|
 Children who
are classified as gifted are, by
definition, highly intelligent individuals who fall at the upper end of
the distribution of mental ability. Yet giftedness is not a guarantee
of academic success. Consider that The
National Commission on
Excellence in Education (1983)
reported that one half of gifted
students do not achieve academically at a level that is commensurate
with their ability. Surprisingly, between ten and twenty percent of
high school dropouts test within the gifted range (Lajoie and Shore,
1981; Whitmore, 1980). Perhaps the most startling statistic in this
regard is that 40 percent of those who graduate within the top 5% of
their high school classes do not complete college. A number of famous
historical figures who were clearly very intelligent (and who probably
who have qualified as gifted) struggled considerably in school; these
individuals later became highly successful in fields ranging from
politics (Woodrow Wilson and Nelson Rockefeller) to science (Albert
Einstein and Thomas Edison) to the arts (Auguste Rodin and Cher). There
are many possible reasons for this lack of academic success among some
of the gifted population. Environmental factors (both within the school
and at home), emotional and affective issues, motivational
difficulties, and other factors all can contribute to a lack of
academic success in students who would, by virtue of their high level
of mental ability, be expected to be high achievers. Another important
factor that can result in underachievement academically, and the one
that I will be discussing in this article, is the presence of learning
disabilities. It comes as a surprise to many people to hear that learning
disabilities are as prevalent in the gifted population as in the
general population, yet there is
nothing in the definition of
learning disabilities (or in their diagnosis) to preclude the gifted
from this category. Rather, this misconception that gifted children
cannot have learning disabilities is, I believe, rooted in the
erroneous belief that learning disabilities are in some way restricted
to those children who are less bright than average. In fact (as I will
expand upon later), children with learning disabilities are by
definition of at least average mental ability. Their problem is one of
lowered achievement, not lowered ability. In this article I will
discuss various definitions of learning disabilities, the diagnostic
process, various manifestations of learning disabilities across the
school-age range, and appropriate interventions for children with
learning disabilities. I will also briefly discuss Attention-Deficit
Hyperactivity Disorder (ADHD) which, while not a learning disability,
often co-occurs with learning disabilities and also frequently
manifests itself in ways that are quite similar to learning
disabilities. While some of what I will say is characteristic of all
children with learning disabilities, I will also attempt to highlight
some issues that are particularly relevant to children within the
gifted population who have learning disabilities.
The
Definition of Learning Disabilities: The
term learning disabilities was first coined in 1963 by Samuel Kirk, but
many other terms were used prior to this time to describe children with
learning problems that are now termed learning disabilities.
Formulating a single definition of learning disabilities that is
acceptable to all professionals in the field has proven difficult. As a
result, several definitions are commonly utilized; these differ to some
degree but generally have the same essential characteristics. The most
commonly used definition first appeared in Public Law 94-142, the
Education for All Handicapped Children Act (Federal Register, 1977). It
was also a part of Public Law 101-476, the 1990 Individuals with
Disabilities Education Act (IDEA) and is also a component of the 1997
Amendments to IDEA, Public Law 105-17. It reads as follows: The
term "specific learning disability" means those children who have a
disorder in one or more of the basic psychological processes involved
in understanding or using language, spoken or written, which disorder
may manifest itself in imperfect ability to listen, think, speak, read,
write, spell or perform mathematical computations. The term includes
such conditions as perceptual handicaps, brain injury, minimal brain
dysfunction, dyslexia and developmental aphasia. The term does not
include a learning problem which is primarily the result of visual,
hearing, or motor handicaps, of mental retardation, of emotional
disturbance, or environmental, cultural, or economic disadvantage (PL
105-17: Federal Register, 1997). This definition of learning
disabilities (and associated features of the Federal law that contains
it) is important for several reasons. First, it was designed to provide
an operational definition of learning disabilities that can be used by
professionals to diagnose learning disabilities in a consistent,
reliable manner. Second, other aspects of the law provided legal
safeguards to assure that children with learning disabilities were
provided with appropriate accommodations to remediate their
disabilities. Third, it provided a system of checks and balances under
which parents of children with learning disabilities could appeal any
decisions made about the services that their children would (or would
not) receive. I will not go into a detailed discussion of all aspects
of Federal Law as it relates to children with learning disabilities,
but I do want to elaborate upon the basic components of the definition
provided above. There are multiple dimensions to the definition, each
of which must be considered in determining whether a child should be
diagnosed with learning disabilities. The following major concepts are
essential parts of IDEA 1997: --The child must have a disorder in one
or more of the basic psychological processes. These processes refer to
cognitive abilities, among them memory (auditory and visual),
perception (auditory and visual), intersensory integration (for example
visual-auditory intersensory integration, the ability to associate a
letter or letters with its appropriate sound (s)), attention, and motor
skills, among many others. --The child must have difficulty in
learning, manifesting itself in oral language (receptive or
expressive), reading, writing, and/or mathematics. That is, their
achievement is less than would be expected given their ability. --The
learning problem is not attributable to being primarily due to other
causes such as visual or auditory impairment, severe motor handicaps,
low mental ability, emotional disturbance, or disadvantage due to
economic situation, environment, or culture. In other words, there is
no other logical explanation for the child's learning difficulties. --A
significant discrepancy exists between the child's potential for
learning (ability) and his or her actual achievement. That is,
underachievement is evident. Be aware that different states and
individual school districts differ in the size of the discrepancy that
is needed for "significance". Also there are different methods for
calculating a discrepancy that go beyond the scope of this article.
