What You Must Know to Understand Learning Disabilities

The Misunderstood Child: Understanding and Coping with Your Child's Learning Disabilities
by Larry B. Silver, M.D.

The fully revised and updated must-have resource to help you become a supportive and assertive advocate for your child.

In print for more than twenty years, The Misunderstood Child has become the go-to reference guide for families of children with learning disorders. This newly revised edition provides the latest research and new and updated content, including:

• How to identify and address specific disabilities, from dyslexia to sensory integration disorder
• New information on the genetics of learning disorders
• Expanded sections on attention-deficit/hyperactivity disorder (ADHD)
• The most recent neurological discoveries about how the brain functions in children with learning disabilities
• Insights about other neurological disorders common among individuals with learning disabilities, such as anxiety disorders, obsessive-compulsive behaviors, anger-control problems, depression, and tic disorders
• Resources, Web sites, and organizations that can aid the treatment process and offer support for both parent and child

Chapter 1

A learning disability is a neurological disorder. That is, it is the result of a nervous system that has been "wired" a little differently. The brain is clearly not damaged, defective, or retarded. But, in certain areas, it processes information in a different way than it is supposed to. There are other problems relating to brain function that might exist along with learning disabilities. We call these comorbid problems.

It is important for you to know of these related problems. Many children, adolescents, and adults with learning disabilities will also have one of these other problems. These problems, too, must be found and addressed. This book will focus primarily on learning disabilities. However, these related, or comorbid, problems will also be explained.

You might find it helpful to have an overview, or "road map," for making sense of these problems, so I'll provide a general outline here. I'll go into each issue in greater detail in later chapters. Parents sometimes tell me that no one seems to know what is wrong with their child; every professional they see has a different label or diagnosis. Often, the problem is that the child does have several areas of difficulty and each professional focuses on one of them.

For many children, something affects the brain early in development, often during the first part of pregnancy. When this happens, it is unlikely that only one area of the brain is involved. Several areas might be affected. To make it easier to study these individuals, professionals separate out each possible problem area and put a label on it. So, depending on which areas of the brain are involved, the person will have different disorders.

For at least 50 percent of individuals, this developmental impact is the result of the genetic code. The problems run in the family because the genetic code tells the brain to wire itself differently. We do not have a full explanation for the other 50 percent. I will discuss some of these possibilities in Chapter 3.

Before I become specific, let me explain another important theme. Although all brain cells are present at birth, most are dormant. The brain grows constantly by having new wires activated and begin firing. We call these maturational spurts. This growth takes place throughout childhood, adolescence, and early adulthood. Each maturational spurt affects the brain the way installing new software affects your computer; suddenly the computer can do things it could not do before. So, too, with each firing of new wires in the brain, the brain can do things it could not do before. As each new area becomes activated, there are two possibilities. It may be that the wires in this area were not affected prenatally and are wired "normally." Thus, when this area of the brain begins to work, the individual suddenly can do things that were difficult before. However, it is possible that when this area of the brain begins to work, it will become apparent that this area is also wired differently. Only we had no way of knowing that until the area began to work. For these individuals, new problems arise.

This is the reason that some children struggle and struggle, then suddenly master things that were difficult before. Professionals working with the child at this time often get the credit for the change. You've heard the story: Mary struggled with reading for several years. Finally, she got Mrs. Jones as a teacher and within a month she was reading. This is also the reason why some children improve in one area only to have another area of difficulty.

The cortex, or thinking part of the brain, has many functions. For our discussion, I will say that there are four basic functions: language skills, muscle (motor) skills, thinking (cognitive) skills, and organization skills, including executive function skills. Any or all of these areas might be wired differently.

Miswiring of the Brain

If the area of the brain that is wired differently relates to language functioning, the person will have a problem called a language disability. The first clue is often a delay in language development. The child is not speaking by age two, or by two and a half or three the child is using only a few words. Some may speak no better by four. If a speech-language therapist works with this child, it might be possible to speed up the development of language. There is a sigh of relief. Then, by four or five another problem becomes clear. This child may have difficulty processing and understanding what is being said (receptive language disability) or might have difficulty organizing thoughts, finding the right words, and speaking in a fluid and clear way (expressive language disability). More help is needed.

As this child enters the early elementary grades, another problem might become apparent. The first task in reading is language-based. The child must recognize units of sound (phonemes) and connect each sound to the correct unit of symbol (grapheme). There are forty-four phonemes in the English language. Each letter has at least one sound; vowels have two sounds (a short and a long sound); certain combinations (sh, th, ch, etc.) have their own sounds. There are thirty-six graphemes in the English language (A through Z and 0 through 9). To read, you must "break this code" by learning what sounds go with what symbols and sounding out words. Many children with a delay in language development and later with receptive and/or expressive language problems have problems learning to read in first grade. Spelling is the reverse of this process. The child must start with the language in their brain and connect it with the right symbols by writing on the page. Thus, many children with reading problems also have problems with spelling.

Some children have a delay in language, receive help, improve, and never have another problem. Others might improve but show up later with receptive and expressive language problems. With help, these problems improve and the child has no further problems. Others progress into reading problems. It just depends on whether the next area of brain activation is also wired differently.

Copyright © 2006 by Larry B. Silver, M.D.

About the Author

Larry B. Silver, M.D., a child and adolescent psychiatrist, is clinical professor of psychiatry at Georgetown University Medical Center in Washington, D.C. Prior to his current appointment, he was acting director and deputy director of the National Institute of Mental Health.