Arizona Advanced Medicine Clinic

Learning Disabilities

Learning Disabilities

Learning disabilities have occurred infamously successful people – Walt Disney, Alexander Graham Bell, and Winston Churchill all had learning disabilities. In the U.S., 15% of the population has some sort of a learning disorder. That’s 1 in 7, according to the National Institutes on Health. Eighty percent of those labeled Learning Disabled (LD) have problems with reading and language skills. Being a successful LD person in life takes some navigation through government red tape and a willingness to get beyond considerable marketing hype. Let’s get down to it.

According to the Federal Special Education Law (Individuals with Disabilities Education Act IDEA) passed in 2004, a learning disorder is

“A disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which disorder may manifest itself in the imperfect ability to listen, think, speak, read, write, spell, or do mathematical calculations. Such term includes such conditions as perceptual disabilities, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. Such term does not include a learning problem that is primarily the result of visual, hearing, or motor disabilities, of mental retardation, of emotional disturbance, or of environmental, cultural, or economic disadvantage.”

The National Joint Committee on Learning Disabilities[1] has a further refinement of the definition:

“Learning disabilities is a general term that refers to a heterogeneous group of disorders manifested by significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning, or mathematical skills. These disorders are intrinsic to the individual, presumed to be due to central nervous system dysfunction, and may occur across the life span. Problems in self-regulatory behaviors, social perception, and social interaction may exist with learning disabilities but do not, by themselves, constitute a learning disability. Although learning disabilities may occur concomitantly with other disabilities (e.g., sensory impairment, mental retardation, serious emotional disturbance), or with extrinsic influences (such as cultural differences, insufficient or inappropriate instruction), they are not the result of those conditions or influences.”

Both these definitions include the concept that learning information is simply more difficult for these individuals, because of various information-processing dysfunctions in the central nervous system.

But the definitions do not include many of the elements that can make up a learning disability. For example, the definitions exclude organ abnormalities – e.g. blindness or deafness. The definitions do not include emotional disturbance and mental retardation. They do not distinguish between a processing or perceptual abnormality – how accurately I see or hear or feelsomething, and a behavioral abnormality – whether I am simply too tired, or too angry, or too oppositional to put out the effort required to learn something. The definitions also ignore that nutrition, allergies, and environmental toxins can contribute to learning disabilities.

Whenever there is too much sensory/intellectual/emotional input, we tend to function at a lower level than normal. If we have learning disabilities, with perceptual and processing difficulties, we become dysfunctional much more rapidly than people who do not have LD. These dysfunctions express themselves in different ways, not necessarily related to learning. Some of us cover our ears and cower down. Some of us get angry and/or frustrated. Some of us cry. Some of us scream. Some of us beat our spouses. Some of us beat ourselves. Some of us just give up trying. Some of us become physically ill in one way or another.

Insurance Companies Dictate with Codes

Diagnosis and treatment is further complicated by the insurance industry.

LD2Each of the specific learning disabilities has a specific ICD-9 code by which an insurance company may identify the specific diagnosis. Which code your doctor uses may mean the difference between insurance coverage and no insurance coverage for the condition. For some peculiar reason, insurance companies often seem to feel that developmental delays should not be covered, since they might repair themselves spontaneously some day. As critics have pointed out, insurance companies make every effort not to pay out claims. Here’s a look behind the scenes of the insurance codes doctors can use:

  • 784.60 covers both dyslexia and alexia (inability to read at all). This is the definition of the International Dyslexia Association: “difficulties with accurate and / or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language that is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.”
  • 315.02 is the code for developmental dyslexia.
  • 784.69 covers Acalculia, Agnosia, Agraphia NOS, Apraxia.
  • 315.2 if for Dyscalculia – occurs where a person has trouble solving arithmetic problems and grasping math concepts.
  • Dysgraphia – use the ICD-9 code for agraphia, 784.69 – occurs when a person struggles to form letters or write within a defined space
  • Auditory and visual processing disorders occur when a person with normal hearing and vision nevertheless has difficulty understanding and using verbal or written language.
    • 315.32 is the code for central auditory processing disorder – this is also the code for “mixed receptive-expressive language disorder”
    • 388.45 is the code for an acquired auditory processing disorder
  • Non-verbal learning disabilities are defined as “specific disorders which originate in the right hemisphere of the brain and cause problems with visual-spatial, intuitive, organizational, evaluative and holistic processing functions. There is a V code, V40.0, problems with learning. 784.6 is a general code that covers “other symbolic dysfunction”.

It is easy to be denied insurance coverage because one digit is wrong.

