
In fifth grade, Dennis' teacher sent him to the school psychologist for
testing. Dennis was diagnosed as having developmental reading and
developmental writing disorders. He was also identified as having an
attention disorder with hyperactivity. He was placed in an all-day special
education program, where he could work on his particular deficits and get
individual attention. His family doctor prescribed the medication Ritalin
to reduce his hyperactivity and distractibility. Along with working to
improve his reading, the special education teacher helped him improve his
listening skills. Since his handwriting was still poor, he learned to type
homework and reports on a computer. At age 19, Dennis graduated from high
school and was accepted by a college that gives special assistance to
students with learning disabilities.
The first step in solving any problem is realizing there is one.
Wallace, sadly, was a product of his time, when learning disabilities were
more of a mystery and often went unrecognized. Today, professionals would
know how to help Wallace. Dennis and Susan were able to get help because
someone saw the problem and referred them for help.
- When a baby is born, the parents eagerly wait for the baby's first
step, first word, a myriad of other "firsts." During routine
checkups, the pediatrician, too, watches for more subtle signs of
development. The parents and doctor are watching for the child to
achieve developmental milestones. The developmental milestones chart
(omitted here; see page 18 of brochure) lists a few of these markers and
the ages and grades that they typically appear.
- Parents are usually the first to notice obvious delays in their child
reaching early milestones. The pediatrician may observe more subtle
signs of minor neurological damage, such as a lack of coordination. But
the classroom teacher, in fact, may be the first to notice the child's
persistent difficulties in reading, writing, or arithmetic. As school
tasks become more complex, a child with a learning disability may have
problems mentally juggling more information.
- The learning problems of children who are quiet and polite in school
may go unnoticed. Children with above average intelligence, who manage
to maintain passing grades despite their disability, are even less
likely to be identified. Children with hyperactivity, on the other hand,
will be identified quickly by their impulsive behavior and excessive
movement. Hyperactivity usually begins before age 4 but may not be
recognized until the child enters school.
- What should parents, doctors, and teachers do if critical
developmental milestones haven't appeared by the usual age? Sometimes
it's best to allow a little more time, simply for the brain to mature a
bit. But if a milestone is already long delayed, if there's a history of
learning disabilities in the family, or if there are several delayed
kills, the child should be professionally evaluated as soon as possible.
An educator or a doctor who treats children can suggest where to go for
help.
By law, learning disability is defined as a significant gap between a
person's intelligence and the skills the person has achieved at each age.
This means that a severely retarded 10-year-old who speaks like a
6-year-old probably doesn't have a language or speech disability. He has
mastered language up to the limits of his intelligence. On the other hand,
a fifth grader with an IQ of 100 who can't write a simple sentence
probably does have LD.
- Learning disorders may be informally flagged by observing
significant delays in the child's skill development. A 2-year delay in
the primary grades is usually considered significant. For older
students, such a delay is not as debilitating, so learning disabilities
aren't usually suspected unless there is more than a 2-year delay. Actual
diagnosis of learning disabilities, however, is made using
standardized tests that compare the child's level of ability to what is
considered normal development for a person of that age and intelligence.
- For example, as late as fifth grade, Susan couldn't add two numbers,
even though she rarely missed school and was good in other subjects. Her
mother took her to a clinician, who observed Susan's behavior and
administered standardized math and intelligence tests. The test results
showed that Susan's math skills were several years behind, given her
mental capacity for learning. Once other possible causes like lack of
motivation and vision problems were ruled out, Susan's math problem was
formally diagnosed as a specific learning disability.
- Test outcomes depend not only on the child's actual abilities, but on
the reliability of the test and the child's ability to pay attention and
understand the questions. Children like Dennis, with poor attention or
hyperactivity, may score several points below their true level of
ability. Testing a child in an isolated room can sometimes help the
child concentrate and score higher.
- Each type of LD is diagnosed in slightly different ways. To diagnose
speech and language disorders, a speech therapist tests the child's
pronunciation, vocabulary, and grammar and compares them to the
developmental abilities seen in most children that age. A psychologist
tests the child's intelligence. A physician checks for any ear
infections, and an audiologist may be consulted to rule out auditory
problems. If the problem involves articulation, a doctor examines the
child's vocal cords and throat.
