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Children with Special Problems

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How to Recognize a Child's Questions: Tips for Parents in Identifying Central Auditory Processing Disorder - By Ann Smith, LCSW

For the first time in my life I know what I what to say, but I don’t know how to say it, “said Leah, my 11 year-old daughter. She was dressed in her favorite purple shirt as we sat on her messy bed, a lumpy blanket as our cushion & papers surrounding us.

I was helping her work on a challenging 5th grade assignment. Her dad & I worried for several years why she wasn’t learning writing skills at the same pace as other children.

Leah’s paradox confused us: she spoke well from an early age, but writing was an excruciating exercise for her. Leah’s comment marked a significant moment of recognition & insight in our family’s ongoing attempt to understand her.

Why did she struggle academically & socially? From the time Leah was 5 years old, my husband & I took her to see professional after professional. No diagnosis made sense to me, but my intuition told me that something was wrong & growing worse.

Although I had worked with children for many years as a child psychotherapist & had encountered various learning problems, Leah’s symptoms weren't familiar to me. However I did wonder about how she was processing language.

She needed constant adult attention & was unhappy playing alone. She asked many questions of children & adults & at times talked incessantly. We later recognized this as her need to understand different situations or sometimes just the meaning of a word.

As she was growing, her world became more confusing. At times she was criticized by teachers & friends as anxious or nosey. She was becoming more anxious in response to the confusion she experienced. Most people she encountered didn’t understand her.

Working together on her writing assignment was one of several breakthroughs along the way. It stands out in my mind because of Leah’s ability to be so insightful at times, in spite of her confusion about the world.

I felt relieved & sad, but also like her dad & I could now start to really help her. The language problem I had always suspected was becoming clearer. Now in retrospect, I can put the pieces of the puzzle together.

In kindergarten Leah came home from school knowing everything about her friends from their favorite color to what they had for lunch & who sat by whom. Mothers of her friends were shocked by how much information I received from her because their children came home & answered questions about their day with the typical answer, “fine”.

I became a resource for parents concerned about their kids, because Leah would tell me about the social scene at school. Little did I know at the time that our discussions helped my daughter organize her day.

As she progressed thru school, I noticed patterns of social, as well as academic instability.

When Leah was 7 years old, we knew something was wrong. Yet, the professional opinion was that we were overly anxious parents. Still, we had her tested by a neuropsychologist, who discovered psychological reasons for difficulties in reading comprehension.

I felt almost certain that she had a language-based learning disability because of her constant questions about information that should have been obvious to her; her refusal to allow us to read stories to her; as well as her inability to retell a story that she had read.

However this wasn't revealed in this battery of tests. Obviously this led to more frustration. Although after the testing we had enough information to hire an educational specialist for her, it still seemed to me something crucial was missing in our understanding of Leah.

By the time Leah reached 5th grade, having scored poorly on her reading comprehension portion of the standardized tests the year before, the afternoon she made this remark convinced me that she had a language disorder.

We were madly searching for a middle school to meet her educational needs. We finally discovered a missing piece of the puzzle after taking her for language testing.

Have you ever put together a jigsaw puzzle with 50 or 100 pieces? There may have been links along the way or groups of pieces that fit together. It wasn't until the audiologist diagnosed my daughter with Central Auditory Processing Disorder that the puzzle began to look like a picture; one we could finally understand.

That afternoon, grappling with the research paper, Leah’s puzzle was almost complete. We found a terrific special middle school that met her learning needs. Today she's an exuberant teenager who is able to manage the demands of a mainstream high school.

Writing is her favorite subject. She no longer needs to ask as many questions, because she has learned other strategies for figuring out the meaning of the world. Most importantly she knows what she needs in order to learn, so that she can ask for help.

Tips for Parents:
If your child exhibits the following, which is a list of some symptoms (but not all inclusive) of Central Auditory Processing Disorder (CAPD), locate a certified audiologist for testing.*

  • Asks questions repeatedly & needs to be given repeated instructions.
  • Has difficulty extracting abstract information in writing & spelling at certain times.
  • Tunes out & can’t pay attention in a large room with loud background noise.
  • Speaks in extraordinarily loud voice.
  • Doesn't process auditory information well; i.e., may not be able to retell a story that is read; may not like to be read stories to; understand a movie & may avoid these situations (by not paying attention, having meltdowns at the suggestions, etc.)
  • Looks or acts “spacey”. 
  • Is clingy to one friend or one parent, at home, in school or new situations.
  • Is known as “overly controlling”, due to the attempt often to rearrange situations according to own needs.

