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By Steven G. Zecker, Ph.D.
Associate Professor of Learning Disabilities Northwestern
University
Introduction: Children
who are classified as gifted are, by definition, highly
intelligent individuals who fall at the upper end of the
distribution of mental ability. Yet giftedness is not a
guarantee of academic success. Consider that The National
Commission on Excellence in Education (1983) reported that one
half of gifted students do not achieve academically at a level
that is commensurate with their ability. Surprisingly, between
ten and twenty percent of high school dropouts test within the
gifted range (Lajoie and Shore, 1981; Whitmore, 1980). Perhaps
the most startling statistic in this regard is that 40 percent
of those who graduate within the top 5% of their high school
classes do not complete college. A number of famous historical
figures who were clearly very intelligent (and who probably who
have qualified as gifted) struggled considerably in school;
these individuals later became highly successful in fields
ranging from politics (Woodrow Wilson and Nelson Rockefeller) to
science (Albert Einstein and Thomas Edison) to the arts (Auguste
Rodin and Cher). There are many possible reasons for this lack
of academic success among some of the gifted population.
Environmental factors (both within the school and at home),
emotional and affective issues, motivational difficulties, and
other factors all can contribute to a lack of academic success
in students whom would, by virtue of their high level of mental
ability, be expected to be high achievers. Another important
factor that can result in underachievement academically, and the
one that I will be discussing in this article, is the presence
of learning disabilities. It comes as a surprise to many people
to hear that learning disabilities are as prevalent in the
gifted population as in the general population, yet there is
nothing in the definition of learning disabilities (or in their
diagnosis) to preclude the gifted from this category. Rather,
this misconception that gifted children cannot have learning
disabilities is, I believe, rooted in the erroneous belief that
learning disabilities are in some way restricted to those
children who are less bright than average. In fact (as I will
expand upon later), children with learning disabilities are by
definition of at least average mental ability. Their problem is
one of lowered achievement, not lowered ability. In this article
I will discuss various definitions of learning disabilities, the
diagnostic process, various manifestations of learning
disabilities across the school-age range, and appropriate
interventions for children with learning disabilities. I will
also briefly discuss Attention-Deficit Hyperactivity Disorder
(ADHD) which, while not a learning disability, often co-occurs
with learning disabilities and also frequently manifests itself
in ways that are quite similar to learning disabilities. While
some of what I will say is characteristic of all children with
learning disabilities, I will also attempt to highlight some
issues that are particularly relevant to children within the
gifted population who have learning disabilities.
The Definition of
Learning Disabilities:
The term learning disabilities was first coined in 1963 by
Samuel Kirk, but many other terms that were used prior to this
time to describe children with learning problems that are now
termed learning disabilities. Formulating a single definition of
learning disabilities that is acceptable to all professionals in
the field has proven difficult. As a result, several definitions
are commonly utilized; these differ to some degree but generally
have the same essential characteristics. The most commonly used
definition first appeared in Public Law 94-142, the Education
for All Handicapped Children Act (Federal Register, 1977). It
was also a part of Public Law 101-476, the 1990 Individuals with
Disabilities Education Act (IDEA) and is also a component of the
1997 Amendments to IDEA, Public Law 105-17. It reads as follows:
The term "specific learning disability" means those
children who have a disorder in one or more of the basic
psychological process involved in understanding or using
language, spoken or written, which disorder may manifest itself
in imperfect ability to listen, think, speak, read, write, spell
or perform mathematical computations. The term includes such
conditions as perceptual handicaps, brain injury, minimal brain
dysfunction, dyslexia and developmental aphasia. The term does
not include a learning problem which is primarily the result of
visual, hearing, or motor handicaps, of mental retardation, of
emotional disturbance, or environmental, cultural, or economic
disadvantage (PL 105-17: Federal Register, 1997). This
definition of learning disabilities (and associated features of
the Federal law that contains it) is important for several
reasons. First, it was designed to provide an operational
definition of learning disabilities that can be used by
professionals to diagnose learning disabilities in a consistent,
reliable manner. Second, other aspects of the law provided legal
safeguards to assure that children with learning disabilities
were provided with appropriate accommodations to remediate their
disabilities. Third, it provided a system of checks and balances
under which parents of children with learning disabilities could
appeal any decisions made about the services that their children
would (or would not) receive. I will not go into a detailed
discussion of all aspects of Federal Law as it relates to
children with learning disabilities, but I do want to elaborate
upon the basic components of the definition provided above.