- In the case of academic skills disorders, academic development in
reading, writing, and math is evaluated using standardized tests. In
addition, vision and hearing are tested to be sure the student can see
words clearly and can hear adequately. The specialist also checks if the
child has missed much school. It's important to rule out these other
possible factors. After all, treatment for a learning disability is very
different from the remedy for poor vision or missing school.
- ADHD is diagnosed by checking for the long-term presence of specific
behaviors, such as considerable fidgeting, losing things, interrupting,
and talking excessively. Other signs include an inability to remain
seated, stay on task, or take turns. A diagnosis of ADHD is made only if
the child shows such behaviors substantially more than other children of
the same age.
- If the school fails to notice a learning delay, parents can request
an outside evaluation. In Susan's case, her mother chose to bring Susan
to a clinic for testing. She then brought documentation of the
disability back to the school. After confirming the diagnosis, the
public school was obligated to provide the kind of instructional program
that Susan needed.
- Parents should stay abreast of each step of the school's evaluation.
Parents also need to know that they may appeal the school's decision if
they disagree with the findings of the diagnostic team. And like Susan's
mother, who brought Susan to a clinic, parents always have the option of
getting a second opinion.
- Some parents feel alone and confused when talking to learning
specialists. Such parents may find it helpful to ask someone they like
and trust to go with them to school meetings. The person may be the
child's clinician or caseworker, or even a neighbor. It can help to have
someone along who knows the child and can help understand the child's
test scores or learning problems.
Although obtaining a diagnosis is important, even more important is
creating a plan for getting the right help. Because LD can affect the
child and family in so many ways, help may be needed on a variety of
fronts: educational, medical, emotional, and practical.
- In most ways, children with learning disabilities are no different
from children without these disabilities. At school, they eat together
and share sports, games, and after-school activities. But since children
with learning disabilities do have specific learning needs, most public
schools provide special programs.
- Schools typically provide special education programs either in a
separate all-day classroom or as a special education class that the
student attends for several hours each week. Some parents hire trained
tutors to work with their child after school. If the problems are
severe, some parents choose to place their child in a special school for
the learning disabled.
- If parents choose to get help outside the public schools, they should
select a learning specialist carefully. The specialist should be able to
explain things in terms that the parents can understand. Whenever
possible, the specialist should have professional certification and
experience with the learner's specific age group and type of disability.
Some of the support groups listed at the end of this booklet can provide
references to qualified special education programs.
- Planning a special education program begins with systematically
identifying what the student can and cannot do. The specialist looks for
patterns in the child's gaps. For example, if the child fails to hear
the separate sounds in words, are there other sound discrimination
problems? If there's a problem with handwriting, are there other motor
delays? Are there any consistent problems with memory?
- Special education teachers also identify the types of tasks the child
can do and the senses that function well. By using the senses that are
intact and bypassing the disabilities, many children can develop needed
skills. These strengths offer alternative ways the child can
learn.
- After assessing the child's strengths and weaknesses, the special
education teacher designs an Individualized Educational Program (IEP).
The IEP outlines the specific skills the child needs to develop as well
as appropriate learning activities that build on the child's strengths.
Many effective learning activities engage several skills and senses. For
example, in learning to spell and recognize words, a student may be
asked to see, say, write, and spell each new word. The student may also
write the words in sand, which engages the sense of touch. Many experts
believe that the more senses children use in learning a skill, the more
likely they are to retain it.
- An individualized, skill-based approach--like the approach used by
speech and language therapists--often succeeds in helping where regular
classroom instruction fails. Therapy for speech and language disorders
focuses on providing a stimulating but structured environment for
heating and practicing language patterns. For example, the therapist may
help a child who has an articulation disorder to produce specific speech
sounds. During an engaging activity, the therapist may talk about the
toys, then encourage the child to use the same sounds or words. In
addition, the child may watch the therapist make the sound, feel the
vibration in the therapist's throat, then practice making the sounds
before a mirror.
