Learning
Disabilities
Imagine having important needs and ideas to communicate, but being unable
to express them. Perhaps feeling bombarded by sights and sounds, unable
to focus your attention. Or trying to read or add but not being able to
make sense of the letters or numbers.
You may not need to imagine. You may be the parent or teacher of a child
experiencing academic problems, or have someone in your family diagnosed
as learning disabled. Or possibly as a child you were told you had a reading
problem called dyslexia or some other learning handicap.
Although different from person to person, these difficulties make up the
common daily experiences of many learning disabled children, adolescents,
and adults. A person with a learning disability may experience a cycle
of academic failure and lowered self-esteem. Having these handicaps--or
living with someone who has them--can bring overwhelming frustration.
But the prospects are hopeful. It is important to remember that a person
with a learning disability can learn. The disability usually only affects
certain limited areas of a child's development. In fact, rarely are learning
disabilities severe enough to impair a person's potential to live a happy,
normal life.
This booklet is provided by the National Institute of Mental Health (NIMH),
the Federal agency that supports research nationwide on the brain, mental
illnesses, and mental health. Scientists supported by NIMH are dedicated
to understanding the workings and interrelationships of the various regions
of the brain, and to finding preventions and treatments to overcome brain
dysfunctions that handicap people in school, work, and play.
The booklet provides up--to-date information on learning disabilities
and the role of NIMH-sponsored research in discovering underlying causes
and effective treatments. It describes treatment options, strategies for
coping, and sources of information and support. Among these sources are
doctors, special education teachers, and mental health professionals who
can help identify learning disabilities and recommend the right combination
of medical, psychosocial, and educational treatment.
In this booklet, you'll also read the stories of Susan, Wallace, and Dennis,
three people who have learning disabilities. Although each had a rough
start, with help they learned to cope with their handicaps. You'll see
their early frustrations, their steps toward getting help, and their hopes
for the future.
The stories of Susan, Wallace, and Dennis are representative of people
with learning disabilities, but the characters are not real. Of course,
people with learning disabilities are not all alike, so these stories
may not fit any particular individual.
UNDERSTANDING THE PROBLEM
Susan
At age 14, Susan still tends to be quiet. Ever since she was a child,
she was so withdrawn that people sometimes forgot she was there. She seemed
to drift into a world of her own. When she did talk, she often called
objects by the wrong names. She had few friends and mostly played with
dolls or her little sister. In school, Susan hated reading and math because
none of the letters, numbers or "+" and "-" signs
made any sense. She felt awful about herself. She'd been told--and was
convinced--that she was retarded.
Wallace
Wallace has lived 46 years, and still has trouble understanding what people
say. Even as a boy, many words sounded alike. His father patiently said
things over and over. But whenever his mother was drunk, she flew into
a rage and spanked him for not listening. Wallace's speech also came out
funny. He had such problems saying words that in school his teacher sometimes
couldn't understand him. When classmates called him a "dummy,"
his fists just seemed to take over.
Dennis
Dennis is 23 years old and still seems to have too much energy. But he
had always been an overactive boy, sometimes jumping on the sofa for hours
until he collapsed with exhaustion. In grade school, he never sat still.
He interrupted lessons. But he was a friendly, well-meaning kid, so adults
didn't get too angry. His academic problems became evident in third grade,
when his teacher realized that Dennis could only recognize a few words
and wrote like a first grader. She recommended that Dennis repeat third
grade, to give him time to "catch up." After another full year,
his behavior was still out of control, and his reading and writing had
not improved.
What Is a Learning Disability?
Unlike other disabilities, such as paralysis or blindness, a learning
disability (LD) is a hidden handicap. A learning disability doesn't disfigure
or leave visible signs that would invite others to be understanding or
offer support. A woman once blurted to Wallace, "You seem so intelligent--you
don't look handicapped!"
LD is a disorder that affects people's ability to either interpret what
they see and hear or to link information from different parts of the brain.
These limitations can show up in many ways--as specific difficulties with
spoken and written language, coordination, self-control, or attention.
Such difficulties extend to schoolwork and can impede learning to read
or write, or to do math.
Learning disabilities can be lifelong conditions that, in some cases,
affect many parts of a person's life: school or work, daily routines,
family life, and sometimes even friendships and play. In some people,
many overlapping learning disabilities may be apparent. Other people may
have a single, isolated learning problem that has little impact on other
areas of their lives.
What Are the Types of Learning Disabilities?
"Learning disability" is not a diagnosis in the same sense as
"chickenpox" or "mumps." Chickenpox and mumps imply
a single, known cause with a predictable set of symptoms. Rather, LD is
a broad term that covers a pool of possible causes, symptoms, treatments,
and outcomes. Partly because learning disabilities can show up in so many
forms, it is difficult to diagnose or to pinpoint the causes. And no one
knows of a pill or remedy that will cure them.
Not all learning problems are necessarily learning disabilities. Many
children are simply slower in developing certain skills. Because children
show natural differences in their rate of development, sometimes what
seems to be a learning disability may simply be a delay in maturation.
To be diagnosed as a learning disability, specific criteria must be met.
The criteria and characteristics for diagnosing learning disabilities
appear in a reference book called the DSM (short for the Diagnostic and
Statistical Manual of Mental Disorders). The DSM diagnosis is commonly
used when applying for health insurance coverage of diagnostic and treatment
services.
Learning disabilities can be divided into three broad categories:
· Developmental
speech and language disorders
· Academic skills disorders
· "Other," a catch-all that includes certain coordination
disorders and learning handicaps not covered by the other terms
Each of these categories includes a number of more specific disorders.
Developmental Speech and Language Disorders
Speech and language problems are often the earliest indicators of a learning
disability. People with developmental speech and language disorders have
difficulty producing speech sounds, using spoken language to communicate,
or understanding what other people say. Depending on the problem, the
specific diagnosis may be:
· Developmental articulation disorder
· Developmental expressive language disorder
· Developmental receptive language disorder
Developmental Articulation Disorder -- Children with this disorder
may have trouble controlling their rate of speech. Or they may lag behind
playmates in learning to make speech sounds. For example, Wallace at age
6 still said "wabbit" instead of "rabbit" and "thwim"
for "swim." Developmental articulation disorders are common.
They appear in at least 10 percent of children younger than age 8. Fortunately,
articulation disorders can often be outgrown or successfully treated with
speech therapy.
Developmental Expressive Language Disorder -- Some children with
language impairments have problems expressing themselves in speech. Their
disorder is called, therefore, a developmental expressive language disorder.
