Piloting a beloved child labeled "learning disabled" through the often choppy seas of mainstream education to a safe learning harbor can be as arduous and frustrating for parents as it is for the student. In New Orleans, however, educators and the medical community are offering ports of hope and new leases on life to families of children who have Attention Deficit Disorder (ADD), Attention Deficit Hyperactivity Disorder (ADHD) and dyslexia.
St. George's Episcopal School Uptown offers special resource programs for children struggling with dyslexia, but until a few years ago, students with ADD and ADHD for the most part were placed on medications to quell disruptive behaviors and passed through a revolving door of schools ill equipped to deal with their special needs. Fortunately, Holy Rosary Academy on Esplanade Avenue took up the challenge of developing a curriculum for kids with special learning needs and discipline challenges and has changed the lives of dozens of children and their families. Holy Rosary was established in 1996 as a middle school for boys with learning problems but later was expanded to include girls and hopes in two years to accommodate up to 250 students in first through eighth grades.
Co-administrator and learning specialist Patty Glaser, who refuses to use the term "learning disabled," developed a curriculum that incorporates multi-sensory approaches to unlocking the multiple intelligences inherent in all humans. The school uses multi-age classes (first and second grades together, third and fourth, etc.) with 12 to 17 students and two teachers in each classroom and places emphasis on reading, writing, math, spelling, language arts, social studies, technology, science, art, music and physical education. The school is considered unique in the Southeast region and is a godsend for parents whose children previously were languishing in highly structured settings with large student bodies and one teacher per classroom.
Marguerite Oestreicher, a local gallery owner who serves on the board at Holy Rosary, says she has seen amazing changes in the school's students and in the lives of their families. "You can take a child whose self-esteem is in shreds, and in a year they think of themselves as learners," says Oestreicher, whose child has dyslexia but not ADD or ADHD. "It's truly been somewhat of a miracle in our lives. This is a child that was profoundly distressed and frustrated because of his inability to learn in a traditional environment. At Holy Rosary, learning is not a punishment. The small class size is exactly what he needed."
Nationally as many as 20 percent of children have learning difficulties that require special attention and sometimes treatment. ADD and ADHD are among the most misunderstood by teachers and parents alike, partly due to the frustrating nature of the disorders and their inherent behavioral challenges.
"The most effective management has been combinations of things," says Carmela Tardo, a pediatric neurologist at LSU Health Sciences Center and Children's Hospital. "First of all, trying to demystify and explain it to parents and teachers. Sometimes accommodations and environmental changes can make a huge difference. We also have to make sure we exclude other conditions, such as depression, anxiety, hunger, fatigue, that may be compounding the issue. If environmental accommodations don't do the trick -- teachers can only make so many changes -- the only other choice is to use medication."
To make matters more complicated, ADD and ADHD -- which statistics show affect 3 to 8 percent of children in Louisiana -- cannot be measured with a simple medical test like diseases such as diabetes, so diagnosis comes from taking family histories, observing the children and talking with parents and teachers.
Treatments range from drugs that calm down the child to make their behaviors more manageable and behavior modification techniques that are time consuming and sometimes frustrating. The American Academy of Pediatrics reports that medications are effective in only about 70 percent of the cases and last only as long as the drugs are in the child's system.
Dr. Bert Quintana, an associate professor at LSU School of Medicine and director of child and adolescent training and child psychopharmacology in research, says there is new hope. The Food and Drug Administration last November approved a new drug, Strattera, that is a non-psychostimulant and is not addictive. It also has fewer side effects than current drugs such as Ritalin.
"This medication is going to revolutionize the treatment of ADHD," he says. LSU was among sites that conducted multi-center studies of the medication, which he says overcomes the "zombie" effects other psychostimulants produce, allows patients to eat and sleep better and doesn't affect their growth. "This is a milder drug. It seems to improve functioning, which is a help. Some of these kids are constantly being faced by failure. No one wants to fail; it's horrible."
ADD and ADHD generally appear by the age of 7 and persist for more than six months, Quintana says. Main features are hyperactivity, impulsivity, aggression, and an inability to focus on and complete tasks. Correct diagnosis and treatment is made harder by the fact that they often coexist with other problems; 20 to 30 percent of children with ADHD also have anxiety disorders, he says, and 18 percent also suffer depression. About 65 percent of ADHD sufferers have it in adolescence and 39 percent take at lease some residuals of it into adulthood.
"Most schools are very intolerant of the child who is a deviation of the norm, from the public schools to the private schools ... from the worst schools to the best," Quintana says. "They are intolerant of anything that is nonconforming to the norm."
While parental and teacher management and medications are helpful to some, other researchers are looking for more long-term ways to help patients. Dr. Barry Schwartz, a neurologist at Tulane Medical Center, uses neurofeedback to help reorganize the brains of children and teenagers suffering from the conditions. It involves hooking up sensors to the patient's ear lobes and forehead and measuring the alpha, beta and theta brainwaves while they're resting and when their minds are active. The therapy utilizes a series of computer-generated puzzles the patient solves by using only the brain. Best results are obtained by children who undergo about 20 treatments spread over a minimum of once a week, although Schwartz says he's seen progress in as few as four to 10 sessions.
"It works well for those people who stay with the program and are accurately diagnosed," he says. "It teaches the brain, which controls our behaviors, and helps to reorchestrate the parts of the brain that control, for example, executive functioning. The brunt of the work is done by the neurofeedback and the brain." It also involves a conscious effort by the patient to perceive what their brain feels like when they are attentive and to consciously try to get back to that state. The effects, the doctor says, can be dramatic.
"It can go from perhaps the depths of despair to the top of Mount Olympus," he says, adding that many patients proudly bring in homework and tests on which they've received good grades or encouraging comments from teachers. "It also helps parents (to understand) that it's not a matter of willpower. It's a relief for everyone."
Schwartz eventually hopes to take his computer-contained neurofeedback therapy into a school to make it more convenient for students to receive consistent treatment and to make more people aware of the new treatment. Regardless of such therapy, however, children with the disorders can still benefit greatly from non-traditional school settings such as Holy Rosary.
"The curriculum is based on developing the eight intelligences with a multi-disciplinary approach," says co-administrator Glaser. "The kids have to see it, touch it, taste it, and do it in order to learn it. ... The method increases retention. Auditory memory is a big difficulty for people with learning differences."
When Holy Rosary students studied ancient civilizations, for instance, they visited Mardi Gras World, and Blaine Kern's artists made a Styrofoam mummy, explained the process of wrapping it and that it was stored in a sarcophagus. The children then returned to their school, wrapped the mummy in papier mache and built a highly decorated sarcophagus. Part of that lesson also included making paper using ancient techniques and creating jewelry. All lessons at the school are backed up by daily reading, writing and discussion exercises.
"These children are bright and have the ability to learn," Glaser says. "They just need to learn differently. They can learn lots of things if it's in a different format."
A key to the school's success, Glaser says, is in integrating information children learn among various subjects instead of keeping classes compartmentalized to one subject. Although the curriculum is unusual for the New Orleans area, it's a combination of tried-and-true learning techniques and research from sources such as Maria Montessori, Harvard professor Howard Gardener and Vygotsky, and it hearkens back to pre-industrial classrooms where students were few and scholars' ages were mixed.
"Our kids are needy," Glaser says. "With all of their needs, we're able to meet them in multiple ways. We have kids who come to us from public and private schools from five parishes. We're a unique entity."