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David Urion, M.D.
David Urion, M.D., is the Director of the Learning Disabilities/Behavioral Neurology Program at Children's Hospital, Boston. The program provides consultation for children with complex learning disorders as well as neurologic management of attention disorders, Gilles de la Tourette's syndrome, language disorders, and autism spectrum disorders. The program has one of the few post-residency fellowship training programs in child behavioral neurology in the United States. Dr. Urion is also Associate Professor of Neurology at Harvard Medical School, where he also serves as the Director of the Division of Service Learning. He 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 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?
- How might a parent's own learning disability impact how he or she responds to their child?
- What kinds of assistive technologies are available?
- 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?
David Urion, M.D.: A learning disability may best be defined as a neurologically-based problem in one or several, but not many, areas of cognitive functioning that is not explained by a general problem of intelligence, a sensory disturbance (i.e., a hearing loss or visual loss), a primary neurologic disorder, a psychiatric disorder, or some form of social deprivation or failure to attend school, and which leads to a deficit in learning when compared to what may be expected based upon the child's level of cognitive potential. There are many ways of subdividing learning disabilities, but most neurologists prefer to divide them along the lines of basic neurologic functions served by the brain — for example, language-based learning disabilities or visual-spatial learning disabilities.
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What causes learning disabilities?
David Urion, M.D.: There appears to be no one cause of learning disabilities. We know that some appear to be hereditary — for example, dyslexia and certain other language-based learning disorders seem to pass through families. In other instances, early brain injury — such as can occur as a consequence of prematurity — is associated with learning disabilities. Certain toxic exposures, such as lead, can produce injury to the developing brain and lead to learning disabilities. Many remain obscure in their origins.
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What, if any, connections exist between learning disabilities? Do they have anything in common?
David Urion, M.D.: Certain kinds of learning disabilities are likely to be seen with certain other issues because of the way the brain is organized. For example, the same regions of the brain control certain aspects of language and motor control. Poor handwriting, therefore, is common in dyslexia, since parts of the brain involved in both motor control and certain language tasks appear to be afflicted in this disorder.
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Don't all people have some form of learning difficulty? Aren't learning disabilities simply a matter of degree?
David Urion, M.D.: While all of us are a mixture of strengths and challenges, children with learning disabilities exhibit discrepancies between their areas of challenge and their overall cognitive abilities that are outside the range of usual variation in the population. That is, a learning disability is defined by a statistical discrepancy between overall ability and certain domains of cognitive ability. To that extent, learning disabilities are a matter of degree. All of us have slightly different body temperatures, but we can all agree that, when a child has a temperature of 104 degrees, it is not a normal variant but a fever.
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Are there early signs of learning disabilities?
David Urion, M.D.: Early signs of learning disabilities can include developmental delay in language, motor, or visual-spatial coordination areas. Children with delayed language acquisition often have later reading or writing troubles, and such children should be followed closely in their early school years. A boy who was late to talk and is having trouble learning to read in first grade should not be dismissed as a normal variation in reading acquisition (although this may be the case) but should be investigated.
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How can a parent determine if a child has a learning disability?
David Urion, M.D.: Evaluation for learning disabilities includes physical, psychological, and cognitive aspects. These are often done through the school system, looking at various capabilities compared to peers. Testing should be done by professionals competent in areas such as psychology, speech/language, reading, and other academic areas, as well as physical and occupational therapy in some cases.
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What can parents do once their child is diagnosed? Where can they go for help?
David Urion, M.D.: Once a child is diagnosed as having a learning disability, schools usually write some form of an Individualized Educational Plan (IEP) that takes observations and diagnostic information and puts actions in place to compensate for and remediate areas of difficulty. If a family does not feel that the evaluation describes their child or that questions have been left unanswered, they should seek outside evaluation to look into this. Professionals in the community, as well as larger facilities such as hospitals, often have such services available.
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What kinds of medical, behavioral, and holistic treatments are available? What are the pros and cons of each type?
David Urion, M.D.: Treatment of all learning disabilities should center on educational interventions. Medical treatments for related medical problems including attention disorders do not seem to affect learning disabilities directly.
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What kinds of financial costs might parents face as they seek help for a child?
David Urion, M.D.: If the child has not been evaluated through the school system first, in most jurisdictions the family would be responsible for the cost of independent testing. In many jurisdictions, schools may be responsible for part or all of such independent testing if the family rejects the findings of the school's testing.
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What is an IEP, and what can parents expect from the IEP process?
David Urion, M.D.: An Individualized Educational Plan (IEP) is a set of observations regarding a child's learning disability that are associated with specific instructional changes or interventions — methods, time required, and personnel needed to achieve this are all stated, along with goals for a given academic year and any modifications of assessment techniques that are warranted on the basis of the child's needs. The process at its best is collaborative between teachers, evaluation personnel, and families.
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What can parents do if they feel a school system is not following their child's IEP?
David Urion, M.D.: Each jurisdiction has specific procedures for making sure that an IEP is being followed. Speaking with the director of special education is a good, informal first step. If this does not explain the situation, then many states have mediation available through the state department of education. Failing that, binding arbitration through hearing officers is possible. The latter is usually rare.
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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?
David Urion, M.D.: The pendulum has swung away from retention for skills-building. Rather, retention is preferred only if the larger developmental goals have not been met (i.e., the child is not cognitively or socially ready for the next step). For a child with a skill deficit, such as decoding troubles in an otherwise good student, promotion with services is now generally preferred. Retention at times of transition from one school setting to another is also to be preferred over retention in the middle of a school setting (i.e., before middle school rather than during middle school).
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What should parents keep in mind when talking with a child about his or her learning disability?
David Urion, M.D.: As in other circumstances, parents should learn to listen to the child, answer the questions the child has, and only go further when the child requests more information. Too much information can be overwhelming. It is also important that, if the parent has strong emotional reactions to the diagnosis, they should have these mastered while talking to the child.
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How might a parent's own learning disability impact how he or she responds to their child?
David Urion, M.D.: Parents who have learning disabilities themselves may over-identify with their child's problems, assuming their own reactions and those of their child will be the same. It is crucial to remember that the child has his or her own authentic experience, which should be respected.
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What kinds of assistive technologies are available?
David Urion, M.D.: The most interesting technology to come along of late has been universal design texts, which allow the teacher and student to call up the assistance a given student needs and suppress other assistance. It is also flexible, in that it can change as needs change over the year.
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What are researchers learning about the nature and treatment of learning disabilities? What research looks most promising?
David Urion, M.D.: Current research using functional magnetic resonance imaging (FMRI), the most promising form of investigation, has told us that the central model of learning disabilities thinking over the last quarter of a century — that functional deficits in certain regions of the brain are the primary cause of learning disabilities — is fundamentally true. FMRI will now help us learn what the nature of that dysfunction is and then what we might do to prevent or ameliorate it.
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