Twice the Challenge: Getting the Right Diagnosis
The signs and symptoms of learning disabilities are too often mistaken for ADHD in children who struggle to read, focus, and sit still. Here’s one family’s story and advice for getting to the root of your child’s challenges at school.
As a pre-schooler, Christie was the most affectionate, enthusiastic, and happy child among her large circle of friends. She was popular with her peers and adored by most of the adults in her life. She was clearly a bright, creative girl, with a ton of ability and a personality to match. She was the biggest source of joy in her parents’ life.
Christie’s parents began to notice signs of learning difficulties shortly after she started first grade. She struggled with reading and learning new facts in school. Her teacher described her distractibility, restlessness, and difficulty following directions. After speaking with Christie’s parents and teacher, her pediatrician diagnosed her as having attention deficit disorder (ADHD) and prescribed a stimulant medication.
The medication reduced Christie’s distractibility and restlessness. Unfortunately, the learning problems continued. She still had difficulty reading and struggled with spelling words. Perhaps ADHD was impairing her concentration and memory; it was difficult to tell. Christie took an inordinate amount of time to complete her homework, but her parents knew this was not uncommon for a child with ADHD.
By second grade, study time was a nightly battle to get Christie started on homework and to keep her on task. The quality of her work was inconsistent. Her parents and teachers knew she was bright and capable of much better work. But the more they pushed her, the more frustrated and reluctant she became to apply herself to schoolwork.
“Christie, you’re not even trying!” her father admonished her at the homework table. “I AM trying!” she yelled, with hurt and bewilderment in her voice. The argument that followed ended with the homework scattered on the floor and Christie running to her room. Why did her parents think she was lazy? Why did they keep picking on her? And, finally, she asked herself, what is wrong with me? Maybe she was stupid after all, as her younger brother delighted in telling her.
By third grade, Christie was falling behind her classmates in reading, spelling, and a number of subjects. Her mother spent hours working on homework with her, which often left both of them frustrated and angry. Her parents also began to see changes in her personality. Their enthusiastic, affectionate, happy child was becoming withdrawn. The once carefree, fun-loving Christie now seemed tense and stressed.
As Christie’s struggle continued, her frustration and confusion grew. She lost confidence in her academic abilities and, not surprisingly, her enthusiasm for school. She became angry and oppositional at home, particularly toward her mother. She argued and fought with her brother constantly. He, in turn, resented Christie because she was getting so much attention from their parents. Christie didn’t want the attention – she was sick of it! She withdrew from the family and spent more time in her room. Christie looked and acted like a child who never had any fun. She became the biggest source of worry and concern in her parents’ life.
Something had to give. Christie’s parents requested a meeting at school with her teacher and principal. That meeting led to a decision to have her tested by the school psychologist. Perhaps ADHD wasn’t the only problem.
The results of the tests showed their new concerns were legitimate. In addition to ADHD, Christie was diagnosed with Developmental Reading Disorder, better known as dyslexia. It is one of the most common learning disabilities, her parents were told, and treating the ADHD did not address the learning problems.
ADHD and Learning Disability
The term “learning disability,” or LD, covers a lot of territory. There is no neat, concise definition. Of all the complex things in the universe, the most complex is the human brain. People learn in unique and idiosyncratic ways.
People with LD are generally of average or above-average intelligence, but they process certain types of information differently from everyone else. When these differences cause significant impairment in the ability to read, write, speak, spell, do math, or build social skills, we call that impairment a learning disability.
Learning disabilities affect one in every seven people, according to the National Institutes of Health. Research studies show that, depending on how learning disorders are defined, 25% to 50% of children with ADHD also have one or more co-existing learning disabilities. Children with both ADHD and LD are at greater risk for academic problems, anxiety and depression, and difficulty with social and family relationships.
Like Christie, children with ADHD and LD suffer chronic frustration that takes a devastating toll on confidence and self-esteem. Their emotional problems are as debilitating as the learning and academic struggles. Like Christie, many of these children function well in the preschool years. When they start school, however, they are likely to experience emotional stress, feelings of insecurity, anxiety associated with expectation of failure, and, sometimes, depression. The emotional problems are likely to become worse over time, as the child falls behind peers in knowledge and achievement.
The difficulties with social skills and relationships that are commonly associated with ADHD may be compounded by a learning disability. Children with both ADHD and LD may have more difficulty reading social cues (such as body language), expressing themselves verbally, and learning from their mistakes.
Warning Signs and Early Intervention
Learning disabilities should be identified and treated as early as possible, preferably before the fourth grade. In a study by the NIH on problems with language and reading, it was found that 67% of students identified as at risk for reading difficulties could achieve average or above average reading ability when they received help early.
It is essential for parents to recognize the warning signs that may be suggestive of learning disability. In the preschool years, the symptoms may involve delays in talking, slow vocabulary growth, and problems in learning the alphabet, numbers, and basic facts, such as the days of the week. There may be trouble interacting with peers, and low ability to follow directions or routines. In the early grades, common symptoms are errors in reading and spelling, transposing numbers, confusing arithmetic signs, inability to plan, poor coordination, and a proclivity to accidents.
What Parents Can Do
If you suspect that your child has a learning disability, ADHD, or both, take action. Get the help your child needs. Become familiar with the services available for children with ADHD and LD, and the legal rights and resources for children with disabilities under the Individuals with Disabilities Education Act (IDEA), Section 504 of the Rehabilitation Act of 1973, and the Americans with Disabilities Act (ADA).
When Christie’s academic problems continued even after her AD/HD was treated, her parents requested a thorough educational evaluation. The testing uncovered a learning disability and provided a clearer picture of her academic struggles. Finally, her parents and teachers developed an individual educational plan (IEP) that gave Christie the help she needed.
Christie is one of the fortunate children whose ADHD and LD were diagnosed and treated at an early age. She works with a remedial reading specialist at school and is showing significant improvement. Homework is still a struggle at times, but Christie knows that, with help from others and a little more effort on her part, she can do well in school. She no longer feels helpless, misunderstood, and inadequate, and that in itself makes a huge difference in her mood and motivation.
Along with the educational interventions, Christie works with a therapist to undo the emotional damage and rebuild her shattered confidence. She enjoys a healthy level of achievement, and the nightly homework battle is an infrequent occurrence rather than the norm. Even better, the enthusiastic and fun-loving Christie is running around the house again.
