11/13/07

Learning Disabilities (LD):

Learning disabilities are diagnosed when there are significant discrepancies between a child's potential and her/his performance in certain circumscribed areas.  Everybody is relatively better at some things than at others, but it gets labeled as a learning disability when there is a great discrepancy in level of functioning. 

Sometimes the LD is mild,  and may not require remediation.  Other times it is more severe, and is interfering with your child's academic performance.  In this case, your child may need academic supports, remediation, and/or instructional or testing accommodations.  I can guide you through getting all of these.  Although every child's needs are different and need to be addressed by a psychologist and education specialist, you may find these websites informative for getting basic information.

Dyslexia:

Dyslexia is a very common learning disability, which is diagnosed when a child tends to reverse letters, mix up similar looking letters or words (such as "b" and "d", or "g" and "q", or words like "dog" and "god"), or spell words in a jumbled order.  All of these mistakes are normal in younger children.  Thus while a younger child who makes a lot of reversals can and should be followed carefully in case she/he is on the way to developing dyslexia, it cannot be formally diagnosed until the child is over age seven.  For more information these website are often helpful to parents.

Auditory Processing Problems:

An auditory processing problem (sometimes referred to as CAPD or Central Auditory Processing Disorder) is diagnosed when a child has normal hearing but has difficulty making sense of what he/she hears.  Most frequently, kids with an auditory processing problem have trouble discriminating between similar sounds, or have trouble understanding what they hear when there is a lot of noise in the background.  Children with auditory processing problems may have other receptive or expressive language problems as well.  If your child appears to have an auditory processing problem, she/he will need further specialized evaluation by a speech and language pathologist and an audiologist.  To find out more about this problem, you might want to review these websites.

Visual Processing Problems:

Visual processing problems are a disorder of the central nervous system that leads people to misinterpret what they see, despite normal vision.  They may have dyslexia, and reverse letters, numbers, or words.  They may also have dysgraphia (problems with writing).  Children with visual processing problems are often distracted or confused by conflicting images on the page, or by a room which has lots of things in it.  They may have difficulty organizing their schoolwork neatly on the page, as well.  These websites provide an introduction to the condition:

Visual-Spatial Relations, Motor Delays (Apraxia), and Dysgraphia:

Sometimes children have difficulty in understanding their position in space.  They may also have difficulty with handwriting (and perhaps spelling).  They may seem clumsy or awkward, although they aren't always.  They may walk into walls, knock into furniture, or produce written schoolwork that is very jumbled and disorganized.  Their drawings may run off the page, or run into each other.  They may have trouble with sports, particularly those that require eye-hand or eye-foot coordination (such as soccer or baseball).  Sometimes the problems seem to be primarily motor-based, other times they seem to have a strong visual-spatial component.  Some people think that these problems originate in part in the child's inability to use his/her eyes properly, and that vision training can help with this problem.  Other people disagree with this theory.  Children with apraxia or dysgraphia are often referred to an Occupational Therapist (OT) for treatment.  The following websites may be useful to you:

Attention Deficit Hyperactivity Disorder (ADHD):

Some children have ADHD, either with or without a learning disability.  This disorder always needs to be diagnosed in the context of the child's age, as younger children are expected to be more physically active and impulsive than older children.  ADHD consists of three main forms:  hyperactive-impulsive, inattentive, and a combined form with characteristics of both.

Children with the hyperactive or combined forms are often the most easily diagnosed, because their activity level is unusually high.  However, it is important to differentiate between a child who has high energy but does not have ADHD and one who is hyperactive.

Children with the inattentive type of ADHD are often not diagnosed until they are older, because they rarely present behavior problems.  However, they may seem distractible or unmotivated.  They forget or lose things a lot, and tend to pay poor attention to the adults around them.  If they are bright, they may do very well in the lower school grades, but begin to struggle as the work gets more complex.

it's important to differentiate carefully between ADHD, processing or language problems, and oppositional behavior.  All three can look very similar to a school or parent.  You may find these website helpful.

