other adults employ increasingly nuanced language that also becomes more abstract and demands the listener infer meaning. Discussions in class, like conversations by the lockers, assume an ever more sophisticated language system. A treasure trove of words that are organized and associated, convertible to alternate forms or meanings, is employed flexibly. The norm is facile use of grammar and syntax to sequence words and create sentences that express simple to complex thoughts. As language develops, the ability to name and analyze one’s own feelings and the feelings of others, and to adjust self-expression and behavior to suit social situations, expands. “For a child with a dual diagnosis of language-based learning disability and ADHD, self-regulation can be even more difficult,” says Dr. Christy Brockhausen, Director of Lower School. “If all a child has to rely on to communicate his or her need is behavior, it can appear as though the child is being oppositional. Too often, the response in schools is to address a behavior instead of treating the underlying cause of the problem, the deficits in a child’s language skills.” The Gateway School recognizes the importance of language skills for social and emotional growth. “We think about language–not just the language needed for academics, but also the language children need to understand and express themselves in various social contexts,” says Ms. Ironside. In small groups, students participate in discrete language therapy
and social development sessions. These classes directly connect language with social-emotional development. Students are seen in the same groups so they learn skills in each developmental strand in a consistent and coordinated fashion. For example, in Lower School, a group will be directly taught the language for a conversation and then practice reciprocal conversation. In social development, they will approach conversation by learning what to talk about, examining the impact of their word choices and phrasing, and how to manage their impulses and emotions. Through adult modeling and by reconstructing conversations, students ensure the intended meaning is clear and their understanding of what was said is clear. In Middle School, the language therapist and school psychologist address skills such as taking perspectives, how to joke appropriately, and how to self-advocate and advocate for others. To foster healthy social-emotional growth, teachers do not merely encourage students to treat each other with respect; they explicitly show them how to empathize or self-advocate. At Gateway, the approach to socialemotional learning revolves around the idea that the school has to teach skills directly. “By graduation,” says Dr. Harrison, “our students are self-reflective, know who they are and where they came from, and can handle themselves well in lots of situations they would have found challenging.” n
Article 6: Diagnosis and Treatment/Intervention
I Carolyn Salzman Head of School The Gateway School
n a widely circulated essay, Emily Perl Kingsley compared her experience of raising a child with a disability to planning a much-anticipated trip to Italy, only to find that her plane had landed in Holland. At first, there was surprise and anxiety that she hadn’t reached her desired destination. But soon, she came to realize all of the joys and wonders that Holland has to offer. For a parent with a child who has a learning disability, this sense of surprise can make it hard to figure out how to begin to support a child’s needs. With a first or only child, parents don’t have a reference point, so they may not even know if anything is amiss. When it comes to language-based learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and executive function disorder, many children don’t present symptoms until preschool or later. A bright child can mask their difficulties for years.
“Despite the presence of specific disorders that are readily apparent to the trained eye, parents can be so successful at scaffolding and intervening in support of their child, it becomes harder for them to embrace the extent or implications of their child’s issues,” says Carolyn Salzman, Head of School at The Gateway School. “Often, it is not until the demands of homework, the inability to solve word problems in math, or the struggle to write a three-paragraph essay are so overwhelming for the child that parents are persuaded to take a close look. The loss of time on the field with a beloved sports team can also motivate parents to seek answers because suddenly it’s clear the child doesn’t understand the coach or cannot remember the rules and plays.” If a parent suspects there are issues affecting their child’s development, a first step is a conversation with their child’s pediatrician. The child’s doctor can measure their progress against expected developmental markers and highlight any areas of concern.