Note that this definition excludes from the diagnosis of learning
disabled many children who are not achieving at a level that is
commensurate with their ability: those who possess low levels of mental
ability and who would therefore not be expected to achieve at age- or
grade-appropriate levels; those who have other problems that are
adversely impacting learning (e.g., vision impairment, depression or
anxiety, cerebral palsy, and those who have not had an adequate
opportunity to learn, among others); and those whose discrepancy
between ability and achievement is not large enough to be considered
significant in the clinical sense. Also, there must be some explanation
as to why the child is underachieving; this is obtained by establishing
a connection between the area of underachievement (e.g., mathematics)
and a psychological process known to underlie mathematical competency
(e.g., auditory memory). This definition, or one quite similar to it,
is used by the vast majority of school systems in the United States to
qualify children for learning disability services. Consider this
example of the implications of the diagnosis for gifted children. A
boy, Lucas, with an intelligence quotient (IQ) of 140 (at the 99th
percentile for his age) would be expected to achieve at a level that is
commensurate with that ability (i.e., that is, at or near the 99th
percentile). Let's say that Lucas is not achieving at this level in an
area (reading). For the sake of this example, assume that Lucas'
achievement on several reading decoding (word recognition) measures
places him in the middle of the average range (i.e., a standard score
of 100, corresponding to the 50th percentile). Despite the fact that
Lucas is decoding at a grade appropriate level, by virtually any
definition of a learning disability he is underachieving due to the
significant mismatch between his ability and his achievement in
reading. This points out an essential (and to many people, very
confusing) feature of learning disabilities: among bright children,
achievement at a level that is below grade level is not required for a
diagnosis of learning disabilities to apply. In fact, if we were to
change Lucas' decoding standard score to 110 (corresponding to the 75th
percentile), he would still qualify for the diagnosis even though his
decoding skills are above those of 75 per cent of his same-grade peers.
This type of scenario occurs very often with gifted underachievers, and
confusion about it almost certainly results in them often not receiving
the diagnosis and associated appropriate services to which they are
legally entitled. Thus, it is often the case that parents need to
aggressively pursue testing for the gifted child, since teachers and
school administrators frequently may believe that there is no need for
an evaluation to be conducted (because the child is performing at grade
level). In extreme cases, it may be necessary to seek the assistance of
a special education advocate or attorney in order to convince a school
district of the need for beginning the diagnostic process. Because
evidence indicates that early intervention results in the best
long-term prognosis, it is important to attempt to determine whether
services are warranted when the child is as young as possible.
The
Evaluation Process: Once a
child is
determined to qualify for testing, the evaluation process can begin. It
is often a time consuming and labor intensive process. If the
evaluation is being conducted by the child's school, often the first
step in the process is a screening-- the administration of a battery of
tests that determine whether there appears to be a need for a more
complete diagnostic evaluation to be conducted. Typically a screening
requires no more than three to four hours of total testing time, and
provides an estimate of the child's ability along with measures of the
child's achievement in the relevant areas. If the decision to continue
with a complete diagnostic evaluation is made, and additional five or
more hours of testing will generally be conducted. These tests
typically will provide a more precise measure of the child's ability,
more achievement measures, and a much more detailed look at the
processes underlying learning. Observations of the child's behavior
during testing, an examination of his or her use of strategies in
problem solving situations, and the child's attentional capacity are
also important components of the diagnostic process. Furthermore, one
or both parents will typically be interviewed to provide a detailed
birth, medical, developmental, social, and academic history of the
child. An interview with the child's classroom teacher and observation
of the child in the classroom environment may also be included in the
assessment process. The evaluation process can often take weeks or even
months to complete when conducted within the school setting. Frequently
a child will be tested only for brief periods at a time (e.g., a class
period), meaning that a large number of testing sessions are needed to
complete the process. Despite
the fact that Federal law guarantees
each child the right to a timely evaluation to determine whether there
is a need for services, it is often the case (especially with gifted
children, since their difficulties may be masked by their brightness)
that school personnel are reluctant to initiate the process.