There are multiple dimensions to the definition, each of which
must be considered in determining whether a child should be
diagnosed with learning disabilities. The following major
concepts are essential parts of IDEA 1997: --The child must have
a disorder in one or more of the basic psychological processes.
These processes refer to cognitive abilities, among them memory
(auditory and visual), perception (auditory and visual),
intersensory integration (for example visual-auditory
intersensory integration, the ability to associate a letter or
letters with its appropriate sound(s)), attention, and motor
skills, among many others. --The child must have difficulty in
learning, manifesting itself in oral language (receptive or
expressive), reading, writing, and/or mathematics. That is,
their achievement is less than would be expected given their
ability. --The learning problem is not attributable to being
primarily due to other causes such as visual or auditory
impairment, severe motor handicaps, low mental ability,
emotional disturbance, or disadvantage due to economic
situation, environment, or culture. In other words, there is no
other logical explanation for the child's learning difficulties.
--A significant discrepancy exists between the child's potential
for learning (ability) and his or her actual achievement. That
is, underachievement is evident. Be aware that different states
and individual school districts differ in the size of the
discrepancy that is needed for "significance". Also
there are different methods for calculating a discrepancy that
go beyond the scope of this article. Note that this definition
excludes from the diagnosis of learning disabled many children
who are not achieving at a level that is commensurate with their
ability: those who possess low levels of mental ability and who
would therefore not be expected to achieve at age- or
grade-appropriate levels; those who have other problems that are
adversely impacting learning (e.g., vision impairment,
depression or anxiety, cerebral palsy, and those who have not
had an adequate opportunity to learn, among others); and those
whose discrepancy between ability and achievement is not large
enough to be considered significant in the clinical sense. Also,
there must be some explanation as to why the child is
underachieving; this is obtained by establishing a connection
between the area of underachievement (e.g., mathematics) and a
psychological process known to underlie mathematical competency
(e.g., auditory memory). This definition, or one quite similar
to it, is used by the vast majority of school systems in the
United States to qualify children for learning disability
services. Consider this example of the implications of the
diagnosis for gifted children. A boy, Lucas, with an
intelligence quotient (IQ) of 140 (at the 99th percentile for
his age) would be expected to achieve at a level that is
commensurate with that ability (i.e., that is, at or near the
99th percentile). Let's say that Lucas is not achieving at this
level in an area (reading). For the sake of this example, assume
that Lucas' achievement on several reading decoding (word
recognition) measures places him in the middle of the average
range (i.e., a standard score of 100, corresponding to the 50th
percentile). Despite the fact that Lucas is decoding at a grade
appropriate level, by virtually any definition of a learning
disability he is underachieving due to the significant mismatch
between his ability and his achievement in reading. This points
out an essential (and to many people, very confusing) feature of
learning disabilities: among bright children, achievement at a
level that is below grade level is not required for a diagnosis
of learning disabilities to apply. In fact, if we were to change
Lucas' decoding standard score to 110 (corresponding to the 75th
percentile), he would still qualify for the diagnosis even
though his decoding skills are above those of 75 per cent of his
same-grade peers. This type of scenario occurs very often with
gifted underachievers, and confusion about it almost certainly
results in them often not receiving the diagnosis and associated
appropriate services to which they are legally entitled. Thus,
it is often the case that parents need to aggressively pursue
testing for the gifted child, since teachers and school
administrators frequently may believe that there is no need for
an evaluation to be conducted (because the child is performing
at grade level). In extreme cases, it may be necessary to seek
the assistance of a special education advocate or attorney in
order to convince a school district of the need for beginning
the diagnostic process. Because evidence indicates that early
intervention results in the best long-term prognosis, it is
important to attempt to determine whether services are warranted
when the child is as young as possible.
The Evaluation
Process:
Once a child is determined to qualify for testing, the
evaluation process can begin. It is often a time consuming and
labor intensive process. If the evaluation is being conducted by
the child's school, often the first step in the process is a
screening--the administration of a battery of tests that
determine whether there appears to be a need for a more complete
diagnostic evaluation to be conducted. Typically a screening
requires no more than three to four hours of total testing time,
and provides an estimate of the child's ability along with
measures of the child's achievement in the relevant areas. If
the decision to continue with a complete diagnostic evaluation
is made, and additional five or more hours of testing will
generally be conducted. These tests typically will provide a
more precise measure of the child's ability, more achievement
measures, and a much more detailed look at the processes
underlying learning. Observations of the child's behavior during
testing, an examination of his or her use of strategies in
problem solving situations, and the child's attentional capacity
are also important components of the diagnostic process.