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Often, it will be a child’s teachers who notice delays and communicate these to parents. At this point, an important step is to schedule a neuropsychological evaluation with a licensed school or clinical psychologist. This evaluation and a language evaluation are valuable tools for parents advocating for their child and the schools dedicated to teaching them. The Division of Child and Adolescent Psychiatry at the Department of Psychiatry of Columbia University’s College of Physicians and Surgeons, defines a neuropsychological evaluation (also called neuropsychological testing) as an in-depth assessment of skills and abilities linked to brain function. This type of evaluation measures such areas as attention, problem solving, memory, language, intelligence, visual-spatial skills, academic skills, and social-emotional functioning. Its purpose is to identify a child’s strengths and weaknesses across a range of skills and propose strategies to support development or remediate weaknesses. A psychologist will administer a battery of tests and using standardized measures, assess and report on quantitative and qualitative information gleaned over the course of several sessions. The psychologist assesses not only specific strengths and weaknesses, but also the child’s behavior throughout. The typical report is long and describes the results and observations and discusses the linkages between any deficits it uncovers. In addition to a diagnosis, the psychologist will note behaviors that are possibly indicative of a disorder. While they may not meet the criteria for a diagnosis, they may be something parents should track. Parents are well advised to repeat this testing periodically. As children age, a disability can emerge more fully. Moreover, the tests change. The tests for older children are more language laden than those for preschoolers, reflecting the normal developmental arc of children. A neuropsychological evaluation can be a valuable resource for parents because it offers insight into a child’s difficulties at school and at home by identifying areas of weakness, explaining their academic and social implications, and recommending therapies,
supports, or medications. Lauren Feiden, Ph.D., Lower School Psychologist at The Gateway School, compares this type of evaluation with a psychoeducational assessment completed by a Board of Education. “While the latter gives a basic understanding of a child’s intellectual capacity and learning differences, a neuropsychological evaluation offers parents the full picture. It can help them understand how their child learns and why, what they are capable of, and how they can help their child be and feel successful in school.” By middle school, some children are sufficiently aware of their problems that hearing the test results from the psychologist demystifies their school experience and is a source of relief. Speech and language therapy addresses the needs of people with speech and communication disorders and is administered by a speech-language pathologist. According to the American Speech-Language-Hearing Association (ASHA), speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive communication, and swallowing disorders in children and adults. Counseling or psychotherapy addresses the child’s emotional and behavioral symptoms with the goal of increasing self-awareness, coping skills, and stamina. Through counseling, the child learns how to self-reflect and control their impulses. Parents can learn how to manage the child at home and to collaborate with the school on behalf of their child. Medications are sometimes recommended for children who have been diagnosed with conditions like ADHD. When medication is introduced, parents are often encouraged to also engage counseling. The Multimodal Treatment of ADHD (MTA) study, funded by the National Institute of Mental Health (NIMH), showed that children receiving a combination of medication and counseling demonstrated significantly higher improvements in problem behaviors, and that these benefits lasted longer than treatment or medication alone.
Open communication and regular meetings between parents and their child’s team guide a family to a better understanding of how their child learns.
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SPECIAL REPORT
Occupational therapy can help children with physical, cognitive, or sensory disabilities. According to the American Occupational Therapy Association (AOTA), in addition to dealing with someone’s physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. Recommendations can also include participation in remedial programs, enrollment in special school settings, and a range of study skills or learning strategies that will support the student academically. Once a diagnosis has been confirmed and a psychological evaluation is completed, an important next step for a child in a public school is the development of an Individualized Education Program, or IEP. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) requires public schools to create an IEP for every student with a disability who is found to meet the federal and state requirements for special education services. Once completed, the IEP will include which services are mandated in order to ensure that student can progress in the least restrictive school setting. In addition to being an academic document, the IEP is also a legal document. A second type of evaluation, a language evaluation, provides a specific analysis of a child’s language system. The state of a child’s language system governs how they will use language to process information and learn. For example, limited working memory can influence language-based tasks such as sentence repetition or recalling details of an instruction or a story. The disorganization typical of executive function disorder will reduce a child’s ability to answer an open-ended question (“Tell me all about the birthday party.”) but have more limited impact on responses to multiple-choice questions. A language evaluation can illuminate where the underlying breakdowns are in aural comprehension, acquiring basic and more mature literacy, as well as in other academic skills. Additionally, the results of a language evaluation can guide both therapists and teachers. Lydia H. Soifer, Ph.D., Assistant Professor of Pediatrics at Albert Einstein College of Medicine and the Staff Developer at The Gateway School, stresses the importance of language evaluations “that analyze and interpret test demands as well as the quality of student responses for their potential impact on learning, versus simply providing test administration and score reporting.” A licensed language therapist conducts the evaluation, which is structured and administered
in very much the same way as a neuropsychological evaluation. In this instance, the focus is exclusively on language: vocabulary, syntax, listening skills, verbal reasoning, discourse, etc. To fully understand the impact of the child’s developing language on academics, the therapist will likely take aspects of the neuropsychological evaluation into consideration. In some cases, the consulting psychologist and/ or language therapist conducting the evaluation will recommend that a child attend a specialized school, like The Gateway School. This type of school usually targets a specific population and designs its program to remediate their particular learning disabilities and educate them. The student-teacher ratios are often low and classes are small. This means students receive a lot of teacher attention and, depending on the school, individualized programming. To be sure the school can meet a student’s needs, the admissions process frequently includes additional assessment by the school’s own educational and therapeutic experts. Once a student is admitted, Gateway has many supports in place to ensure they are successful. Teachers employ direct, explicit, and multisensory instruction, use language carefully so as to not overwhelm them, and breakdown skills so the student is motivated by incremental successes. Several related services are provided by in-house staff. These include language therapy, occupational therapy, and counseling. Importantly, these services are done during a therapy block so that students aren’t pulled out of other academic classes, as may be done in a typical mainstream public school. Above all, Gateway’s placement of students within its program is driven by the learning profile of the student, and it stresses partnership with the family. In a program that meets students at their level and teaches skills, strategies, and content incrementally, sequentially, and consistently using instructional approaches validated by research, students become skilled and strategic independent learners. Open communication and regular meetings between parents and their child’s team guide a family to a better understanding of how their child learns. With time, families are able to recognize how their child’s disabilities manifest themselves in and out of school and the kinds of age-appropriate, effective strategies that can support them. Fortified, parents are able to fully enjoy all the wonder their child has to offer. n
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