Pervasive Developmental Disorder (PDD):

Children diagnosed with PDD, also knows as Autism Spectrum Disorder, typically have impairment in a number of areas.  They are often delayed in their language acquisition, may exhibit a fondness for routinized activities, are easily thrown off by transitions, and may appear withdrawn or unrelated, with poor eye contact.  They may also have poor motor skills.  However, some children with PDD are socially inappropriate in the opposite direction, and may be overly friendly to everyone, even relative strangers.  Most children with PDD are rather concrete, and have difficulty with symbolization and abstract reasoning.

Although the stereotype of an autistic child is of somebody who rocks, flicks, doesn't talk, and has wordless tantrums (and these kind of children certainly exist), PDD is a spectrum disorder.  This means that there are many high-functioning children with PDD, as well as the lower-functioning ones that fit the stereotype.   High-functioning children may be concrete and quirky, and may excel at things like computers.  They may be able to function in a general education setting, perhaps with some academic supports.  These higher functioning children are often not diagnosed until they are older.  The causes and appropriate treatment of PDD remain controversial.

Asperger's:

Asperger's is a particular form of PDD.  A child is diagnosed with Asperger's if he/she meets the diagnostic requirements for PDD, but has relatively intact language.  These children often seem relatively normal, except that they are somewhat socially awkward and "geeky."  They may have a narrow, intense set of interests.  They sometimes come across like "little professors," at least in their area of interest.  Thus they may not be diagnosed until they are older.

Sensory Integration Disorder (SID):

Children with sensory integration disorders have difficulty processing sensory input (the syndrome is sometimes called sensory processing disorder).  They are often over- or under-sensitive to environmental stimuli.  They may react strongly to the texture of clothing, the taste or texture of foods, etc. 

SID remains a somewhat controversial diagnosis because many children with sensory integration disorders also have an autism spectrum disorder or other problem such as ADHD or LD. Some people see the sensory problems as a symptom of the other problem, while others see it as a separate syndrome. 

Occupational therapists have pioneered the description of SID.  However, the differential diagnosis of these conditions can be difficult since it does frequently occur as a symptom of another condition.  If I suspect your child has a sensory integration disorder that is not part of another condition, I will refer you to an occupational therapist (OT) for further assessment and treatment.

Emotional Problems:

Like adults, children and teens can have emotional problems that interfere with their good functioning, or leave them unhappy or stressed.  There are many possible causes of these problems.  Frequently, they are reactive.  Your child may be struggling with other problems (such as learning disabilities or ADHD) that can adversely affect his/her self-esteem.  Or, your family may be addressing difficult issues--divorce, a major illness in one member, a recent death, a move to another city, an unwelcome change of school, etc. No matter how good a job you are doing in helping your child cope, he/she can often benefit from some therapy to help her/him over the hump in dealing with these issues.  Other times, your child is adopted and had a difficult history before coming to live with you.

On the other hand, children sometimes seem to have problems that have a life of their own.  They seem sad, or anxious, no matter what is going on or how well their life seems to be going.  They may be angry much of the time, or irritable, or moody.  Their mood may stabilize for a while, but then it deteriorates again.

Sometimes these problems run in families.  One of the parents may also struggle with depression, irritability, or anxiety.  Often, this means that they are particularly well-attuned to their child's struggles and act quickly to get their child evaluated and get them the help they need.

Anxiety:

Anxiety needs to be assessed in the context of the child's age.  Younger children have certain developmentally predictable fears.  Kids around nine months old often have stranger anxiety, while 1 1/2 year olds are often separation anxious.  Four year olds frequently have nightmares and many fears.  Teenagers often worry about whether they will appeal romantically to others, or about the college admission process.

However, if your child has more anxiety than is typical of child of his/her age then further assessment and intervention is needed.  The recommended treatment of anxiety remains controversial.  Some people suggest modifying the child's environment; others suggest psychotherapy.  Still others believe that medication is the best course of treatment.  Many practitioners recommend a combination of strategies.

If I feel that anxiety is contributing to your child's problems, I'll discuss treatment options with you and make recommendations for what I believe will most benefit your child and his/her particular situation.  In addition, you may find these websites helpful.