Furthermore, one or both parents will typically be interviewed
to provide a detailed birth, medical, developmental, social, and
academic history of the child. An interview with the child's
classroom teacher and observation of the child in the classroom
environment may also be included in the assessment process. The
evaluation process can often take weeks or even months to
complete when conducted within the school setting. Frequently a
child will be tested only for brief periods at a time (e.g., a
class period), meaning that a large number of testing sessions
are needed to complete the process. Despite the fact that
Federal law guarantees each child the right to a timely
evaluation to determine whether there is a need for services, it
is often the case (especially with gifted children, since their
difficulties may be masked by their brightness) that school
personnel are reluctant to initiate the process. In this event,
parents may need to step in and advocate as strongly as they can
for an evaluation. A reminder to a school psychologist that
Federal law is on the child's side in these matters may be
necessary in order to get the assessment process started. Still,
it may be the case that the district does not agree to conduct
an evaluation; in this case, a parent's only remaining option
may be to seek a private evaluation (at the parent's expense).
Private evaluations are essentially the same as those conducted
within the school setting, except that they can usually be
completed in a more timely manner due to fewer scheduling
issues. A number of different types of professionals conduct
learning disabilities evaluations, including learning
disabilities specialists, school psychologists, and clinical
psychologists. These individuals may work in private practice,
or in a university or hospital clinic setting. Be advised that
because of the time-intensive nature, private evaluations are
expensive; in the Chicago area, for example, the cost ranges
from about $1000 to well over $2000. Insurance may pay for all
or part of the cost of an evaluation; it is best to check with
the company before beginning the process because different
insurers have varying requirements for co-payment.
Types of Learning
Disabilities:
Learning disabilities affect anywhere from four to seven percent
of school-age children (in 1995-1996, 5.5% of a school children
in the United States received learning disabilities services
(U.S. Department of Education, 1998)) and can manifest
themselves in many different ways. Moreover, the ways in which a
learning disability affects a child often change as the child
progresses through school. This is in part due to the maturing
child changing in the ways they process information and in part
due to the changing demands of the school curriculum. The most
common type of learning disability results in underachievement
in reading (typically decoding), which also frequently results
in written language difficulties (especially in spelling). Other
children experience significant underachievement only in areas
requiring mathematical calculation. Still others experience a
combination of reading, writing, and mathematics difficulties.
For some children, difficulties in oral language (receptive and
or expressive) underlie their learning disability, while some
children have intact oral language skills. A relatively new
category of learning disability, nonverbal learning
disabilities, is being increasingly diagnosed. Children with
nonverbal learning disabilities experience difficulties in areas
such as motor skills, visual-spatial orientation, social
relationships, organization, and aspects of mathematics, while
they are often quite strong in areas requiring verbal abilities.
Gifted children with learning disabilities often experience
difficulties that are qualitatively different than those
experienced by their non-gifted learning disabled peers. By
virtue of their high level of mental ability, they are often
able to perform surprisingly well on tasks that allow them to
utilize this strength. For example, a gifted child who is
experiencing significant difficulties in decoding while reading
may actually be capable of comprehending what is read
deceptively well, since he or she is able to utilize strong
conceptualization and reasoning skills and a rich fund of
general knowledge to make sense out of the material. Unless this
child is asked to read aloud, it might not even be apparent that
there is a problem in the area of decoding. As another example,
a gifted child with significant difficulties in arithmetic
computation might possess good underlying mathematical concepts
(e.g., a solid understanding of place value) and might also be
able to apply this conceptual understanding to a variety of
"everyday" mathematical activities such as time and
money concepts, reading charts, tables and figures, and
utilizing good estimation skills. Given that there is a large
emphasis on computational skills (especially in the early
grades), these areas of strength may go largely unrecognized.
Often a learning disability is not "pure", in the
sense that it can be neatly categorized as belonging to a
particular category or subtype. Rather, frequently the
manifestations of a child's learning disability include those
typically seen in two or more subtypes. For example, many
children experience underachievement in reading, written
language, and mathematics. Furthermore, in a number of cases,
children with learning disabilities also meet the criteria for
additional, co-morbid, conditions. For example, affective
difficulties (e.g., depression), anxiety, and attention-deficit
hyperactivity disorder, among others, are commonly diagnosed in
children with learning disabilities.
