Parents and Physicians Working Together
From annual school check-ups to coughs and fevers, scraped knees, mysterious rashes, swollen glands and a host of other common (and not-so-common) symptoms, physicians and parents are partners in providing the best medical care possible to children and adolescents. Together with parents, medical providers are in the unique position of interacting with children throughout their school years, watching them grow not only physically but also in terms of their language, social-emotional and academic development. This perspective makes them ideal partners for both identifying potential learning problems and helping parents make wise decisions about the kinds of help that, if provided early and with precision, could truly be “prescriptions for success.”
The article below, written for physicians (shhh! you can read it too!) was published in the October 2004 Journal of Child Neurology. It spells out some of the ways that medical professionals can play active roles in helping parents and school personnel address problems with learning and attention in school age children. We encourage you to share this article with your pediatrician.
From Research-to-Policy-to-Practice: A Prescription for Success
In a perfect world, the challenge of teaching would be a simple, straightforward endeavor. Healthy children would cross over the threshold of well-appointed and esthetically pleasant school buildings, having just enjoyed a well-balanced breakfast at their kitchen tables, and be greeted by enthusiastic building administrators and well-prepared teachers. Classroom instruction would reflect current research-based practices, and homework and assessments would be personalized to each individual child. Grade promotion would always be grounded in successful mastery of theory and content in subject areas, and students would progress seamlessly through the elementary, middle and high school grades, perfectly positioned to transition to post-secondary academic or pre-vocational settings or to gainful employment. Parents, teachers and school counselors and administrators would maintain open lines of communications, offering complimentary feedback and relying upon each other for honest and timely dialogue about questions and concerns.
In reality, and for segments of the student population, certain aspects of this fairy tale trajectory may hold true. However, for substantial numbers of others, including many with specific learning disabilities, the path from preschool to gainful employment is fraught with frustration and failure. Special education students, of whom students with learning disabilities comprise more than half the total number, fare far worse than those without these intrinsic challenges, and even with learning and behavioral support and intervention programs in place, current kindergarten through grade 12 school systems deposit almost 15% of our nation’s school-age youth at the brink of adulthood ill-prepared to become independent and contributing members of society, and worse, unable to realize their full potential.
There is, however, good reason for optimism. Substantial policy efforts are underway to influence the reauthorization of the Individuals with Disabilities Education Act to incorporate major improvements that reframe key issues, such as what constitutes “adequate yearly progress,” who is a “qualified teacher,” what is meant by “research-based practice,” and whether a “response to intervention” approach to early identification and treatment of learning disabilities is a viable alternative to current discrepancy approaches to assessment and classification. These major improvements to current policy have enormous implications for practice, and changes currently being considered in Congressional committee have the potential to reverse decades of unproductive mandates and prevent struggling students from having to endure failure before undergoing evaluation, being tracked into low-performing academic tracks instead of providing meaningful individualized and targeted instruction, and overlooking their unique social and informational needs and those of their families.
There has always been a certain tension between the world of education and other endeavors, perhaps owing to the presumption that there was little real science underlying educational practice and that, for example, engineering, medicine, and even the performing and fine arts held to a certain level of precision, discipline and professionalism that differentiated them from teaching. The notion of teacher as “expert” is not nearly as pervasive as that of physician, architect or musician, and the status of teachers in the eyes of the public has unfortunately suffered greatly as a result of highly politicized reports of poor learning outcomes for so many students with and without disabilities.
Medical practitioners have long enjoyed almost unconditional access to (and respect within) the education community, and increasingly large investments in neuroimaging and intervention studies, genetics and functional mapping of brain development and function, have begun to pay dividends in building a knowledge base from which early care providers and educators can make curricular decisions and tailor experiences and instruction to children at risk for learning failure. Physicians and medical researchers are being called on with increasing frequency to help problem-solve appropriate educational responses to clinical manifestation of specific learning disabilities and co-occurring disorders of language, behavior and attention in individual children, as well as to participate as members of school-based committees on special education and as a provider of ongoing professional development for staff.
As a community, physicians with expertise in child development and an appreciation of school-related challenges are uniquely positioned to contribute to the school success of children with learning disabilities. Here are some specific examples:
Help dispel the stubborn mythology that surrounds specific learning disabilities.This is especially pertinent with regard to the area of reading (dyslexia). For example, there is still a popular faulty perception that individuals with dyslexia “see” letters upside down and that dyslexia is a single problem (i.e., trouble “sounding-out words”) rather than a diagnosis that encompasses such features as decoding speed and accuracy, vocabulary, comprehension, spelling and written expression.
Convey the message that “learning disabilities are real.”Parents and educators should be reminded that the science and underlying etiology of this disorder are far from complete, and there is only of late an emerging precision (and even consensus) about best treatment and intervention practices. There needs to be explicit reference to learning disabilities as lifelong, and reference should be made to how learning disabilities can impact an individuals’ ability to function at different times across the life span. Also important is to articulate the notion that the impact of learning disabilities is not limited to any one skill area (i.e., reading, math, listening) and that learning disabilities do not result from educational impoverishment or from physical, sensory or motor impairments; that they are as likely to appear in boys as in girls; and that they do not result from lack of motivation or effort on the part of the individual.
Guide parents and educators to better understand the similarities and differences between different classes of disorders.Although disorders of learning, attention, mood and anxiety often have overlapping characteristics and co-occur with some frequency, each has recommended treatment approaches, and each demands unique evaluation protocols to determine efficacy and monitor successful outcomes. This is particularly important with regard to comorbid learning disabilities and Attention-Deficit Hyperactivity Disorder (ADHD), about which there is confusion and misunderstanding of how different pharmacological protocols are often used, and what impact they have on a student's improved availability to benefit from effective instruction.
Communicate with parents and others that there is no “cure” for learning disabilities.Although pharmacologic intervention has been proven effective to address features of some disorders that fall along the developmental spectrum (and, indeed, individuals with comorbid learning disabilities and ADHD are well known to have been shown marked benefit from psychostimulants and other pharmacologic agents), effective treatment approaches for specific learning disabilities alone rarely involve medicine, diet or other non-behavioral approaches. It should be reassuring to parents and educators that best practice dictates a well-targeted and intensive program of instruction and support for these individuals, coupled with careful and ongoing observation and progress monitoring. Just as physicians require feedback from patients and care providers during a medication trial, so, too, should parents and educators commit to evaluating progress during periods of focused instruction, documenting the child’s response to intervention and making needed adjustments.
Assist parents and educators to demand accountability from each other and from the systems within they operate.Educators should be encouraged to facilitate early screening efforts that ensure that students do not have to wait to fail before being identified as “at risk” of learning failure and thereby deemed eligible for referral for special education evaluation. Parents should be empowered to be proactive in sharing concerns with school personnel and with medical providers. They should be apprised of their due process rights so that they can be effective advocates for their child and be prepared to work with school personnel to either circumvent the needs for special education referral or participate in pre-referral activities that clarify the nature of a student's difficulties and lead to consensus about how best to address learning problems early and with robust and effective strategies.