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by Larry B. Silver, MD
As parents you are familiar with the term learning
disability. Yet, it seems that there are so many types,
and each educator or other professional you work with
uses different terms or ways to describe your son or
daughter. The following outline might be helpful in
putting these terms and concepts in perspective.
Let me quickly outline a simple scheme describing what the brain
must do in order for learning to take place. The first step is
input, getting information into the
brain, primarily from the eyes and the ears. Once this information
has arrived, the brain needs to make sense out of it, a process
called integration.
Next, the information must be stored and later retrieved, the
memory process. Finally, the brain
must send some kind of message back to the nerves and muscles--its
output. Let’s review each area of
possible learning disability.
INPUT DISABILITIES
Information arrives at the brain as impulses, transmitted along
neurons, primarily from our eyes--called
"visual input"--and from our ears--called "auditory
input." This input process takes place in the brain. It
does not pertain to visual problems, such as nearsightedness or
farsightedness, or to any hearing problems. This central input
process of seeing, or hearing, or in any other way taking in or
perceiving one’s environment is referred to as "perception." Thus we
speak of a child who has a perceptual disability in the area of
visual input as having a visual perceptual
disability, and one with a disability in the area of
auditory input as having an auditory
perceptual disability. some children have both kinds of
perceptual disabilities, or they may have problems when both inputs
are needed at the same time-- for example, seeing what the teacher
writes on the blackboard while listening to the explanation of what
is being written.
Visual Perceptual Disabilities
Your child may have difficulty in organizing the position and
shape of what he or she sees. Input may be perceived with
letters reversed or rotated: An e
might look like a 9; and E might look like a W, or a 3, or an M. The
child may confuse similar looking letters because of these rotations
or reversals: d,b,p,g, and q, may be confused with any one of the
others. The word" was" might be perceived as "saw", or "dog" as
"god."
This confusion with position of input shows up almost immediately
when the child begins to read, to write, or to copy letters or
designs.
Another child might have a
"figure-ground" problem, that is difficulty in
focusing on the significant figure
instead of all the other visual inputs in the background. This
occurs in real-life situations as well as in looking at printed
matter or electronic images. For example, the child is told to pass
the salt shaker but has difficulty finding it among the many dishes
and platters. Reading requires focusing on specific letters or
groups of letters, then tracking from left to right, line after
line. Children with this disability may have reading problems. They
jump over words or skip lines.
Judging distance is another visual
perceptual task which can go awry. Your child may
misjudge depth, bumping into things, falling off a chair, or
knocking over a drink because the hand reaches too far for it. What
you take for habitual carelessness or poor eyesight may in fact be
just this sort of perceptual error.
There are other types of visual
perceptual problems. While playing in an open field or
gym, your child may become confused and disoriented because of
trouble organizing his or her position in space. Or the child may
have difficulty in understanding left and right, or up and down.
One very common type of visual
perceptual disability is related to doing things when the
eyes have to tell the hands or legs what to do. When such
information is unreliable, activities like catching a ball, jumping
rope, doing puzzles, or using a hammer and nails become difficult or
impossible. To catch a ball, the eyes must focus on the ball
(figure-ground), the brain must perceive the correct position and
path of the ball (depth perception) and tell the various parts of
the body exactly where to move and when, and then the body must
obey. A child who misperceives distance or speed, or whose brain
misdirects the body, may miss the ball completely.
Auditory Perceptual Disabilities
As with visual perception, your child may have difficulty with
one or several aspects of auditory
perception. Those who have difficulty distinguishing
subtle differences in sounds will misunderstand what you are saying
and respond incorrectly. Words that sound alike are often
confused--"blue" and "blew", or "ball" and "bell." You may ask a
child, "How are you?" He may answer, "I’m nine." He thought he heard
an "old" instead of "are"..or in addition to the "are."
Some children have difficulty with
auditory figure-ground. He or she might be watching
television in a room where others are playing or talking. You are in
the kitchen and call out to the child. You might be into your third
paragraph before he or she begins to pick your voice (figure) out of
the other sound inputs (background). It appears that the child never
listens or pays attention.
Some children cannot process sound input as fast as normal people
can. This is called an "auditory lag." If you speak at a normal
pace, the child may miss part of what you are saying. You have to
speak slower, or give separate instructions, before he or she can
follow you. If you were to say, "It’s getting late--go upstairs,
wash your face and get into your pajamas, then come down for a
snack," your child may hear only the first part and stay upstairs.