*You can find a certified audiologist in a teaching hospital affiliated with a medical school, or by contacting your pediatrician; a pediatric neurologist; or neuropsychologist.

**Join the Learning Disabilities Association of America, which you can find online. It is a wonderful online resource for parents of children with learning disabilities.

If you would like to share any reactions or questions, please email me: annsmithmsw@aol.com. I look forward to hearing from you.

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Assessing & Managing School-Age Children with Behavioral Problems - By Gary Direnfeld, MSW, RSW

Your child is about 7 years old. The teacher reports problems listening in class, sitting still & getting into conflict with peers. First thought always seems to be ADHD (attention deficit hyperactivity disorder). But what if that was not the case?

Assessing school-age children with behaviour problems takes more than just a superficial look at behaviour. While many children present with the above-mentioned symptoms, the cause can range from neurological to psychological to family to social issues.

By way of example, the above symptoms can be seen in children with ADHD, but can also be seen in children with allergies, or by children who are bullied & by children whose parents are undergoing separation / divorce, not to mention children who are witness to domestic violence or subject to abuse or neglect themselves.

To add to the complexity, there can also be multiple variables contributing to behaviour, so a child can suffer as the result of several conditions; kind of like having a broken leg & a cold at the same time.

Hence to help school-age children with behaviour problems, assessment must come before determining the management strategies. Unless you've assessed the cause of the problems correctly, wrong management strategies may be applied.

The danger here is that with the wrong management strategies the behaviour may not only continue, but worsen. In some cases, people will then apply the same wrong management strategies more harshly only to then worsen problems even more.

A good well-rounded assessment model takes a bio-psycho-social approach. With this model the child may be seen by a number of professionals, or at least one professional who is able to interview the parents & child as well as at least obtain school records & ask a range of questions ranging from the child’s health & development to family matters to school related issues.

From a single well structured interview with a professional who takes a bio-psycho-social approach, it can then generally be determined if other professionals need to be brought in such as a medical practitioner, psychologist, speech-language pathologist, social worker or others.

The result of this approach should be the determination of issues underlying the behaviour. In other words the assessment(s) should then explain the cause or causes of the behaviour problems. Thereafter, an appropriate course of action or management strategies can be recommended.

Depending on the assessment results & if the causes of the behaviour problems relate to biological, psychological, family or social issues, the management strategies can include anything from medication to change of diet to individual, family or parental counseling, to special education or instruction.

One thing is for sure, a mere description of a few behavioural problems as at the outset of this article can't be relied upon to lead directly to management strategies. Dig deeper with a bio-psycho-social approach to be assured of targeting the right cause & ensuring the probability of successfully helping the child in question.

Gary Direnfeld, MSW, RSW
(905) 628-4847

Gary Direnfeld is a social worker. Courts in Ontario, Canada, consider him an expert on child development, parent-child relations, marital & family therapy, custody & access recommendations, social work & an expert for the purpose of giving a critique on a Section 112 (social work) report.

Call him for your next conference & for expert opinion on family matters. Services include counselling, mediation, assessment, assessment critiques & workshops.

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Dyslexia: How to Recognize Dyslexia in Children - By Susan du Plessis

The term "dyslexia" was introduced in 1884 by the German ophthalmologist, R. Berlin. He coined it from the Greek words "dys" meaning ill or difficult and "lexis" meaning word, and used it to describe a specific disturbance of reading in the absence of pathological conditions in the visual organs. In a later publication, in 1887, Berlin stated that dyslexia, "presuming right handedness," is caused by a left-sided cerebral lesion. He spoke of "word-blindness" and detailed his observations with six patients with brain lesions who had full command over verbal communications but had lost the ability to read.

In the century to follow the narrow definition Berlin attached to the term dyslexia would broaden. Today the term dyslexia is frequently used to refer to a "normal" child -- or adult -- who seems much brighter than what his reading and written work suggest. While the term is mostly used to describe a severe reading problem, there has been little agreement in the literature or in practice concerning the definition of severe or the specific distinguishing characteristics that differentiate dyslexia from other reading problems. Instead of getting involved in the wrangling over a definition, one could simply use the "symptoms" below as an indication that a child has a reading problem and therefore needs help.


