Pretend that you are a child in a second-grade classroom. You have an above-average IQ and you are motivated to learn. When you try to read printed text, however, you can't make sense out of the words and sentences. The print says, "Pam saw the dog play;' but you invert the m in "Pam" into a w, you reverse the letters in "saw" to read "was," and you leave out the I in "play." To you, the sentence reads, "Paw was the dog pay." What sense does that make? After struggling day after day, you begin to give up. While other children are reading their books, you just sit and look around. And because so much of the information and instruction given in school involves reading, you are falling behind in most of your subjects. The teacher thinks you have an attention deficit, your classmates call you "stupid," and your parents wonder if you are just lazy. Inside, you know they are all wrong, but you can't figure out why you are having so much trouble. Actually, you are showing signs of a reading disorder—but it may be a long time before you get an official diagnosis and any real help with your difficulties in school.

Unless you have experienced a communication or learning disorder yourself, it is hard to imagine the frustrations that children with these problems feel every day in school. They are just as smart as other children and can learn just as fast as other children, but in some specific area they have significant difficulty with language or learning. They fall behind in school, they may feel rejected by their classmates, and their self-esteem plummets. Many withdraw, show signs of depression or anxiety, or act out in school. Among adolescents with learning disorders, the high school dropout rate is about 40% (American Psychiatric Association, 2000).

The table below describes the main communication and learning disorders. In communication disorders children have significant difficulty producing speech sounds, using spoken language to communicate, or understanding what other people say (Mash & Wolfe, 2005). Learning disorders (often referred to as learning disabilities) involve diffficulties with specific skills such as reading, mathematics, or writing. With both types of disorders, children tend to have average to above-average intelligence. They should be capable of learning quickly in school, but their disorder slows them down and disrupts their performance. Communication and learning disorders are also highly connected.

Communication and Learning Disorders

Categories of Disorders Symptoms and Behaviors
Communication Disorders:  
Phonological Disorder Problems with the articulation or production of language sounds. Most frequent problems involve the I, r; s, z, and th sounds, e.g., saying "cwy" instead of "cry." Problems persist beyond what is developmentally normal and interfere with school and social activities. About 10% of preschoolers show mild phonological problems. By age 7, 2% to 3% have a phonological disorder.
Expressive Language Disorder Problems using words to communicate thoughts, desires, and feelings. Expression lags significantly behind the child's ability to understand language (receptive language). Speech usually begins late and progresses slowly. Limited vocabulary, short sentences, and simple grammatical structures characterize speech. Affects 2% to 3% of children.
Mixed Receptive-Expressive Language Disorder Problems in expressive language combined with difficulty understanding language. Trouble making sense out of sounds, words, sentences. Seen in less than 3% of children.
Stuttering Repeating or prolonging speech sounds, e.g., "g-g-g-g-g-go" or "Mo-ah-ah-ah-ah-mmy." Child struggles to finish or continue sounds and words; may develop ways to avoid or compensate for problem sounds. Stuttering usually has a gradual onset between ages 2 and 7. Affects 1% of children; 3:1 males. Usually self-correcting; 80% of children who stutter at age 5 no longer stutter by first grade.
Learning Disorders:  
Reading Disorder Reading ability substantially below the level expected given the child's age, intelligence, and education. Trouble recognizing basic words; common errors include letter reversals (b/d; p/q), transpositions (top/pot), letter inversions (m/w; u/n), and omissions (reading place instead of palace). Trouble decoding (separating the sounds in words). Difficulties with reading comprehension, spelling, and writing. Up to 20% of schoolchildren have significant reading problems.
Mathematics Disorder Math ability is substantially below the level expected given the child's age, intelligence, and education. Trouble recognizing numbers and symbols, memorizing basic math facts (e.g., multiplication tables), aligning numbers, and understanding abstract concepts (e.g., place value and fractions). Child may also have problems with visual-spatial abilities. Disorder usually noticed when formal math instruction begins in grade 2 or 3. About 1 % of children receive official diagnoses, but 6% score low enough on standardized math tests to be considered as having the disorder.
Writing Disorder Writing ability is substantially below the level expected given the child's age, intelligence, and education. Problems with writing, drawing, copying figures, and other fine-motor skills involving hand-eye coordination. Large-motor skills (e.g., running, throwing, climbing) are normal. Written work is low in interest and poorly organized; sentences are short; work contains many errors in spelling, punctuation, and grammar. Disorder affects up to 10% of children.

Source: Mash & Wolfe (2005)

Communication and learning disorders are examples of "hidden" problems in childhood—they too often go undiagnosed and untreated. About 5% of u.s. students receive official diagnoses of learning disorders, but educators estimate that at least 20% of children suffer from reading disorders alone (Mash & Wolfe, 2005; Shaywitz, Escobar, Shaywitz, Fletcher, & Makuch, 1992). Children with communication and learning disorders already receive half of all of the special education services provided in schools, and even more children could obviously benefit from these programs. The newer approaches to assessment we described earlier in this chapter, especially curriculum-based assessment and response-to-intervention, are increasingly being used to more accurately identify and help students with a variety of learning disorders.

Communication and learning disorders are strongly genetic and related to abnormalities in how the brain functions. When a parent has a communication disorder, about half of that person's children also have communication disorders. Children with a phonological disorder (see table) show less than normal activation in the left temporal region of their brains, a region strongly related to language function (Wood, Felton, Flowers, & Naylor, 1991). Research has linked expressive language disorder to recurrent ear infections (Lonigan, Fischel,Whitehurst, Arnold, & Valdez-Menchaca, 1992); such infections may lead to hearing loss that reduces input to the developing brain. And children with stuttering, reading, and writing disorders show more than normal activity in the right half of their brains (Mash & Wolfe, 2005). It seems that disruptions in prenatal brain development cause many of these disorders. Even minor defects can change how the brain sorts, organizes, and brings information together from specific brain areas; and these changes in turn hamper the child's ability to interpret and make sense out of the information.

In many of these cases, the disorders correct themselves or the children learn ways to compensate for their difficulties. Stuttering and expressive language disorders, for example, often correct themselves by age 6 or 7 (Mash & Wolfe, 2005). Or children who stutter can learn to slow down and breathe deeply before continuing. Speech therapists can train children with phonological disorder in articulation and help them learn to produce correct speech sounds. Children with reading, math, and writing disorders typically receive educational supports in school. They benefit from direct instruction, drill and practice, and learning strategies for breaking problems and assignments into smaller units. Counseling and therapy also can help children improve their self-esteem, deal with peer rejection, and learn how to monitor and control their own learning and thought processes. With help, families can learn to provide more effective supports for children with communication and learning disorders. On the bright side, most people with these disorders find ways to compensate and go on to live normal lives.