What Are Appropriate
Services, and What Can Parents Do to Assure that Their Children
Receive Them:
There are many potential services that can be provided for
children with learning disabilities. For most children with a
diagnosis of learning disabilities, in-school services are
provided one or more times per week. These services may be
offered in a one-on-one manner in the child's classroom or in a
resource room, or they may be administered in a small group
setting. Typically in a small group setting the children are
matched as closely as possible in terms of grade level and the
nature of the disability. In more serious cases, the child may
be placed in a self-contained classroom with other children who
are all experiencing some type of learning or behavior problem.
These self-contained special education classrooms are generally
becoming less common as school districts increasingly attempt to
provide services in the regular classroom (a process known as
'inclusion' or 'mainstreaming'). Some children also receive
remedial services from trained learning disabilities
professionals during after-school hours. In some instances,
these after-school services are provided in lieu of
interventions within the school setting. Some parents (and
children) prefer the after-school remediation, feeling that it
may reduce the possible stigma that can accompany leaving the
child's regular classroom for special services. (My own
observations suggest that this fear is often unwarranted, and
that most children experience minimal trauma as a result of
leaving the classroom. Keep in mind that most classrooms have at
least a few children who require special education services of
some type). There are also activities that are remedial in
nature that can be provided within the home environment. Among
this type of treatment are a variety of computer software
programs that aim to strengthen deficient processes underlying
learning and thus enhance academic achievement. A variety of
other materials are also available, although generally I advise
against a parent trying to serve as a primary provider of an
intervention. Successful professionals in the field have
typically have had substantial post-graduate training, and it is
unrealistic for a parent to expect to be able to provide the
same quality of treatment that a professional can. Additionally,
I have witnessed too many instances where the parent-child
relationship was seriously eroded because of stressors
introduced as a result of one or both parents trying to play the
role of remediator as well as mother or father. Be advised that
LD services are generally required for an extended period of
time. It is generally unrealistic to expect significant
improvement in achievement to occur as a result of a few weeks
or months of intervention, no matter how appropriate and
intensive this intervention might be. Although high intelligence
generally is associated with a better prognosis for children
with learning disabilities, the remedial process is still a
time-consuming process. Typically diagnostic re-evaluations are
conducted every two to three years to assess the change that has
occurred and possibly identify new areas of remedial emphasis
for the future. Communication is an important aspect of the
remedial process. Those individuals who are working with the
child (i.e., the classroom teacher, LD specialist within the
school, private practitioner, and so on) should be in
communication with each other on a regular basis to guarantee
that the services being provided are appropriate and not
overlapping to a significant degree. Parents should be assertive
in stating their expectations regarding services. Keep in mind,
special education services are costly and school districts are
typically not eager to provide such services. Those parents who
attend school staffings, maintain regular contact with school
personnel, and indicate that they will be seeking the services
to which they are entitled by law typically are more successful
in receiving the appropriate interventions for their children.
As I mentioned previously, it behooves parents to be aware of
the rights that are guaranteed them under Federal law. In
meeting with parents during conferences, I always stress the
role of parental education. By that I mean that parents should
take it upon themselves to learn as much as they can about the
disabilities that their child possesses. While it is not
realistic to become an expert in the field, there are many
books, videotapes, and other materials available that are
oriented towards increasing parentsą understanding of learning
disabilities and what can be done to appropriately service
children with learning disabilities. Today, most national
bookstore chains have entire sections devoted to special
education in general and learning disabilities in particular,
Many of these materials are oriented towards laypersons who lack
professional training in the field. Additionally, professional
organizations such as the Learning Disabilities Association of
America (LDA) and the International Dyslexia Society (IDA) offer
publications and hold national and regional meetings, with much
of the content aimed at the parents of children with learning
disabilities. There is also an organization, Parents of Gifted
and Talented Learning-Disabled Children (301-986-1422), that is
specifically oriented to provide information to parents of
children who are "doubly exceptional". The Internet
also can be a valuable source of information for many parents,
although my personal experience has been that there is also
considerable misinformation disseminated via the various forums
that the Internet provides. In other words, let the consumer
beware when "surfing the web".