Susan, who often calls objects by the wrong names, has an expressive language
disorder. Of course, an expressive language disorder can take other forms.
A 4-year-old who speaks only in two-word phrases and a 6-year-old who
can't answer simple questions also have an expressive language disability.
Developmental Receptive Language Disorder -- Some people have trouble
understanding certain aspects of speech. It's as if their brains are set
to a different frequency and the reception is poor. There's the toddler
who doesn't respond to his name, a preschooler who hands you a bell when
you asked for a ball, or the worker who consistently can't follow simple
directions. Their hearing is fine, but they can't make sense of certain
sounds, words, or sentences they hear. They may even seem inattentive.
These people have a receptive language disorder. Because using and understanding
speech are strongly related, many people with receptive language disorders
also have an expressive language disability.
Of course, in preschoolers, some misuse of sounds, words, or grammar is
a normal part of learning to speak. It's only when these problems persist
that there is any cause for concern.
Academic Skills Disorders
Students with academic skills disorders are often years behind their classmates
in developing reading, writing, or arithmetic skills. The diagnoses in
this category include:
· Developmental
reading disorder
· Developmental writing disorder
· Developmental arithmetic disorder
Developmental Reading Disorder -- This type of disorder, also known
as dyslexia, is quite widespread. In fact, reading disabilities affect
2 to 8 percent of elementary school children.
When you think of what is involved in the "three R's"--reading,
'riting, and 'rithmetic--it's astounding that most of us do learn them.
Consider that to read, you must simultaneously:
· Focus attention on the printed marks and control eye movements
across the page
· Recognize the sounds associated with letters
· Understand words and grammar
· Build ideas and images
· Compare new ideas to what you already know
· Store ideas in memory
Such mental juggling requires a rich, intact network of nerve cells that
connect the brain's centers of vision, language, and memory.
A person can have problems in any of the tasks involved in reading. However,
scientists found that a significant number of people with dyslexia share
an inability to distinguish or separate the sounds in spoken words. Dennis,
for example, can't identify the word "bat" by sounding out the
individual letters, b-a-t. Other children with dyslexia may have trouble
with rhyming games, such as rhyming "cat" with "bat."
Yet scientists have found these skills fundamental to learning to read.
Fortunately, remedial reading specialists have developed techniques that
can help many children with dyslexia acquire these skills.
However, there is more to reading than recognizing words. If the brain
is unable to form images or relate new ideas to those stored in memory,
the reader can't understand or remember the new concepts. So other types
of reading disabilities can appear in the upper grades when the focus
of reading shifts from word identification to comprehension.
Developmental Writing Disorder -- Writing, too, involves several
brain areas and functions. The brain networks for vocabulary, grammar,
hand movement, and memory must all be in good working order. So a developmental
writing disorder may result from problems in any of these areas. For example,
Dennis, who was unable to distinguish the sequence of sounds in a word,
had problems with spelling. A child with a writing disability, particularly
an expressive language disorder, might be unable to compose complete,
grammatical sentences.
Developmental Arithmetic Disorder -- If you doubt that arithmetic
is a complex process, think of the steps you take to solve this simple
problem: 25 divided by 3 equals ?
Arithmetic involves recognizing numbers and symbols, memorizing facts
such as the multiplication table, aligning numbers, and understanding
abstract concepts like place value and fractions. Any of these may be
difficult for children with developmental arithmetic disorders. Problems
with numbers or basic concepts are likely to show up early. Disabilities
that appear in the later grades are more often tied to problems in reasoning.
Many aspects of speaking, listening, reading, writing, and arithmetic
overlap and build on the same brain capabilities. So it's not surprising
that people can be diagnosed as having more than one area of learning
disability. For example, the ability to understand language underlies
learning speak. Therefore, any disorder that hinders the ability to understand
language will also interfere with the development of speech, which in
turn hinders learning to read and write. A single gap in the brain's operation
can disrupt many types of activity.
"Other" Learning Disabilities
The DSM also lists additional categories, such as "motor skills disorders"
and "specific developmental disorders not otherwise specified."
These diagnoses include delays in acquiring language, academic, and motor
skills that can affect the ability to learn, but do not meet the criteria
for a specific learning disability. Also included are coordination disorders
that can lead to poor penmanship, as well as certain spelling and memory
disorders.
Attention Disorders
Nearly 4 million school-age children have learning disabilities. Of these,
at least 20 percent have a type of disorder that leaves them unable to
focus their attention.
Some children and adults who have attention disorders appear to daydream
excessively. And once you get their attention, they're often easily distracted.
Susan, for example, tends to mentally drift off into a world of her own.
Children like Susan may have a number of learning difficulties. If, like
Susan, they are quiet and don't cause problems, their problems may go
unnoticed. They may be passed along from grade to grade, without getting
the special assistance they need.
In a large proportion of affected children--mostly boys--the attention
deficit is accompanied by hyperactivity. Dennis is an example of a person
with attention deficit hyperactivity disorder--ADHD. They act impulsively,
running into traffic or toppling desks. Like young Dennis, who jumped
on the sofa to exhaustion, hyperactive children can't sit still. They
blurt out answers and interrupt. In games, they can't wait their turn.
These children's problems are usually hard to miss. Because of their constant
motion and explosive energy, hyperactive children often get into trouble
with parents, teachers, and peers.
By adolescence, physical hyperactivity usually subsides into fidgeting
and restlessness. But the problems with attention and concentration often
continue into adulthood. At work, adults with ADHD often have trouble
organizing tasks or completing their work. They don't seem to listen to
or follow directions. Their work may be messy and appear careless.
Attention disorders, with or without hyperactivity, are not considered
learning disabilities in themselves. However, because attention problems
can seriously interfere with school performance, they often accompany
academic skills disorders.
What Causes Learning Disabilities
Understandably, one of the first questions parents ask when they learn
their child has a learning disorder is "Why? What went wrong?"
Mental health professionals stress that since no one knows what causes
learning disabilities, it doesn't help parents to look backward to search
for possible reasons. There are too many possibilities to pin down the
cause of the disability with certainty. It is far more important for the
family to move forward in finding ways to get the fight help.
Scientists, however, do need to study causes in an effort to identify
ways to prevent learning disabilties.
Once, scientists thought that all learning disabilities were caused by
a single neurological problem. But research supported by NIMH has helped
us see that the causes are more diverse and complex. New evidence seems
to show that most learning disabilities do not stem from a single, specific
area of the brain, but from difficulties in bringing together information
from various brain regions.
Today, a leading theory is that learning disabilities stem from subtle
disturbances in brain structures and functions. Some scientists believe
that, in many cases, the disturbance begins before birth.