- Researchers are also investigating nonstandard teaching methods. Some
create artificial learning conditions that may help the brain receive
information in nonstandard ways. For example, in some language
disorders, the brain seems abnormally slow to process verbal
information. Scientists are testing whether computers that talk can help
teach children to process spoken sounds more quickly. The computer
starts slowly, pronouncing one sound at a time. As the child gets better
at recognizing the sounds and heating them as words, the sounds are
gradually speeded up to a normal rate of speech.
For nearly six decades, many children with attention disorders have
benefited from being treated with medication. Three rugs, Ritalin
(methylphenidate), Dexedrine (dextroamphetamine), and Cylert (pemoline),
have been used successfully. Although these drugs are stimulants in the
same category as "speed" and "diet pills," they seldom
make children "high" or more jittery. Rather, they temporarily
improve children's attention and ability to focus. They also help children
control their impulsiveness and other hyperactive behaviors.
- The effects of medication are most dramatic in children with ADHD.
Shortly after taking the medication, they become more able to focus
their attention. They become more ready to learn. Studies by NIMH
scientists and other researchers have shown that at least 90 percent of
hyperactive children can be helped by either Ritalin or Dexedrine. If
one medication does not help a hyperactive child to calm down and pay
attention in school, the other medication might.
- The drugs are effective for 3 to 4 hours and move out of the body
within 12 hours. The child's doctor or a psychiatrist works closely with
the family and child to carefully adjust the dosage and medication
schedule for the best effect. Typically, the child takes the medication
so that the drug is active during peak school hours, such as when
reading and math are taught.
- In the past few years, researchers have tested these drugs on adults
who have attention disorders. Just as in children, the results show that
low doses of these medications can help reduce distractibility and
impulsivity in adults. Use of these medications has made it possible for
many severely disordered adults to organize their lives, hold jobs, and
care for themselves.
- In trying to do everything possible to help their children, many
parents have been quick to try new treatments. Most of these treatments
sound scientific and reasonable, but a few are pure quackery. Many are
developed by reputable doctors or specialists--but when tested
scientifically, cannot be proven to help. Following are types of therapy
that have not proven effective in treating the majority of
children with learning disabilities or attention disorders:
- Megavitamins
- Colored lenses
- Special diets
- Sugar-free diets
- Body stimulation or manipulation
- Although scientists hope that brain research will lead to new medical
interventions and drugs, at present there are no medicines for speech,
language, or academic disabilities.
The effects of learning disabilities can ripple outward from the
disabled child or adult to family, friends, and peers at school or work.
- Children with LD often absorb what others thoughtlessly say about
them. They may define themselves in light of their disabilities, as "behind,"
"slow," or "different."
- Sometimes they don't know how they're different, but they know how
awful they feel. Their tension or shame can lead them to act out in
various ways--from withdrawal to belligerence. Like Wallace, they may
get into fights. They may stop trying to learn and achieve and
eventually drop out of school. Or, like Susan, they may become isolated
and depressed.
- Children with learning disabilities and attention disorders may have
trouble making friends with peers. For children with ADHD, this may be
due to their impulsive, hostile, or withdrawn behavior. Some children
with delays may be more comfortable with younger children who play at
their level. Social problems may also be a product of their disability.
Some people with LD seem unable to interpret tone of voice or facial
expressions. Misunderstanding the situation, they act inappropriately,
turning people away.
- Without professional help, the situation can spiral out of control.
The more that children or teenagers fail, the more they may act out
their frustration and damage their self-esteem. The more they act out,
the more trouble and punishment it brings, further lowering their
self-esteem. Wallace, who lashed out when teased about his poor
pronunciation and was repeatedly suspended from school, shows how
harmful this cycle can be.
- Having a child with a learning disability may also be an emotional
burden for the family. Parents often sweep through a range of emotions:
denial, guilt, blame, frustration, anger, and despair. Brothers and
sisters may be annoyed or embarrassed by their sibling, or jealous of
all the attention the child with LD gets.
