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Filling a gap
The Reed Institute advocates a team approach to diagnosing and treating learning disabilities
Physical disabilities in children tend to be obvious and, fortunately, there is no lack of medical and lay practitioners ready to help. Mental disabilities – apart from acute retardation – can be trickier to diagnose, but here, too, trained mental-health professionals are readily available to carry out treatment.
Learning disabilities are another matter altogether. Since the children involved are not mentally-ill – indeed, many may be above-average in intelligence – their conditions often go completely undiagnosed and their failings are attributed to character flaws like laziness or lack of confidence. Even when a proper diagnosis is made, however, finding help can be problematic. That became apparent to Sherry Payne almost as soon as she arrived in Bangkok 12 years ago. Payne, with 25 years experience in special education in the United States, found that her services were soon very much in demand. “I got here and found that there were very limited services,” Payne recalls. “So little by little parents started looking for help. I’d hear about it and, on a one-by-one basis, I would meet some of those needs. That grew and grew until I was just about working full-time.” Payne went on to set up a school for the learning disabled, but she says she did not find the experience completely satisfying. “Running a full time school is not my love,” she notes. Payne says she much preferred the consulting and testing she carried out for schools, but even that had its limitations. The field of learning disabilities is broad enough to go beyond the expertise of an individual practitioner and Payne believes the work is best carried out as a team. Now, with the establishment of the Reed Institute that is exactly what Payne and her two colleagues, speech therapist Dr Richard Logan and clinical psychologist, Ali Khakpoor, are doing. Based in a spacious, home-like facility on Sukhumvit 38, the Reed Institute team carries out extensive student evaluations and assessments leading to a detailed report suggesting appropriate intervention programmes. Some of this may take place at Reed itself on an individual basis or in the Institute’s activity-filled 5-hour “Saturday Jam”. Reed also runs a summer camp. At the moment, Reed Institute caters mainly to English-language speakers although the Saturday Jam includes Japanese staff and quite a number of Japanese student participants. Payne says that Reed is capable of testing Thai speakers and if the demand warrants it, the Institute will expand to meet the need. Indeed, says Khakpoor, he and his colleagues have every intention of reaching out to the community at large. “We want Reed to be a multi-disciplinary organisation, an umbrella organisation, working as a team with many competent professionals in their fields, to try to support the whole community.” Diagnosis and intervention Learning disabilities are extremely varied. One young girl Payne has been working with, for example, has extreme difficulty making even the simplest descriptions. In one recent exercise, the girl was asked to describe a series of nine contiguous rectangles exhibiting the pattern of two coloured followed by one blank. After many revisions, she finally managed to complete the task, not with a description, but with a series of commands: ‘Colour two rectangles, leave one blank. Colour two rectangles, leave one blank. Colour two rectangles again and leave one blank in the line of nine rectangles.’ “It took a long time to get this and because this is accurate I’ll accept it and we’ll work on improving it later,” Payne says. Actually, it is remarkable the girl is getting help at all, Dr Logan observes. “So few children are placed for oral language, but many children are very poor in this skill – in describing or telling about things in their language. “From my point of view, most learning-disabled youngsters have a language-based problem,” Dr Logan asserts. “Reading is language-based, for example. It’s based on phonological awareness – knowing sounds. That’s also true of written language.” Effective treatment must be preceded by careful and lengthy assessment, Dr Logan stresses. He describes how, in his initial consultation, he would narrow down the underlying language problems of a hypothetical young boy – let’s call him Stephen – who had been referred him. “First, I would listen to his speech. Does he have sound problems? Does he substitute one sound for another? Does he distort sounds? Does he have a sentence structure that is commensurate to his age? Does he use a vocabulary that would be commensurate with his age? “You do a language sample. You ask him to describe pictures and so forth and you get a great deal of information – how he puts words together, how he uses words. You end up with a general idea of what kind of a deficit he has in language usage.” Let’s suppose that after further evaluation, probably in consultation with