Errors in Fetal Brain Development
Throughout pregnancy, the fetal brain develops from a few all-purpose
cells into a complex organ made of billions of specialized, interconnected
nerve cells called neurons. During this amazing evolution, things can
go wrong that may alter how the neurons form or interconnect.
In the early stages of pregnancy, the brain stem forms. It controls basic
life functions such as breathing and digestion. Later, a deep ridge divides
the cerebrum--the thinking part of the brain--into two halves, a right
and left hemisphere. Finally, the areas involved with processing sight,
sound, and other senses develop, as well as the areas associated with
attention, thinking, and emotion.
As new cells form, they move into place to create various brain structures.
Nerve cells rapidly grow to form networks with other parts of the brain.
These networks are what allow information to be shared among various regions
of the brain.
Throughout pregnancy, this brain development is vulnerable to disruptions.
If the disruption occurs early, the fetus may die, or the infant may be
born with widespread disabilities and possibly mental retardation. If
the disruption occurs later, when the cells are becoming specialized and
moving into place, it may leave errors in the cell makeup, location, or
connections. Some scientists believe that these errors may later show
up as learning disorders.
Through experiments with animals, scientists at NIMH and other research
facilities are tracking clues to determine what disrupts brain development.
By studying the normal processes of brain development, scientists can
better understand what can go wrong. Some of these studies are examining
how genes, substance abuse, pregnancy problems, and toxins may affect
the developing brain.
Genetic Factors -- The fact that learning disabilities tend to
run in families indicates that there may be a genetic link. For example,
children who lack some of the skills needed for reading, such as hearing
the separate sounds of words, are likely to have a parent with a related
problem. However, a parent's learning disability may take a slightly different
form in the child. A parent who has a writing disorder may have a child
with an expressive language disorder. For this reason, it seems unlikely
that specific learning disorders are inherited directly. Possibly, what
is inherited is a subtle brain dysfunction that can in turn lead to a
learning disability.
There may be an alternative explanation for why LD might seem to run in
families. Some learning difficulties may actually stem from the family
environment. For example, parents who have expressive language disorders
might talk less to their children, or the language they use may be distorted.
In such cases, the child lacks a good model for acquiring language and
therefore, may seem to be learning disabled.
Tobacco, Alcohol, and Other Drug Use -- Many drugs taken by the mother
pass directly to the fetus. Research shows that a mother's use of cigarettes,
alcohol, or other drugs during pregnancy may have damaging effects on
the unborn child. Therefore, to prevent potential harm to developing babies,
the U.S. Public Health Service supports efforts to make people aware of
the possible dangers of smoking, drinking, and using drugs.
Scientists have found that mothers who smoke during pregnancy may be more
likely to bear smaller babies. This is a concern because small newborns,
usually those weighing less than 5 pounds, tend to be at risk for a variety
of problems, including learning disorders.
Alcohol also may be dangerous to the fetus' developing brain. It appears
that alcohol may distort the developing neurons. Heavy alcohol use during
pregnancy has been linked to fetal alcohol syndrome, a condition that
can lead to low birth weigh, intellectual impairment, hyperactivity, and
certain physical defects. Any alcohol use during pregnancy, however, may
influence the child's development and lead to problems with learning,
attention, memory, or problem solving. Because scientists have not yet
identified "safe" levels, alcohol should be used cautiously
by women who are pregnant or who may soon become pregnant.
Drugs such as cocaine--especially in its smokable form known as crack--seem
to affect the normal development of brain receptors. These brain cell
parts help to transmit incoming signals from our skin, eyes, and ears,
and help regulate our physical response to the environment. Because children
with certain learning disabilities have difficulty understanding speech
sounds or letters, some researchers believe that learning disabilities,
as well as ADHD, may be related to faulty receptors. Current research
points to drug abuse as a possible cause of receptor damage.
Problems During Pregnancy or Delivery -- Other possible causes
of learning disabilities involve complications during pregnancy. In some
cases, the mother's immune system reacts to the fetus and attacks it as
if it were an infection. This type of disruption seems to cause newly
formed brain cells to settle in the wrong part of the brain. Or during
delivery, the umbilical cord may become twisted and temporarily cut off
oxygen to the fetus. This, too, can impair brain functions and lead to
LD.
Toxins in the Child's Environment -- New brain cells and neural
networks continue to be produced for a year or so after the child is born.
These cells are vulnerable to certain disruptions, also.
Researchers are looking into environmental toxins that may lead to learning
disabilities, possibly by disrupting childhood brain development or brain
processes. Cadmium and lead, both prevalent in the environment, are becoming
a leading focus of neurological research. Cadmium, used in making some
steel products, can get into the soil, then into the foods we eat. Lead
was once common in paint and gasoline, and is still present in some water
pipes. A study of animals sponsored by the National Institutes of Health
showed a connection between exposure to lead and learning difficulties.
In the study, rats exposed to lead experienced changes in their brainwaves,
slowing their ability to learn. The learning problems lasted for weeks,
long after the rats were no longer exposed to lead.
In addition, there is growing evidence that learning problems may develop
in children with cancer who had been treated with chemotherapy or radiation
at an early age. This seems particularly true of children with brain tumors
who received radiation to the skull.
Are Learning Disabilities Related to Differences
in the Brain?
In comparing people with and without learning disabilities, scientists
have observed certain differences in the structure and functioning of
the brain. For example, new research indicates that there may be variations
in the brain structure called the planum temporale, a language-related
area found in both sides of the brain. In people with dyslexia, the two
structures were found to be equal in size. In people who are not dyslexic,
however, the left planum temporale was noticeably larger. Some scientists
believe reading problems may be related to such differences.
With more research, scientists hope to learn precisely how differences
in the structures and processes of the brain contribute to learning disabilities,
and how these differences might be treated or prevented.
GETTING HELP
Susan
Susan was promoted to the sixth grade but still couldn't do basic math.
So, her mother brought her to a private clinic for testing. The clinician
observed that Susan had trouble associating symbols with their meaning,
and this was holding back her language, reading, and math development.
Susan called objects by the wrong words and she could not associate sounds
with letters or recognize math symbols. However, an IQ of 128 meant that
Susan was quite bright. In addition to developing an Individualized Education
Plan, the clinician recommended that Susan receive counseling for her
low self-esteem and depression.
Wallace
In the early 1960s, at the request of his ninth grade teacher, Wallace
was examined by a doctor to see why he didn't speak or listen well. The
doctor tested his vocal cords, vision, and hearing. They were all fine.