Directional confusion may take a number of forms, from being uncertain of which is left and right to being unable to read a map accurately, says Dr. Beve Hornsby in her book "Overcoming Dyslexia." A child should know his left and right by the age of five, and be able to distinguish someone else's by the age of seven. Directional confusion affects other concepts such as up and down, top and bottom, compass directions, keeping one's place when playing games, being able to copy the gym teacher's movements when he is facing you, and so on. As many as eight out of ten severely dyslexic children have directional confusion. The percentage is lower for those with a mild condition, she says.

Directional confusion is the reason for reversing of letters, whole words or numbers, or for so-called mirror writing. The following symptoms indicate directional confusion:

* The dyslexic may reverse letters like 'b' and 'd', or 'p' and 'q', either when reading or writing.
* He may invert letters, reading or writing 'n' as 'u', or 'm' as 'w'.
* He may read or write words like 'no' for 'on', or 'rat' for 'tar'.
* He may read or write 17 for 71.
* He may mirror write letters, numbers and words.


Many dyslexics have trouble with sequencing, i.e. perceiving something in sequence and also remembering the sequence. Naturally this will affect their ability to read and spell correctly. After all, every word consists of letters in a specific sequence. In order to read one has to perceive the letters in sequence, and also remember what word is represented by the sequence of letters in question. By simply changing the sequence of the letters in 'name', it can become 'mean' or 'amen'.

The following are a few of the dyslexia symptoms that indicate sequencing difficulties:

* When reading, the dyslexic may put letters in the wrong order, reading 'felt' as 'left', or 'act' as 'cat'.
* He may put words in the wrong order, reading 'are there' for 'there are'.
* He may omit letters, i.e. reading or writing 'cat' for 'cart', or 'wet' for 'went'.

Dyslexics may also have trouble remembering the order of the alphabet, strings of numbers, for example telephone numbers, the months of a year, the seasons, and events in the day. Younger children may also find it hard to remember the days of the week. Some are unable to repeat longer words orally without getting the syllables in the wrong order, for example words like 'preliminary' and 'statistical'.


A frequent comment made by parents of children struggling with their reading is, "He is so careless, he gets the big difficult words, but keeps making silly mistakes on all the little ones." Certainly, the poor reader gets stuck on difficult words, but many do seem to make things worse by making mistakes on simple words they should be able to manage -- like 'if', 'to', 'and'.

It is important to note that this is extremely common, and not a sign that a child is particularly careless or lazy.


Research has revealed a dramatic link between the abnormal development of spoken language and learning disabilities such as dyslexia. The following are just a few examples:

* A study in 1970 of Doctor Renate Valtin of Germany, based on one hundred pairs of dyslexic and normal children, found indications of backwardness in speech development and a greater frequency of speech disturbances among dyslexics than among normal children.
* According to Doctor Beve Hornsby, author of "Overcoming Dyslexia," about 60 percent of dyslexics were late talkers.
* In her book "Learning Disabilities," author Janet Lerner states, "language problems of one form or another are the underlying basis for many learning disabilities. Oral language disorders include poor phonological awareness, delayed speech, disorders of grammar or syntax, deficiencies in vocabulary acquisition, and poor understanding of oral language."

In most cases, a baby should be able to understand simple words and commands from the age of nine months. From around a year he should be saying his first words. By two he should have a vocabulary of up to 200 words, and be using simple two-word phrases such as "drink milk." By three he should have a vocabulary of up to 900 words and be using full sentences with no words omitted. He may still mix up his consonants but his speech should be comprehensible to strangers. By four, he should be fully able to talk, although he may still make grammatical errors.

If a child talks immaturely, or still makes unexpected grammatical errors in his speech when he is five years old, this should alert the parents to probable later reading problems. The parents should immediately take steps to improve the child's language.


Some dyslexics suffer from poor handwriting skills. The word "dysgraphia" is often used to describe a difficulty in this area, and is characterized by the following symptoms:

* Generally illegible writing.
* Letter inconsistencies.
* Mixture of upper/lower case letters or print/cursive letters.
* Irregular letter sizes and shapes.
* Unfinished letters.
* Struggle to use writing as a communicative tool.


* Makes up a story, based on the illustrations, which bears no relation to the text.
* Reads very slowly and hesitantly.
* Loses orientation on a line or page while reading, missing lines or reading previously-read lines again.
* Tries to sound the letters of the word, but is then unable to say the correct word. For example, sounds the letters 'c-a-t' but then says 'cold'.
* Reads with poor comprehension.
* Remembers little of what he reads.
* Spells words as they sound, for example 'rite' for 'right'.
* Ignores punctuation. He may omit full stops or commas and fail to see the need for capital letters.
* Poor at copying from the board.