- Counseling can be very helpful to people with LD and their families.
Counseling can help affected children, teenagers, and adults develop
greater self-control and a more positive attitude toward their own
abilities. Talking with a counselor or psychologist also allows family
members to air their feelings as well as get support and reassurance.
- Many parents find that joining a support group also makes a
difference. Support groups can be a source of information, practical
suggestions, and mutual understanding. Self-help books written by
educators and mental health professionals can also be helpful. A number
of references and support groups are listed at the end of this booklet.
- Behavior modification also seems to help many children with
hyperactivity and LD. In behavior modification, children receive
immediate, tangible rewards when they act appropriately. Receiving an
immediate reward can help children learn to control their own actions,
both at home and in class. A school or private counselor can explain
behavior modification and help parents and teachers set up appropriate
rewards for the child.
- Parents and teachers can help by structuring tasks and environments
for the child in ways that allow the child to succeed. They can find
ways to help children build on their strengths and work around their
disabilities. This may mean deliberately making eye contact before
speaking to a child with an attention disorder. For a teenager with a
language problem, it may mean providing pictures and diagrams for
performing a task. For students like Dennis with handwriting or spelling
problems, a solution may be to provide a word processor and software
that checks spelling. A counselor or school psychologist can help
identify practical solutions that make it easier for the child and
family to cope day by day.
- Every child needs to grow up feeling competent and loved. When
children have learning disabilities, parents may need to work harder at
developing their children's self-esteem and relationship-building
skills. But self-esteem and good relationships are as worth developing
as any academic skill.
Susan
Susan is now in ninth grade and enjoys learning. She no longer believes
she's retarded, and her use of words has improved. Susan has become a
talented craftsperson and loves making clothes and furniture for her
sister's dolls. Although she's still in a special education program, she
is making slow but steady progress in reading and math.
Wallace
Over the years, Wallace found he liked tinkering with cars and singing
in the church choir. At church, he met a woman who knew about learning
disabilities. She told him he could get help through his county social
services office. Since then, Wallace has been working with a speech
therapist, learning to articulate and notice differences in speech sounds.
When he complains that he's too old to learn, his therapist reminds him, "It's
never too late to work your good brain!" His state vocational
rehabilitation office recently referred him to a job-training program.
Today, at age 46, Wallace is starting night school to become an auto
mechanic. He likes it because it's a hands-on program where he can learn
by doing.
Dennis
Dennis is now age 23. As he walks into the college job placement
office, he smiles and shakes hands confidently. After shuffling through a
messy stack of papers, he finally hands his counselor a neatly typed
resume. Although Dennis jiggles his foot and interrupts occasionally, he's
clearly enthusiastic. He explains that because tape-recorded books and
lectures got him through college, he'd like to sell electronics. Dennis
says he'll also be getting married next year. He and his fiancee are
concerned that their children also will have LD. "But we'll just have
to watch and get help early--a lot earlier than I did!"
Even though most people don't outgrow their brain dysfunction, people
do learn to adapt and live fulfilling lives. Dennis, Susan, and Wallace
made a life for themselves--not by being cured, but by developing their
personal strengths. Like Dennis' tape-recorded books and lectures, or
Wallace's hands-on auto mechanics class, they found alternative ways to
learn. And like Susan's crafts or Wallace's singing, they found ways to
enjoy their other talents.
- Even though a learning disability doesn't disappear, given the right
types of educational experiences, people have a remarkable ability to
learn. The brain's flexibility to learn new skills is probably greatest
in young children and may diminish somewhat after puberty. This is why
early intervention is so important. Nevertheless, we retain the ability
to learn throughout our lives.
- Even though learning disabilities can't be cured, there is still
cause for hope. Because certain learning problems reflect delayed
development, many children do eventually catch up. Of the speech and
language disorders, children who have an articulation or an expressive
language disorder are the least likely to have long-term problems.
Despite initial delays, most children do learn to speak.
- For people with dyslexia, the outlook is mixed. But an appropriate
remedial reading program can help learners make great strides.