If you gave the first part of the instructions, then waited a few
seconds before you added the rest, however, the child might hear the
whole thing.
Disabilities with input from the Other
Senses
Some children appear to be unable to understand
tactile input or touch fully and appear to dislike
being touched. Children who are clumsy may be having difficulty with
messages coming into the brain from certain nerve endings in the
muscles (called "proprioceptors"). At this time we know very little
about such perceptual disabilities. Future studies should help us to
understand them better. We also have to wait for future studies for
more knowledge of smell and taste disabilities.
INTEGRATION DISABILITIES
Once the information coming into the brain is registered, it has
to be understood. At least two steps are required to do this:
sequencing and
abstraction.
Suppose that your brain recorded the following three graphic
symbols: d, o, g. No problems with visual perception. But to make
sense of the perception, you have to place the symbols in the right
order, or sequence. Is it d-o-g, or g-o-d or d-g-o, or what? Then
you have to infer meaning from the context in which the word is
used, both a general meaning and a specific meaning. For example,
"the dog" and "your dog" have very different meanings. The ability
to draw general applications from specific words and to attach
subtle shading to the basic meanings of words is referred to as
"abstract thinking."
The process of integrating input, of understanding what your
brain has recorded, thus requires both sequencing and abstraction.
Your child might have a disability in one area or the other, or
both. A child who has difficulty sequencing what comes in from the
eyes is said to have a visual sequencing disability. So, too, the
child might have difficulty with visual abstraction or auditory
abstraction.
Sequencing Disabilities
A child with such a disability might hear or read a story, but in
recounting it, start in the middle, go to the beginning, then shift
to the end. Eventually the whole story comes out, but the
sequence of events is wrong. Or a
child might see the math problem as
16 - 3 =? on the blackboard, but write it as 61 - 3 = ? Or a
child might see
2 + 3 = ? and write 2 + 5 = 3. The child knows the right answer
but gets the sequence wrong. Spelling words with all of the right
letters in the wrong order can also reflect this disability.
Or a child may memorize a sequence--the
days of the week, for example--and then be
unable to use single units out of the sequence correctly.
If you ask what comes after Wednesday, the child cannot answer
spontaneously, but must go back over the whole list, "Sunday,
Monday, Tuesday, Wednesday ...," before she or he can answer.
A child with a sequence disability might hit the baseball then
run to third rather than first base or have difficulty with board
games that require moving in a particular sequence. Or when setting
the dinner table, he or she might have trouble placing each item in
the proper place.
Abstraction Disabilities
Once information is recorded in the brain and laced in the right
sequence, one must be able to infer meaning. Most learning disabled
children have only minor difficulties in this area.
Abstraction--the ability to derive the correct
general meaning from a particular word or symbol--is a
very basic intellectual task. If the disability in this area is too
great, the child is apt to be functioning at a retarded level.
Some children do, however, have problems with abstraction. The
teacher may be doing a language-arts exercise with a group of second
graders. He or she reads a story about a police officer, let us say.
The teacher then begins a discussion of police officers in general,
asking the pupils if they know any men or women who are police
officers in their neighborhoods, and if so, what do they do? A child
with an abstraction disability may not be able to answer such a
question. He or she can only talk about the particular officer in
the story and not about law officers in general. Older children
might have difficulty understanding jokes. Much of humor is based on
a play on words which confuses them.
Short-term memory is
the process by which you hold on to information as long as you are
concentrating on it. For example, when you call the information
operator for a long-distance number, you get a ten-digit number with
an area code. Like most people, you can probably retain these
numbers long enough to dial the number if you do it right away and
nothing interrupts your attention. However, if someone starts
talking to you in the course of dialing, you may lose the number.
Or, you might go to the store with five things in mind to buy, but
by the time you get there so many different impressions have
intervened that you’ve forgotten an item or two on your list.
Long-term memory
refers to the process by which you store information that you have
repeated often enough. You can retrieve this information quickly by
thinking of it--you can come up with your current address and phone
number quite readily, for example--or you may have to spend a little
more time and effort to think or it--your mother’s home address, for
example.
If your child has a memory disability, it is most likely a
short-term one. Like abstraction disabilities, long-term memory
disabilities interferes so much with functioning that children who
have them are more likely to be classified as retarded. It may take
ten to fifteen repetitions for a child with this problem to retain
what the average child retains in three or five repetitions. Yet the
same child usually has no problem with long-term memory. Your child
probably surprises you at times by coming up with details that you
have forgotten about, something that happened several years ago.
