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Gail Grodzinsky, Ph.D.

Gail Grodzinsky, Ph.D. received her Master's degree from New York University, her Ph.D. from Boston College (Department of Counseling, Developmental Psychology and Research Methods) and was a post-doctoral fellow at Harvard Medical School, Department of Psychiatry, Cambridge Hospital. Her interest in pediatric neuropsychology was a natural path following her career as a learning disabilities specialist in public schools (New York and Massachusetts). Her interest in assessment and educational solutions for children with developmental disorders led to numerous publications on executive functions in ADHD and learning disabled boys (many co-authored with Dr. Russell A. Barkley). She also contributed the School Setting Report in The Consumer-Oriented Neuropsychological Report (2001, Armengol, Kaplan, & Moes, Eds.). Dr. Grodzinsky is a frequent guest speaker at the Harvard Medical School Cambridge Series and the University of California San Diego Medical School on ADHD, Nonverbal Learning Disabilities (NLD) and Subtypes of NLD. In addition to her active independent practice providing neuropsychological evaluations for children and adolescents, she offers consultation and in-service workshops to many school systems in New England. She spoke with us in June, 2003

• What is a learning disability? What are the different types of learning disabilities?
• What causes learning disabilities?
• What, if any, connections exist between learning disabilities? Do they have anything in common?
• Don't all people have some form of learning difficulty? Aren't learning disabilities simply a matter of degree?
• Are there early signs of learning disabilities?
• How can a parent determine if a child has a learning disability?
• What can parents do once their child is diagnosed? Where can they go for help?
• What kinds of medical, behavioral, and holistic treatments are available? What are the pros and cons of each type?
• What kinds of financial costs might parents face as they seek help for a child?
• What is an IEP, and what can parents expect from the IEP process?
• What can parents do if they feel a school system is not following their child's IEP?
• What can parents do when they believe their child is struggling in school but have been told the child does not qualify for special education?
• What are the pros and cons of having children repeat grades? Who is responsible for the decision to hold a child back?
• What should parents keep in mind when talking with a child about his or her learning disability?
• What are researchers learning about the nature and treatment of learning disabilities? What research looks most promising?

What is a learning disability? What are the different types of learning disabilities?

Gail Grodzinsky, Ph.D.: A learning disability is a general term that describes specific kinds of learning problems that cause a person to have difficulty acquiring certain skills. The skills most often affected are reading, writing, math, listening, speaking, and reasoning. The term does not include learning problems that are primarily the result of visual, hearing, motor disabilities, mental retardation, emotional disturbance, or environmental, cultural, or economic disadvantage.

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What causes learning disabilities?

Gail Grodzinsky, Ph.D.: As of now, no one is certain what causes learning disabilities. It is thought that learning disabilities may be caused by hereditary, teratogenic factors (for instance, alcohol or cocaine use during pregnancy), medical factors (premature birth, diabetes, meningitis of mother or offspring), and/or environmental factors (malnutrition, poor prenatal healthcare). A leading theory among scientists is that learning disabilities stem from subtle disturbances in the way brain structures are formed. Researchers are also studying genetic links.

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What, if any, connections exist between learning disabilities? Do they have anything in common?

Gail Grodzinsky, Ph.D.: A child who has difficulty learning sequences will likely have problems learning a sequence regardless of content. For example, sequential learning is important in letter-sound relationships, learning basic math skills, handwriting, as well as every-day activities such as tying shoelaces. Some children may have more difficulty with verbal sequences while others may have difficulty with nonverbal sequences. It is the underlying skill (e.g., short_term memory, visual processing speed, sequential learning, integrating information, or seeing the "big picture,") that determines the connection between different learning disabilities.