- With age, and appropriate help from parents and clinicians, children
with ADHD become better able to suppress their hyperactivity and to
channel it into more socially acceptable behaviors. As with Dennis, the
problem may take less disruptive forms, such as fidgeting.
- Can an adult be helped? For example, can an adult with dyslexia still
learn to read? In many cases, the answer is yes. It may not come as
easily as for a child. It may take more time and more repetition, and it
may even take more diverse teaching methods. But we know more about
reading and about adult learning than ever before. We know that adults
have a wealth of life experience to build on as they learn. And because
adults choose to learn, they do so with a determination that most
children don't have. A variety of literacy and adult education programs
sponsored by libraries, public schools, and community colleges are
available to help adults develop skills in reading, writing, and math.
Some of these programs, as well as private and nonprofit tutoring and
learning centers, provide appropriate programs for adults with LD.
As of 1981, people with learning disabilities came under the protection
of laws originally designed to protect the rights of people with mobility
handicaps. More recent Federal laws specifically guarantee equal
opportunity and raise the level of services to people with disabilities.
Once a learning disability is identified, children are guaranteed a free
public education specifically designed around their individual needs.
Adolescents with disabilities can receive practical assistance and extra
training to help make the transition to jobs and independent living.
Adults have access to job training and technology that open new doors of
opportunity.
Increased Services, Equal Opportunity
The Individuals with Disabilities Education Act of 1990 assures a
public education to school-aged children with diagnosed learning
disabilities. Under this act, public schools are required to design and
implement an Individualized Educational Program tailored to each child's
specific needs. The 1991 Individuals with Disabilities Education Act
extended services to developmentally delayed children down to age 5. This
law makes it possible for young children to receive help even before they
begin school.
- Another law, the Americans with Disabilities Act of 1990, guarantees
equal employment opportunity for people with learning disabilities and
protects disabled workers against job discrimination. Employers may not
consider the learning disability when selecting among job applicants.
Employers must also make "reasonable accommodations" to help
workers who have handicaps do their job. Such accommodations may include
shifting job responsibilities, modifying equipment, or adjusting work
schedules.
- By law, publicly funded colleges and universities must also remove
barriers that keep out disabled students. As a result, many colleges now
recruit and work with students with learning disabilities to make it
possible for them to attend. Depending on the student's areas of
difficulty, this help may include providing recorded books and lectures,
providing an isolated area to take tests, or allowing a student to tape
record rather than write reports. Students with learning disabilities
can arrange to take college entrance exams orally or in isolated rooms
free from distraction. Many colleges are creating special programs to
specifically accommodate these students.
- Programs like these made it possible for Dennis to attend and succeed
in college. The HEATH Resource Center, sponsored by the American Council
on Education, assists students with learning disabilities to identify
appropriate colleges and universities. Information on the HEATH center
and related organizations appears at the end of this brochure.
Public Agency Support
Effective service agencies are also in place to assist people of all
ages. Each state department of education can help parents identify the
requirements and the process for getting special education services for
their child. Other agencies serve disabled infants and preschool children.
Still others offer mental health and counseling services. The National
Information Center for Children and Youth can provide referrals to
appropriate local resources and state agencies.
- Counselors at each state department of vocational rehabilitation
serve the employment needs of adolescents and adults with learning
disabilities. They can refer adults to free or subsidized health care,
counseling, and high school equivalence (GED) programs. They can assist
in arranging for job training that sidesteps the disability. For
example, a vocational counselor helped Wallace identify his aptitude for
car repair. To work around Wallace's language problems, the counselor
helped locate a job-training program that teaches through demonstrations
and active practice rather than lectures.
- State departments of vocational rehabilitation can also assist in
finding special equipment that can make it possible for disabled
individuals to receive training, retain a job, or live on their own. For
example, because Dennis couldn't read the electronics manuals in his new
job, a vocational rehabilitation counselor helped him locate and
purchase a special computer that reads books aloud.
- Finally, state-run protection and advocacy agencies and client
assistance programs serve to protect these fights. As experts on the
laws, they offer legal assistance, as well as information about local
health, housing, and social services.
