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For kids with special learning needs, roadblocks remain

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Science  25 Sep 2015:
Vol. 349, Issue 6255, pp. 1465-1466
DOI: 10.1126/science.349.6255.1465

Dyslexic children should be in a dedicated program by first grade, researchers told lawmakers.


Despite decades of neuroscience advancement, new diagnostic technologies, and a focus on studying children with disabilities, many children with special needs like attention deficit hyperactivity disorder (ADHD) and dyslexia are still being left behind at school.

“We have all this stuff—new brain imaging technologies, big data samples, etc.—why are we not making really fast progress?” said Damien Fair, associate professor in behavioral neuroscience and psychiatry at the Oregon Health & Science University.

Fair spoke at a 9 September briefing on Capitol Hill, as one of three scientists presenting the latest research on why these children tend to fare poorly in school and what can be done about it. The briefings, organized by AAAS with support from the Dana Foundation, provide scientific evidence to lawmakers with the hope that it will help them find solutions to society's problems, said Erin Heath, associate director of the AAAS Office of Government Relations.

“Education is a topic that comes up again and again, because it touches nearly every aspect of our society,” Heath said.

Early identification is the first roadblock that separates special needs children from an effective education. For children with ADHD, that is due in part to the “heterogeneity problem,” in which children diagnosed with the same condition have different underlying issues in their brain, said Fair. Doctors may check the same boxes to diagnose two children with ADHD, but the cause may not be the same, making it difficult to identify the appropriate therapies. Studies of the brain have found that normal control populations are also heterogeneous in brain physiology and behavior, further complicating efforts to study people with ADHD.

Figuring out how to characterize this variation is likely to be a major research area going forward, Fair said, and may lead to more individualized therapies.

Even when special needs children are identified, many children are deprived of intervention because their parents can't afford the best programs.

In the case of dyslexia, specialized schools may charge tuition that rivals an expensive university, said Sally E. Shaywitz, co-director of the Yale Center for Dyslexia and Creativity and a professor in learning development at Yale University.

“Many of the people hardest hit by dyslexia are minority students and those from low-income families,” Shaywitz said, even though the condition affects all population segments and languages.

Roughly 8 to 10% of children in the United States have a learning disability, and about 1 in 5 people suffer from dyslexia. Across the general population, there is a link between strong reading skills and high IQ. That's not the case for people with dyslexia, which means that even very bright children can have a reading deficit.

In the wrong setting, even a smart kid can think herself a failure because of dyslexia.

“Allowing children to fail, to think they're ‘dumb,’ is no longer acceptable,” Shaywitz said.

Dyslexic children are best identified and placed in a special program by the first grade, according to research by Shaywitz scheduled for publication in October. That is two grades earlier than most previous estimates.

The best model, she said, is a specialized charter school that doesn't charge tuition. “We need early identification, and it can be done. And we need early intervention. If you wait until third grade, kids give up,” Shaywitz said. “We now know it's first grade, and we need to act on it.”

For children with ADHD, learning difficulties tend to appear later on in development, said Martha Denckla, a neurology professor at the Johns Hopkins University School of Medicine and director of developmental cognitive neurology at the Kennedy Krieger Institute.

“In my clinic, we find that for grades K-1 to 3, children with ADHD didn't show up with academic lags. But later on, the deficits emerged,” she said. “Yes, we should do early identification, but we can't drop our vigilance.”

Around third grade, a student with ADHD begins to academically “fall apart.” The child may seem to be doing well while they're learning. But wait a few minutes after the lesson, and they have trouble remembering what they've learned.

“Something seems to be interfering with these children's new learning,” Denckla said.

Children with ADHD tend to react slower when tested for motor ability, eye movements, comprehension, and processing speed, according to Denckla.

These students need to be taught in a way that reduces competing demands on attention, allows them more freedom of movement while learning, and encourages repetition of skills, she said. Focusing on sitting still or positioning a pen on paper takes up too many cognitive resources.

“Anything you ask children with ADHD to respond to with consistent speed, they do not do as well as others,” Denckla said. “Sometimes children who are hyperactive are slow.”

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