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Learning Difficulties: The Diagnosis Debate

All my life, I have known that my mother cannot do math. She can't figure the tip on a restaurant bill, can't be trusted to convert foreign currencies in her head, and is easily impressed by anyone who can handle a calculator. I was raised, in fact, on the legend of my mother's poor math skills and the cliff-hanging question of whether she would pass the easy math class and graduate from college. She did pass it  -- and went on to be a college English professor. She was just no good at math.

I wonder from time to time whether there's anyone left anymore who is just no good at math. Or anyone who is just a slow reader, as my friend's brother was in the late '60s. Nowadays, my children's friends and my friends' children who don't do well in one subject all seem to end up officially diagnosed with learning problems and are given extra time to work especially hard with tutors in the areas in which they have difficulty.

I see this often in my practice, as with the mother who brought a 10-year-old boy to see me. He was having a lot of trouble in school, and it turned out that one reason was that his handwriting was terrible, so his teacher would give him failing grades on everything he turned in. What he needed, I thought, was to do his homework on a computer and eventually, perhaps, go to medical school and become a doctor, just like all the other kids with unreadable handwriting. What he got, from a school evaluation, was a diagnosis of "fine motor delay with cognitive skills normal or advanced for age." I have to wonder if he'd have been better off with the more old-fashioned version: He's a smart kid who just has really awful handwriting.

And then there are the parents who come into my office with a 2-year-old, concerned that she's hyperactive. And I have to try to explain that all 2-year-olds are hyperactive, that endless motion and short bursts of concentration are developmentally normal.

There seems to be a terrible craving for diagnoses. For reasons I don't fully understand, many parents would rather have a child with a documented learning problem than one who's just a rotten speller. (My best friend in medical school was a rotten speller, but nobody knew it because of his unreadable handwriting.) And parents like me, who resist diagnoses, are often seen by teachers as being "in denial." The truth is, I haven't wanted my children diagnosed with anything at all  -- I belong to the old school, which believes that labels are self-fulfilling. I had a teacher tell me that my 5-year-old needed to work on peer-group relationship-building skills, and as I nodded in appreciation of the jargon, she offered me the name of a counselor. But my child was reasonably happy in school, and so it seemed to me that we were leaning toward thought control here. See? In denial.

Of course, there are real learning disabilities and children who need help and special tutoring. But I'm talking about kids who don't quite follow the predicted patterns. We seem to be blurring the line between legitimate problems and the everyday likes and dislikes, strengths and weaknesses that make us all better at some things than at others. Even children with simple "differences" in their social behavior seem to be at high risk of diagnosis.

To me, it makes sense that someone who's lousy at math can work to get better at math, that a kid with awful handwriting can learn to type, and that a rotten speller can be urged to use the dictionary.

My mother would be labeled as having a learning disability if she were in school today. I can only hope that the extra time spent improving her math skills wouldn't have taken away from the reading she loved and the subjects where she shone. My elementary school friend's brother might have a learning disability. I might have one too, though it didn't become critical until medical school: I have awful spatial perception. If someone needs to look at a series of cross-sectional drawings and then mentally integrate them and make some judgments, that someone should not be me. (Aren't you glad I'm not reading your CAT scan?)

I wonder if this need to set our children up with diagnoses for every deviation from some homogeneous norm is yet another insidious pressure on increasingly pressured young lives. You're not a good reader? Do you realize how important reading is in life? We have to get this seen to immediately  -- oh, okay, you have a diagnosis, there's a reason you aren't reading three grades ahead of your age.

And what about the children who truly do need extra attention? Are we doing them any favors by putting pathological labels onto the ends of the "normal" spectrum? I have to wonder: Are we of the borderline cases just examples of the obvious  -- that different children have different learning styles? And, of course, that some people are just lousy at math.

Contributing editor Perri Klass, M.D., mother of three, is a pediatrician at Boston Medical Center.

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