Ask Dr. Silver
The following are past questions and answers from Dr. Larry Silver on this topic.
When is the earliest that a child should be assessed for a learning disability?
I have a 4-and-a-half-year-old son. I have recently been through two assessments with a pediatrician. One says says he has learning difficulties and the other says he comes somewhere under the Austism Spectrum Disorder. I think there is a possibility of dyslexia. Could you advise me what the minimum age of a child is to assess for dyslexia?
Marisa
The earliest clues of a possible learning disability might be noticed in preschool. Formal testing often is not done until first grade.
(May 2008)
How can we get our procrastinating child to finish her projects?
Our 16-year-old daughter was diagnosed in 3rd grade with a learning disability. Her full scale IQ is 105, with her verbal being 25 points higher then her performance scores. She uses a ritalin patch for ADD. Our frustration with her is that she often procrastinates to the point where she gets totally overwhelmed. Her work ethic is not good at all. She hates school and honestly could be doing much better.
One example of this: she has a 23% in her photography elective class. The teacher said she takes amazing photos, but never finishes her projects! Any suggestions? We are having to nag her constantly, and she often tells us her work is all caught up when it isn't.
I hear that your daughter has a learning disability and that this disability was noted since third grade. Has she received special education services? These problems do not go away but change over time. Has she been tested recently? She might have problems now with reading and retaining what she has read or with organizing her thoughts when she has to write an answer or paper.
You also note the use of Ritalin. This medication is used for ADHD but will not impact on any learning disabilities. Before you continue to “blame the victim,” seeing her as lazy, unmotivated, or procrastinating, be sure that the school and you have not clarified if she continues to have learning disabilities. My bet is that current testing will show that she does and that these disabilities are what is frustrating her. Please, don’t continue to be frustrated. She is even more frustrated. Find out why she is struggling.
(January 2008)
Is first grade too early to request an LD evaluation?
Is first grade too early to request an LD evaluation? My child is completely inept at reading and spelling. He writes letters backwards and struggles with some three letter words. He also has a speech issue that is currently being addressed.
Most school systems will not evaluate a child until the end of third grade. However, if you are concerned, and especially if there is a family history of LD, you should push for an assessment. If the school will not do it, have a psycho-educational evaluation completed privately.
(December 2007)
Would testing for ADHD help a six-year old with behavioral and academic problems?
My 6-year-old son is in first grade and is having difficulty learning his spelling words and math concepts. He has speech delays, difficulty processing and trouble following directions. He was in first steps and an early childhood program. He went through a battery of tests at age 2-and-a-half and was seen by a developmental specialist but has no specific diagnosis. He has behavioral problems and angry outbursts but is usually corrected with time out.
At school, his teacher says he has trouble focusing and staying on task. He laughs or smiles when corrected and pounds on his desk. On the bus, he changes seats while the bus is moving and sits on the back of the seat. His sleep is a concern.
He gets up in the early morning around 4:00-5:00 am and has ever since he was 18 months old. He had a sleep study and had his tonsils and adenoids taken out, but it didn't help. He has his own internal clock and he is up several hours before school starts, making him exhausted before his 8:30 pm bedtime. I wonder if testing him for attention deficit disorder would be helpful.
Terri
Your descriptions of your son suggest that he has a language-based Learning Disability and possibly a receptive/expressive Language Disability. He also sounds as if he has ADHD.
You need to start with your family physician to explore for ADHD. You need to meet with the principal of your school to discuss the need for a comprehensive assessment to explore for the other diagnoses. If your school refuses to do this (and many do until the end of third grade), you may need to have the studies done privately and then take them back to the school. I share your concerns. You do need to act now.
(December 2007)
What does a parent do when more than one of their children might have LD?
I have a three sons aged nine, six, and four. Our oldest was having difficulty keeping up with his class. Since kindergarten, he was always categorized as being a little behind. His teachers said it was due to our multi-language home environment.
His new fourth grade teacher is saying that he is reading at a second grade level and that there is a possibility he might be held back. Because of this, I started spending lot of time working on his reading, but as I was doing this, I noticed his younger brother, who is six years old, has better comprehension of the story and can respond faster and correctly to my questions. So many times he stared at me with a blank look because he didn't understand my questions and didn't know how to answer me.
I have a feeling my oldest son might have auditory processing disorder. He passed his school's hearing test. He is really a kind and gentle boy who can't seem to make friends even though he tries so hard. He can't seem to get the right words to express himself unlike his brothers. He wants to be accepted by his schoolmates and tries to join in their conversations, but it's either out of context or inappropiate, which is keeping him from making friends. This is really hurting his self esteem and is making him more aggressive towards his brothers.
