Listen and Learn When Treating Children With Learning Disabilities

This post was co-authored by Dr. Miranda Melcher.

Evaluation complete and diagnosis in hand, it is now time to begin treatment for someone with a Learning Disability (LD). Best practice recommends you meet the student where they are, scaffolding the interventions to plan for success, and then removing the scaffolding slowly when you are convinced that the child has internalized the lessons. Directly teach to create generalization and transfer of the skills from the clinician’s office to the real worlds of home, school, playground, and community. As an LD is a developmental disability, the child's needs constantly shift and change as the child matures and should be reconsidered regularly.

Beginning Treatment With a Child with Learning Issues

Since we can’t treat all of the child’s issues at the same time, the most pressing need should be identified, and adjusted as necessary. This means monitoring and discussing what is causing the child the most distress and getting them appropriate help in that area. It’s important to leave time and resources for the things they are good at as well as the issues needing help. So where to begin? Talk with your client to see what is most pressing for them!

Listen and Learn From Your Client

Every client presents with different assets and challenges. Therefore, the single best source of information we have about a client is the client themselves. However, our students have not necessarily learned how to articulate their feelings and reactions in an organized, coherent manner and have different capacities according to their age and development. Regardless, the information they report is often our most important and accurate source of their challenges (Broitman et al 2020).

A source of information about treatments and interventions that is often overlooked is the online community of people, including adults, with LD. Blogs, Facebook groups, etc., are useful sources of information to help find effective techniques for coping with LD. These sites also provide narratives of experiences of having LD that may resonate for your client but which they may not yet be able to articulate. Even if the experiences found in these areas are not the same as your client’s, it may help begin a conversation, for example with questions like “In what ways does this person’s experience seem similar and different to yours?”

Experiment With Interventions

People with LDs can have different communication styles and preferences than neurotypical people, including therapists. To make sure you are both on the same page, it is important to (1) repeat back to them what you are hearing and ask if that is correct and (2) ask them to repeat back to you what they have heard you say. Make it clear that you are asking continuously and explicitly for correction and clarification to improve your understanding of their experience, not to make their experience fit into a preexisting mental model or methods of intervention. Therapists need to get very detailed and specific with clients to diagnose the multitude of issues each problem contains, and to make sure that the effort of communicating clearly is on both parties, not just the client.

Language or techniques that may be appropriate with neurotypical clients/students, for example, validating feelings without problem-solving, focusing on emotional issues before practical ones, or asking open-ended feelings-based questions as starting points, may not work with your neurodiverse client. This might be for several reasons, including that there is often a strongly problem-based (maybe sensory/environmental) reason that has brought the client to a therapist who is also an LD specialist as opposed to a more general therapist/tutor. Alternatively, clients may not yet be familiar enough with articulating their feelings, experiences, and needs to feel comfortable answering open-ended and/or emotional questions.

When listening to clients, general responses such as “I’m sorry you’re feeling that way” can come across as platitudes. On the other hand, a more structured response like “I’m sorry you’re feeling that way, can you tell me more about the feeling you mentioned?” may seem more helpful. Explore with your client whether validation or problem-solving is preferred in general or in each specific situation. Permit them to teach you what will work best with them. (Broitman et al 2020). Once you have identified the concerns for your particular client, the two of you can and should customize how you will best work together.

Offer an Alternative Experience to Your Client

The process of getting to an LD specialist often involves years of being told to conform in some impossible way, and clients are often aware without understanding that “something is different” and “wrong,” and often trained to try and “suck it up” or “fit in,” rather than express their feelings, reactions, and emotions. This is the years-long social training you will have to patiently try to disrupt.

Given the possibility of previous negative experiences with a professional, your client might need to begin their work with you by first getting permission to express emotions, especially negative ones. Your client will be watching to see if you are going to repeat the difficult interactions and re-traumatize them.

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You might experiment together with using different modalities (if legally permitted in your state) of communication/expression, i.e., in-person vs. phone or video vs. text vs. email, etc. (even if geographically near), to determine what provides your client with the most safety and opportunity to accurately assess the dangers for them in working with you. Text communications allow for real-time interventions and can be very helpful!

In addition to experimenting with communication modalities, explicitly discussing response timelines with clients is critical. We have found therapist availability has been a big factor in connecting with our clients with LD. Discuss with your client how frequently, for what duration, and with what amount of flexibility in timing and modality might work, with room for trials and experimentation. You must make sure you respond to your client within the expected timeframe.

Encouraging Agency

All of this goes toward the psychological goal of helping clients, even children, feel like active participants in their treatment, with appropriate amounts of agency, rather than as passive recipients of treatments determined by qualified adult experts. Given that an LD presentation is quite individualized and changes over time, ensuring clients feel able to actively contribute their feelings, reactions, and ideas to the treatment process is important in directing interventions to areas of highest immediate need, building sustainable skills, and promoting self-awareness and self-confidence.

One concrete way of ensuring that this framework of encouraging agency is apparent from the outset is making clients aware of how the team is sharing information about treatments internally and with the client, to avoid the feeling of “being talked about behind one’s back”. While it is likely not appropriate to include the client in all those communications, their awareness, and permission for such information to be shared, even if a child or minor, is important for engendering feelings of transparency. This is part of proactive teamwork aimed at improving the client’s experience in their environment, rather than feeling they need to be “fixed” in a more physical/ medical sense (Broitman et al 2020).

Dr. Miranda Melcher is an expert on neurodiverse inclusive education and co-author of the book NVLD and Developmental Visual-Spatial Disorder in Children.