By: Rachel Fisch-Kaplan

It was confounding, confusing and by all external appearances, emotionally depressing. After years of coasting along under the academic radar, something had changed and for the first time in his life Tom felt completely lost. It wasn’t that he had been a straight A student. His teachers had always been supportive, if not effusive at their parental conferences and his report cards were consistently filled with Bs of all types. But by the time I met Tom and his parents, halfway through his final year in middle school, the three of them could barely speak to one another. What had happened? Why had he become unmotivated at school? Why, when asked direct questions, did Tom often look down at his lap and reply “Huh?” even when he had something to say? Why had Tom given up?

A clinical diagnosis of Attention Deficit Disorder was a good first step, but Tom was nevertheless continuing to struggle. Despite being an extremely hard worker, he did not know how to prepare for a test, which more times than not resulted in disappointment. This led to frustration, then acceptance and self-depreciating behaviors, and ultimately isolation and rejection across social and educational surroundings.

Attempting to decipher some answers, Tom underwent an intensive psycho-educational evaluation. This assessment suggested that the core of Tom’s issues might not be psychologically or emotionally based, but instead actually be rooted in his inability to approach language based tasks and interactions with the ease and acuity expected of young adults of his age. A plausible jumping off point had finally been identified and now more specific examination of Tom’s strengths and weaknesses was called for. Tom was referred to a speech-language pathologist, and this is where my work with him began.

Tom’s parents, like many parents, were confused about why they were being referred to a speech therapist since his articulation was clear. Most people hear the term speech-language pathologist and immediately focus in on the ‘speech’ element of our expertise which is only a fraction of what we, as communication specialists, are trained to do. While our work with pre-schoolers often focuses on developing “typical” speech patterns, we work with all kinds of communication disorders that impair a person’s ability to speak or understand language. Communication skills have many components and are at the heart of the educational experience, serving to increase the way people learn about the world around them, utilize knowledge, and interact with others.

The focus of treatment for school-age children tends to be quite different than that with pre-schoolers. Often, once children have mastered the correct pronunciation of their speech sounds and basic language concepts, they dive right into the educational experience free of any lingering speech or language issues. However, when children, like Tom, seem to suddenly hit a wall, the solution can be more than a little cryptic. Why does this happen, seemingly out of the blue? Studies have shown that most children diagnosed with language learning disabilities have been found to have average to superior intelligence, so much so, that throughout their early academic years, they have been able to figure out ways to navigate through their areas of difficulty, effectively covering up their struggles and getting by on the breadth of their creativity and intellect. However, as the academic demands of their schooling get increasingly more complex, the strategies they have subconsciously employed for years are insufficient to meet these expectations. For example; the middle grades emphasize applying knowledge to specific subjects and writing. Mastery of form(phonology, morphology, syntax); semantics (meaning), pragmatics (function), executive function(organization, planning) are assumed. If a child, rather than mastering these skills, develops compensatory strategies, he can wind up with grades and advancement that are not reflective of assumed academic achievements.

In Tom’s case, an in depth assessment of his expressive, receptive and use of pragmatic language skills revealed significantly impaired processing abilities, compounded by disorganization in his use of language when speaking and writing. This identification gave us a starting point, but at this juncture, Tom had faced failure on a daily basis for so long that he had given over to the possibility that he just wasn’t smart enough to get through middle and high school, let alone college and beyond. Our first hurdle was to convince Tom that he was indeed intelligent. However, words are cheap. Rather than give him motivational speeches, we had to show him that he could be successful, that he just needed to find and then use the right tools.

Verbal and written expression were the most troublesome areas for Tom, so we started there. Much emphasis was placed upon visualization, which is a remarkably effective tool to facilitate language. Without censorship, we brainstormed ideas on a given topic, throwing away items that did not support our topic of discussion and deciding in what order to put them in. From there, Tom found it easy to write the ideas into paragraph form. Unfortunately, many of our teens start with the last step and immediately feel stuck. Their ideas are not supported or are tangential. While the above strategy utilizes more steps, the finished product often takes less time to achieve and almost always yields tangible results.

While Tom had mastered reading, his processing difficulties often left him unable to decipher the details and specific meaning of what he read. Similar difficulties were present when information was presented verbally in his classroom. To combat this we collaborated with Tom’s teachers, suggesting strategies and techniques to modify how new material was presented in lessons to accommodate Tom’s comprehension needs.

Another issue we addressed with Tom was the requesting of further information to aid his understanding. Sometimes, children are not aware that they missed salient facts, other times they are just too embarrassed to ask or they rely on the wrong person to fill in unclear information. Tom was not writing down homework assignments as his teacher gave them out. Rather than ask his teacher to repeat herself, he regularly asked classmates who in turn sometimes gave him misinformation. Subsequently, Tom would often be unprepared for tests or hand in homework assignments that were incorrect. Having the teachers check his assignment book or ask him to repeat back to them the assignment would have helped. Certainly we want to foster independence in our children; however, helping Tom, his teachers and parents understand that there was a process and progression in achieving this independence took the pressure off of everyone. While at first, this was embarrassing to Tom, when positive results followed, his discomfort quickly abated.

Today, Tom appears to be a re-invention of himself. His frustration levels have notably decreased over time, and he now channels his emotions by focusing on his future; his passionate desire to work in the film industry. This interest has driven him to excel academically, and he currently holds a 3.9 grade point average. He has landed leading roles in his school‘s musical productions, which required focus, memorization, and insight. His social interactions, while still being wrought with the emotions and hardships that define the teenage years, are appropriate and healthy. In short, Tom is a success story and an example of how effective change can occur when each child is given the parental, educational and clinical attention that they deserve and crave.