How can I find out if I'm right or wrong about my feeling and how can I get the school's help? I'm learning that LD runs in the family; can my other boys have LD as well? I'm starting to notice that my six-year-old might have ADHD and my four-year-old has a speech problem. How can I get them evaluated if there is no sign of academic problems? I don't want to wait and have them be in the same position as their older brother. I am so grateful for your website because I know I'm not alone.
Janice
First, let's discuss your nine-year-old. He is in the fourth grade and reading at the second grade level. This means he is still struggling with decoding words and has not yet solidly moved to reading comprehension. You did not mention it, but I suspect he has difficulties writing his words correctly and with spelling. You also describe him as having difficulty processing what he hears and difficulty organizing his thoughts in order to respond verbally. These behaviors suggest a possible receptive/expressive language disability.
These are two excellent reasons for his school professionals to not focus on keeping him back but focus on why he is behind. Comprehensive psycho-educational and speech-language evaluations are essential. The results will help to clarify his problems and what needs to be done to help. (What Do You Do If You Suspect Your Child Has a Learning Disability?)
Now, for your other children. LD has a strong familial pattern. If LD runs in your family and we suspect that your nine-year-old has LD, it would be wise to watch the other children carefully and to seek help as soon as you become concerned. Take a look at LD Basics on LD Online to find out more.
(December 2007)
Can a child read well and still be dyslexic?
Is it possible for a child to be able to read at or slightly above grade level, but still have dyslexia? My nine-year-old son does fine in reading (he did have two years of Title 1 reading assistance), but has difficulty spelling and has handwriting that is often illegible.
Dyslexia is a name used for a specific type of learning disability, a language-based reading disability. Don’t focus on the label. If he is nine and still struggling with spelling and handwriting, you should ask your school special education specialist or a private specialist to assess and find out why.
(November 2007)
Does my son have non-verbal learning disabilities?
My son, who is now 15, has just been diagnosed with non-verbal learning disabilities (NVLD). He has been on an IEP since the age of three, due to speech apraxia, and later for LD, which affected his math, reading, and writing skills. He also has a diagnosis of ADHD and is on Concerta 54 mg a day.
I have read up on the NVLD and he does exhibit most of the signs of this disorder, as well as for his other diagnosis. My question is can he have learning disabilities that are both verbal and nonverbal and what can I do to help him? About two years ago, he made some very poor choices and as a result, charges were made against him. At this point, he is on probation, seeing a therapist and attending group sessions.
Due to his legal situation and his inability to understand the seriousness of his actions, my husband and I decided to homeschool him, basically out of fear that he may get into more trouble. We, however, are faced to with the dilemma of him not having any friends and don't know how to solve this situation either since he has never done well with making friends. I would appreciate any input or help you could give us. Our greatest fear is that he will never be able to fit into mainstream society and will end up getting into more and more trouble.
A non-verbal learning disability can be part of a larger picture of learning disabilities or can be part of other psychiatric disorders. Given the difficulties he has had, it would be important for you to have both an educational consultant who could clarify if there are remaining learning disabilities and a mental health professional who understands such problems. If your school professionals cannot help with the learning/learning disabilities aspects of your question, you could seek a private consultant. Since he is on medication, the best mental health professional would be a Child and Adolescent Psychiatrist.
(November 2007)
What is visual perception disorder?
Please tell me...what is visual perception disorder? How is it corrected? My granddaughter is eight years old and tries so hard to read and do her school work, struggles with reading and spelling. What can we do? Is there help with eye exercises? Is this recommended, and is it done by an optometrist or an ophthalmologist?
Thank you for any help.
A visual perception disorder might impact on several aspects of processing visual information received by the brain. These problems might include recognizing specific letters/numbers/shapes; the ability to distinguish left and right images of visual stimuli; the ability to analyze these visual stimuli and interpret there meaning. Intervention would depend on where the problems are. To clarify if such problems exist, it is best to do a formal psycho-educational evaluation. Your school might do this or you might need to have it done privately.
Visual perception problems are related to how the brain processes visual stimuli and not to the visual processes associated with the eye and vision. If your daughter has problems with vision (nearsighted, farsighted, astigmatism, etc.) this should be checked by an optometrist or ophthalmologist. If not a problem or if the problem is corrected by glasses, the focus should be on the role of the brain.
(November 2007)
Should you wait until age seven to assess a child for ADD, LD, or other learning problems?