Stuttering in children
Q.My 5-year-old son is just starting to stutter. What causes this? Could it be a sign of anxiety over starting kindergarten?
A.  The causes of stuttering aren't clear. Also, the cause of stuttering may be different for different individuals. Stuttering isn't caused by:
  • Emotional or psychological problems or trauma.

  • Parenting style or a family's lifestyle, although a predisposition to stutter may be inherited. But how a family reacts to a child's stuttering may affect the degree to which the problem persists & the child's anxiety level about it.

  • Times of stress or excitement, although hectic times may worsen a child's existing stuttering.

Stuttering is common in children as they undertake the enormous task of acquiring language & speech. Stuttering usually begins between ages 2 & 5. Most children outgrow it without treatment. But some won't. And it's difficult to determine in advance which children will or won't.

The bottom line is this: If you're concerned, have your child evaluated by a speech pathologist.

The Stuttering Foundation of America offers the following advice to parents of children who stutter:

  • Listen to what your child says, not how he or she says it.

  • Don't interrupt or complete your child's sentences.

  • Maintain eye contact with your child when he or she speaks.

  • Speak at a relaxed pace. Wait a second or so before responding to a stuttering child. This gives the child an opportunity to respond & demonstrates that you're not impatient or annoyed with the stuttering.

Stuttering Foundation of America here's a link to their website!

Stuttering: Myth vs. Fact

By Beth Gilbert
6 Jul 2001

Stuttering specialist Catherine Montgomery had a blind patient who stuttered. Someone once asked him which was more difficult to deal with in life - blindness or stuttering.  

"The man thought for a moment," Montgomery recalls. "Then he replied, 'Stuttering - because unlike my blindness, people don't understand that stuttering is beyond my control.'"  

"Interesting, isn't it?" she says. "You'd never think of saying to a blind person, 'Slow down & you'll be able see,' or 'If you just tried a little harder you could see.' But most of us think if a stutterer just relaxed & tried a little harder, he could speak fluently. That's not the case," says Montgomery, M.S., CCC-SLP, executive director & founder of The American Institute for Stuttering in New York City, N.Y. 

Stuttering is a chronic dysfluency or break in fluent speech. It's characterized by sound, syllable, word or phrase repetitions; hesitations, fillers (um, ah) & revisions in word choices. It can also include unnatural stretching out of sounds & blocks in which a sound gets stuck & just won't come out. Stuttering may be accompanied by muscle tension, facial tics & grimaces.    

No one really knows for sure exactly what causes it, but researchers believe there's a neurological basis with a strong genetic component. Currently, the medical community categorizes stuttering as a psychiatric disorder - just like they do schizophrenia & bipolar disorder.   

"There are probably multiple factors that can cause stuttering," says Gerald Maguire, M.D., assistant clinical professor & director of residency training in the department of psychiatry at the University of California at Irvine.

"There is a strong genetic component - stuttering does run in families. But it may be a combination of genetics, something neurological & something environmental. Since about 99% of all stutterers develop the disorder in childhood - usually before age 9 or 10 - it indicates that something occurs in the developing brain."   

"The idea that stuttering is a brain disorder in the same category as schizophrenia & bipolar disorder is very controversial," says Maguire, a stutterer. In fact, there has been a push to re-categorize stuttering as something other than psychiatric. "Some feel it attaches a stigma to a disorder that's already very misunderstood by most."   

Among the things researchers do know about stuttering is that it's not caused by emotional or psychological problems. It's not a sign of low intelligence.

The average stutterer's IQ is 14 points higher than the national average. And it's not a nervous disorder or a condition caused by stress. "If stress caused stuttering, we'd all be stutterers," says Montgomery. Stuttering can, however, be made worse by anxiety or stress. And anxiety & stress can be a product of stuttering. 

Stuttering really has two layers, says Mongomery. "There's the neurological-genetic-environmental layer & then there's the part that goes on inside your head layer, the conditioned or learned response. 

"For example," says Montgomery, "on the first day of pre-school, Mommy takes little Michael by the hand to meet his teacher. Smiling, the teacher asks Michael, 'What's your name?' And even though he's never stuttered before, he says, 'M-M-Michael.' And he sees a response - maybe the teacher stops smiling for a minute or Mommy tightens her grip on his hand. Consciously or unconsciously, he may think, 'I have trouble saying my name.'   

"So the next time someone asks his name, he has a memory flash of that first time he had trouble saying his name, which sets up a fight or flight response & he stutters over his name," says Montgomery.  