In
this event, parents may need to step in and advocate as strongly as
they can for an evaluation. A reminder to a school psychologist that
Federal law is on the child's side in these matters may be necessary in
order to get the assessment process started. Still, it may be the case
that the district does not agree to conduct an evaluation; in this
case, a parent's only remaining option may be to seek a private
evaluation (at the parent's expense). Private evaluations are
essentially the same as those conducted within the school setting,
except that they can usually be completed in a more timely manner due
to fewer scheduling issues. A number of different types of
professionals conduct learning disabilities evaluations, including
learning disabilities specialists, school psychologists, and clinical
psychologists. These individuals may work in private practice, or in a
university or hospital clinic setting. Be advised that because of the
time-intensive nature, private evaluations are expensive; in the
Chicago area, for example, the cost ranges from about $1000 to well
over $2000 Insurance may pay for all or part of the cost of an
evaluation; it is best to check with the company before beginning the
process because different insurers have varying requirements for
co-payment.
Types
of Learning Disabilities: Learning
disabilities affect anywhere from four to seven percent of school-age
children (in 1995-1996, 5.5% of school children in the United States
received learning disabilities services (U.S. Department of Education,
1998) and can manifest themselves in many different ways. Moreover, the
ways in which a learning disability affects a child often change as the
child progresses through school. This is in part due to the maturing
child changing in the ways they process information and in part due to
the changing demands of the school curriculum. The most common type of
learning disability results in underachievement in reading (typically
decoding), which also frequently results in written language
difficulties (especially in spelling). Other children experience
significant underachievement only in areas requiring mathematical
calculation. Still others experience a combination of reading, writing,
and mathematics difficulties. For some children, difficulties in oral
language (receptive and or expressive) underlie their learning
disability, while some children have intact oral language skills. A
relatively new category of learning disability, nonverbal learning
disabilities, is being increasingly diagnosed. Children with nonverbal
learning disabilities experience difficulties in areas such as motor
skills, visual-spatial orientation, social relationships, organization,
and aspects of mathematics, while they are often quite strong in areas
requiring verbal abilities. Gifted children with learning disabilities
often experience difficulties that are qualitatively different than
those experienced by their non-gifted learning disabled peers. By
virtue of their high level of mental ability, they are often able to
perform surprisingly well on tasks that allow them to utilize this
strength. For example, a gifted child who is experiencing significant
difficulties in decoding while reading may actually be capable of
comprehending what is read deceptively well, since he or she is able to
utilize strong conceptualization and reasoning skills and a rich fund
of general knowledge to make sense out of the material. Unless this
child is asked to read aloud, it might not even be apparent that there
is a problem in the area of decoding. As another example, a gifted
child with significant difficulties in arithmetic computation might
possess good underlying mathematical concepts (e.g., a solid
understanding of place value) and might also be able to apply this
conceptual understanding to a variety of "everyday" mathematical
activities such as time and money concepts, reading charts, tables and
figures, and utilizing good estimation skills. Given that there is a
large emphasis on computational skills (especially in the early
grades), these areas of strength may go largely unrecognized. Often a
learning disability is not "pure", in the sense that it can be neatly
categorized as belonging to a particular category or subtype. Rather,
frequently the manifestations of a child's learning disability include
those typically seen in two or more subtypes. For example, many
children experience underachievement in reading, written language, and
mathematics. Furthermore, in a number of cases, children with learning
disabilities also meet the criteria for additional, co-morbid,
conditions. For example, affective difficulties (e.g., depression),
anxiety, and attention-deficit hyperactivity disorder, among others,
are commonly diagnosed in children with learning disabilities.
What
Are Appropriate Services, and What Can
Parents Do to Assure that Their Children Receive Them: There
are
many potential services that can be provided for children with learning
disabilities. For most children with a diagnosis of learning
disabilities, in-school services are provided one or more times per
week. These services may be offered in a one-on- one manner in the
child's classroom or in a resource room, or they may be administered in
a small group setting. Typically in a small group setting the children
are matched as closely as possible in terms of grade level and the
nature of the disability. In more serious cases, the child may be
placed in a self-contained classroom with other children who are all
experiencing some type of learning or behavior problem. These
self-contained special education classrooms are generally becoming less
common as school districts increasingly attempt to provide services in
the regular classroom (a process known as 'inclusion' or
'mainstreaming'). Some children also receive remedial services from
trained learning disabilities professionals during after-school hours.