I am concerned that my bright five-year-old daughter may be displaying signs of ADD. Since starting school, she has displayed a high level of achievement in both reading and math. She has been well-supported at home. However, her teacher has commented that although she is very bright, she often day dreams and requires extra time to complete classroom tasks.
She is very quiet and appears anxious when answering questions, speaking in front of the class or meeting new people. We have also noted in the home environment that requests frequently have to be repeated up to four times before she answers. Having a general conversation is difficult because of her fidgeting, slow processing or her being cognitively engaged elsewhere. During homework tasks, she requires ongoing prompting in order to focus.
She becomes very frustrated when she makes mistakes and, out of frustration, becomes defiant. She is popular with her school friends and although shy, manages to make friends in new environments. Also, I am not sure whether this is relevant, but her motor function appears delayed and she has struggled in her attempts to ride a scooter or bike. She is also prone to accidents and falling when running.
I am unsure whether it is too early to seek an assessment or even raise the issue with the school. The general advice from the literature that I have read is that assessment should not be sought until the child is seven due to underdeveloped cerebellum. What is your general opinion on this?
Don’t be so quick to rush to ADHD as the cause. Your descriptions suggest more the possibility that she might have a language disability (difficulty quickly processing what she hears and difficulty organizing her thoughts to respond). Or, she might have a motor disability (Sensory Integration Disorder), resulting in her gross and fine motor difficulties. Although not yet in first grade, she shows early signs of a potential learning disability. The behaviors I least hear you describe would be those associated with ADHD.
I encourage you to request that her school professionals assess her. Waiting until age seven and the end of first grade is to wait until she fails. Act now so that the help she needs is in place during first grade. These studies would include a speech-language evaluation, an occupational therapy evaluation, and an educational assessment (called a psycho-educational evaluation). These test results will clarify her needs and the services she will need. If your school system refuses to test her until she is seven, try to get the studies done privately.
(September 2007)
How is a psychoeducational evaluation different from a nueropsychological evaluation?
I have an 8-year-old son who is struggling with reading and writing, but does fine with mathematics. I've taken him to a developmental optometrist, who found some problems with tracking and binocularity. He's also been tested by an audiologist, who found that he has problems hearing in background noise, but felt that due to his age, he might still be developing this skill.
I feel like I need to take him to someone who can give me an overall idea of what's happening. I'm unsure whether to take him for a neuropsychological exam to someone who does psychoeducational exams. Can you explain the difference between these two and tell me which you think would be better for him now?
It is important to identify why he has a reading and writing problem. Formal testing should provide this information.
Psychoeducational evaluations focus on identifying if the individual has cognitive/academic problems. If present, what are they, were are the strengths, and where are the weaknesses. The results help to develop an intervention strategy. A neuropsychological evaluation assesses does not focus on learning but on the function of most areas of brain function. The testing is more elaborate (and probably more expensive). The results will help to clarify if there is a learning disability and, if so, what to do about it.
Note from LD OnLine: To find out more about evaluation, please visit What Do You Do If You Suspect That Your Child Has a Learning Disability?.
(September 2007)
Who should test a child for learning disabilities—the school or the doctor?
My nine-year-old daughter is in the third grade. Her work goes from good to okay to poor throughout the school year. She is getting ready to get out of school in less than two weeks. Since first grade, I have asked her teachers, school counselors, and her pediatrician to evaluation her for learning disabilities. Her biological father has ADHD and dyslexia.
I cannot get anyone to take the responsibility to test her. The school says it’s her doctor’s area, but her doctor says it is the school’s. Who really is the one who should be testing her? Her teacher says she spaces out in classes and she inverts digital 2’s and 5’s, the word “a” and “the,” and “b’s” and “d’s.” She also says her mind tells her to stand when she’s repeatedly told to sit, especially at her desk in school and at the table when eating anywhere.
Please help me help her. Her teacher even hinted she’d be better off staying back another year. I don’t know how she would handle that.
Thank you.
Wow!! Talk about passing the buck. Your descriptions suggest that she might have a learning disability and/or ADHD. One does not have to guess which. Given her difficulties with letter/number reversals and her not being where she should be academically at the end of third grade, the possibility of a learning disability is real. This possibility is even greater given that her biological father has a form of LD called dyslexia.
The only way to clarify is to have her take a battery of tests called a psycho-educational evaluation. Insist that her school professionals do such testing. See Sample Letter-Requesting an Initial Evaluation for Special Education Services. If she has LD, she will need special education services plus appropriate accommodations. The question of repeating third can only be answered after these data are available.
Should you have a history, going back to preschool of her being fidgety/hyperactive, inattentive, and/or impulsive, her family doctor should evaluate for ADHD. If she has this disorder, medication might help. Remember, it is not on or the other. Many children have both and both need to be addressed.