The teacher concluded that Wallace must have "brain damage,"
so not much could be done. Wallace kept failing in school and was suspended
several times for fighting. He finally dropped out after tenth grade.
He spent the next 25 years working as a janitor. Because LD frequently
went undiagnosed at the time when Wallace was young, the needed help was
not available to him.
Dennis
In fifth grade, Dennis' teacher sent him to the school psychologist for
testing. Dennis was diagnosed as having developmental reading and developmental
writing disorders. He was also identified as having an attention disorder
with hyperactivity. He was placed in an all-day special education program,
where he could work on his particular deficits and get individual attention.
His family doctor prescribed the medication Ritalin to reduce his hyperactivity
and distractibility. Along with working to improve his reading, the special
education teacher helped him improve his listening skills. Since his handwriting
was still poor, he learned to type homework and reports on a computer.
At age 19, Dennis graduated from high school and was accepted by a college
that gives special assistance to students with learning disabilities.
How Are Learning Disabilities First Identified?
The first step in solving any problem is realizing there is one. Wallace,
sadly, was a product of his time, when learning disabilities were more
of a mystery and often went unrecognized. Today, professionals would know
how to help Wallace. Dennis and Susan were able to get help because someone
saw the problem and referred them for help.
When a baby is born, the parents eagerly wait for the baby's first step,
first word, a myriad of other "firsts." During routine checkups,
the pediatrician, too, watches for more subtle signs of development. The
parents and doctor are watching for the child to achieve developmental
milestones. The developmental milestones chart (omitted here; see page
18 of brochure) lists a few of these markers and the ages and grades that
they typically appear.
Parents are usually the first to notice obvious delays in their child
reaching early milestones. The pediatrician may observe more subtle signs
of minor neurological damage, such as a lack of coordination. But the
classroom teacher, in fact, may be the first to notice the child's persistent
difficulties in reading, writing, or arithmetic. As school tasks become
more complex, a child with a learning disability may have problems mentally
juggling more information.
The learning problems of children who are quiet and polite in school may
go unnoticed. Children with above average intelligence, who manage to
maintain passing grades despite their disability, are even less likely
to be identified. Children with hyperactivity, on the other hand, will
be identified quickly by their impulsive behavior and excessive movement.
Hyperactivity usually begins before age 4 but may not be recognized until
the child enters school.
What should parents, doctors, and teachers do if critical developmental
milestones haven't appeared by the usual age? Sometimes it's best to allow
a little more time, simply for the brain to mature a bit. But if a milestone
is already long delayed, if there's a history of learning disabilities
in the family, or if there are several delayed skills, the child should
be professionally evaluated as soon as possible. An educator or a doctor
who treats children can suggest where to go for help.
How Are Learning Disabilities Formally Diagnosed?
By law, learning disability is defined as a significant gap between a
person's intelligence and the skills the person has achieved at each age.
This means that a severely retarded 10-year-old who speaks like a 6-year-old
probably doesn't have a language or speech disability. He has mastered
language up to the limits of his intelligence. On the other hand, a fifth
grader with an IQ of 100 who can't write a simple sentence probably does
have LD.
Learning disorders may be informally flagged by observing significant
delays in the child's skill development. A 2-year delay in the primary
grades is usually considered significant. For older students, such a delay
is not as debilitating, so learning disabilities aren't usually suspected
unless there is more than a 2-year delay. Actual diagnosis of learning
disabilities, however, is made using standardized tests that compare the
child's level of ability to what is considered normal development for
a person of that age and intelligence.
For example, as late as fifth grade, Susan couldn't add two numbers, even
though she rarely missed school and was good in other subjects. Her mother
took her to a clinician, who observed Susan's behavior and administered
standardized math and intelligence tests. The test results showed that
Susan's math skills were several years behind, given her mental capacity
for learning. Once other possible causes like lack of motivation and vision
problems were ruled out, Susan's math problem was formally diagnosed as
a specific learning disability.
Test outcomes depend not only on the child's actual abilities, but on
the reliability of the test and the child's ability to pay attention and
understand the questions. Children like Dennis, with poor attention or
hyperactivity, may score several points below their true level of ability.
Testing a child in an isolated room can sometimes help the child concentrate
and score higher.
Each type of LD is diagnosed in slightly different ways. To diagnose
speech and language disorders, a speech therapist tests the child's pronunciation,
vocabulary, and grammar and compares them to the developmental abilities
seen in most children that age. A psychologist tests the child's intelligence.
A physician checks for any ear infections, and an audiologist may be consulted
to rule out auditory problems. If the problem involves articulation, a
doctor examines the child's vocal cords and throat.
In the case of academic skills disorders, academic development in reading,
writing, and math is evaluated using standardized tests. In addition,
vision and hearing are tested to be sure the student can see words clearly
and can hear adequately. The specialist also checks if the child has missed
much school. It's important to rule out these other possible factors.
After all, treatment for a learning disability is very different from
the remedy for poor vision or missing school.
ADHD is diagnosed by checking for the long-term presence of specific behaviors,
such as considerable fidgeting, losing things, interrupting, and talking
excessively. Other signs include an inability to remain seated, stay on
task, or take turns. A diagnosis of ADHD is made only if the child shows
such behaviors substantially more than other children of the same age.
If the school fails to notice a learning delay, parents can request an
outside evaluation. In Susan's case, her mother chose to bring Susan to
a clinic for testing. She then brought documentation of the disability
back to the school. After confirming the diagnosis, the public school
was obligated to provide the kind of instructional program that Susan
needed.
Parents should stay abreast of each step of the school's evaluation. Parents
also need to know that they may appeal the school's decision if they disagree
with the findings of the diagnostic team. And like Susan's mother, who
brought Susan to a clinic, parents always have the option of getting a
second opinion.
Some parents feel alone and confused when talking to learning specialists.
Such parents may find it helpful to ask someone they like and trust to
go with them to school meetings. The person may be the child's clinician
or caseworker, or even a neighbor. It can help to have someone along who
knows the child and can help understand the child's test scores or learning
problems.
What Are the Education Options?
Although obtaining a diagnosis is important, even more important is creating
a plan for getting the right help. Because LD can affect the child and
family in so many ways, help may be needed on a variety of fronts: educational,
medical, emotional, and practical.
In most ways, children with learning disabilities are no different from
children without these disabilities. At school, they eat together and
share sports, games, and after-school activities. But since children with
learning disabilities do have specific learning needs, most public schools
provide special programs.
