If you are reading this, you are probably a parent whose child is struggling with reading or is falling behind in school. You are wondering if your child really has a learning problem or if he just has lousy teachers. You think he is simply lazy, unmotivated, naughty or 'slow'. Maybe you blame yourself for not spending enough time with him on his studies. But then you've also spent loads of money, time and energy on extra tutoring, bribes, punishments and enrichment programmes and still nothing has worked.Well, before you waste more time and money, what you need is a correct diagnosis. Have you had your child diagnosed by a professional? Or did you merely rely on her teachers' and your own observations? Or you're not even really sure you should go to a professional? If you don't get the right diagnosis, how are you going to find the right solution?
Alright, let's take the guesswork out of this. Learning disabilities are not all that hard to spot. They fall into three main categories:
1. Coordination problems
2. Hearing problems
3. Attention problems
99.9% of children who have learning difficulties fall into one, two or all three of the above categories. (There are other problems that interfere with learning, but they are not learning disorders. I will talk about that in another post.)
Under each category is a list of symptoms which indicate a likely problem in that area. These are by no means absolute. This is just a checklist of symptoms, not a standardised test with definite numbers and distribution ranges. For a proper diagnosis, you must consult a professional. This list is to let you know whether you have reason enough to see one.
Please note that this checklist is for children ages 5 and up. This list should NOT be used for a child who has not yet attended school or been taught to read.
General
__ Child is bright but not doing equally well in school
__ Has low self-confidence
__ Slow to complete homework, unable to work independently
__ Easily frustrated about schoolwork; gives up easily
__ Avoids reading and writing tasks, prefers sports, art or physical activities
__ Has a very vivid imagination
1. Visual and coordination problems
Reading
__ Reads slowly, does not recognise words previously learned
__ Little understanding of what is read
__ Skips or repeats words when reading
__ Uses finger to follow text, otherwise loses place while reading
__ When reading, moves the whole head instead of just the eyes
__ Reads words or numbers in reverse (was - saw, no - on, for - of, 16 - 19)
Writing
__ Reverses letters and numbers (b,d,p,q; 6,9; n,u; +,x)
__ Mixes capital and small letters (taBLe)
__ Transposes letters or numbers (first - frist, 124 - 142)
__ Writes in reverse strokes (right to left, bottom to top)
__ Wrong spacing and sizing (my dad - myd ad, dark - darK)
__ Copies letter by letter, repeating or leaving out letters, words and punctuation marks
__ Handwriting is very messy - too large, cannot stay within the lines or very spidery
__ Writes slowly, last one to finish copying
Physical coordination and strength
__ Clumsy and uncoordinated, poor at ball games (badminton, tennis)
__ Does not sit up straight, supports head with non-writing hand or leans head over writing hand
__ While sitting, clings to legs of chair
__ Confuses left and right, over and under
__ Holds pencil in an unusual way
__ Presses pencil too hard or too lightly
__ Paper is often crumpled; makes holes or tears paper when erasing
__ Says words out loud, talks to self, makes noises, hums or sings while writing
__ Rubs eyes, complains of dizziness, headaches or stomach-aches while reading
__ Has a lazy eye (one or both eyes turned in or out)
__ Holds head at an angle, looks out of the corner of the eyes or has trouble making eye contact
__ Shakes legs when concentrating
__ Has pain in the arm or neck, gets tired quickly when writing
__ As a baby, started crawling or walking earlier or later than other children
__ As a child, was late to learn motor skills like buttoning clothes or tying shoes
A problem in this area indicates poor physical coordination (difficulty copying correctly and writing legibly) and/or poor visual perception (difficulty recognising what is seen). A mild problem is called dysgraphia, a moderate to severe problem is called dyspraxia.
90-95% of children with dyslexia have problems in this area.
Who can diagnose this problem? An occupational therapist with a specialisation in learning difficulties, a developmental psychologist or developmental paediatrician, or a learning disabilities specialist. A psychiatrist or your regular paediatrician would NOT be the correct people to ask as they are not trained nor do they possess the equipment and tests for the assessment of dyslexia.
