Family doctor

All children are expected to go to school, but not all children are equally capable of learning. The four most common reasons for learning problems are:

• below average intellectual ability
• a specific learning disability, or dyslexia as it is sometimes called
• ADD(Attention Deficit Disorder)
• being male.

In this discussion I will focus primarily on literacy skills - reading and writing - because they are the foundation for most of the learning activities which take place in classrooms.

INTELLECTUAL ABILITY

The concept of intelligence is difficult to define precisely, but there is no doubt that global intellectual ability is correlated with academic achievement. We may not be able to define or measure intelligence precisely, but we are all usually able to identify children whom we describe informally as being "bright", average, or "slow", referring to their perceived intellectual ability. Interestingly, these informal assessments are usually quite accurate, which implies that, whatever intelligence may be, we can usually recognise it when we see it. It is also a fact of common observation that "bright" children are likely to do well academically and make good progress at school, averagely intelligent children will probably perform at an average level, and "slow" children will struggle and need extra help.

Intelligence can be formally assessed using standardised IQ tests, which usually provide an overall IQ score (where the average range is 90 - 110) as well as sub-test scores for various dimensions or facets of intelligence, for example verbal as opposed to nonverbal abilities. IQ tests have been severely criticised in recent decades, in particular on the grounds of cultural bias in their content, but if used sensibly they are still our best estimate of that elusive quality we call intelligence. If your child has learning difficulties and you are not sure about their intellectual level, an IQ test can help to clarify the situation.

The sub-test scores of an IQ test are also used by some practitioners to attempt to analyze and diagnose possible causes for a specific learning disability, as opposed to a global learning problem which may be due to below average intellectual ability.

A child's level of intellectual ability is innate, and cannot be significantly modified.

SPECIFIC LEARNING DISABILITY

Some children have great difficulty learning to read and write despite normal intelligence, and in the absence of any other factor which could conceivably impede their learning, e.g. a sight or hearing problem. Some children who appear to be of at least average intelligence, who come from supportive home backgrounds where reading has been encouraged, who have no sight or hearing problems, and who have received appropriate and skillful teaching, struggle to acquire and retain literacy skills. The simplest and most logical explanation for the difficulties these children experience, is that they have an innate, neurologically-based problem with processing print, despite normal intelligence. In other words, they have a specific learning disability, or dyslexia as it is sometimes called. Dyslexia literally means "difficulty with reading", but in practice it invariably implies a difficulty with writing as well.

Dyslexic children may have an early history of delayed language development. They typically show little interest in pre-academic activities at kindergarten level, and are slow to learn to write their name. Once at school they find it hard to learn the alphabet, to learn letter-sound associations, and to form letters properly when they start to write. Their progress with reading and writing is painfully slow. New skills are acquired only with great effort, and are quickly forgotten if not constantly reinforced. After a year or so, as these children begin to realise that they are falling behind their classmates, reading and writing may come to be seen as aversive and so are avoided, with consequent loss of the learning opportunities which are so badly needed. Self-esteem inevitably suffers, and these normally intelligent children may start to see themselves and talk about themselves as being "dumb".

Experience has shown that dyslexic children do best with a reading and writing program which includes a significant emphasis on phonics, the building blocks of literacy. In recent decades many schools have used what is sometimes called a "whole language" approach to the teaching of reading and writing, which works well for many children but is not helpful for dyslexic children.

Most Western countries have organisations which specialise in the assessment and remediation of specific learning disabilities. For children suspected of being dyslexic, they will carry out detailed assessments of the many psychological functions which are thought to be part of the complex processes of reading and writing, in the hope of being able to identify a deficit or "malfunction" in the system. Unfortunately, even if such a processing deficit can be identified it can't be fixed, but appropriate teaching strategies can help to work around it.

Dyslexic children (who are usually male) need:

• recognition and acceptance of their problem
• assessment of their difficulties with processing print
• a reading and spelling program with an emphasis on phonics
• modification of their classroom program to take their individual needs into account
• extra tuition
• great patience and persistence from everyone involved.

With appropriate teaching and support dyslexic children do make progress, but reading and writing are likely always to be effortful for them. In their senior years at school, reader-writer assistance may be necessary for exams.

ADD(Attention Deficit Disorder) and ADHD(Attention Deficit Hyperactivity Disorder)

About 5% of children (most of them boys) demonstrate a pattern of behaviours in the classroom which includes:

• a high level of physical activity
• restlessness and fidgetiness when made to sit still
• difficulty remaining seated for any length of time
• a short attention span for most classroom activities
• difficulty persisting with written tasks independently
• distractibility
• impulsively disruptive classroom behaviour, e.g. calling out or being silly
• low boredom threshold.

It is likely that a child who consistently and persistently manifests such behaviours has a particular personal style which has come to be known as attention deficit hyperactivity disorder or ADHD. It's a moot point whether this particular pattern of behaviours should be called a "disorder", but there can be no doubt that children with ADHD cause problems for themselves and their teachers in the classroom.

It is obvious that children who are restless, fidgety, inattentive, distractible, and fail to complete tasks, are unlikely to be working to their potential, and will require appropriate behaviour management techniques in order to do so. However, it is an unfortunate fact that a significant number of ADHD children suffer the double blow of also being dyslexic, which makes it very difficult for them to meet the behavioural and learning expectations of their teachers.

Stimulant medication (e.g. ritalin) has been shown to be very effective in treating the behavioural symptoms of ADHD such as restlessness, distractibility, and impulsiveness, but it cannot help with associated dyslexia, other than to provide children with the opportunity to focus better on their learning.

ADD and ADHD-some points of difference

The terms ADHD and ADD are often used interchangeably, but they are in fact two recognisably different conditions. Children who have attention deficit disorder without hyperactivity, i.e. ADD, tend to be vague, daydreamy, distractible, forgetful, somewhat restless, and have difficulty following instructions. They are not hyperactive and not intrusively disruptive like children with ADHD, but require extra input and patience from their teachers to help them follow instructions and remain on task. Children with ADD need monitoring to ensure that they have taken instructions on board accurately, may also need written prompts and reminders, and can benefit from having tasks broken into chunks to help with task completion.

BEING MALE

While the majority of boys perform to expectation in the classroom, it is a fact that boys are more likely than girls to have learning difficulties or to achieve at a level below their apparent potential. This is partly because boys are more likely than girls to be dyslexic or have ADHD, but also because there is a noticeable tendency for some boys simply to be less interested in the language and literacy focus of most classroom activities. These boys are much more interested in sport or practical, hands-on activities, and they become increasingly bored with school, particularly from about Year 10 on. They become reluctant students except for technical subjects and physical education, and are keen to leave school as soon as possible. In this case, the problem is not theirs, but is due to the fact that the education system does not suit their talents and interests.