After the Diagnosis: How to See the Forest for the Trees

By Kathy Platzman, Ph.D.

Many parents are overwhelmed with information after their child receives a diagnosis of a learning difference. Taking a moment to formulate a plan allows parents to see the big picture of their child’s treatment.

The diagnosis
Jim and Irene know that their 3rd grader, Tommy, is having problems in school. This year has been difficult for Tommy with his grades getting lower and his level of frustration getting higher. When Jim and Irene sought a diagnosis, tests revealed that Tommy has a reading disorder cou- pled with significant visual memory problems.

Jim and Irene are told that addressing these difficulties will require entering into the Individualized Education Plan (IEP) process at school. They are advised to find a good tutor and possibly an educational advocate to guide them as they work with the school. Their heads are swim- ming with new information and terminology that is unfamiliar. In the blink of an eye they have gone from simple concern for Tommy’s school difficulties to a confusing new world of assessments and modifications.

Tommy’s parents, like thousands of others, receive this news in different ways. Jim finds himself mentally revisiting his own childhood reading problems. He found learn- ing hard and humiliating and is dismayed that his own son is going to have to endure what he did. Irene is taking the news in stride, even optimistically. Her countenance says: “Great… now we have some answers…this is something we can get to work on…right away. Let’s get to it!”

They receive many recommendations for what to do, what to try, what to hope for. The meeting, which is sup- posed to give them direction, leaves Jim and Irene with even more questions. What do we do first? How much is it going to cost? Will Tommy feel stigmatized? Will he suffer through endless hours of drudgery, humiliation and dis- couragement? How do we tell Tommy? What about the extended family? Will there be a negative reaction? They feel that they have to get moving quickly, which leaves them feeling exhausted and irritated.

Time for a deep breath
Many parents struggle after a learning difference diagno- sis. After getting the news, there can be a sense of relief that a problem has been identified. Now a treatment plan can begin to take shape, right? Actually, identifying and acknowledging a problem for their child and making a plan to address it can often lead to a cascade of unanswered questions and unresolved emotions for the parents. To complicate matters these questions and emotions might differ from parent to parent, and there may be conflict on which course of action to take. This can be a time for stress and confusion within the family.

While the urge to mobilize and act can be strong, it can be quite helpful to take time to assess, adapt and plan be- fore taking action. The irony is that sometimes the right treatment approach is far less clear than the simple definition of the problem. This is because treatments are not “one size fits all” in nature. Individual differences within each family are the rule, not the exception. What is right for one family may be wrong for another. The effectiveness of treatment approaches depends on these individual differences, including the child’s overall profile (strengths, as well as weaknesses) and the family’s specific abilities, challenges, resources and vulnerabilities. Although professionals hope to help families receive the best treatment, the journey can be difficult if the unique characteristics of each client are not taken into account when creating a treatment plan.

Guidelines for treatment
Psychologists work with families struggling to find the best ways to support and facilitate development for a child with a learning problem. After the diagnosis is made, a plan of treatment that not only takes into account the central problem, but also acknowledges the family’s strengths and challenges, must be defined. This process takes time initially but it will arm parents with clear goals, effective coping skills and less stress for the long term. There is much to consider in answering the question: “How do I know what is best for my child?”

Models for treatment of children with learning differences vary, but the common factor remains constant: the individual strengths and weaknesses of each child must be central to the plan. The developmental, functional and emotional level of the child has to be well understood when designing and planning a treatment plan. This refers to the child’s ability to regulate his behavior, attention and mood, to communicate and problem-solve using gestures and words, to reason and think symbolically, and to cope with emotions by relying on others when overwhelmed or confused.

Individual differences do not exclusively pertain to the learning difference but may also include health/biomedical issues (e.g. allergies, difficulty sleeping well), sensory profiles (e.g. ability to concentrate in busy/noisy environments), information processing (e.g. how easily a child understands auditory, visual and kinesthetic information), and narrative and motor sequential output (e.g. the ability to tell a logical story or to write legibly). These issues need to be well-defined before designing treatment strategies.

Relationships must be taken into account since learning does not occur in a vacuum. When planning interventions, the relationship between the child and the person helping him should be amiable, consistent and healthy. Adults who forge warm, strong, meaningful relationships with the child will be the most effective “agents of change.” By taking into account the child’s interests and self-motivators, good decisions can be made. The child can receive help through a positive experience which is especially important when the struggles are tough.

In all of these areas, parents are the most important resource. Not only do they know their own child better than anyone else, they also know what their family can do to help him. Even though a child might work with a professional to address the problem, parents are often the ones who help him on a daily basis with homework and other tasks that may be difficult. Parents can ensure that the child is surrounded by loving people who can sympathize and support with love and compassion. This familial support helps when motivation wanes.

Formulate a plan
Applying the above guidelines, Jim and Irene begin to form a treatment plan. Since Tommy’s vision is an ongoing concern, and because his sleeping and eating patterns are less regulated than other children his age, Tommy’s parents decide to focus on these issues first. They make appointments with a vision specialist, an allergist and a nutritionist. At the same time, they take advantage of strong family relationships and have Tommy’s cousins over once a week for “homework” nights. Tommy gets special reading tutoring from his cousins while having fun. At this point they wait to contact a reading specialist until they have more information. As Tommy’s parents become more informed and experienced about his treatment, they can take the next steps to ensuring his improvement and success.

It’s normal for parents to feel overwhelmed and lost after a child receives a diagnosis of a learning difference. However, parents can use this time to feel empowered by gaining knowledge about their child and the learning difference. By taking a step back and looking closely at their child’s strengths and weaknesses, the community and educational resources available, and the personal relationships which enrich a child’s life, everyone can begin to move forward.

Kathy Platzman, a Kids Enabled editorial advisory board member, is a licensed psychologist with a private practice focusing on assesment and treatment of infants, children and families with a wide range of developmental disabilities. She used the D.I.R./Floortime model to address difficulties and promote development in children with social and emotional, and/or information processing challenges. Dr. Platzman can be reached at kplatzman@floortimeatlanta.com or 404-373-8335.

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