Attention
Attention deficits are among the most common causes of
academic underachievement. Teachers, parents, and clinicians must be careful
not to misinterpret this symptom as a poor attitude or lack of motivation:
children with attention deficits only become more anxious and confused when
told that they can do it if they really want to. Although some of them have
behavior problems as well, for most attention deficits comprise a significant
learning disorder. Affected children are bored in school, and their day-to-day
performance is erratic and inconsistent. They have trouble deciding what is
relevant when they listen or read. Many experience inordinate mental fatigue
and are inattentive to details. They often make careless errors and organize
their work poorly. Writing is especially difficult for them, and many have
associated memory problems.
Memory
Schools put a great deal of stress on memory -- far
more than most careers or professions do. Certain children with otherwise
intact cognitive capacities have serious memory deficiencies. Some find it
difficult to register new facts or procedures in short-term memory; they study
for hours without retaining salient material. Sometimes this deficit is
confined to one processing modality, such as the visual, sequential, or
verbal. Other students have difficulty maintaining several items at once in
active working memory. They forget the content of a book chapter while reading
it, or lose their train of thought while solving a mathematics problem or
trying to remember a word's spelling or translation.
Many students cannot meet academic demands on long-term
memory. They have difficulty transferring facts or skills to permanent storage
and filing them away systematically. Some suffer from an inability to retrieve
stored learning effortlessly, a phenomenon known as delayed automatization.
Children with limited access to stored material recall slowly and imprecisely,
and may have reduced capacity to recognize patterns or associations they have
previously encountered.
Language
Problems may occur at various levels of verbal
processing and production. Some children have difficulty interpreting and
manipulating the sounds of language. They often must use contextual cues to
understand speech, and they commonly find it difficult to read, spell, or
learn foreign languages. Others have difficulties at the semantic level --
understanding the meanings of words and the relationships among them. Many
students are confused about syntax, word order, or grammatical forms.
Inability to cope with abstract, symbolic, and technical language ultimately
has disastrous effects on school achievement.
Some children speak fluently but understand poorly;
others understand well but express themselves ineptly. These discrepancies are
often confusing to adults, who may not suspect a disabling language deficit in
a child who seems to communicate fluently in social settings. The everyday
conversational skill of such students is in striking contrast to their lack of
facility with more academic, literate English.
Organizational skills
To succeed in school, children must develop effective
techniques and habits of organization. Some children suffer from
temporal-sequential disorganization: they have difficulty allocating and
estimating time, following schedules, meeting deadlines, and solving problems
in stages. Other children have trouble with material-spatial organization:
keeping track of possessions, maintaining notebooks, arranging desks, and
finding objects like pencils and books. Another type of problem is disorderly
transitions: difficulty in settling down and functioning effectively when
expectations or settings change. Some children have problems related to
prospective retrieval; they cannot remember what they are required to do.
Neuromotor functioning
Some students write poorly because their fingers do
not keep pace with the flow of their thoughts and language. They may grasp
pencils awkwardly, form letters poorly, and hesitate on every word. They often
prefer printing to cursive writing, and they are reluctant to complete written
assignments. They may have gaps in motor visualization or motor sequential
memory, deficits in the hand movements required for writing, or finger agnosia
(impaired awareness of the location of fingers). Like children with attention
deficits, they are often accused of being lazy or having a poor attitude, and
in many cases neither they nor the adults around them understand what the true
problem is.
Higher cognitive functions
Problem-solving skills, creative and critical
thinking, analogical reasoning, and concept formation spare memory and make
school more gratifying for competent learners. Students with deficiencies in
these areas become bored and apathetic and rely on rote learning without full
understanding. The problem may be generalized or limited to certain fields
such as history or chemistry.
Social cognition
Some students cannot meet the social demands of school
life. They lack social cognitive awareness and skill -- a constant source of
public humiliation. They do not know how to approach peers, interpret their
responses, predict their reactions, or resolve personal conflicts. Many show
signs of verbal pragmatic dysfunction: they do not use and understand language
in relevant ways in social contexts, and therefore inadvertently offend or
annoy others when they speak. A closely related problem is deficient political
skills --inability to win the respect and admiration of teachers or
influential classmates.
The misinterpretation and mismanagement of
neurodevelopmental dysfunctions may have more devastating effects than the
disorders themselves. Children whose problems are unrecognized may become
anxious and depressed, reject demands for academic performance, decide that
success is impossible, and lose all ambition. They may then live from day to
day without considering the future, act out aggressively to mask their
feelings of ineptitude, and try to punish families whose expectations they
cannot satisfy, while continuously denying their problems and denigrating the
school instead.
School personnel, parents, clinicians, and the child
must collaborate in evaluation and treatment. These problems are best
approached by a multidisciplinary team using a neurodevelopmental and
educational test battery to examine the child's neurodevelopmental strengths
and weaknesses, neurological status, academic skills, and emotional problems.
The resulting description is usually more valuable than a mere list of test
scores or a label such as attention deficit disorder or learning disability.
Once the nature of the problem has been defined,
several steps should be taken. First the child, parents, and teachers should
be educated about the child's problems and strengths. The child and teacher
must make use of strategies for circumventing weaknesses, such as providing
more time to take tests. The child should also be given help to strengthen
weak functions, continued counseling, and medication for attention deficits if
necessary. Efforts should be made to emphasize and enhance the child's strong
points. (Not all variation in academic skills is a sign of deviation or
deficiency; many of these students have highly specialized rather than
dysfunctional brains, and often succeed when allowed to practice their
specialties as adults). A long-term commitment is required.
Children with neurodevelopmental dysfunctions
experience excessive failure and intolerable humiliation. Because schools have
tremendous potential to help or harm them, school personnel must become more
sophisticated in recognizing their problems. Greater community awareness and
more research are also needed. Mental health professionals must accept the
challenge to provide the understanding and humane care needed by these
children and their desperate and understandably confused families.
~~~~~~~~~~
© 1995, Harvard Medical School
Health Publications Group. This article has been posted on NLD on the
Web! with the permission of the author. It may not be copied without the express
written permission of Harvard Medical School Health Publications
Group.
About the author:
Melvin D. Levine, MD, is a Professor of Pediatrics at the University of North
Carolina Medical School in Chapel Hill, North Carolina and the Director of the University's Clinical Center for the Study of
Development and Learning. Dr. Levine is also the founder of All
Kinds of Minds, a non-profit Institute for the study of differences in learning,
and co-chairs the Institute's Board of Directors with Charles R.
Schwab.
Source: Levine, Melvin, Childhood neurodevelopmental dysfunction and learning
disorders, Vol. 12, Harvard Mental Health Letter, 07/01/95.
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