(August 2007)
Are memory difficulties considered learning disabilities?
Is the inability to memorize a learning disability? As a child, I was unable to memorize the arithmetic tables and to this day cannot add or subtract, multiply or divide accurately. As a teenager and an adult this inability to memorize has made it impossible to learn a second language because I'm unable to memorize and retain vocabulary.
Now at age 55, I'm under pressure at my job to learn a second language and even though I try to explain this problem, no one will believe that it is a learning disability. They keep pointing out that I have learned one language so I should be able to learn two. Of course, they all speak two or three fluently. I need some data to back me up. Can you help?
By the way, my IQ is 140 and I have an Ed.D. from Teachers College-Columbia University. I can learn, I just can't memorize.
Thank you,
Susan
There are many types of memory - working memory, short term memory, long term memory. And each type of memory is different for visual and for auditory processing. It is possible that you have a specific type of memory deficit that would make specific tasks, such as learning a new language difficult. I cannot be more specific. If it is important to you, you might request formal testing to clarify if you have a deficit in memory and, if so, in what areas.
(June 2007)
What are some symptoms of pervasive developmental disorder?
A student shows signs of inattentiveness. Often, he does not do work without constant one-on-one redirection. Still, minimal work is done. He is often playing with hands in an imaginary way, assuming they are action figures. He shows concern for only himself. He has no empathy for others, even when he uses inappropriate physical or verbal aggression. The child is 8 years old.
His parents are seeing him as gifted, but no classroom observation or information has been used in the diagnosis. Critical thinking activities and a diverse learning environment, as well as curriculum, are given. The child does not complete the basic work even when extensions are given to expand on the subject.
What are the steps to getting a child tested, evaluated as gifted, or having a disability? Can a child be gifted (only) and still not be able to interact with classmates and stay on task in order to get the introduction to a lesson. Thank you for your help.
Based on the descriptions you provide, your student might have what is called a Pervasive Developmental Disorder. Discuss this concept with your school consultants and explore how to get the student’s parents involved in a full evaluation. If my clinical impression is correct, the student will need special education services.
(May 2007)
What do you do when the school won’t test your child for learning disabilities?
Dr. Silver,
I am a parent of a 15-year-old son who has not been diagnosed. The school district he is in tells me that they do not have a way to assess him. Therefore, his needs are not being met. They keep sending me to all kinds of doctors to be diagnosed (i.e. medical, eye, psychologist) and they are all sending me back to the school district for testing.
What can I do? It is very frustrating to know that if my child is diagnosed, there are people and foundations that would fit him perfectly. His school's learning disability teacher does not know the techniques that are suggested in the articles at this site. Please help me.
I do not understand what your school professionals mean when they say they do not have a way to assess him. (Is it possible that you have not provided me with other important information?) Your public school system cannot send you to someone else to do studies.
Step one (if not already done), seek a parent consultant/advocate who can advise you on your rights. Step two, with this advocate, present a formal request to the principal of his public school, requesting an evaluation. Step three, if refused, ask for the procedure for filing an appeal and file one. Good luck.
(May 2007)
Can a person who writes but can’t read be dyslexic?
After learning about dyslexia in my AP psychology class, I've been wondering whether I had it. It would explain my constant and perpetuating difficulty reading, but I seem to be an ok writer and have always taken honors and AP English classes. Of course, I was never able to read any of the required novels. Instead, I relied on classroom discussions and summaries to help me understand the books. Would it be possible for me to be dyslexic if I can write but not read? I seem to have some of the symptoms but not all.
I’m sorry it took high school and reading about dyslexia for anyone (you) to question why you have so much difficulty reading. Speak to your parents about requesting formal testing to clarify why you have this problem. Only by understanding the reason(s) will you be able to know what type of help will be most useful.
(May 2007)
If a parent wants a new objective evaluation performed by a professional, should they share former evaluation results?
Dr. Silver,
My daughter was tested for learning disabilities through the school in second grade. She was diagnosed with expressive language disorder and with short-term auditory and visual processing disorder. She's in sixth grade now and I want her to be retested by outside of the school to see what issues she's dealing with now.
I don't want the school to know that I'm doing it and want to see if the new testing is in line with the old results. I contacted a licensed psychologist who wants to review the school's diagnosis before he tests her. I'm afraid it might sway him and I want a completely new, fresh and unbiased diagnosis. Must he see the old evaluation or can I keep it from him until after the testing? What's the right thing for me to do?