Schools typically provide special education programs either in a separate
all-day classroom or as a special education class that the student attends
for several hours each week. Some parents hire trained tutors to work
with their child after school. If the problems are severe, some parents
choose to place their child in a special school for the learning disabled.
If parents choose to get help outside the public schools, they should
select a learning specialist carefully. The specialist should be able
to explain things in terms that the parents can understand. Whenever possible,
the specialist should have professional certification and experience with
the learner's specific age group and type of disability. Some of the support
groups listed at the end of this booklet can provide references to qualified
special education programs.
Planning a special education program begins with systematically identifying
what the student can and cannot do. The specialist looks for patterns
in the child's gaps. For example, if the child fails to hear the separate
sounds in words, are there other sound discrimination problems? If there's
a problem with handwriting, are there other motor delays? Are there any
consistent problems with memory?
Special education teachers also identify the types of tasks the child
can do and the senses that function well. By using the senses that are
intact and bypassing the disabilities, many children can develop needed
skills. These strengths offer alternative ways the child can learn.
After assessing the child's strengths and weaknesses, the special education
teacher designs an Individualized Educational Program (IEP). The IEP outlines
the specific skills the child needs to develop as well as appropriate
learning activities that build on the child's strengths. Many effective
learning activities engage several skills and senses. For example, in
learning to spell and recognize words, a student may be asked to see,
say, write, and spell each new word. The student may also write the words
in sand, which engages the sense of touch. Many experts believe that the
more senses children use in learning a skill, the more likely they are
to retain it.
An individualized, skill-based approach--like the approach used by speech
and language therapists--often succeeds in helping where regular classroom
instruction fails. Therapy for speech and language disorders focuses on
providing a stimulating but structured environment for heating and practicing
language patterns. For example, the therapist may help a child who has
an articulation disorder to produce specific speech sounds. During an
engaging activity, the therapist may talk about the toys, then encourage
the child to use the same sounds or words. In addition, the child may
watch the therapist make the sound, feel the vibration in the therapist's
throat, then practice making the sounds before a mirror.
Researchers are also investigating nonstandard teaching methods. Some
create artificial learning conditions that may help the brain receive
information in nonstandard ways. For example, in some language disorders,
the brain seems abnormally slow to process verbal information. Scientists
are testing whether computers that talk can help teach children to process
spoken sounds more quickly. The computer starts slowly, pronouncing one
sound at a time. As the child gets better at recognizing the sounds and
heating them as words, the sounds are gradually speeded up to a normal
rate of speech.
Is Medication Available?
For nearly six decades, many children with attention disorders have benefited
from being treated with medication. Three drugs, Ritalin (methylphenidate),
Dexedrine (dextroamphetamine), and Cylert (pemoline), have been used successfully.
Although these drugs are stimulants in the same category as "speed"
and "diet pills," they seldom make children "high"
or more jittery. Rather, they temporarily improve children's attention
and ability to focus. They also help children control their impulsiveness
and other hyperactive behaviors.
The effects of medication are most dramatic in children with ADHD. Shortly
after taking the medication, they become more able to focus their attention.
They become more ready to learn. Studies by NIMH scientists and other
researchers have shown that at least 90 percent of hyperactive children
can be helped by either Ritalin or Dexedrine. If one medication does not
help a hyperactive child to calm down and pay attention in school, the
other medication might.
The drugs are effective for 3 to 4 hours and move out of the body within
12 hours. The child's doctor or a psychiatrist works closely with the
family and child to carefully adjust the dosage and medication schedule
for the best effect. Typically, the child takes the medication so that
the drug is active during peak school hours, such as when reading and
math are taught.
In the past few years, researchers have tested these drugs on adults who
have attention disorders. Just as in children, the results show that low
doses of these medications can help reduce distractibility and impulsivity
in adults. Use of these medications has made it possible for many severely
disordered adults to organize their lives, hold jobs, and care for themselves.
In trying to do everything possible to help their children, many parents
have been quick to try new treatments. Most of these treatments sound
scientific and reasonable, but a few are pure quackery. Many are developed
by reputable doctors or specialists--but when tested scientifically, cannot
be proven to help. Following are types of therapy that have not proven
effective in treating the majority of children with learning disabilities
or attention disorders:
· Megavitamins
· Colored lenses
· Special diets
· Sugar-free diets
· Body stimulation or manipulation
Although scientists hope that brain research will lead to new medical
interventions and drugs, at present there are no medicines for speech,
language, or academic disabilities.
How Do Families Learn To Cope?
The effects of learning disabilities can ripple outward from the disabled
child or adult to family, friends, and peers at school or work.
Children with LD often absorb what others thoughtlessly say about them.
They may define themselves in light of their disabilities, as "behind,"
"slow," or "different."
Sometimes they don't know how they're different, but they know how awful
they feel. Their tension or shame can lead them to act out in various
ways--from withdrawal to belligerence. Like Wallace, they may get into
fights. They may stop trying to learn and achieve and eventually drop
out of school. Or, like Susan, they may become isolated and depressed.
Children with learning disabilities and attention disorders may have trouble
making friends with peers. For children with ADHD, this may be due to
their impulsive, hostile, or withdrawn behavior. Some children with delays
may be more comfortable with younger children who play at their level.
Social problems may also be a product of their disability. Some people
with LD seem unable to interpret tone of voice or facial expressions.
Misunderstanding the situation, they act inappropriately, turning people
away.
Without professional help, the situation can spiral out of control. The
more that children or teenagers fail, the more they may act out their
frustration and damage their self-esteem. The more they act out, the more
trouble and punishment it brings, further lowering their self-esteem.
Wallace, who lashed out when teased about his poor pronunciation and was
repeatedly suspended from school, shows how harmful this cycle can be.
Having a child with a learning disability may also be an emotional burden
for the family. Parents often sweep through a range of emotions: denial,
guilt, blame, frustration, anger, and despair. Brothers and sisters may
be annoyed or embarrassed by their sibling, or jealous of all the attention
the child with LD gets.
Counseling can be very helpful to people with LD and their families. Counseling
can help affected children, teenagers, and adults develop greater self-control
and a more positive attitude toward their own abilities. Talking with
a counselor or psychologist also allows family members to air their feelings
as well as get support and reassurance.
Many parents find that joining a support group also makes a difference.
Support groups can be a source of information, practical suggestions,
and mutual understanding. Self-help books written by educators and mental
health professionals can also be helpful. A number of references and support
groups are listed at the end of this booklet.
Behavior modification also seems to help many children with hyperactivity
and LD. In behavior modification, children receive immediate, tangible
rewards when they act appropriately. Receiving an immediate reward can
help children learn to control their own actions, both at home and in
class. A school or private counselor can explain behavior modification
and help parents and teachers set up appropriate rewards for the child.