Depression:

Childhood depression looks different at different ages.  Young children who are depressed are frequently angry, irritable, and misbehave.  They may have sleep disturbances, or appear hyperactive.  Depression in older children and teens more closely resembles adult depression.  Their mood is down, they may have appetite disturbances (gaining or losing weight), and may over- or under-sleep.  They may avoid previously enjoyed activities or people.  Depression, particularly in older children or teens, can be an emergency as it carries with it a higher risk of suicide.

Like with anxiety, the treatment of depression is controversial.  Various practitioners recommend some mixture of psychotherapy, medication, and environmental modifications.  Again, if I feel that your child is depressed we will talk carefully about the various options that are available to you.  You may want to look at these websites, as well.

Oppositional Behavior:

Like all childhood behavior, "bad" behavior has to be evaluated in a developmental context.  It is well known that children of certain ages--particularly toddlers and teens--are especially defiant and oppositional.  At the same time, oppositional behavior that reflects a fundamental disregard of others rights, or that becomes excessively physical or puts the child or others in danger, represents a mental health problem.  This angry behavior can be reactive, or it may reflect a more serious underlying problem.  If your child is oppositional and defiant, you'll know it.  What you may not be as sure about is whether this behavior is of concern or not.

Oppositional behavior often co-occurs with other problems such as ADHD.  It can also be misdiagnosed, if the child has problems such as a receptive language problem or other learning disability.  Oppositional behavior is often addressed through a combination of environmental manipulations, psychotherapy, and perhaps medication.  The following websites may offer you some useful introductory information.

Bipolar Disorder:

Bipolar disorders, characterized by vacillation between depression and mania or agitation, or by a tendency to become manic (without a tendency toward depression) were originally thought to occur only in adults.  More recently, the diagnosis has been extended downward to include children and teens.  The exact diagnostic criteria for pediatric bipolar disorder remain fluid.  However, virtually everyone agrees that bipolar disorders have a strong biochemical and genetic component, and run in families.  Although some people think that the diagnosis has been over-used in children, it is important to get a good diagnosis of your child's problems.

Clearly, there is a certain kind of moody child who sinks into depressions or flies into rages with relatively little provocation.  These children have difficulty in calming themselves once they "lose it," and can briefly seem very irrational.  Most people agree that people with bipolar disorders often benefit from taking mood stabilizers; psychotherapy is an important adjunct to that treatment.   If your child does have a bipolar disorder, early treatment can help keep the disease from progressing.  Websites that may be of interest include:

Trauma, PTSD (Post-Traumatic Stress Disorder), and RAD (Reactive Attachment Disorder):

Some children have been exposed to traumatic events or losses which have an enduring impact on them.  They may be adopted, and their experiences prior to the adoption were difficult.  Or, an unfortunate event may have impacted on the family.  The source of these traumas is very variable.  It may include circumstances as widely varied as a traffic accident, the death of a parent or sibling, frightening surgery or medical treatments at an early age, a horrific fire, or witnessing a frightening crime.

Children who have had these sorts of experiences are often left with a number of symptoms.  Their behavior may be poor, or they may fly into rages easily.  They may be fearful, have intrusive thoughts or images, or be emotionally numb.  They may have bad dreams.  They may be clingy, or have difficulty in attaching.  They may be fine most of the time, but become terrified or enraged in certain evocative situations (such as a trip to the doctor, exposure to mildly sexual behavior, or a visit to a restaurant that reminds them of their family or country of origin).

If your child has experienced trauma, you are likely aware of this.  However, there is a great deal that you can do to help your child heal and recover.  Psychotherapy is very important; medication and environmental manipulation may also be useful.

While there are a broad range of diagnoses that get applied to children who have endured trauma, these websites discuss some of the major ones.

Summary:

There is a wealth of information out there, in books and on websites.  There are many support groups for parents, and in some cases for children.  There are chat rooms, message boards, and blogs.  It is my hope that the links I've provided will give you a toehold to get started.  If you want further information, please Contact Me.

In addition, please remember that while it is important to take care of your child's special needs, it is also important that you not ignore your own needs or those of your spouse or other children.  Your family is embarking on a long venture, but it can be rewarding and fulfilling.