When Johnny Can’t Learn – Cincinnati Children’s Can Help
It will only be a matter of weeks before kids start heading back to school. Some parents will have questions and concerns beyond routine immunizations and sports physicals about their child’s ability to keep up academically.
Cincinnati Children’s offers resources for families whose children struggle in school – The Reading and Literacy Discovery Center and the Neuropsychology Program.
The Reading and Literacy Discovery Center (RLDC) is dedicated to improving literacy and reading skills in children and to enabling every child to discover reading as a path to learning. Services are offered for children with reading disorders, i.e., dyslexia, and programs are underway to improve early literacy in partnership with the public library and local schools. Dyslexia and diminished literacy are two separate issues that require different interventions.
“Literacy problems happen at home, when a child isn’t exposed to reading before entering kindergarten,” says Scott Holland, PhD, executive director of the RLDC.
Dyslexia is a reading disability that occurs in the brain of a child who struggles with language and written symbols for words. Roughly 6-10 percent of children in the general population have dyslexia. It occurs in every language and affects more boys than girls. There is also a high co-morbidity with ADHD and speech/language delay. In the Cincinnati area, 20-30 percent of children have poor literacy skills. These children start out with poor reading abilities in kindergarten and often fall further behind their grade level from there.
Says Holland, “Kids with dyslexia can’t read fast or accurately, and they don’t understand what they read. By the fourth grade, when they should be reading to learn, that’s when they really fall behind.”
Having dyslexia does not mean a child is lazy or not trying hard. Nor does it mean they aren’t smart. Children with reading problems can be very successful in school and life with the right support.
Parents may call 513-803-READ to get help for their child. During the initial phone call, they will be asked some screening questions to determine what services their child needs. If appropriate, an evaluation is scheduled. The evaluation takes about 1½ hours to complete and is scored using standardized measures and norms that are easy to interpret.
The assessment reveals the child’s strengths and weaknesses in skills that are important to reading, such as vocabulary, executive function and phonological awareness. Parents receive a list of recommendations that outline what they, the school and the child can do to help. The information can also be used to develop a 504 plan or an Individualized Education Program with the school.
The RLDC offers something very different from what parents can find anywhere else, says Holland. “Our foundation is in the neuroscience research of reading, and the treatments we offer are a direct translation of that research. Currently we are offering evaluations. But in the coming year, we will begin offering evidence-based treatments that work and have staying power in remediating the problems kids have with phonological awareness, fluency and comprehension.”
Early intervention is critical, but evaluating children who aren’t of reading age is a challenge. The RLDC team, which includes teachers and speech/language pathologists, is working with the Speech Language Pathology Division and Pediatric Primary Care to provide early screening and follow-up for reading problems in preschool children at well-check visits.
The RLDC is also testing a web-based program that can be used at home to improve reading fluency and comprehension in children. It tracks the child’s progress and provides data.
“As the child improves, the program gets harder,” says Holland. “It’s designed to be used 20 minutes a day, four days a week. We’ve seen really significant improvements in children’s reading ability and in the brain activity supporting reading in our pilot study with this program. This type of research is really what differentiates the RLDC from other programs in Cincinnati.”
Being able to pinpoint a child’s reading problem and prescribe the right treatment that is specific for an individual child is important, says Holland. “To do that, you need a domain-specific evaluation and evidence-based treatments for each reading domain (phonemic awareness, vocabulary, fluency, and comprehension).
The RLDC is also approaching the issue from the teacher’s perspective. They are working with the College of Mount St. Joseph and Xavier University on their dyslexia and diagnostic certification programs. “We are developing an online curriculum that teachers who are working toward a master’s degree in reading education could complete at home,” says Holland.
The services offered at RLDC are typically not covered by insurance but are offered on a fee-for-service basis. Says Holland, “Dyslexia is not yet recognized as a medical problem. It is considered an educational problem. Meanwhile, we connect families who can’t afford to pay for our services with the medical center’s financial assistance programs, and we offer generous scholarships to those who qualify.”
The new DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) classifies dyslexia as a specific learning disability, so Holland and his colleagues are hoping that health insurers will eventually allow claims to be covered for dyslexia.
Says Holland, “Kids with dyslexia may never read at their grade level, but we can help them read to the best of their ability.”
The Neuropsychology Program helps children with medical conditions that affect the brain to learn, grow and reach their highest potential.
You would expect issues with some medical conditions – a brain tumor, a head injury or epilepsy. But diseases like diabetes, leukemia, liver, kidney or heart failure can also affect brain function, as can the treatment for these conditions. In addition, babies born prematurely or who were exposed to illegal drugs during the pregnancy are at a higher risk for deficits.
Different conditions have different effects, and every child is unique. Effects could include memory loss, poor attention, mood regulation issues, slowed thinking, or compromised organizational skills. “Helping these kids requires a different and often more comprehensive approach than what we would use for a child with dyslexia,” says Dean Beebe, PhD, director of the Neuropsychology Program. “We assess areas of thinking that are usually not tested by schools, such as memory and problem-solving.”
To make an appointment, a family must get a referral from the child’s doctor or medical team. (Note: Physicians can refer through Epic by opening an order and searching on “Neuropsych,” by faxing a referral to 513-636-7756 or calling the intake line directly at 513-636-8107).
“When a patient is referred, our intake office will call the family within one business day to schedule an appointment – usually offering a slot two weeks out,” says Beebe.
In most cases, the consultation is a three-step process that includes a parent interview, a child evaluation and then feedback. Within a few weeks of the evaluation, the family receives a report that explains:
- What’s going on with the child
- The child’s strengths and weaknesses
- How their medical condition might relate to their brain function
- Recommendations for healthcare, school and home.
Families can share the report with the child’s school. The primary care physician has access to the entire report through Epic but also receives a one- to two-page summary of action items related to healthcare.
“We don’t tell doctors what to do,” says Beebe, “but we offer suggestions to help. For example, we might suggest a medication or referral to another service, like OT/PT. We may explain that the child has trouble adhering to medications because of a memory deficit and suggest ways to deal with it. In some cases, we tell the primary care provider that the child is not developmentally where you would expect them to be, so here is an alternate approach to consider.”
The Neuropsychology Program sees children of all ages – from infants to young adults; has no wait list and provides practical, evidence-based recommendations to families and physicians in reports that are easy to read and understand.
The length of the evaluation varies, according to how complex the child’s condition is. But Beebe says they’ve reduced their billable hours by 20 percent in the past couple of years to provide right-sized care to patients.
Nearly all insurance plans pay for neuropsychology services, but the amount depends on the individual policy.
Says Beebe, “We’re at a point where primary care physicians have a lot of good options for helping kids who are struggling in school. Sometimes, it’s not about us making lives better immediately, but about giving families the opportunity and the resources to make life better for themselves.”
