Developmental Disorders and Learning Disabilities

Children’s cognitive and social skills are evaluated as they enter and progress through school. Sometimes this evaluation indicates that a child needs special assistance with language or in learning how to interact with others. Evaluation and diagnosis of a child can be the first step in helping to provide that child with the type of instruction and resources needed. But diagnosis and labeling also have social implications. It is important to consider that children can be misdiagnosed and that once a child has received a diagnostic label, the child, teachers, and family members may tend to interpret the actions of the child through that label. The label can also influence the child’s self-concept. Consider, for example, a child who is misdiagnosed as learning disabled. That child may expect to have difficulties in school, lack confidence, and out of these expectations, have trouble indeed. This self-fulfilling prophecy, or tendency to act in such a way as to make what you predict will happen, comes true, calls our attention to the power that labels can have whether or not they are accurately applied.

It is also important to consider that children’s difficulties can change over time; a child who has problems in school may improve later or may live under circumstances as an adult where the problem (such as a delay in math skills or reading skills) is no longer relevant. That person, however, will still have a label as learning disabled. It should be recognized that the distinction between abnormal and normal behavior is not always clear; some abnormal behavior in children is fairly common. Misdiagnosis may be more of a concern when evaluating learning difficulties than in cases of autism spectrum disorder where unusual behaviors are clear and consistent.

Keeping these cautionary considerations in mind, let’s turn our attention to some developmental and learning difficulties.

Autism Spectrum Disorders

Autism spectrum disorder (ASD) is a developmental disorder that affects communication and behavior. The estimate published by the Center for Disease Control (2018)[ is that about 1 out of every 59 children in the United States has been diagnosed with Autism Spectrum Disorder (ASD), which covers a wide variety of ranges in ability, from those with milder forms (formerly known as Asperger’s Syndrome) to more severe deficits in communication.

A person with autism has difficulty with and a lack of interest in learning language. An autistic child may respond to a question by repeating the question or might rarely speak. Sometimes autistic children learn more difficult words before simple words or can complete complicated tasks before they can complete easier ones. The person often has difficulty reading social cues such as the meanings of non-verbal gestures such as a wave of the hand or the emotion associated with a frown. Intense sensitivity to touch or visual stimulation may also be experienced. Autistic children often have poor social skills and cannot communicate with or empathize with others emotionally. People with autism often view the world differently and learn differently than people who do not have autism. Autistic children tend to prefer routines and patterns and become upset when routines are altered. For example, moving the furniture or changing the daily schedule can be very upsetting.

Many children with ASD are not identified until they reach school age, although our ability to diagnose children earlier continues to improve. In the 2017-2018 school year, about 710,000 children on the spectrum received special education through the public schools. These disorders are found in all racial and ethnic groups and are more common in boys than in girls. All these disorders are marked by difficulty in social interactions, problems in various areas of communication, and difficulty altering patterns or daily routines. There is no single cause of ASD and the causes of these disorders are to a large extent, unknown. In cases involving identical twins, if one twin has autism, the other is also autistic about 75 percent of the time. Rubella, fragile X syndrome and PKU that have been untreated are some of the medical conditions associated with risks of autism.

Some individuals benefit from medications that alleviate some of the symptoms of ASD, but the most effective treatments involve behavioral intervention and teaching techniques used to promote the development of language and social skills. Children also excel when they are in structured learning environments that accommodate the needs of children on the spectrum.

Impaired Theory of Mind in Individuals with Autism

People with autism or an autism spectrum disorder (ASD) typically show an impaired ability to recognize other people’s minds. Under the DSM-5, autism is characterized by persistent deficits in social communication and interaction across multiple contexts and restricted, repetitive patterns of behavior, interests, or activities. These deficits are present in early childhood, typically before age three, and lead to clinically significant functional impairment. Symptoms may include lack of social or emotional reciprocity, stereotyped and repetitive use of language or idiosyncratic language, and persistent preoccupation with unusual objects.

About half of parents of children with ASD notice their child’s unusual behaviors by age 18 months, and about four-fifths notice by age 24 months, but often a diagnosis comes later, and individual cases vary significantly. Typical early signs of autism include:

• No babbling by 12 months.
• No gesturing (pointing, waving, etc.) by 12 months.
• No single words by 16 months.
• No two-word (spontaneous, not just echolalic) phrases by 24 months.
• Loss of any language or social skills, at any age.