Who can provide treatment for this? An occupational therapist (preferably one specialising in learning difficulties), a vision therapist or developmental ophthalmologist, or a learning disabilities specialist. A regular ophthalmologist or a tutor (for extra coaching) would not be helpful. Please also note that a developmental psychologist or developmental paediatrician can only provide a diagnosis but not treatment.
For best results, combine with biomedical treatment.
2. Hearing problems
__ Sometimes does not appear to hear when you talk
__ Often says "huh" or "what?" and asks you to repeat
__ Difficulty listening to one person talking when there is background noise (fan, TV, traffic)
__ Unable to listen and take notes at the same time
__ Difficulty following a sequence of instructions or letters, hears only the first or last item
__ Unable to repeat what you just said; cannot remember things heard
__ Has problems associating letters with their sounds
__ Difficulty remembering the pronunciation of words already learned
__ Mispronounces similar words (pin - pen, he - her, they - there, a - are)
__ Spells phonetically and inconsistently (twelve - twoilv, thoif, tuv)
__ Substitutes sounds when speaking (tiger - kiger, the - ge, don't - dome)
__ Says words using the wrong tone (in tonal languages like Chinese)
__ As a baby, started talking later than other children or had ear infections
This problem is called Auditory Processing Disorder (APD). This is a problem with hearing acuity (cannot hear clearly). This is a 'software' problem in which the brain is not correctly interpreting the sound signals from the ear. It is not the same as hearing loss (cannot hear soft sounds). Hearing loss is a 'hardware' problem resulting from a busted eardrum or non-functioning cochlea. A person with APD can hear soft sounds just fine but can't make out what is being said, even if it's really loud.
A study has found that 43% of children with learning difficulties have APD. Those who have a combination of coordination and hearing problems are often unable to read beyond a 2nd-grade level (officially illiterate).
How do you know which problem your child has? A test to rule out hearing loss (called a pure tone test) is recommended before testing for APD. A pure tone test is available at any audiologist's office.
Who can diagnose APD? A speech-language pathologist or audiologist with the training and equipment for diagnosing APD, an auditory neuroscientist, a learning disabilities specialist and many others. Some of these professionals can be found in hospitals, some are in research universities and some are in private companies.
Who can treat this problem? Any of the above people can provide treatment, but ask first if they have it. Some places just have tests and not treatment. Treatment for APD is by auditory therapy. There are many, many options for auditory therapy. Some the more popular ones are Fast ForWord, Samonas and Tomatis. For optimum results, do it concurrently with biomedical treatment.
For more info on APD, read:
When the Brain Can't Hear: Unraveling the Mystery of Auditory Processing Disorderby Teri James Bellis, Ph.D.
See also: Symptoms of Auditory Processing Disorder (in pictures).
3. Attention / Hyperactivity / Impulsivity
__ Dreamy, has a short attention span, easily distracted. (Only check this if child has problem focusing in all activities. If child only has problems with homework but no problems watching TV or playing computer games, do not check this.)
__ Starts work without listening to directions first
__ Often loses homework or personal belongings, or forgets to bring them to school
__ Fidgety, can't sit still in chair
__ Constantly running around as if driven by a motor
__ Does not seem to feel pain when falling or bumping into things
Problems in this area may be an indication of ADHD. However, many other problems also produce some of the symptoms listed here—these symptoms are not entirely exclusive to ADHD. If you go strictly by the DSM-IV definition, 8 out of 9 of the symptoms are merely side effects of learning disabilities. Here, as much as possible, I have excluded the symptoms which are due to learning disabilities. Some of them still overlap with learning disabilities, so a professional assessment is very necessary here.
A diagnosis of ADHD can only be reached after all other possible explanations have been ruled out, especially dyspraxia and Auditory Processing Disorder. If the child has a coordination or listening problem, what appears as inattention is merely a side effect. (See Experience dyslexia for yourself.) A child who has a learning disability but no ADHD would have trouble doing his homework or paying attention in class for longer than 5 minutes, but can play computer games or watch tv for hours on end. A child who truly has ADHD would have difficulty paying attention in class, playing a computer game or watching a movie for more than 5 minutes.
ADHD should always be the last diagnosis, never the first. Always have your child assessed for coordination problems and hearing problems BEFORE being assessed for ADHD, otherwise you will get a wrong diagnosis.