Sophisticated brain imaging technology is now making it possible to
directly observe the brain at work and to detect subtle malfunctions that
could never be seen before. Other techniques allow scientists to study the
points of contact among brain cells and the ways signals are transmitted
from cell to cell.
- With this array of technology, NIMH is conducting research to
identify which parts of the brain are used during certain activities,
such as reading. For example, researchers are comparing the brain
processes of people with and without dyslexia as they read. Research of
this kind may eventually associate portions of the brain with different
reading problems.
- Clinical research also continues to amass data on the causes of
learning disorders. NIMH grantees at Yale are examining the brain
structures of children with different combinations of learning
disabilities. Such research will help identify differences in the
nervous system of children with these related disorders. Eventually,
scientists will know, for example, whether children who have both
dyslexia and an attention disorder will benefit from the same treatment
as dyslexic children without an attention disorder.
- Studies of identical and fraternal twins are also being conducted.
Identical twins have the same genetic makeup, while fraternal twins do
not. By studying if learning disabilities are more likely to be shared
by identical twins than fraternal twins, researchers hope to determine
whether these disorders are influenced more by genetic or by
environmental factors. One such study is being conducted by scientists
funded by the National Institute of Child Health and Human Development.
So far, the research indicates that genes may, in fact, influence the
ability to sound out words.
- Animal studies also are adding to our knowledge of learning
disabilities in humans. Animal subjects make it possible to study some
of the possible causes of LD in ways that can't be studied in humans.
One NIMH grantee is researching the effects of barbiturates and other
drugs that are sometimes prescribed during pregnancy. Another researcher
discovered through animal studies that certain prenatal viruses can
affect future learning. Research of this kind may someday pinpoint
prenatal problems that can trigger specific disabilities and tell us how
they can be prevented.
- Animal research also allows the safety and effectiveness of
experimental new drugs to be tested long before they can be tried on
humans. One NIH-sponsored team is studying dogs to learn how new
stimulant drugs that are similar to Ritalin act on the brain. Another is
using mice to test a chemical that may counter memory loss.
- This accumulation of data sets the stage for applied research. In the
coming years, NIMH-sponsored research will focus on identifying the
conditions that are required for learning and the best combination of
instructional approaches for each child.
- Piece by piece, using a myriad of research techniques and
technologies, scientists are beginning to solve the puzzle. As research
deepens our understanding, we approach a future where we can prevent
certain brain and mental disorders, make valid diagnoses, and treat each
effectively. This is the hope, mission, and vision of the National
Institute of Mental Health.
Several publications, organizations, and support groups exist to help
individuals, teachers, and families to understand and cope with learning
disabilities. The following resources provide a good starting point for
gaining insight, practical solutions, and support. Further information can
be found at libraries and book stores.
Publications
Books for Children and Teens With Learning Disabilities
- Fisher, G., and Cummings, R. The Survival Guide for Kids with LD.
Minneapolis: Free Spirit Publishing, 1990. (Also available on cassette)
- Gehret, J. Learning Disabilities and the Don't-Give-Up-Kid.
Fairport, NY: Verbal Images Press, 1990.
- Janover, C. Josh: A Boy with Dyslexia. Burlington, VT:
Waterfront Books, 1988.
- Landau, E. Dyslexia. New York: Franklin Watts Publishing Co.,
1991.
- Marek, M. Different, Not Dumb. New York: Franklin Watts
Publishing Co., 1985.
- Levine, M. Keeping A Head in School: A Student's Book about
Learning Abilities and Learning Disorders. Cambridge, MA: Educators
Publishing Services, Inc., 1990.
- Books for Adults With Learning Disabilities
- Adelman, P., and Wren, C. Learning Disabilities, Graduate School,
and Careers: The Student's Perspective. Lake Forest, IL: Learning
Opportunities Program, Barat College, 1990.
- Cordoni, B. Living with a Learning Disability. Carbondale,
IL: Southern Illinois University Press, 1987.
- Kravets, M., and Wax, I. The K&W Guide: Colleges and the
Learning Disabled Student. New York: Harper Collins Publishers,
1992.