A short-term memory disability
can occur with information learned through what one sees--visual
short-term memory disability--or with information learned through
what one hears--auditory short-term memory disability. Often the two
are combined. For example, you might go over a spelling list one
evening with your son. He looks at it several times, listens to you,
and can write down the spellings correctly from memory. He seems to
have it down pat, but that’s because he’s concentrating on it. The
next morning he has lost most or all of the words. Or a teacher may
go over a math concept in class until your daughter understands
it--she’s concentrating on it. Yet when she comes home that night
and does her homework, she has completely forgotten how to do the
problems.
OUTPUT DISABILITIES
Information comes out of the brain either by means of
words--language output--or through muscle activity, such as writing,
drawing, gesturing, and so forth--motor output. A child or
adolescent may have a language disability or motor disability.
Language Disability
Two forms of language are used in communication,
spontaneous language and demand language. You use
spontaneous language in situations where you initiate whatever is
said. Here you have the luxury of picking the subject and taking
some time to organize your thoughts and to find the correct words
before you say anything. In a demand language situation, someone
else sets up a circumstance in which you must communicate. A
question is put to you, for example. Now you have no time to
organize your thoughts or find the right words; you have only a
split second in which you must simultaneously organize, find words,
and answer more or less appropriately.
Children with a specific language
disability usually have no difficulty with spontaneous
language. They do, however, often have problems with demand
language. The inconsistency can be quite striking. A youngster may
initiate all sorts of conversation, may never keep quiet, in fact,
and may sound quite normal. But put into a situation that demands a
response, the same child might answer "Huh?" or "What?" or "I don’t
know." Or the child may ask you to repeat the question to gain time,
or not answer at all. If the child is forced to answer, the response
may be so confusing or so circumstantial that it is difficult to
follow. She or he may sound totally unlike the child who was
speaking so fluently just a minute ago. This inconsistency or
confusion in language behavior often puzzles parents and teachers. A
teacher might put a child down as lazy or negative because he or she
does well when volunteering to speak or answer a question, but won’t
answer or says "I don’t know" when called on. The explanation could
lie in the child’s inability to handle demand language, but
contradictory behavior like this makes sense only if you know about
the disability.
Motor Disabilities
If a child has difficulty in using large muscle groups, this is
called a gross motor disability.
Difficulty in performing tasks that require many muscles to work
together in an integrated way is called a
fine motor disability.
Gross motor disabilities can
cause your child to be clumsy, to stumble, to fall, to bump into
things, or to have trouble with generalized physical activities like
running, climbing, or swimming.
The most common form of fine motor
disability shows up when the child begins to write. The
problem lies in an inability to get the many muscles in the dominant
hand to work together as a team. Children and adolescents with this
"written language" disability have slow and poor handwriting. A
typical expression of this problem is, "My hand doesn’t work as fast
as my head is thinking."
Watch your own hand as you write something and notice the many
detailed fine muscle activities that it takes to write legibly.
Writing requires a constant flow of such activities. Now place your
pen in your non-dominant hand and try to write. If you go very
slowly, it is tedious but your handwriting is legible. If you go at
a regular pace, however, your hand aches and your handwriting
deteriorates immediately. Shape, size, spacing,
positioning--everything about it looks awful no matter how hard you
try. A child with fine motor disability goes through this all the
time.
When a child has a visual perceptual problem, the brain, which
has incorrectly recorded or processed information, will probably
misinform the muscles during activities that require eye-hand
coordination. This is referred to as a visual motor disability.
ESTABLISHING
YOUR CHILD’S PROFILE
Obviously the learning process is much more complex, but this
simple model for describing specific learning disabilities should be
helpful. The important thing is that if your child has one or more
of these disabilities, you must know that, along with you son’s or
daughter’s specific profile of strengths.
Look at the checklist of specific learning disabilities below. Do
you know where your child’s disabilities lie? Where the strengths
lie? If not, ask the special-education team at your school or the
person who does the testing to clarify this for you.
| Specific
Learning Disabilities
Input Memory
Visual perception
Visual short-term memory
Auditory perception
Auditory short-term
memory
Visual long-term memory
Auditory long-term memory
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Integration
Output Visual
sequencing
Spontaneous language
Auditory sequencing
Demand language
Visual abstraction
Gross motor
Auditory abstraction
Fine motor
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