The pattern can continue without intervention. Studies show by age 7 children begin to develop attitudes & feelings about their speech difficulties & by age 12 speech patterns are set - which makes it difficult to overcome stuttering.  

"Lots of kids go thru stuttering as a period in their development - & that's OK for most kids," says Scott Yaruss, Ph.D., an assistant professor at the University of Pittsburgh, clinical research consultant at Children's Hospital of Pittsburgh & co-director of the Stuttering Center of Western Pennsylvania.  

In fact, researchers say 1 in 4 American preschoolers stutter at some point. Only one in 30 in older children, however, actually develop real stuttering problems, according to the U.S. Department of Health & Human Services.  

"Most get better - but some get worse," Yaruss adds. "The problem is, at this time it's difficult to tell who is stuttering normally in their development & who is at risk for problems.

For years, the advice was to do nothing. Ignore it & it'll probably go away. That's not true anymore. Today, the best advice is to have your child evaluated by a speech language pathologist who specializes in stuttering."  

Speech language pathologists who are certified by the American Speech-Hearing-Language Association (that's the equivalent of the American Medical Association for speech pathologists) have the letters CCC-SLP after their name. They mean "Certificate of Clinical Competence - Speech Language Pathologist."   

Most experts agree your child should be evaluated if he begins to demonstrate a physical awareness of his stuttering. Does he become frustrated, distressed or anxious? Does she become tense or tighten her muscles when she has trouble getting the words out? 

The second signal is family history. "Not every child of a stutterer will become a stutterer," says Yaruss. "But since stuttering runs in families, there's no reason to wait."   

Children don't learn to stutter from a parent, researchers say. But they may learn the frustration that comes with stuttering from the parent.  

Treatment usually varies according to the age of the stutterer, says Yaruss. And different therapies work for different children. A speech language pathologist who specializes in stuttering can match your child with the right therapy.   

To treat a very young child, the speech pathologist usually works with the family to help stack the deck in the child's favor to be as fluent as possible. This may include encouraging parents to create a calm setting for conversation, ensuring that only one person talks at a time & making sure the child doesn't feel rushed to speak. "As the child approaches age 7, we begin to work more with the child & less with the family," he says. "We encourage the child to speak more slowly & help shape the child's speech with specific therapies."  

In adults, the approach may include a 3 pronged approach of cognitive behavioral therapy (to help weaken the connection between stuttering & your reaction to it & to help change your thinking patterns about what makes you feel badly about stuttering), speech therapy & medication. 

At UC Irvine, Maguire is currently conducting clinical trials in adults on a new generation of drugs used to treat schizophrenia & Tourette's Syndrome. These drugs - risperidone & olanzapine - are dopamine blockers. Dopamine is a neurotransmitter chemical that sends messages from one cell to the next.  

Research indicates that stutterers may have dopamine levels that are too high in one area of the brain. The drugs are designed to block the impulses that encourage stuttering. Maguire, who is also a participant in the trials, says the outcomes have been very positive. 

But for now, Maguire says, the best bet in beating stuttering is early intervention. "The earlier the therapy occurs, the better the results in resolving stuttering," he says.   

Yaruss agrees. "The key is to catch the disfluency before it becomes ingrained & the child begins to believe 'I'm not good at talking.' But it's also important to know this: A person who stutters can still do anything in the world that a non-stutterer can," he adds

Fast Facts About Stuttering 

  • Stuttering affects more than 3 million Americans. 
  • The exact cause of stuttering is still unknown, but researchers believe it is neurologically based with a strong genetic component.  
  • One in 30 American children stutters. About 75 percent of them will outgrow it.
  • Males are four times more likely to stutter than females. 
  • The average IQ of people who stutter is 14 points higher than the national average. 
  • Early intervention is critical. Research shows the likelihood of total recovery significantly diminishes as the child grows older. 
  • Parents should contact a specialist in stuttering treatment if their child shows signs of stuttering as early as age two. 

Sources: The U.S. Department of Health and Human Services, The National Stuttering Association and The American Institute for Stuttering.  

More Information, Please . . . 

In addition to valuable nuts-and-bolts information, many organizations offer resources like referrals to speech language pathologists who specialize in stuttering, and support groups for stutterers and parents of stutterers. Want to learn more? Consider the following Web sites: 

  • The site for The Stuttering Foundation of America can be visited at


Last reviewed:
  On 13 Feb 2006
  By John M. Grohol, Psy.D.

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