Thank you,
Gail
I support your wish to have updated studies for your daughter done privately. However, it is important that the psychologist doing the updated testing have a previous baseline in order to assess for progress or for lack of progress. Showing previous testing will not bias the examiner. The testing is based on standard scores and the results will be accurate readings for your daughter.
(May 2007)
How can I help my homeschooled daughter who has trouble with comprehension?
My daughter is in sixth grade. She had attended public school since kindergarten and had begun to have falling grades in fourth and fifth grades. We began homeschooling her this year and were shocked at her lack of comprehension skills. She forgets things as soon as she reads them. Even when I try to read assignments to her in an exciting way, she does not retain the information. Last week we did a whole unit on the Scientific Method in Science. This week the term was reintroduced and she acted as if she had never heard the term. I hate getting frustrated when I know this is not something she is doing intentionally. Is she ADD? She never acts hyperactive. She is very laid back and can concentrate on and remember TV shows and comic book stories. If she is ADD, I have no intention of medicating her. Is there a natural medicine or change in food or curriculum that can help her?
Thank you,
Darcey
Yes, she can be helped. She needs a diagnosis. I bet that if your daughter had continuous headaches or stomachaches or any other physical problem you would have rushed to her doctor and perhaps seen as many specialists as you needed in order to help her. Why do you see disorders of the brain as different?
You describe what might be learning disabilities and you describe possible ADHD. Discuss each with your pediatrician. There are formal test to clarify if she has a learning disability. These studies can be done by your school professionals or by private professionals. Your family doctor should be able to assess for ADHD; and, if she has this disorder, treat it. Treatment would be based on what she has. Home schooling might give you a false sense of security because of the lack of the same expectations needed in school.
Please, have the right professionals make the right diagnoses. Then, design your interventions/treatments on the confirmed diagnoses. Disorders of the brain are just as debilitating as those of other body systems.
(April 2007)
Can a really busy person get diagnosed without spending much time at it?
Is there a way I could be diagnosed without having to go to my general practitioner? During the week, I have college and have to work so I never have spare time to go to the doctors. But I want an official diagnosis that I have ADD or ADHD. It would help me get a little extra help in college
There is no easy or quick way to diagnose or treat ADHD. You need to be seen by a physician to establish the diagnosis and to receive treatment. Maybe you could find someone at your college's Health Services so that you do not have to travel. Again, if you have a problem that is impacting on your success, you must find the time to get the proper diagnosis and treatment.
(April 2007)
How can I get evaluated when I have social anxiety disorder and LD or ADD?
I think I may have Social Anxiety Disorder and ADD or a learning disability and I think the effects of my childhood have played a role in it. I think I have had it for most of my life but I can't deal with it anymore. I feel like I am going to have a nervous breakdown. I'm always irritable, I can't communicate well with people (especially around a group of people, I get very nervous). I feel disconnected and frustrated.
It is affecting my job. My boss tells me that I don't focus and I make stupid mistakes all the time. I'm afraid I will get fired. I don't know where to go. What places in New York City specialize in both disorders? I want to get a full evaluation. I get very overwhelmed trying to find the right resources.
Maria
Anxiety Disorders and ADHD are best diagnosed by a psychiatrist. Learning Disabilities are best diagnosed by a psychologist who does psycho-educational testing. I would start with a psychiatrist and go from there. Sorry, I cannot give you a name in NYC. Perhaps your family physician can recommend someone.
(April 2007)
Should a practitioner diagnose a learning disability if the client also has a mood disorder?
I am working with a client that has a long history of emotional and behavioral difficulties. To make a long story short, he has significant and mood disturbances and does meet the discrepancy criteria for an LD. Is it appropriate to give an LD diagnosis even in the presence of a severe mood disorder? His lack of achievement in my opinion is better explained by the mood disorder rather than an LD. I know that most clinicians would give the LD diagnosis, but I don't feel like it is ethical when considering the underlying process.
Thanks for your advice!
Dr. Smith
There is a continuum of neurologically-based disorders that are frequently found together. This continuum includes learning disabilities, ADHD, emotional regulatory disorders (anxiety disorder, depression, anger-control problems, obsessive-compulsive disorder), Bipolar Disorder, and tic disorders.
Thus, the question is not whether your client has a learning disability or a mood disturbance. He might have both and assessing for all possibilities is essential. Should he have learning disabilities, he will need special education services along with accommodations. If he has one or more of the emotional regulatory disorders or Bipolar Disorder, he will also need treatment for these diagnoses.
(April 2007)
For more information on this topic, please visit the Evaluation / LD Testing section in LD InDepth.