Some children will have difficulty in learning their math facts while others can learn their facts but will have difficulty with more conceptual material. For example, a child who happens to be more adept at linear, logical thinking will do better in basic algebra and statistics; whereas a youngster whose style is more "holistic" (seeing the "big picture" or the forest through the trees) will be more facile at concepts but perhaps not as quick with rote material such as facts and figures. Each individual has a preferred style of learning that serves as a natural path when solving everyday problems. Learning strengths allow the child to compensate and manage content areas that are more difficult. However, when a child can not adequately acquire a fundamental skill (reading, math, etc.) despite solid intelligence and otherwise intact learning ability, that child is considered learning disabled and requires remedial assistance."

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Don't all people have some form of learning difficulty? Aren't learning disabilities simply a matter of degree?

Gail Grodzinsky, Ph.D.: When a child's learning style or pattern of learning impacts a critical developmental skill, for example, memory problems that may affect learning to read or remembering the multiplication tables — and, depending on the severity and importance of the effected skill, the child is said to have a leaning disability. For example, reading is a necessary skill, and if you have difficulty learning to read, you are considered to be learning-disabled. In contrast, singing is not considered a prerequisite skill in reading or math; hence, the inability to carry a tune does not put you at risk for school failure.

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Are there early signs of learning disabilities?

Gail Grodzinsky, Ph.D.: If your child has any of these characteristics, ask yourself, "Is my child's behavior making things so hard for her that she is not progressing compared to other children her age?"

• Is she slow to learn nursery rhymes, the alphabet, color names?
• Does she have a short attention span, is restless or hyperactive, and does not complete tasks?
• Does she have trouble following directions?
• Does she have speech problems, difficulty making clear speech sounds, stuttering, does she have a unusually loud, soft, high, or low voice?
• How can a parent determine if a child has a learning disability?

Watch for delays in developmental milestones. Learning disabilities may be informally flagged by observing significant delays in the child's skill development. A one to two year delay in the primary grades usually requires investigation.

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How can a parent determine if a child has a learning disability?

Gail Grodzinsky, Ph.D.: Determining whether a student has a learning disability is a multi-step task, and it is accomplished differently in different locales. The process usually begins with the concerns of a teacher, parent, or pediatrician about the student's difficulty in acquiring a basic skill. Teachers and other professionals collect specific information about student performance and confer with school-based teams to develop strategies for help in the classroom. If these strategies produce positive results, the case is closed. If difficulties persist, a teacher or parent could refer the case for a special education evaluation. Once a referral is made, schools must follow the guidelines and procedures outlined by the Individuals with Disabilities Education Act (IDEA). For more specific information about a particular school's procedures, contact the special education chairperson or representative at that school or at the local education agency's central office.

Once a referral is received, the school conducts a formal evaluation of the student. In the case of a suspected learning disability, the evaluation usually includes assessments of intellectual potential, academic achievement, emotional functioning, hearing and vision, social functioning, and performance in the classroom. When the assessments are completed, a "group of qualified professionals and the parent of the child" examine the results. Both the specific strengths and the specific weaknesses of the student are identified. If the results reveal learning difficulties that meet the local criteria (for example, a significant discrepancy between IQ and achievement), the team will identify the student as having a learning disability.

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What can parents do once their child is diagnosed? Where can they go for help?

Gail Grodzinsky, Ph.D.: Creating an educational plan for getting the right help after diagnosis is very important. Because learning disabilities can affect the child and family in so many ways, help may be needed on a variety of fronts: educational, medical, emotional, and practical.

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What kinds of medical, behavioral, and holistic treatments are available? What are the pros and cons of each type?

Gail Grodzinsky, Ph.D.: Any well-researched treatment recommended by a trained and qualified professional is likely to have some merit. There is rarely just "one" intervention that will have an impact on a child with a learning disability. Often, a multidimensional treatment plan works best. For example, while a reading-disabled child will clearly benefit from explicit instruction in word decoding, comprehension skills and exposure to literature should also be considered. "Cure" therapies — including computer software, one-size-fits-all reading programs, restricted diets, special glasses, etc. -- must be viewed with extraordinary caution and cynicism.