Parents can more readily get a diagnosis and insurance coverage for ADD than they can for LD, yet “the system” is unclear about the differences, or if there is a difference between the two.

Learning Disabilities Versus ADHD

It is estimated that 7% of children aged 4 to 17 are affected with LD, and an equal number are affected with ADHD.[2] Note: Attention Deficit Disorder (ADD) is not quite the same as Attention Deficit Hyperactivity Disorder (ADHD), but the two are usually lumped together in the statistics.

More importantly, ADHD and LD are often found in the same child.

LD tends to run in families, so heredity may play a role. Some cases of LD can be traced to brain development, both before and after birth, so low birth weight, lack of oxygen, premature birth, and early nutrition may be a factor in learning disabilities. Infants and young children are susceptible to environmental toxins. Lead and mercury are linked to learning disabilities.

ADD is also a broad category covering different things – attention, activity, and impulsivity. As is the case with learning disabilities, ADD may have a genetic link, may be related to birthing issues, nutrition, and environmental toxins.

In both cases, there is an issue with brain chemicals called neurotransmitters. These chemicals help send messages between nerve cells in the brain.

What can you do for your child?

LD3In some classrooms, 100% of students are on medication for some form of learning or attentional disorder. Medication is associated with increased risk of heart disease and sudden death, even in children. Doing nothing is associated with increased dropout rates, and poor functioning in society.

According to California neurologist Dr. Fred Baughman, “The single, biggest heath care fraud in U.S. history – the representation of attention deficit hyperactivity disorder (ADHD) to be an actual disease, and the drugging of millions of entirely normal American children as “treatment,” is spreading like a plague – still. Once children are labeled with ADHD, they are no longer treated as normal. Once methylphenidate hydrochloride, or any psychiatric drug, courses through their brain and body, they are, for the first time, physically, neurologically, and biologically abnormal.”[3]

Are children with ADHD and/or LD really broken? Do they actually have a disease treatable with drugs? Are they capable of learning in some way without any further pharmaceutical or behavioral intervention?

LD4Increasingly, parents want a drug-free solution. At the Arizona Center for Advanced Medicine, we look for what is causing the problem, and we take a holistic view.

First, we distinguish between the child who simply has difficulty learning because he sees letters reversed and the child who has difficulty learning because he does not see the letters at all – either because his visual pathways are impaired, or because he is not looking where the letters are.

Then we look at nutrition, since a starving brain has an extremely difficult time simply functioning, much less learning anything. We often think of the brain as a computer that just has to be plugged in to an electric outlet in order to work perfectly. However, if the software is deficient or corrupted, the computer sits there on the desk, but does not run your programs very well. Similarly, the brain functions through electrical impulses and specific pathways. However, in order to generate those impulses, it requires many nutrients – proteins to supply the amino acids needed for manufacture of neurotransmitters and other messengers, glucose to supply the energy needed for the manufacturing process, lots of vitamins and minerals to serve as co-factors, or assistants, in the manufacturing process… And the pathways have to be correctly developed, and able to handle the flow of information. If any of these components are missing or deficient, then the brain can no longer process information at top speed. It slows down, or gets the messages garbled.

We also look at food sensitivities and allergies – some specific foods can cause a child to become agitated, to space out, or to become violent. In our office we have seen well-behaved children suddenly start to bite their mothers, hit their siblings, wander around in a daze – all when they are tested for specific foods. Sometimes what sets the kids off are not foods, but rather colorings, additives, and preservatives. Red dye #40 is a big culprit, for example. The symptoms are readily reversible, when the appropriate dilution of the substance is administered, and the effects are reproducible.

We look at the child’s environment – identifying anything in the environment which might be toxic to them. For example, sometimes a child will react to mold in the classroom, or have a bad day every time the grass is cut because of allergies to the grass. Some children react to pesticides or to chemical air “fresheners.”

We also look at brain processing of all the sensory modalities – touch, hearing, and vision appear to be the most significantly affected. Some children cannot abide having tags in their clothes, and always have to have the tags cut out before they will wear the garment. Some children cannot stand to be touched, because they find that light touch is painful – but they are perfectly OK with being hugged very hard, or wrapped in a blanket. Some children cover their ears when they go into an echoing mall – or simply have a melt-down. Conventional medicine has no treatment for these behaviors except sedating drugs. We actually use specific sensory exercises and music therapies to restore the normal functioning of the sensory nerves which clearly were dysfunctional.

LD5We enable the brain to make more connections, and with the treatment we let it know where to make the new connections. We can restore function to the starving brain, and enable the children finally to catch up in school, and to learn information as easily as their peers. They may require some tutoring to catch up, but at least now they have the ability to do the work – they just have to learn the mechanics, like all their peers.