In some instances, these after-school services are provided in lieu of
interventions within the school setting. Some parents (and children)
prefer the after- school remediation, feeling that it may reduce the
possible stigma that can accompany leaving the child's regular
classroom for special services. (My own observations suggest that this
fear is often unwarranted, and that most children experience minimal
trauma as a result of leaving the classroom. Keep in mind that most
classrooms have at least a few children who require special education
services of some type). There are also activities that are remedial in
nature that can be provided within the home environment. Among this
type of treatment are a variety of computer software programs that aim
to strengthen deficient processes underlying learning and thus enhance
academic achievement. A variety of other materials are also available,
although generally I advise against a parent trying to serve as a
primary provider of an intervention. Successful professionals in the
field typically have had substantial post-graduate training, and it is
unrealistic for a parent to expect to be able to provide the same
quality of treatment that a professional can. Additionally, I have
witnessed too many instances where the parent-child relationship was
seriously eroded because of stressors introduced as a result of one or
both parents trying to play the role of remediator as well as mother or
father. Be advised that LD services are generally required for an
extended period of time. It is generally unrealistic to expect
significant improvement in achievement to occur as a result of a few
weeks or months of intervention, no matter how appropriate and
intensive this intervention might be. Although high intelligence
generally is associated with a better prognosis for children with
learning disabilities, the remedial process is still a time-consuming
process. Typically diagnostic re-evaluations are conducted every two to
three years to assess the change that has occurred and possibly
identify new areas of remedial emphasis for the future. Communication
is an important aspect of the remedial process. Those individuals who
are working with the child (i.e., the classroom teacher, LD specialist
within the school, private practitioner, and so on) should be in
communication with each other on a regular basis to guarantee that the
services being provided are appropriate and not overlapping to a
significant degree. Parents should be assertive in stating their
expectations regarding services. Keep in mind, special education
services are costly and school districts are typically not eager to
provide such services. Those parents who attend school staffings,
maintain regular contact with school personnel, and indicate that they
will be seeking the services to which they are entitled by law
typically are more successful in receiving the appropriate
interventions for their children. As I mentioned previously, it
behooves parents to be aware of the rights that are guaranteed them
under Federal law. In meeting with parents during conferences, I always
stress the role of parental education. By that I mean that parents
should take it upon themselves to learn as much as they can about the
disabilities that their child possesses. While it is not realistic to
become an expert in the field, there are many books, videotapes, and
other materials available that are oriented towards increasing parents’
understanding of learning disabilities and what can be done to
appropriately service children with learning disabilities. Today, most
national bookstore chains have entire sections devoted to special
education in general and learning disabilities in particular, Many of
these materials are oriented towards laypersons who lack professional
training in the field. Additionally, professional organizations such as
the Learning Disabilities Association of America (LDA) and the
International Dyslexia Society (IDA) offer publications and hold
national and regional meetings, with much of the content aimed at the
parents of children with learning disabilities. There is also an
organization, Parents of Gifted and Talented Learning-Disabled Children
(301-986-1422), that is specifically oriented to provide information to
parents of children who are "doubly exceptional". The Internet also can
be a valuable source of information for many parents, although my
personal experience has been that there is also considerable
misinformation disseminated via the various forums that the Internet
provides. In other words, let the consumer beware when "surfing the
web".
Attention
Deficit Hyperactivity Disorder: Approximately
one-quarter to one-third of all children with learning disabilities
also qualify for the diagnosis of attention deficit hyperactivity
disorder (ADHD). Additionally, ADHD manifests itself in ways that are
often difficult to distinguish from learning disabilities. As a result,
most evaluations for learning disabilities will also include at least a
consideration that ADHD is a viable diagnosis as well. ADHD manifests
itself in several ways; the behaviors most commonly associated with
ADHD include inattention, hyperactivity, and impulsivity. Under the
current conceptualization of the disorder, some children display
primarily hyperactive and impulsive symptoms, while others show mostly
difficulties in focusing and maintaining attention. Still others with
ADHD display a combination of hyperactive/impulsive and inattentive
behaviors. ADHD does not in and of itself result in academic
underachievement. However, like a learning disability, ADHD often
results in children performing at a level that is below that at which
they are capable. One of the hallmarks of the disorder is inconsistency
in performance; that is, a child with ADHD may be able to perform at a
high level on a particular task on one day, yet show a much poorer
level of performance on an essentially identical task shortly
thereafter. As a result of this inconsistent performance, many children
with ADHD are erroneously labeled as unmotivated, lazy or uncaring.