The "whole" child must be considered in any treatment plan. How are the child's self-esteem, behavior (how they act), and learning style affected by their learning disability? Sometimes, it is necessary to prioritize treatment components. For example, structuring the classroom environment before a medical approach is used can be helpful in some cases.

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What kinds of financial costs might parents face as they seek help for a child?

Gail Grodzinsky, Ph.D.: The cost of an independent evaluation is sometimes, but not always, covered by medical insurance. Often a highly qualified educational tutor is helpful, although rarely covered by insurance. Occasionally, parents may want to seek legal counsel regarding their legal rights; this is not covered by insurance either. A parent may decide to look into a private school or a special education school. This is an option that may not be endorsed by the public school and would be at the parent's expense.

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What is an IEP, and what can parents expect from the IEP process?

Gail Grodzinsky, Ph.D.: An Individualized Education Program (IEP) is a written agreement between the parents and the school about what the child needs and what will be done to address these needs. IEPs must be drawn up by the educational team for the exceptional child and must include the following:

• The student's present levels of academic performance
• Annual goals for the student
• Short-term instructional objectives related to the annual goals
• The special education and related services that will be provided and the extent to which the child will participate in regular education programs
• Plans for starting the services and the anticipated duration of services
• Appropriate plans for evaluating, at least annually, whether the goals and objectives are being achieved
• Transition planning for older students

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What can parents do if they feel a school system is not following their child's IEP?

Gail Grodzinsky, Ph.D.: Every parent should receive a copy of their rights when they attend their first IEP meeting (many school districts mail a copy of the rights prior to such a meeting). In this pamphlet, the appeal process is explained.

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What can parents do when they believe their child is struggling in school but have been told the child does not qualify for special education?

Gail Grodzinsky, Ph.D.: Some parents may consider seeking consultation or an independent evaluation from a qualified professional such as a neuropsychologist, clinical psychologist, or psychiatrist.

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What are the pros and cons of having children repeat grades? Who is responsible for the decision to hold a child back?

Gail Grodzinsky, Ph.D.: Grade retention has been used as a means for a child to "catch up" on prerequisite skills to prevent failure when they go on to the next grade. Despite popular belief that repeating a grade is a remedy for students who fail basic skills, research has shown that retention does NOT improve grade performance except during the repeat year and only on some skills. The apparent benefit of retention tends to diminish over time so that differences in academic performance between retained children and those promoted disappear in later grades. Retention does NOT in itself correct a learning disability, nor will a repeat year using the same curriculum and same methods "fix" a learning problem. Alternatives to retention include promotion with remedial assistance.

Grade retention for reasons of social or behavioral "immaturity" also warrants careful consideration. The child should be evaluated to ensure she does not have a social or emotional learning disability that is impacting her progress.

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What should parents keep in mind when talking with a child about his or her learning disability?

Gail Grodzinsky, Ph.D.: Parents should tell their child that she has a weakness in reading or math or attention (or language, etc.) and that it needs to be worked on. But it should also be emphasized that, with good effort and the right kind of help, she can learn to read (or do math) well. Children should NOT be told that they have something wrong with their brain, but they should be told their learning difficulties are not the result of being stupid or lazy.

Having a learning disability makes learning harder but not impossible. It should not be a child's mantra in life that "I cannot read or write because I have a learning disability or ADHD." With effort and the right kind of help, learning disabilities can be remediated and ADHD can be managed.

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What are researchers learning about the nature and treatment of learning disabilities? What research looks most promising?

Gail Grodzinsky, Ph.D.: Currently, the research on subtypes of reading (decoding, comprehension, and fluency), math (computation, concepts, and application), and attention (with or without impulsivity/hyperactivity) has been enormously helpful in curriculum development and classroom accommodations that target specific subtypes.

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Produced by WGBH. Copyright 2003