Doctors’ Notes


Learning Disabilities & Children Who Struggle In School

The first day of school in the fall is a big day for everybody. Kids are excited to start a new adventure, and parents are often eager to start or get back to a more regular routine after the dog days of summer. As parents, we all want our kids to enjoy school, expect then to do well, and look forward to seeing what new things they’ll learn. But what happens if things don’t work out quite that way?  By winter, the newness of school has certainly worn off, and there will be some kids who are really struggling. What’s a parent to do if your child begins to struggle in school?

First, it’s important to talk with your child’s teacher. He or she may see things that you haven’t seen, and may be aware of dynamics in the classroom that you are not. You should also make sure that your child is getting enough sleep and eating well, especially a healthy breakfast before school. (For lots of great information on diet and sleep, see the Doctor’s Notes page on our web site.) Stress can also impact children’s performance at school, just like it can impact adults. Are there things going on in your family, community, or at school that are stressful for your child?  Is your child being bullied at school or on the bus? Finally, look at the work your child is being assigned. Is it all material that she already knows? Sometimes when kids are bored, they just tune out, which may look like simple lack of effort or ability. Providing more interesting and challenging work can make all the difference.

Learning Disabilities

If none of these explanations fit for your child, though, the possibility of learning disabilities (LD) must be addressed. Learning disabilities are common, estimated to be present in 8-10% of the general population. Many have a strong genetic component, and children who have lived through early life adversity (things such as prenatal substance exposure, premature birth, malnutrition, institutional care, abuse or neglect, etc) also have a higher incidence of LDs.

A learning disability is defined by the National Center for Learning Disabilities ( as a neurological disorder that affects the brain’s ability to receive, process, store, and/or respond to information. LDs are not the same as intellectual disability, and many individuals with learning disabilities have very strong overall cognitive skills, while struggling in one or more particular areas of learning. One of the most common, and probably most well-known, learning disabilities is dyslexia, in which affected individuals often have superior overall cognitive skills, but struggle to decode and encode words,, making learning to read very difficult. Albert Einstein, among other notable “really smart people,” had dyslexia.  Other common disabilities include difficulty with math and calculations, visual-spatial and auditory processing disabilities (affecting how the brain uses information that comes in through the eyes or ears), problems with short-term memory, and problems with overall organizational skills, also known as “executive functioning.” Children may have one or more disabilities, and these often travel together with attention-deficit/hyperactivity disorder (ADHD).  (For more on ADHD, see our Doctor’s Note on the subject.)


Learning disabilities are diagnosed by demonstrating a significant difference between a child’s overall cognitive functioning and his capabilities in specific subsets of work. Licensed clinical psychologists administer a panel of validated tests that measure the child’s overall cognitive capacities and academic achievements, as well as capabilities in specific areas where the child is struggling. Exactly which tests should be used varies depending upon the age of the child, and the specific struggles being experienced. These tests are usually given in several sittings of 1-4 hours, depending upon the age and abilities of the child. Younger children, and children with problems sitting still for long periods of time, may need to be tested in multiple short sessions to get an accurate assessment of their needs.

If you suspect your child may have a learning disability, having a thorough evaluation early is key to helping your child get the help that she needs, and to move on to academic success. Parents are often concerned that this will “label” their child in ways that are harmful to her long-term success. While that’s understandable, nothing could be further from the truth. Studies have shown over and over again that even very young children are aware of their struggles compared to their peers, and can spiral in a downward cycle of anger, embarrassment, and poor self-esteem when they work hard but can’t achieve success. Understanding why certain things are hard, and using different teaching strategies early on, can help children achieve success and avoid these so-called “secondary disabilities” that come from repeated failure.

Public schools in Pennsylvania are required to provide this testing for any child in public school districts (and, yes, even if the child attends a private school) within 60 days of the parent’s written request/consent. In these days of tight education budgets, that’s a tall order for schools, to be sure, but it remains the law. As a parent, you may may have to be a bit of a ‘squeaky wheel” to make sure your child’s needs are being met as required by state law. The Pennsylvania Education Law Center has an excellent Parent Guide to Special Education in Pennsylvania available to help guide you through the process, among other very helpful resources.