Like children with learning disabilities, many children with ADHD
possess a number of strengths; as with children with learning
disabilities, these strengths often go unrecognized and/or
underappreciated. Moreover, many of the characteristics of children
with ADHD are compatible with giftedness: these children are often
energetic, creative, and excel at tasks requiring divergent thinking.
In fact, there have been suggestions that the high energy level and
high intensity characteristic of gifted children may at times result in
them be inappropriately diagnosed with ADHD, while their giftedness
remains unrecognized. Furthermore, the ways in which ADHD manifests
itself change as a child grows older. Typically, overactive and
impulsive behaviors decrease in frequency with age, while
organizational and time management problems and difficulties related to
social interactions (especially with peers) become more prominent.
Unlike with learning disabilities, a medical intervention for ADHD is
effective in many cases. The most commonly used treatment, stimulant
medication, is effective in reducing symptoms in a large majority of
children who take it. Increasingly, other pharmacological treatments,
including tricyclic antidepressants and antihypertensives, are being
prescribed to children who either do nor respond to psychostimulants or
who have adverse side effects (most commonly insomnia and decreased
appetite) to them. There are also a variety of psychologically based
treatments for ADHD as well. Substantial evidence exists to support the
idea that the combination of a pharmacological and a psychological
intervention provides greater symptom reduction than either type of
treatment alone. Among common psychologically oriented treatments are
behavior modification and metacognitive training. Behavior modification
requires the establishment of a reward system (a 'token economy') to
reinforce desired behaviors (which could range from 'getting homework
done in a timely manner' to 'not interrupting conversations' to
'getting ready for school in the morning without reminders or
assistance'). A well planned token economy is often necessary because
children with ADHD have been found to be less sensitive than their
non-ADHD peers to the typical reinforcement contingencies that are a
part of everyday living. Rather, children with ADHD require
reinforcement that is more powerful, more frequent, and more linked in
time to the desired behavior than do their non-ADHD peers. While many
parents feel that establishing a token economy in the home (or school)
must be a fairly simple matter, my experience has shown quite clearly
that they benefit greatly from the guidance of a trained professional
(e.g., a psychologist or social worker) in establishing, adjusting, and
maintaining such a plan. Metacognitive training is an intervention that
focuses on getting the child to think about and analyze his or her
behavior, with the goal of becoming capable of recognizing problematic
situations and dealing with them in an appropriate manner.
Metacognitive training is particularly well suited to children who are
gifted, since success rates are best with those who are highly
intelligent and possess good verbal skills. Again, there are
professionals who specialize exclusively in this type of intervention.
Summary: As I have
described, children who
are gifted are as likely to have learning disabilities or
attention-deficit hyperactivity disorder as any other children. Due to
some of the characteristics of gifted children (most notably their high
levels of intelligence), however, gifted children often are not
identified as LD or ADHD as accurately or as early in their lives as
their non- gifted peers. Early diagnosis and intervention is important
in reducing the difficulties that gifted children with co-occurring
learning disabilities and/or attention-deficit hyperactivity disorder
experience in their academic, emotional, and social lives. Parents of
children who are gifted need to be aware of the criteria for inclusion
for LD or ADHD and may often be required to strongly advocate for their
children so that they may receive the appropriate special education
services to which they are entitled under Federal law.
References:
Federal Register (1977).
Washington, D. C.: U. S. Government Printing Office. Federal Register
(1997). Washington, D. C.: U. S. Government Printing Office. Lajoie,
S.P., & Shore, B. M. (1981). Three myths? The
over-representation
of the gifted among drop- outs, delinquents and suicides. Gifted Child
Quarterly, 25, 138-141. National Commission on Excellence in Education
(1983). A nation at risk: The imperative for educational reform.
Washington, D. C.: U. S. Government Printing Office. U. S. Department
of Education. (1998) To assure the free appropriate public education of
all children with disabilities. Twentieth Annual Report to Congress on
the Implementation of the Individuals with Disabilities Education Act.
Washington, D.C.: U.S. Government Printing Office. Whitmore, J. R.
(1980) Giftedness, conflict and underachievement. Boston: Allyn and
Bacon.
Dr.
Steven G. Zecker is an
associate
professor in Communication Sciences and Disorders at Northwestern
University in Evanston, Illinois.
--article from
the Center for Talent Development
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