Children with ASD experience difficulties explaining and predicting other people’s behavior, leading to problems in social communication and interaction. Children who are diagnosed with an autistic spectrum disorder usually develop the theory of mind more slowly than other children and continue to have difficulties with it throughout their lives.

The Sally-Anne test is performed to test whether someone lacks the theory of mind. The child sees the following story: Sally and Anne are playing. Sally puts her ball into a basket and leaves the room. While Sally is gone, Anne moves the ball from the basket to the box. Now Sally returns. The question is: where will Sally look for her ball? The test is passed if the child correctly assumes that Sally will look in the basket. The test is failed if the child thinks that Sally will look in the box. Children younger than four and older children with autism will generally say that Sally will look in the box.

Learning Disabilities

What is a learning disability? If a child is mentally disabled, that child is typically slow in all areas of learning. However, a child with a learning disability has problems in a specific area or with a specific task or type of activity related to education. A learning difficulty refers to a deficit in a child’s ability to perform an expected academic skill (Berger, 2005). These difficulties are identified in school because this is when children’s academic abilities are being tested, compared, and measured. Consequently, once academic testing is no longer essential in that person’s life (as when they are working rather than going to school) these disabilities may no longer be noticed or relevant, depending on the person’s job and the extent of the disability.

Dyslexia is a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. Dyslexia is one of the most commonly diagnosed disabilities and involves having difficulty in the area of reading. This diagnosis is used for a number of reading difficulties. For example, the child may reverse letters, have difficulty reading from left to right, or have problems associating letters with sounds. Dyslexia appears to be rooted in some neurological problems involving the parts of the brain active in recognizing letters, verbally responding, or being able to manipulate sounds (National Institute of Neurological Disorders and Stroke, 2006). Treatment typically involves altering teaching methods to accommodate the person’s particular problematic area.

Attention Deficit Hyperactivity Disorder (ADHD) is considered a neurological and behavioral disorder in which a person has difficulty staying on task, screening out distractions, and inhibiting behavioral outbursts. The most commonly recommended treatment involves the use of medication, structuring the classroom environment to keep distractions at a minimum, tutoring, and teaching parents how to set limits and encourage age-appropriate behavior (NINDS, 2006). Some people say that the term Attention Deficit is a misnomer because people who suffer from ADHD actually have great difficulty tuning things out. They are bombarded with information… their brains are trying to pay attention to everything. They do not have a deficit of attention- they are trying to pay attention to too many things at once, so everything suffers.

Recent research suggests that several brain structures may be implicated in ADHD. These studies have mainly focused on the frontal lobe and prefrontal cortex. Some studies suggest that the frontal lobe is underdeveloped in children and adults with ADHD. The frontal lobe is involved in executive function, attention, planning, impulse control, motivation, and decision-making. In some cases the development is delayed, but catches up to expected standards by adulthood; in other cases, the frontal lobe never fully develops.

In general, ADHD is treated with stimulants. While this may seem counter-intuitive (why give a hyperactive child a stimulant?), it makes a lot of sense when you understand the neurological processes involved. There are two ways that stimulants may work to help people with ADHD focus. Some researchers have found that the stimulants activate the underdeveloped parts of the brain (prefrontal cortex and frontal lobe) thereby making these brain areas function more as they should. This allows the child or adult to focus properly. Other researchers suspect that the stimulants affect the way the neurotransmitters function in these brain areas, leading to better function in those areas.

There is still a lot of controversy about medicating children with ADHD. While there is clear evidence that medication works to control the negative effects of ADHD, there are also negative side effects that must be dealt with including problems sleeping, changes in appetite, headaches, and more. Further, the long term effects of medicating young children are not well understood. For these reasons, many parents prefer an intervention that does not involve medication. The most common non-pharmaceutical intervention for ADHD is Cognitive Behavioral Therapy (CBT). CBT works by helping children to become aware of their thought processes, and then to learn to change those thought processes to be more beneficial or positive. CBT can also help by educating parents about ways to help their children learn about self-control and discipline. There is good evidence that CBT is effective in treating ADHD. Indeed, in some studies, children treated with CBT have better long-term outcomes than children treated with medication. Some studies show that a combination of medication and CBT is most beneficial because the medication helps with behavior change more quickly, allowing for the child to learn through CBT more quickly. The CBT then helps with longer-term behavior change so that the child can stop taking medications and deal effectively with their ADHD symptoms based on what they have learned through CBT.