Parents and teachers can help by structuring tasks and environments for
the child in ways that allow the child to succeed. They can find ways
to help children build on their strengths and work around their disabilities.
This may mean deliberately making eye contact before speaking to a child
with an attention disorder. For a teenager with a language problem, it
may mean providing pictures and diagrams for performing a task. For students
like Dennis with handwriting or spelling problems, a solution may be to
provide a word processor and software that checks spelling. A counselor
or school psychologist can help identify practical solutions that make
it easier for the child and family to cope day by day.
Every child needs to grow up feeling competent and loved. When children
have learning disabilities, parents may need to work harder at developing
their children's self-esteem and relationship-building skills. But self-esteem
and good relationships are as worth developing as any academic skill.
SUSTAINING HOPE
Susan
Susan is now in ninth grade and enjoys learning. She no longer believes
she's retarded, and her use of words has improved. Susan has become a
talented craftsperson and loves making clothes and furniture for her sister's
dolls. Although she's still in a special education program, she is making
slow but steady progress in reading and math.
Wallace
Over the years, Wallace found he liked tinkering with cars and singing
in the church choir. At church, he met a woman who knew about learning
disabilities. She told him he could get help through his county social
services office. Since then, Wallace has been working with a speech therapist,
learning to articulate and notice differences in speech sounds. When he
complains that he's too old to learn, his therapist reminds him, "It's
never too late to work your good brain!" His state vocational rehabilitation
office recently referred him to a job-training program. Today, at age
46, Wallace is starting night school to become an auto mechanic. He likes
it because it's a hands-on program where he can learn by doing.
Dennis
Dennis is now age 23. As he walks into the college job placement office,
he smiles and shakes hands confidently. After shuffling through a messy
stack of papers, he finally hands his counselor a neatly typed resume.
Although Dennis jiggles his foot and interrupts occasionally, he's clearly
enthusiastic. He explains that because tape-recorded books and lectures
got him through college, he'd like to sell electronics. Dennis says he'll
also be getting married next year. He and his fiancee are concerned that
their children also will have LD. "But we'll just have to watch and
get help early--a lot earlier than I did!"
Can Learning Disabilities Be Outgrown or Cured?
Even though most people don't outgrow their brain dysfunction, people
do learn to adapt and live fulfilling lives. Dennis, Susan, and Wallace
made a life for themselves--not by being cured, but by developing their
personal strengths. Like Dennis' tape-recorded books and lectures, or
Wallace's hands-on auto mechanics class, they found alternative ways to
learn. And like Susan's crafts or Wallace's singing, they found ways to
enjoy their other talents.
Even though a learning disability doesn't disappear, given the right types
of educational experiences, people have a remarkable ability to learn.
The brain's flexibility to learn new skills is probably greatest in young
children and may diminish somewhat after puberty. This is why early intervention
is so important. Nevertheless, we retain the ability to learn throughout
our lives.
Even though learning disabilities can't be cured, there is still cause
for hope. Because certain learning problems reflect delayed development,
many children do eventually catch up. Of the speech and language disorders,
children who have an articulation or an expressive language disorder are
the least likely to have long-term problems. Despite initial delays, most
children do learn to speak.
For people with dyslexia, the outlook is mixed. But an appropriate remedial
reading program can help learners make great strides.
With age, and appropriate help from parents and clinicians, children with
ADHD become better able to suppress their hyperactivity and to channel
it into more socially acceptable behaviors. As with Dennis, the problem
may take less disruptive forms, such as fidgeting.
Can an adult be helped? For example, can an adult with dyslexia still
learn to read? In many cases, the answer is yes. It may not come as easily
as for a child. It may take more time and more repetition, and it may
even take more diverse teaching methods. But we know more about reading
and about adult learning than ever before. We know that adults have a
wealth of life experience to build on as they learn. And because adults
choose to learn, they do so with a determination that most children don't
have. A variety of literacy and adult education programs sponsored by
libraries, public schools, and community colleges are available to help
adults develop skills in reading, writing, and math. Some of these programs,
as well as private and nonprofit tutoring and learning centers, provide
appropriate programs for adults with LD.
What Aid Does the Government Offer?
As of 1981, people with learning disabilities came under the protection
of laws originally designed to protect the rights of people with mobility
handicaps. More recent Federal laws specifically guarantee equal opportunity
and raise the level of services to people with disabilities. Once a learning
disability is identified, children are guaranteed a free public education
specifically designed around their individual needs. Adolescents with
disabilities can receive practical assistance and extra training to help
make the transition to jobs and independent living. Adults have access
to job training and technology that open new doors of opportunity.
Increased Services, Equal Opportunity
The Individuals with Disabilities Education Act of 1990 assures a public
education to school-aged children with diagnosed learning disabilities.
Under this act, public schools are required to design and implement an
Individualized Educational Program tailored to each child's specific needs.
The 1991 Individuals with Disabilities Education Act extended services
to developmentally delayed children down to age 5. This law makes it possible
for young children to receive help even before they begin school.
Another law, the Americans with Disabilities Act of 1990, guarantees equal
employment opportunity for people with learning disabilities and protects
disabled workers against job discrimination. Employers may not consider
the learning disability when selecting among job applicants. Employers
must also make "reasonable accommodations" to help workers who
have handicaps do their job. Such accommodations may include shifting
job responsibilities, modifying equipment, or adjusting work schedules.
By law, publicly funded colleges and universities must also remove barriers
that keep out disabled students. As a result, many colleges now recruit
and work with students with learning disabilities to make it possible
for them to attend. Depending on the student's areas of difficulty, this
help may include providing recorded books and lectures, providing an isolated
area to take tests, or allowing a student to tape record rather than write
reports. Students with learning disabilities can arrange to take college
entrance exams orally or in isolated rooms free from distraction. Many
colleges are creating special programs to specifically accommodate these
students.
Programs like these made it possible for Dennis to attend and succeed
in college. The HEATH Resource Center, sponsored by the American Council
on Education, assists students with learning disabilities to identify
appropriate colleges and universities. Information on the HEATH center
and related organizations appears at the end of this brochure.
Public Agency Support
Effective service agencies are also in place to assist people of all ages.
Each state department of education can help parents identify the requirements
and the process for getting special education services for their child.
Other agencies serve disabled infants and preschool children. Still others
offer mental health and counseling services. The National Information
Center for Children and Youth can provide referrals to appropriate local
resources and state agencies.