colleagues, Stephen’s teachers and parents, Dr Logan has determined that, among other things, Stephan has an extremely weak vocabulary for his age. It is a problem that clearly requires attention. Here, Khakpoor, the team’s clinical psychologist, adds an important consideration. “Knowing what kind of intervention is suitable is not really enough,” he cautions. “The child needs to want to do it.” “We have to think of motivation,” Khakpoor reminds us. “Who wants to do things they’re bad at? For example, you’re bad at reading, so we give you more of that. So it is not that straightforward and easy to implement what we think should be done just because we have determined what the problem is. We need to work as a team, not only with a team of professionals, but also the parents and everybody involved to increase the motivational level and to make this fun.” You have to make the task “doable”, Khakpoor asserts, even if it means throwing out certain academic standards for the child. “Everybody can succeed at some level, but if you just stick to those levels of success that have been predetermined by grades, you’re doomed to fail. Instead, make it doable, make it achievable and make the individual feel they have succeeded.” In Stephan’s case, Dr Logan says, it would be important to build his vocabulary in subjects he is most interested in. “He has to have something to talk with, so you would try to build a vocabulary that belongs to him around his areas of interest,” Dr Logan explains. “Let’s say he likes motorcycles. Then you would build vocabulary around that. You build from words, to phrases, to sentences. Those are the building blocks.” This is more than just having a conversation, Dr Logan says. “Children learn through motor activity. When you are teaching speech and language you have to have them do things instead of just sitting there, naming nouns or naming verbs. That just doesn’t work. So you have them move to show how a motorcycle would work – turning its handles and showing how you start it. It’s like play,” he says. The appropriate environment One of the more pressing questions among parents and educators is whether children with learning disabilities should be kept with their more able peers or separated out for special treatment. For the Reed team, the answer is clear-cut. In all but the most severe cases, the children should be educated in a normal classroom environment. “Inclusion is something that is very dear to all three of us,” says Khakpoor. “We are really associated with inclusion policy.” That has not been standard practice in the past, Dr Logan observes. “In the past we’ve had pullouts. You pulled children out of reading, out of math and you pulled them out of language and social studies. You took them away from something they have difficulty with. They don’t want to go and the other children would say, ‘We know where you’re going. You’re a dummy.’ It really created a lot of problems with children. Payne strongly agrees but she adds an important qualification. “I think a child should be removed from the classroom nearly never. But that only works if the classroom can be modified to meet the needs of the student. If you can be flexible in your teaching goals and your classroom setup, you can teach both sets of students in the same class”. Again, says Khakpoor, having achievable goals is essential. Forcing a student to meet the demands of an advanced maths curriculum, for example, may be unrealistic and counterproductive.
Here, adds Payne, it is important that the parents are on board. “We very much need the parents to be a part of this. If they tell us their goal is for their child to pass their IGCSE math and we know the child can’t use a calculator and we know that the child has very serious math difficulties, then we need to seriously talk about whether this an appropriate goal. Have we set the child up to fail? If we know there is a problem, we can be sure the child knows it as well.” Perhaps the only thing that is certain about learning disabilities it is that the earlier they are addressed the better. “Early intervention is ideal because you get to the problem earlier and because the child has not yet experienced the failure or frustration that’s going to cause the secondary behaviour problems. They can be every bit as much of a handicap as their primary deficit.” Happily that intervention is becoming more and more available here in Thailand.
|© The Post Publishing Public Co., Ltd. All rights reserved 2004 | Last modified: December 6, 2004 |
The Reed Institute’s staff of specialists, from left: Dr Richard Logan, Shirley Payne and Ali Khakpoor.
The photos show various activities from Reed’s Saturday Jam and summer camps where behavioural goals include confidence building, following directions, risk taking, performing, and teamwork. Photos courtesy of Reed Institute
“Maybe we need to deal with things that we deal with everyday. Maybe we should focus on calculation, money management, bank accounts, checks – understanding those things. Maybe those are more addressable goals,” he says.