Learning Disorders and Brain Organization (continued)

The observations of the examiner and the reports of parents and teachers also help to determine if there are difficulties with attention. Since teachers and parents see the child throughout the day and for longer periods of time, they can notice instances when attention fades that may not be observed by an examiner.

Executive functioning

Executive functions are best thought of as those aspects of cognition that relate to an internal supervisor who directs a child's thinking and guides her behavior. These skills directly help a child make goals for herself and come up with the ideas that will help her meet those goals efficiently. These skills develop in young children and continue to evolve well into the teen years and young adulthood. Specific aspects of these broad skills include:

Verbal working memory refers to the efforts a child makes in order to guide behavior and stay on task. Often children exhibit this when they use internal "self- talk" to remind themselves of how to act in a special situation and may also be seen when they internally generate rules about the way they should behave.

Nonverbal working memory also allows the child to guide behavior, but it is more focused on the ways to do this that are not verbal in nature. In this way, a child often holds events in mind, sequences these events and uses a sense of time to help manage behavior in a coordinated way.

Inhibition reflects the ability to stop oneself from doing something that is automatically done in favor of acting in a more goal directed manner and using feedback to coordinate responses in a more specific manner.

Fluency and flexibility are skills related to being able to quickly generate strategies for problem solving and to being able to use forethought and planning to make solutions happen quickly and easily. These skills also refer to how easily a child can adapt her behavior to fit the demands of a particular situation and to shift between different scenarios smoothly.

Self-regulation/motivation/arousal are a set of processes that encompass a child's awareness of himself and help him to maintain appropriate behaviors, control interest and enthusiasm for activities (even if he is not thrilled to be engaged in these activities), and to be consistently alert to the events and stimuli around him.

Visual Skills and the Sensorimotor Domains

These areas refer to visual and tactile ways of taking in information as well as motor planning, motor speed and coordination, and the precision of motor skills to accomplish a set goal. The child has to recognize and discriminate what information to look at, touch and feel. The child then has to decide which modality to use for providing an answer - a verbal response, a constructional response, or a graphomotor response through writing.

Difficulties in any of the areas described above may lead to problems in academics. Children with compromised intellectual functioning will not be expected to perform as well as their peers in academic areas. Similarly, problems with language, reduced skills for remembering new information, and weaknesses in attention, executive functioning, visual-spatial skills, or sensorimotor functioning may contribute to or cause problems with learning in general. These cognitive weaknesses may also be related to difficulties learning specific subjects or may lead a child to be less invested in learning because it is difficult for him to perform some of the basic skills required for solid academic performance. It is important to note that some children may show some problems in the areas described above which do not appear to lead to any academic delays.

Putting it All Together - Academic Functioning

Demands change

All academic areas of functioning have two features; a mechanical aspect and a higher level, or language-based, aspect. In reading, a child learns the mechanics of decoding words and also reads for meaning. In mathematics, a child computes written problems and also solves functional word problems. In writing, a child learns handwriting skills and also organizes and expresses her ideas in paragraphs. By third grade a child is no longer learning to read. It's assumed that he's mastered mechanical decoding skills and is reading for meaning: making inferences, drawing conclusions, processing ambiguities and comprehending figurative expressions; in other words, he is reading in order to learn. The emphasis changes in middle school, where a child is learning how to learn. She needs to adjust her reading to the demands of the text and has to express her thinking in writing. There are increasing demands for metacognition, which is concerned with developing strategies and understanding the purpose of their work. In middle school, a child is required to become more independent, and, in high school, it's assumed that he's independent, that he has developed strategies and knows when to use them. For example, in middle school a teacher might say "this is how you should study; now go home and do it." In high school he has to figure out which strategy to apply in order to be successful.

In all academic areas, some children have good basic skills development, but have difficulty with study skills, such as monitoring and checking work familiarizing themselves with school requirements studying by reorganizing the material rather than merely reading and re-reading it acquiring strategies for retaining information, moving information to long term storage knowing how to consolidate or integrate what they've learning prioritizing and keeping track of long and short term assignments

Reading

The mechanical aspect of reading is decoding; the higher level, language-based aspect is comprehension. Assessment of reading includes

1. decoding (sight words, phonemic awareness, reading rate and accuracy)
2. comprehension, literal and inferential
3. fluency and automaticity

Some characteristics in a child with a reading problem are: lack of automaticity in learning letters, associating letters with sounds, rhyming and playing sound games, hesitant and dysfluent reading, difficulty retaining facts or a story line, understanding character, plot, setting or theme.

Math

The mechanical aspect of math is computation; the higher level aspect is understanding and solving word problems.

Assessment of math includes

1. calculations (automaticity and computational processes)
2. word problems
3. fluency of math fact recall and steps involved in problem solving

Some characteristics of a child with a math problem are: using fingers for computation, poor ability to complete simple math computation in addition, subtraction, multiplication and division with whole numbers, then fractions and decimals, lack of automaticity of math fact recall, confusing columns, poor spacing when writing out math problems, not understanding the mathematical implications of words such as half, second, etc., inability to identify the key word in a problem or what operation the problem calls for.

Writing

The mechanical aspect of writing is spelling and handwriting; the higher level aspect is the ability to sequence events, write an outline and write a paragraph or story. Assessment of writing includes

1. handwriting (grip, posture, motor planning and production)
2. spelling (rules and conventions, spelling of words with predictable vs. irregular patterns)
3. writing process (planning, revising, formulation, fluency, structure, mechanics)

Some characteristics of a child with a writing problem are: motor problems, lack of automaticity in letter formation, copying from the board, organizing and sequencing of ideas.

How the Child Thinks and Feels

Some children with learning difficulties may feel demoralized or guilty or worried or sad or angry. Questionnaires completed by the child, parent and teacher can be helpful, and for some children projective measures will contribute to understanding the child's psychological functioning.

Next Steps

Formulation of diagnosis

Good evaluations offer a comprehensive approach and tailor the assessment to the needs of the child. The evaluation appointments provide a time for structured tests as well as a setting to try specific interventions that may then be used at home or at school. Recommendations to the school and family should be useful, specific and practical so that the appropriate resources are brought to bear in a child's behalf. A good evaluation should help the parents, teachers, and the child know what things can be done so that the child can do better in school and learn skills necessary for life after school. They can also help all people involved know how to have reasonable expectations about the child's abilities and to know when, where, and under what conditions she may have more difficulty with learning.