Learning and Intelligence

Schools and Testing

When Should School Begin?

Children in the United States begin school around age 5 or 6. In fact, most Western countries follow this model. But WHY do we begin school at 5 or 6? For the most part, this age was chosen as a matter of convenience. In countries where the mother is expected to work, the age at which children begin school tends to be younger. That said, research does not support that children should begin formal education so early. Many research studies suggest age 7 is the most appropriate age to begin formalized school. Before age 7, children learn best through play. By age 7, most children can learn in a more formal academic-forward setting.

The Controversy Over Testing In Schools

Children’s academic performance is often measured with the use of standardized tests. Achievement tests are used to measure what a child has already learned. Achievement tests are often used as measures of teaching effectiveness within a school setting and as a method to make schools that receive tax dollars (such as public schools, charter schools, and private schools that receive vouchers) accountable to the government for their performance. In 2001, President George W. Bush signed into effect the No Child Left Behind Act mandating that schools administer achievement tests to students and publish those results so that parents have an idea of their children’s performance and the government has information on the gaps in educational achievement between children from various social class, racial, and ethnic groups. Schools that show significant gaps in these levels of performance are to work toward narrowing these gaps. Educators have criticized the policy for focusing too much on testing as the only indication of performance levels.

Aptitude tests are designed to measure a student’s ability to learn or to determine if a person has potential in a particular program. These are often used at the beginning of a course of study or as part of college entrance requirements. The Scholastic Aptitude Test (SAT) and Preliminary Scholastic Aptitude Test (PSAT) are perhaps the most familiar aptitude tests to students in grades 6 and above. Learning test-taking skills and preparing for SATs has become part of the training that some students in these grades receive as part of their pre-college preparation. Other aptitude tests include the MCAT (Medical College Admission Test), the LSAT (Law School Admission Test), and the GRE (Graduate Record Examination). Intelligence tests are also a form of aptitude tests that are designed to measure a person’s ability to learn.

The World of School

Remember Urie Bronfenbrenner’s ecological systems model we learned about when we first examined theories of development? This model helps us understand an individual by examining the contexts in which the person lives and the direct and indirect influences on that person’s life. School becomes a very important component of children’s lives during middle childhood and one way to understand children is to look at the world of school. We have discussed educational policies that impact the curriculum in schools above. Now let’s focus on the school experience from the standpoint of the student, the teacher and parent relationship, and the cultural messages or hidden curriculum taught in school in the United States.

Parents vary in their level of involvement with their children’s schools. Teachers often complain that they have difficulty getting parents to participate in their child’s education and devise a variety of techniques to keep parents in touch with daily and overall progress. For example, parents may be required to sign a behavior chart each evening to be returned to school or may be given information about the school’s events through websites and newsletters. There are other factors that need to be considered when looking at parental involvement. To explore these, first ask yourself if all parents who enter the school with concerns about their child are received in the same way? If not, what would make a teacher or principal more likely to consider the parent’s concerns? What would make this less likely?

Lareau and Horvat (2004) found that teachers seek a particular type of involvement from particular types of parents. While teachers thought they were open and neutral in their responses to parental involvement, in reality, teachers were most receptive to support, praise, and agreement coming from parents who were most similar in race and social class with the teachers. Parents who criticized the school or its policies were less likely to be given a voice. Parents who have higher levels of income, occupational status, and other qualities favored in society have family capital. This is a form of power that can be used to improve a child’s education. Parents who do not have these qualities may find it more difficult to be effectively involved.

Student Perspectives

Imagine being a 3rd-grader for one day in public school. What would the daily routine involve? To what extent would the institution dictate the day’s activities and how much of the day would you spend on those activities? Would you always be on task? What would you say if someone asked you how your day went? or “What happened in school today?” Chances are, you would be more inclined to talk about whom you sat at lunch with or who brought a puppy to class than to describe how fractions are added.