- Magnum, C., and Strichard, S., eds. Colleges with Programs for
Students with Learning Disabilities. Princeton, NJ: Petersons
Guides, 1992.
- Books for Parents
- Greene, L. Learning Disabilities and Your Child: A Survival
Handbook. New York: Fawcett Columbine, 1987.
- Novick, B., and Arnold, M. Why Is My Child Having Trouble in
School? New York: Villard Books, 1991.
- Silver, L. The Misunderstood Child: A Guide for Parents of
Children with Learning Disabilities: 2d ed. Blue Ridge Summit, PA:
Tab Books, 1992.
- Silver, L. Dr. Silver's Advice to Parents on Attention-Deficit
Hyperactivity Disorder. Washington, DC: American Psychiatric Press,
1993.
- Vail, P. Smart Kids with School Problems. New York: EP
Dutton, 1987.
- Weiss, E. Mothers Talk About Learning Disabilities. New York:
Prentice Hall Press, 1989.
Books and Pamphlets for Teachers and Specialists
- Adelman, P., and Wren, C. Learning Disabilities, Graduate School,
and Careers. Lake Forest, Learning Opportunities Program, Barat
College, 1990.
- Silver, L. ADHD: Attention Deficit-Hyperactivity Disorder,
Booklet for Teachers. Summit, NJ: CIBA-GEIGY, 1989.
- Smith, S. Success Against the Odds: Strategies and Insights from
the Learning Disabled. Los Angeles: Jeremy Tarcher, Inc., 1991.
- Wender, P. The Hyperactive Child, Adolescent, and Adult.
Attention Disorder through the Lifespan. New York: Oxford University
Press, 1987.
- Related Pamphlets Available From NIH
- Facts About Dyslexia
- National Institute of Child Health and Human Development
- Building 31, Room 2A32
- 9000 Rockville Pike
- Bethesda, MD 20892 (301) 496-5133
- Developmental Speech and Language Disorders--Hope through Research
- National Institute on Deafness and Other Communicative Disorders
- P.O. Box 37777
- Washington, DC 20013 (800) 241-1044
- Support Groups and Organizations
- American Speech-Language-Hearing Association
- 10801 Rockville Pike
- Rockville, MD 20852 (800) 638-8255
- Provides information on speech and language disorders, as well as
referrals to certified speech-language therapists.
- Attention Deficit Information Network
- 475 Hillside Avenue
- Needham, MA 02194 (617) 455-9895
- Provides up-to-date information on current research, regional
meetings. Offers aid in finding solutions to practical problems faced by
adults and children with an attention disorder.
- Candlelighters Childhood Cancer Foundation
- 7910 Woodmont Avenue, Suite 460
- Bethesda, MD 20814 (800) 366-2223
- Provides information and support for children treated for cancer who
later experience learning disabilities.
- Center for Mental Health Services
- Office of Consumer, Family, and Public Information
- 5600 Fishers Lane, Room 15-81
- Rockville, MD 20857 (301) 443-2792
- This new national center, a component of the U.S. Public Health
Service, provides a range of information on mental health, treatment,
and support services.
- Children with Attention Deficit Disorders (CHADD)
- 499 NW 70th Avenue, Suite 308
- Plantation, FL 33317 (305) 587-3700
- Runs support groups and publishes two newsletters concerning
attention disorders for parents and professionals.
- Council for Exceptional Children
- 11920 Association Drive
- Reston, VA 22091 (703) 620-3660
- Provides publications for educators. Can also provide referral to
ERIC Clearinghouse for Handicapped and Gifted Children.
- Federation of Families for Children's Mental Health
- 1021 Prince Street
- Alexandria, VA 22314 703) 684-7710
- Provides information, support, and referrals through federation
chapters throughout the country. This national parent-run organization
focuses on the needs of children with broad mental health problems.
- HEATH Resource Center
- American Council on Education
- 1 Dupont Circle, Suite 800
- Washington, DC 20036 (800) 544-3284
- A national clearinghouse on post-high school education for people
with disabilities.
