Understanding learning and attention disabilities, Maryland expert talks diagnosis and treatment
BALTIMORE -- One in five people in the United States struggle with learning or attention disabilities, according to the Learning Disability Association of America. While they can make learning challenging for students and tricky to pinpoint, there are some ways you can identify and treat them effectively.
WJZ spoke with Julie A. Morrison, Psy.D. of Columbia, Maryland, who has 35 years of expertise in treating children and adolescents with learning difficulties. She says even the most driven individuals can find school and life significantly more difficult when they have a learning or attention disability.
Understanding dyslexia, dysgraphia and dyscalculia
Learning disabilities are conditions that affect one's ability to understand or use spoken or written language, perform mathematical calculations, coordinate movements, or direct attention.
According to the National Institute of Health, dyslexia is the most common learning disability, accounting for around 80% of patients who have a learning disability. Dyslexia, a reading disability, is defined as having an unexpected difficulty in reading for an individual who has the intelligence to be a much better reader.
Morrison says the symptoms of dyslexia differ for each person.
"At younger ages, some children will reverse letters or even reverse numbers. That's normal really up until through the age of seven. If it persists beyond that, it's kind of a red flag for dyslexia," Morrison said. "There's really two types of dyslexia and if the person has both, it's called mixed dyslexia. So one of the types is more phonetic, and the other type is more recognizing letter patterns."
While dyslexia is the most common learning disorder, it's not the only one that can have a major impact on a student's life, and academic performance.
"Any written language disorder is called dysgraphia - and then there are subtypes of that. And then for math, it's called dyscalculia," Morrison said. "Let's say somebody has a reading disorder. They may have dyslexia, or they may have problems with reading comprehension. They don't have to be dyslexic. That could be because they have an attention problem where they have trouble paying attention to what they read," Morrison explained.
Understanding ADHD and executive function disorders
Executive functioning disorders, like attention-deficit/hyperactivity disorder (ADHD) can make classroom learning difficult, even though they are not classified as traditional learning disabilities. According to the NIH, ADHD is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development.
"There's lots of nuances, even with ADHD. Some kids are certainly the hyperactive, impulsive type. They have trouble regulating," Morrison said. "Other kids may have trouble paying attention, but they don't necessarily have those other symptoms."
Located in the pre-frontal cortex of the brain, executive-functioning skills are responsible for a person's ability to initiate tasks, organize, plan, retain multistep directions or information, and inhibit certain behaviors.
"There's a bunch of different executive functions. Any time anybody is trying to accomplish a goal or a task, all those pieces have to come together," Morrison said. "People with executive functioning weaknesses have a hard time with that. That can be due to lots of different things. In the case of ADHD, we're looking more at problems with what we call working memory—mental multitasking, or it can be problems inhibiting stuff."
Morrison says an indicator for ADHD is when symptoms present themselves outside the classroom environment, creating challenges in everyday tasks that rely on executive functioning skills.
"A client that I saw told me that she'd actually forget to make dinner, so she'd have to set an alarm. Initiating even a routine task that you do every day can be hard. There is something called time blindness, where it can be hard to track time. It is hard to initiate the task or stick with the task," Morrison said.
Diagnosing learning and attention disorders
Because the symptoms of various psychological disorders can overlap, many practitioners, like Dr. Morrison, use specialized assessments to determine the source of a patient's symptoms and how to best treat them.
"I do a neuropsychological-styled evaluation. For example, with reading, I'm not just having them read to me and looking at that. I'm also looking at the foundational skills that go along with that. How do they process sounds? How do they process visual patterns? If they're having a problem with reading comprehension, for example, are they having trouble understanding? Can they listen to a passage and tell me what they heard? Do they understand language or not? It's looking in different domains," Morrison explained.
While not every student will be above average in every skill, Morrison says the diagnosis process is about identifying a pattern of strengths and weaknesses. These patterns can present themselves differently depending on setting and age.
Morrison says learning, and executive functioning disorders can present differently in children, adolescents and adults.
"I often see kids, especially in early elementary school. They'll come to me because they're a behavior problem in school. They're just falling out, they're being disruptive, and people will think in terms of misbehavior, when in fact it can be something else," Morrison said. "Either an undiagnosed learning disability where they're overwhelmed, or an attention problem where they're having trouble regulating. And kids can be explosive when angry. You might have heard before that when you talk about anxiety, there's a fight or flight response, so sometimes kids will act out."
For patients who have spent years wondering why they've had to work harder than their peers to meet the academic status quo, discovering that they have a learning disability can be an enlightening and emotional experience.
"Sometimes they'll be in tears because they've known something was wrong their whole life."
"I've diagnosed practicing physicians; I've diagnosed people in graduate school and law school who have had suspicions their whole life. Sometimes they'll be in tears, because they've known something is wrong their whole life," Morrison said. "Oftentimes, people in those professions are gifted intellectually. And so maybe they've been tested before and people don't recognize the disparity and their difficulties, or they've just put in extra work and gotten by."
Learning disabilities and attention disorders are often accompanied by other mental health challenges. Morrison says that she often sees patients with learning or attention disorders who have developed mood disorders like anxiety or depression.
"In many of the people I see, they have all three. So it's not like they're just isolated things. And if you're anxious, stressed, and preoccupied, that's going to make your attention worse," Morrison said. "Often people don't have a sense of what ADHD is or what it looks like. Often times, people don't realize that trouble regulating emotion can be part of that."
How can you treat a learning disability?
Early intervention is important for treating learning disabilities or executive functioning challenges because they don't go away with time.
"Learning disabilities are kind of there for life unless you remediate them. People can certainly learn coping strategies. There's plenty of people who never get help, and they learn workarounds and do the best they can. But it's not going to go away without some kind of intervention," Morrison explained.
Parents can seek support for their students starting at the school level, talking with school psychologists and administrators to see if the school will do testing. If the school doesn't provide testing, they may need to seek it from another party. When presented with a diagnosis, schools can provide students with academic accommodations, through a 504 plan, or an Individualized Education Program (IEP).
For high-school and college students, adding treatments like executive coaching may be helpful.
"Certainly by high school and college, executive coaching can be helpful for people with ADHD who have trouble with organization, time management, retaining what they hear in lectures, how to study for an exam, or planning how to do a research project," Morrison said.
She said one of the keys to successfully treating learning disabilities or executive functioning disorders is making sure the patient has a support system.
"They're either getting professional help from a therapist or coach. Maybe they have someone in the school environment who can be a support in that setting. Especially for kids in high school and college, I see they get overwhelmed. It just feels like things keep coming at them. They fall behind. They can't catch up," Morrison said.
In addition to behavioral treatments, medication can be helpful for attention disorders.