McLaren (1999) describes the student’s typical day as filled with a constrictive and unnecessary ritual that damages the desire to learn. Students move between various states as they negotiate the demands of the school system and their own personal interests. The majority of the day (298 minutes) takes place in the student state. In this state, the student focuses on a task or tries to stay focused on a task, is passive, compliant, and often frustrated. Long pauses before getting out the next book or finding materials sometimes indicate that frustration. The street corner state is one in which the child is playful, energetic, excited, and expresses personal opinions, feelings, and beliefs. About 66 minutes a day take place in this state. Children try to maximize this by going slowly to assemblies or when getting a hall pass-always eager to say ‘hello’ to a friend or to wave if one of their classmates is in another room. This is the state in which friends talk and play. In fact, teachers sometimes reward students with opportunities to move freely or to talk or to be themselves. But when students initiate the street corner state on their own, they risk losing recess time, getting extra homework, or being ridiculed in front of their peers. The home state occurs when parents or siblings visit the school. Children in this state may enjoy special privileges such as going home early or being exempt from certain school rules in the mother’s presence, or it can be difficult if the parent is there to discuss trouble at school with a staff member. The sanctity state is a time in which the child is contemplative, quiet, or prayerful. Typically the sanctity state is a very brief part of the day.

Cultural Influences

Another way to examine the world of school is to look at the cultural values, concepts, behaviors, and roles that are part of the school experience but are not part of the formal curriculum. These are part of the hidden curriculum but are nevertheless very powerful messages. The hidden curriculum includes ideas of patriotism, gender roles, the ranking of occupations and classes, competition, and other values. Teachers, counselors, and other students specify and make known what is considered appropriate for girls and boys. The gender curriculum continues into high school, college, and professional school. Students learn a ranking system of occupations and social classes as well. Students in gifted programs or those moving toward college preparation classes may be viewed as superior to those who are receiving tutoring.

Gracy (2004) suggests that cultural training occurs early. Kindergarten is an “academic boot camp” in which students are prepared for their future student role-that of complying with an adult imposed structure and routine designed to produce docile, obedient, children who do not question meaningless tasks that will become so much of their future lives as students. A typical day is filled with structure, ritual, and routine that allows for little creativity or direct, hands-on contact. “Kindergarten, therefore, can be seen as preparing children not only for participation in the bureaucratic organization of large modern school systems but also for the large-scale occupational bureaucracies of modern society.” (Gracy, 2004, p. 148)

Emphasizing math and reading in preschool and kindergarten classes is becoming more common in some school districts. It is not without controversy, however. Some suggest that emphasis is warranted in order to help students learn math and reading skills that will be needed throughout school and in the world of work. This will also help school districts improve their accountability through test performance. Others argue that learning is becoming too structured to be enjoyable or effective and that students are being taught only to focus on performance and test-taking. Students learn student incivility or lack of sincere concern for politeness and consideration of others is taught in kindergarten through 12th grades through the “what is on the test” mentality modeled by teachers. Students are taught to accept routinized, meaningless information in order to perform well on tests. And they are experiencing the stress felt by teachers and school districts focused on test scores and taught that their worth comes from their test scores. Genuine interest, an appreciation of the process of learning, and valuing others are important components of success in the workplace that are not part of the hidden curriculum in today’s schools.

Until middle childhood, the development process isn’t usually as structured as it is during middle childhood when children enter the formal education setting. Children in school are taught new ways of thinking about things that they already know—they learn why they structure sentences the way they do, and they learn new words not through hearing them from others but from lists provided by teachers or determined by committees. They are even taught how to play sports in specific ways with explicit rules that they get tested on in written form. This is quite a departure from the organic learning of younger years.

Learning in this new way is difficult for some children who have never had to sit down for formal instruction. Structured learning can also shed light on learning difficulties and learning disabilities. Educators today are trained to recognize the signs of many learning disabilities so that children can get help early on in their academic careers.

Developing social relationships in the school environment and keeping up with the changing relationships at home can be difficult tasks for children during middle childhood. Children begin the period relatively dependent on their parents. By the end of the period, children should be able to act autonomously in terms of decision-making and caring for themselves. This change may feel quick to parents, and it can be difficult for them to let go of control and to allow the child to make more decisions. In order for the child to continue healthy development, though, that gradual letting go is necessary. Parents should pay close attention to their children to recognize signs that the child can take on new responsibilities. This will help the child continue developing their skills, sense of self, sense of place in the family, and sense of place in the greater community.