- Learning Disabilities Association of America
- 4156 Library Road
- Pittsburgh, PA 15234 (412) 341-8077
- Provides information and referral to state chapters, parent
resources, and local support groups. Publishes news briefs and a
professional journal.
- Library of Congress
- National Library Service for the Blind and Physically Handicapped
- 1291 Taylor Street, NW
- Washington, DC 20542 (202) 707-5100
- Publishes Talking Books and Reading Disabilities, a fact sheet
outlining eligibility requirements for borrowing talking books.
- National Alliance for the Mentally Ill
- Children and Adolescents Network (NAMICAN)
- 2101 Wilson Boulevard, Suite 302
- Arlington, VA 22201 (800) 950-NAMI
- Provides support to families through personal contact and support
meetings. Provides education regarding coping strategies; reading
material; and information about what works--and what doesn't.
- National Association of Private Schools for Exceptional Children
- 1522 K Street, NW Suite 1032
- Washington, DC 20005 (202) 408-3338
- Provides referrals to private special education programs.
- National Center for Learning Disabilities
- 381 Park Avenue South, Suite 1420
- New York, NY 10016 (212) 687-7211
- Provides referrals and resources. Publishes "Their World"
magazine describing true stories on ways children and adults cope with
LD.
- National Information Center for Children and Youth with Disabilities
- P.O. Box 1492
- Washington, DC 20013 (800) 695-0285 or 202-884-8200
- Publishes newsletter, arranges workshops. Advises parents on the laws
entitling children with disabilities to special education and other
services.
- Orton Dyslexia Society
- Chester Building, Suite 382
- 8600 LaSalle Road
- Baltimore, MD 21286-2044 (410) 296-0232
Answers individual questions on reading disability. Provides
information and referrals to local resources.
To arrange for special college entrance testing for LD adults, contact:
- ACT Special Testing (319) 337-1332
- SAT Scholastic Aptitude Test (609) 771-7137
- GED (202) 939-9490
MESSAGE FROM THE NATIONAL INSTITUTE OF MENTAL HEALTH
Research conducted and supported by the National Institute of Mental
Health (NIMH) brings hope to millions of people who suffer from mental
illness and to their families and friends. In many years of work with
animals as well as human subjects, researchers have advanced our
understanding of the brain and vastly expanded the capability of mental
health professionals to diagnose, treat, and prevent mental and brain
disorders.
Now, in the 1990s, which the President and Congress have declared "The
Decade of the Brain," we stand at the threshold of a new era in brain
and behavioral sciences. Through research we will learn even more about
mental disorders such as depression, manic-depressive illness,
schizophrenia, panic disorder, and obsessive-compulsive disorder. And we
will be able to use this knowledge to develop new therapies that can help
more people overcome mental illness.
The National Institute of Mental Health is part of the National
Institutes of Health (NIH), the Federal Government's primary agency for
biomedical and behavioral research. NIH is a component of the U.S.
Department of Health and Human Services.
Acknowledgments
This booklet was written by Sharyn Neuwirth, M.Ed., an education writer
and instructional designer in Silver Spring, MD. Scientific information
and review was provided by NIMH staff members L. Eugene Arnold, M.D.; F.
Xavier Castellanos, M.D.; and Judith Rumsey, Ph.D. Also providing review
and assistance were Marcia Henry, Ph.D., Orton Dyslexia Society; Reid
Lyon, Ph.D., National Institute of Child Health and Human Development;
Jean Petersen, Learning Disabilities Association; and Larry B. Silver,
M.D., Georgetown University. Editorial direction was provided by Lynn J.
Cave, NIMH.
All material in this publication is free of copyright restrictions and
may be copied, reproduced, or duplicated without permission from NIMH;
citation of the source is appreciated.
- U.S. Department of Health and Human Services
- Public Health Service
- National Institutes of Health
- National Institute of Mental Health
- NIH Publication No. 93-3611
- Printed 1993
Bulk sales (S/N 017-024-01577-6) by the U.S. Government Printing
Office, Superintendent of Documents, Mail Stop: SSOP, Washington, DC
20402-9328.
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