Are We Diagnosing Learning Disability Often Enough?

Over his ten years of life so far my son has ‘collected’ a fair list of diagnosis. First he was given ‘severe autism with global developmental delay’, then six months later the genetic condition ‘Neurofibromatosis Type 1’, then a few years later two complex eye conditions, a year later a third eye condition (a tumour on his optic nerve), two years later epilepsy and in the last few months cortical dysphasia which at first appeared to be a brain tumour! Every one of those diagnosis was given by medical professionals, geneticists, therapists and neurologists. Yet one diagnosis seemed to just ‘happen’ over time that everyone knew about yet no-one spoke about: learning disability.

I knew my son was ‘behind’ others from as young as a few months old. He was ‘late’ to hold his head, give eye contact, respond to his name, speak, interact with his environment, crawl, walk, use a spoon and so on. There wasn’t anything in fact that he wasn’t late at. Before he was even two years old I was told verbally he had the woolly and hopeful diagnosis of ‘global developmental delay’. Wether intentional or not it very much gave the impression that one magic wonderful day my son would suddenly ‘catch up’ with everyone else and all would be perfect. When autism was talked about that became the ‘dominant’ issue and the global delay was rarely mentioned.

Until suddenly without anyone saying anything I received a standard letter from an appointment listing my son’s diagnosis and on it I read ‘learning disability.’ There was no appointment to diagnose, no waiting list to join and no discussion. His ‘global developmental delay’ just magically changed to ‘learning disability’ and that was it.

Yet for so many others that two worded diagnosis seems to never be mentioned. Why is that?

Party it seems to be due to an increase in genetic knowledge. We can now break down genes to an amazing level and more and more children and adults are being diagnosed with rare genetic conditions. While these conditions remain rare it is common for all ‘symptoms’ including learning disability to be generalised under the umbrella of the genetic condition. While years ago the opposite may have been true and the person had a general learning disability now we see the genetic abnormality to be the cause and therefore often lump everything under that one diagnosis. Perhaps as more people get diagnosed with the same genetic conditions we may find that not everyone with that condition actually has learning disabilities and therefore adding ‘with learning disability’ would be a more helpful addition to any genetic diagnosis.

Another reason seems to be the increase in autism diagnosis. I see more and more children diagnosed on the autism spectrum who do have clear learning disabilities but who can not get the latter diagnosed because of a (wrong) assumption that ‘it’s all part of autism’. Yet according to the National Autistic Association, the leading UK charity for autism here are the facts:

Between 44% – 52% of autistic people may have a learning disability.

Between 48% – 56% of autistic people do not have a learning disability.

Autism, on its own, is NOT a learning disability.

Autism, according to Wikipedia is described as follows: ‘Autism is a developmental disorder characterized by difficulties with social interaction and communication, and by restricted and repetitive behaviour. Parents usually notice signs during the first three years of their child’s life.’

Where as ‘learning disability’ is described by Mencap, the leading charity for people with learning disabilities as: ‘A learning disability is a reduced intellectual ability and difficulty with everyday activities – for example household tasks, socialising or managing money – which affects someone for their whole life.People with a learning disability tend to take longer to learn and may need support to develop new skills, understand complicated information and interact with other people.’

Mencap goes on to say that around a THIRD of people with a learning disability may also be autistic. By default that means two thirds are not.

Autism and learning disability are two very different conditions.

I am thrilled that we are progressing with genetic knowledge and diagnosing more and more genetic abnormalities and differences. With knowledge comes power. I am also delighted that we are becoming better at picking up both children and adults who are autistic. But I do hope we continue to make sure that everyone, like my son, gets a diagnosis of learning disability when necessary because without it we are denying both present and future support (it’s a life long condition), limiting educational support, and leaving children and adults feeling failures because they don’t understand why they are struggling.

Oh and let’s not only make sure we continue to diagnose learning disability when necessary but let’s make sure more parents, professionals and medical experts explain that global developmental delay is unlikely to mean ‘catch up’ and actually is just a fluffy pre-diagnosis to learning disability.

Let’s tell people the truth. There is no shame in learning disability so why hide it?

My son isn’t hiding his learning disability and neither should anyone else.

What My Ten Year Old Taught Me About Learning Difficulties

A few months ago my ten year old daughter said something that changed the entire way I look at learning difficulties. I hope it will make you think too.

I remembered it was a Wednesday because that’s the day that clinic is always on. I had picked my daughter up early from school as she had an appointment to see a specialist. My daughter attends mainstream school where she is thriving even though she is autistic, has an eating disorder and anxiety. Coming out of school for appointments is a regular occurrence and this specialist was one she had been seeing for six years. I wasn’t expecting anything significant to happen as that day was just a regular check up.

I was right; the check up went as expected and there was nothing significant to report…well nothing significant about the appointment that is.

What I didn’t expect to happen was the conversation in the car on the journey there. Who knew that a ten minute conversation could leave a lasting impression that has radically changed my thinking!

The journey started off quietly. My daughter is so anxious in school she doesn’t speak (a condition known as selective mutism) and sometimes if I pick her up from school during the day it can take a few minutes before she chats freely. I always carry on and let her talk when she feels ready, if she even wants to that is.

I pulled out of the school car park and headed to the clinic. I was at the second set of traffic lights when she started talking. Out of nowhere she asked a simple question:

“Mum, do I have learning difficulties?”

As I drove I answered her question as honestly and as simply as I could. I have a background in teaching and thought I had a good knowledge of what learning difficulties is so I told her that we usually class learning difficulties as a struggle with academic things like maths, reading, writing and understanding what people say. She thought about that for a brief moment and then checked her own understanding by listing a few children she knew from her class, also including her own brother who attends a different school and who has severe non verbal autism, who she thought fitted this description. Knowing her class well from volunteering in her school I was able to confirm to her that, yes, all the children she had mentioned, including her brother, did in fact have learning difficulties.

As I concentrated on the road ahead I wasn’t expecting her next comment at all.

“Mum, I don’t like the name learning difficulties.”

I had to ask her why. She was ready to answer right away.

“Well I struggle with some things but people think I am clever just because I can read and write, but all those children I mentioned are clever too. I mean my brother can use google street map, My friend knows loads about superheroes and my other friend is great at building Lego. So why do people say they have learning difficulties just because reading or counting is hard. That’s unfair.”

I was so glad I was just pulling into the parking at the clinic because what she had just said was so powerful I needed her to say it again.

‘Naomi can you say that last bit again please?’

“Ok mum. Why do people say my friends and my brother have learning difficulties just because reading and counting is hard for them. I think that’s unfair. Don’t we all struggle with something?’

I let her words sink in before I even turned my engine off. I couldn’t actually believe that I had never thought about it that way before.

It took my ten year old to shake up my beliefs. She doesn’t see any of her friends, or her brother, as different. She recognised that everyone struggles with something, after all even though she could read and write and count well here she was attending a clinic because of something she struggled with. Why wasn’t her issue classed as learning difficulties when her friends and brother’s struggles were?

Children can teach us so much if we let them. What my ten year old taught me about learning difficulties is something I will never forget.

It isn’t fair to judge anyone by their struggles when every single one of us struggles with something. We really aren’t any different to anyone else.

Thats powerful. I had no idea my ten year old could be so insightful.