You can also pay to have your child tested privately, although this is expensive, and rarely covered by health insurance. Sometimes private testing may be able to be completed faster than the 60 days allowed in the public system, and sometimes, depending upon a child’s individual history, it may be clear from the start that more in-depth testing than schools provide is in order. In general, the testing done by your public school district is a good starting place.

Individualized Plans

Once a learning disability is diagnosed, then individualized plans to help the child use his strongest skills to work around his weaker ones can be devised.  he psychologist doing the testing will likely make suggestions for how to help your child work around specific areas of weakness. For some learning disabilities, there is scientific evidence that certain methods of teaching work better than others, so parents should ask the psychologist if there are evidence-based curricula that would meet your child’s individual needs. Dyslexia is again a good example; more practice with the same methods of learning to read (phonics or “whole-word” approaches are used in most schools) will not help, since the part of the brain that typically learns to read that way is not working correctly. Using a multi-sensory curriculum, which uses several different parts of the brain together, can allow a child to be very successful in learning to read. Once a learning disability is diagnosed, parents need to educate themselves about the disability, and how children with that disability learn best, to be an effective advocate for your child. Ask the psychologist who does your child’s testing to recommend further reading on your child’s learning needs. Some good starting places include the National Center for Learning Disabilities, noted above, as well as:

The International Dyslexia Association and The Learning Disabilities Association of America.

Public schools in Pennsylvania are required to provide all children with a “free and appropriate public education,” regardless of (physical or learning) disability. Schools are also required to provide this education in “the least restrictive environment,” meaning as close to a typical classroom experience as can meet the child’s needs. Parents of children with physical, mental, or developmental disabilities but no significant learning differences can work with the school to outline a so-called “504 plan.” Named for the section of a 1973 law outlining rights of those with disabilities, a 504 plan is a legally binding agreement between parents and the school district outlining the supports that will be provided by the district to help that child learn. Examples might include access to an elevator for a child who uses a wheelchair, an in-class aide for a child with autism, or an audio amplification system for a child with hearing impairment.

Children who have a documented disability for which the regular curriculum needs to be modified qualify for an Individual Education Plan, or IEP. An IEP is also a legally-binding agreement with the public school, outlining individualized educational goals, based upon the child’s identified strengths as well as areas of difficulty. Parents are encouraged and expected to participate in setting these goals, as well as ongoing monitoring of the child’s progress towards those goals over time. Parents may need to advocate for evidence-based curricula for their child’s particular needs, especially if one is not already in place at the school. The IEP team typically consists of regular classroom and special education teachers, the school psychologist, school administrators, and parents, although others may be involved as indicated by the child’s needs. Goals should be updated every 2-3 years, depending upon the child’s needs, which may require updated testing.

Appeals Process

If parents disagree with the school’s assessment, the overall plan for meeting the child’s needs, the specific goals laid out in an IEP, or the assessment of progress towards those goals, there is an appeals process whereby parents can challenge the school’s plan. Parents are allowed to bring an advocate or attorney, if needed, to the appeals hearings. Parents can also request, in writing, that their child be given outside testing when the child’s difficulties are not clearly explained by the testing available from the school, or that the school district pay for the child to attend a private school, when the district’s schools cannot meet the student’s unique educational needs. These are obviously options only for children with the most severe disabilities, but it is important to know that the options exist, and that there is an appeals process if you disagree with the school’s assessment of your child’s learning needs.

Final Thoughts

Private schools are not required to provide any of these services, although some do an excellent job of meeting individual student learning needs. A school may be an excellent private school, and may even be a great fit for other children in a given family, but if the school is unwilling or unable to meet a child’s individual learning needs, then the child may be better served to move to the family’s public school system, where the school is required to meet the child’s needs.

All children deserve the right to learn and grow to their fullest potential. When children struggle in school, we owe it to them to identify their strengths as well as their vulnerabilities, and then to work together to help them use the strengths to work around the vulnerabilities. When we provide this support from early on, before children become convinced that they’re stupid or hate school, we can truly given them wings to fly.

Dr. Sarah Springer, a Kids Plus Shareholder Physician, is the Medical Director of Adoption Health Services of Western Pennsylvania.