Who can diagnose ADHD? A developmental psychologist or developmental paediatrician, a clinical psychologist or a learning disabilities specialists. What is important is not so much the person, but the tool that they use for the assessment. There are many methods, each with its pros and cons. (More on ADHD assessment methods another day.) General practitioners (GPs), paediatricians and psychiatrists do NOT possess these tools and are not qualified to diagnose your child, much less prescribe any psychoactive drugs without a proper diagnosis!
Most children with learning problems actually have dyslexia only. They do not have ADHD, even though their parents or teachers may insist so. A handful of children have dyslexia and ADHD. Very, very few children have ADHD only. Those who have ADHD only cannot be said to have dyslexia because they do not have any trouble with learning - they are simply not available to learn. But they do have a learning difficulty because ADHD interferes with learning.
A typical scenario is where a parent sees that their child can't do their schoolwork for more than five minutes before running off (although he can watch TV for hours). They figure that a short attention span means ADHD, so they go to the doctor and ask for Ritalin. This is not only dumb, it is downright dangerous. (Because, sad to say, most doctors will just write a prescription for Ritalin without doing any proper assessment. Those who can give drugs do not have the proper testing equipment and those who can do proper tests do not give drugs.)
If your child has been diagnosed with dyslexia but no ADHD, then follow the treatment options in the respective categories.
If your child has dyslexia and ADHD, then follow the treatment options in the respective categories, in addition, (depending on the cause of your child's ADHD), you might want to look into neurofeedback and biomedical treatment.
If your child has ADHD only but no dyslexia, go for biomedical treatment.
Again, it is imperative to know what the problem is before you can pursue the correct course of treatment. There is no substitute for proper testing. Please do not use this list of symptoms to self-diagnose or start going for this or that treatment without a correct diagnosis. (You may be able to afford wasting the money but you can't afford to waste the time.)
No professional would treat your child without a diagnosis, but there are many unscrupulous (or sometimes well-meaning but ignorant) people out there who try to sell you miracle cures. Like people who tell you that eating their supplements would make your child brighter (which of course doesn't work because your child is not dumb in the first place), or "child enhancement centres" which are great for developing non-academic skills like art and music, but certainly does not cure neurological disorders. Or "motivational camps", which are of course useless as well because dyslexia is not an attitude problem, it is a neurological problem. So, rule of thumb — if they don't ask you for the diagnosis, you won't need to ask if they have the cure.
If you checked a few or a lot of the items in the list above, you have enough reason to suspect a learning disability in one or more areas. If there are only a few symptoms, this does not mean that "maybe it's nothing" or that "maybe he's just careless" or "maybe she's just unmotivated". It means that your child probably has a mild learning disability, but it is a learning disability nonetheless. The best thing you can do is to have your child assessed by a professional.
Early diagnosis and early treatment gives you the best chance of success. "Early" means before age 3 for best results. If not, by age 7. After 7, the prognosis (prospect for recovery) starts going downhill. And it goes very, VERY rapidly downhill after the age of 10 or so. This is due to the physical maturation process of the brain — a physical process that everyone goes through WITHOUT EXCEPTION, and which cannot be changed. So don't think that "maybe my child can still catch up when he's 15" — not going to happen. Unless your child is an elephant and his brain matures on a different schedule from other humans'. Otherwise, this is an unstoppable natural process. The older you are, the less malleable your brain is. So please don't kid yourself and say, "Oh, why don't we wait and see, maybe she'll grow out of it." No, she won't. She will get slightly better because the brain does grow, but grow out of it? No.
To understand why, you'll have to understand how the brain develops (and deteriorates). (More on neurology another day.) There is a saying in Malay - Melentur buluh biar dari rebung. If you want to bend a bamboo, do it when it's still a shoot. If you wait until it has hardened into a full-grown bamboo (or even an adolescent bamboo), you can send it to the best and most expensive bamboo-benders in the top hospitals in the USA, England or Germany and pay them your entire fortune, but no-one will be able to do it for you. Because it can no longer be done. Your child's brain is like that bamboo. It's an irreversible physical process. If you want to change it, do it while the brain is still malleable.
See also:
• The Experience of Dyslexia
• Symptoms of Auditory Processing Disorder (in pictures)
• Causes and Treatments for ADHD