Attention Deficit
Hyperactivity Disorder:
Approximately one-quarter to one-third of all children with
learning disabilities also qualify for the diagnosis of
attention deficit hyperactivity disorder (ADHD). Additionally,
ADHD manifests itself in ways that are often difficult to
distinguish from learning disabilities. As a result, most
evaluations for learning disabilities will also include at least
a consideration that ADHD is a viable diagnosis as well. ADHD
manifests itself in several ways; the behaviors most commonly
associated with ADHD include inattention, hyperactivity, and
impulsivity. Under the current conceptualization of the
disorder, some children display primarily hyperactive and
impulsive symptoms, while others show mostly difficulties in
focusing and maintaining attention. Still others with ADHD
display a combination of hyperactive/impulsive and inattentive
behaviors. ADHD does not in and of itself result in academic
underachievement. However, like a learning disability, ADHD
often results in children performing at a level that is below
that at which they are capable. One of the hallmarks of the
disorder is inconsistency in performance; that is, a child with
ADHD may be able to perform at a high level on a particular task
on one day, yet show a much poorer level of performance on an
essentially identical task shortly thereafter. As a result of
this inconsistent performance, many children with ADHD are
erroneously labeled as unmotivated, lazy or uncaring. Like
children with learning disabilities, many children with ADHD
possess a number of strengths; as with children with learning
disabilities, these strengths often go unrecognized and/or
underappreciated. Moreover, many of the characteristics of
children with ADHD are compatible with giftedness: these
children are often energetic, creative, and excel at tasks
requiring divergent thinking. In fact, there have been
suggestions that the high energy level and high intensity
characteristic of gifted children may at times result in them be
inappropriately diagnosed with ADHD, while their giftedness
remains unrecognized. Furthermore, the ways in which ADHD
manifests itself change as a child grows older. Typically,
overactive and impulsive behaviors decrease in frequency with
age, while organizational and time management problems and
difficulties related to social interactions (especially with
peers) become more prominent. Unlike with learning disabilities,
a medical intervention for ADHD is effective in many cases. The
most commonly used treatment, stimulant medication, is effective
in reducing symptoms in a large majority of children who take
it. Increasingly, other pharmacological treatments, including
tricyclic antidepressants and antihypertensives, are being
prescribed to children who either do nor respond to
psychostimulants or who have adverse side effects (most commonly
insomnia and decreased appetite) to them. There are also a
variety of psychologically based treatments for ADHD as well.
Substantial evidence exists to support the idea that the
combination of a pharmacological and a psychological
intervention provides greater symptom reduction than either type
of treatment alone. Among common psychologically oriented
treatments are behavior modification and metacognitive training.
Behavior modification requires the establishment of a reward
system (a 'token economy') to reinforce desired behaviors (which
could range from 'getting homework done in a timely manner' to
'not interrupting conversations' to 'getting ready for school in
the morning without reminders or assistance'). A well planned
token economy is often necessary because children with ADHD have
been found to be less sensitive than their non-ADHD peers to the
typical reinforcement contingencies that are a part of everyday
living. Rather, children with ADHD require reinforcement that is
more powerful, more frequent, and more linked in time to the
desired behavior than do their non-ADHD peers. While many
parents feel that establishing a token economy in the home (or
school) must be a fairly simple manner, my experience has shown
quite clearly that they benefit greatly from the guidance of a
trained professional (e.g., a psychologist or social worker) in
establishing, adjusting, and maintaining such a plan.
Metacognitive training is an intervention that focuses on
getting the child to think about and analyze his or her
behavior, with the goal of becoming capable of recognizing
problematic situations and dealing with them in an appropriate
manner. Metacognitive training is particularly well suited to
children who are gifted, since success rates are best with those
who are highly intelligent and possess good verbal skills.
Again, there are professionals who specialize exclusively in
this type of intervention.
Summary: As I have
described, children who are gifted are as likely to have
learning disabilities or attention-deficit hyperactivity
disorder as any other children. Due to some of the
characteristics of gifted children (most notably their high
levels of intelligence), however, gifted children often are not
identified as LD or ADHD as accurately or as early in their
lives as their non-gifted peers. Early diagnosis and
intervention is important in reducing the difficulties that
gifted children with co-occurring learning disabilities and/or
attention-deficit hyperactivity disorder experience in their
academic, emotional, and social lives. Parents of children who
are gifted need to be aware of the criteria for inclusion for LD
or ADHD and may often be required to strongly advocate for their
children so that they may receive the appropriate special
education services to which they are entitled under Federal law.e
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