Counselors at each state department of vocational rehabilitation serve
the employment needs of adolescents and adults with learning disabilities.
They can refer adults to free or subsidized health care, counseling, and
high school equivalence (GED) programs. They can assist in arranging for
job training that sidesteps the disability. For example, a vocational
counselor helped Wallace identify his aptitude for car repair. To work
around Wallace's language problems, the counselor helped locate a job-training
program that teaches through demonstrations and active practice rather
than lectures.
State departments of vocational rehabilitation can also assist in finding
special equipment that can make it possible for disabled individuals to
receive training, retain a job, or live on their own. For example, because
Dennis couldn't read the electronics manuals in his new job, a vocational
rehabilitation counselor helped him locate and purchase a special computer
that reads books aloud.
Finally, state-run protection and advocacy agencies and client assistance
programs serve to protect these fights. As experts on the laws, they offer
legal assistance, as well as information about local health, housing,
and social services.
What Hope Does Research Offer?
Sophisticated brain imaging technology is now making it possible to directly
observe the brain at work and to detect subtle malfunctions that could
never be seen before. Other techniques allow scientists to study the points
of contact among brain cells and the ways signals are transmitted from
cell to cell.
With this array of technology, NIMH is conducting research to identify
which parts of the brain are used during certain activities, such as reading.
For example, researchers are comparing the brain processes of people with
and without dyslexia as they read. Research of this kind may eventually
associate portions of the brain with different reading problems.
Clinical research also continues to amass data on the causes of learning
disorders. NIMH grantees at Yale are examining the brain structures of
children with different combinations of learning disabilities. Such research
will help identify differences in the nervous system of children with
these related disorders. Eventually, scientists will know, for example,
whether children who have both dyslexia and an attention disorder will
benefit from the same treatment as dyslexic children without an attention
disorder
.
Studies of identical and fraternal twins are also being conducted. Identical
twins have the same genetic makeup, while fraternal twins do not. By studying
if learning disabilities are more likely to be shared by identical twins
than fraternal twins, researchers hope to determine whether these disorders
are influenced more by genetic or by environmental factors. One such study
is being conducted by scientists funded by the National Institute of Child
Health and Human Development. So far, the research indicates that genes
may, in fact, influence the ability to sound out words.
Animal studies also are adding to our knowledge of learning disabilities
in humans. Animal subjects make it possible to study some of the possible
causes of LD in ways that can't be studied in humans. One NIMH grantee
is researching the effects of barbiturates and other drugs that are sometimes
prescribed during pregnancy. Another researcher discovered through animal
studies that certain prenatal viruses can affect future learning. Research
of this kind may someday pinpoint prenatal problems that can trigger specific
disabilities and tell us how they can be prevented.
Animal research also allows the safety and effectiveness of experimental
new drugs to be tested long before they can be tried on humans. One NIH-sponsored
team is studying dogs to learn how new stimulant drugs that are similar
to Ritalin act on the brain. Another is using mice to test a chemical
that may counter memory loss.
This accumulation of data sets the stage for applied research. In the
coming years, NIMH-sponsored research will focus on identifying the conditions
that are required for learning and the best combination of instructional
approaches for each child.
Piece by piece, using a myriad of research techniques and technologies,
scientists are beginning to solve the puzzle. As research deepens our
understanding, we approach a future where we can prevent certain brain
and mental disorders, make valid diagnoses, and treat each effectively.
This is the hope, mission, and vision of the National Institute of Mental
Health.
What Are Sources of Information and Support?
Several publications, organizations, and support groups exist to help
individuals, teachers, and families to understand and cope with learning
disabilities. The following resources provide a good starting point for
gaining insight, practical solutions, and support. Further information
can be found at libraries and book stores.
Publications
Books for Children and Teens With Learning Disabilities
Fisher, G., and Cummings, R. The Survival Guide for Kids with LD. Minneapolis:
Free Spirit Publishing, 1990. (Also available on cassette)
Gehret, J. Learning Disabilities and the Don't-Give-Up-Kid. Fairport,
NY: Verbal Images Press, 1990.
Janover, C. Josh: A Boy with Dyslexia. Burlington, VT: Waterfront Books,
1988.
Landau, E. Dyslexia. New York: Franklin Watts Publishing Co., 1991.
Marek, M. Different, Not Dumb. New York: Franklin Watts Publishing Co.,
1985.
Levine, M. Keeping A Head in School: A Student's Book about Learning Abilities
and Learning Disorders. Cambridge, MA: Educators Publishing Services,
Inc., 1990.
Books for Adults With Learning Disabilities
Adelman, P., and Wren, C. Learning Disabilities, Graduate School, and
Careers: The Student's Perspective. Lake Forest, IL: Learning Opportunities
Program, Barat College, 1990.
Cordoni, B. Living with a Learning Disability. Carbondale, IL: Southern
Illinois University Press, 1987.
Kravets, M., and Wax, I. The K&W Guide: Colleges and the Learning
Disabled Student. New York: Harper Collins Publishers, 1992.
Magnum, C., and Strichard, S., eds. Colleges with Programs for Students
with Learning Disabilities. Princeton, NJ: Petersons Guides, 1992.
Books for Parents
Greene, L. Learning Disabilities and Your Child: A Survival Handbook.
New York: Fawcett Columbine, 1987.
Novick, B., and Arnold, M. Why Is My Child Having Trouble in School? New
York: Villard Books, 1991.
Silver, L. The Misunderstood Child: A Guide for Parents of Children with
Learning Disabilities: 2d ed. Blue Ridge Summit, PA: Tab Books, 1992.
Silver, L. Dr. Silver's Advice to Parents on Attention-Deficit Hyperactivity
Disorder. Washington, DC: American Psychiatric Press, 1993.
Vail, P. Smart Kids with School Problems. New York: EP Dutton, 1987.
Weiss, E. Mothers Talk About Learning Disabilities. New York: Prentice
Hall Press, 1989.
Books and Pamphlets for Teachers and Specialists
Adelman, P., and Wren, C. Learning Disabilities, Graduate School,
and Careers. Lake Forest, Learning Opportunities Program, Barat College,
1990.
Silver, L. ADHD: Attention Deficit-Hyperactivity Disorder, Booklet for
Teachers. Summit, NJ: CIBA-GEIGY, 1989.
Smith, S. Success Against the Odds: Strategies and Insights from the Learning
Disabled. Los Angeles: Jeremy Tarcher, Inc., 1991.
Wender, P. The Hyperactive Child, Adolescent, and Adult. Attention Disorder
through the Lifespan. New York: Oxford University Press, 1987.
Related Pamphlets Available From NIH
Facts About Dyslexia
National Institute of Child Health and Human Development
Building 31, Room 2A32
9000 Rockville Pike
Bethesda, MD 20892 (301) 496-5133
Developmental Speech and Language Disorders--Hope through Research
National Institute on Deafness and Other Communicative Disorders
P.O. Box 37777
Washington, DC 20013 (800) 241-1044
Support Groups and Organizations
American Speech-Language-Hearing Association
10801 Rockville Pike
Rockville, MD 20852 (800) 638-8255
· Provides information on speech and language disorders, as well
as referrals to certified speech-language therapists.
Attention Deficit Information Network
475 Hillside Avenue
Needham, MA 02194 (617) 455-9895
· Provides up-to-date information on current research, regional
meetings. Offers aid in finding solutions to practical problems faced
by adults and children with an attention disorder.
Candlelighters Childhood Cancer Foundation
7910 Woodmont Avenue, Suite 460
Bethesda, MD 20814 (800) 366-2223
· Provides information and support for children treated for cancer
who later experience learning disabilities.
Center for Mental Health Services
Office of Consumer, Family, and Public Information
5600 Fishers Lane, Room 15-81
Rockville, MD 20857 (301) 443-2792
· This new national center, a component of the U.S. Public Health
Service, provides a range of information on mental health, treatment,
and support services
.
Children with Attention Deficit Disorders (CHADD)
499 NW 70th Avenue, Suite 308
Plantation, FL 33317 (305) 587-3700
· Runs support groups and publishes two newsletters concerning
attention disorders for parents and professionals.
Council for Exceptional Children
1110 N. Glebe Road
Arlington, VA 22201-5704 (800)224-6830
URL: http://www.cec.sped.org/index.html
· Professional membership organization for special education professionals,
publishes two professional journals and other materials on disabilities
and gifted education.
ERIC Clearinghouse on Disabilities and Gifted Education.
1110 N. Glebe Rd.
Arlington, VA 22201-5704 (800)328-0272
E-mail: ericec@cec.sped.org
URL: http://ericec.org
· Federally funded information clearinghouse that produces and
distributes information on disabilities and gifted education and is part
of the ERIC database system.
Federation of Families for Children's Mental Health
1101 King St., Suite 420
Alexandria, VA 22314
Phone: (703) 684-7710
Fax: (703) 836-1040
Email: ffcmh@ffcmh.org
Internet: http://www.ffcmh.org
· · Provides information, support, and referrals through
federation chapters throughout the country. This national parent-run organization
focuses on the needs of children with broad mental health problems.
HEATH Resource Center
American Council on Education
1 Dupont Circle, Suite 800
Washington, DC 20036 (800) 544-3284
· · A national clearinghouse on post-high school education
for people with disabilities.
Learning Disabilities Association of America
4156 Library Road
Pittsburgh, PA 15234 (412) 341-8077
· · Provides information and referral to state chapters,
parent resources, and local support groups. Publishes news briefs and
a professional journal.
Library of Congress
National Library Service for the Blind and Physically Handicapped
1291 Taylor Street, NW
Washington, DC 20542 (202) 707-5100
· · Publishes Talking Books and Reading Disabilities, a
fact sheet outlining eligibility requirements for borrowing talking books.
National Alliance for the Mentally Ill
Children and Adolescents Network (NAMICAN)
2101 Wilson Boulevard, Suite 302
Arlington, VA 22201 (800) 950-NAMI
· · Provides support to families through personal contact
and support meetings. Provides education regarding coping strategies;
reading material; and information about what works--and what doesn't.
National Association of Private Schools for Exceptional Children
1522 K Street, NW Suite 1032
Washington, DC 20005 (202) 408-3338
· · Provides referrals to private special education programs.
National Center for Learning Disabilities
381 Park Avenue South, Suite 1420
New York, NY 10016 (212) 687-7211
· · Provides referrals and resources. Publishes "Their
World" magazine describing true stories on ways children and adults
cope with LD.
National Information Center for Children and Youth with Disabilities (NICHCY)
P.O. Box 1492
Washington, DC 20013-1492
1-800-695-0285
(202) 884-8200
E-mail: nichcy@aed.org
URL: http://www.nichcy.org
· · Provides personal responses to questions on disability
issues, referrals to other organizations and agencies, information searches
of NICHCY databases and library, technical assistance to parent and professionals,
as well as numerous publications, many of which are free of charge.
Orton Dyslexia Society
Chester Building, Suite 382
8600 LaSalle Road
Baltimore, MD 21286-2044 (410) 296-0232
Answers individual questions on reading disability. Provides information
and referrals to local resources.
To arrange for special college entrance testing for LD adults, contact:
ACT Special Testing (319) 337-1332
SAT Scholastic Aptitude Test (609) 771-7137
GED (202) 939-9490
MESSAGE FROM THE NATIONAL INSTITUTE OF MENTAL HEALTH
Research conducted and supported by the National Institute of Mental Health
(NIMH) brings hope to millions of people who suffer from mental illness
and to their families and friends. In many years of work with animals
as well as human subjects, researchers have advanced our understanding
of the brain and vastly expanded the capability of mental health professionals
to diagnose, treat, and prevent mental and brain disorders.
Now, in the 1990s, which the President and Congress have declared "The
Decade of the Brain," we stand at the threshold of a new era in brain
and behavioral sciences. Through research we will learn even more about
mental disorders such as depression, manic-depressive illness, schizophrenia,
panic disorder, and obsessive-compulsive disorder. And we will be able
to use this knowledge to develop new therapies that can help more people
overcome mental illness.
The National Institute of Mental Health is part of the National Institutes
of Health (NIH), the Federal Government's primary agency for biomedical
and behavioral research. NIH is a component of the U.S. Department of
Health and Human Services.
Acknowledgments
This booklet was written by Sharyn Neuwirth, M.Ed., an education writer
and instructional designer in Silver Spring, MD. Scientific information
and review was provided by NIMH staff members L. Eugene Arnold, M.D.;
F. Xavier Castellanos, M.D.; and Judith Rumsey, Ph.D. Also providing review
and assistance were Marcia Henry, Ph.D., Orton Dyslexia Society; Reid
Lyon, Ph.D., National Institute of Child Health and Human Development;
Jean Petersen, Learning Disabilities Association; and Larry B. Silver,
M.D., Georgetown University. Editorial direction was provided by Lynn
J. Cave, NIMH.
All material in this publication is free of copyright restrictions and
may be copied, reproduced, or duplicated without permission from NIMH;
citation of the source is appreciated