24 - 30 August 2000
Issue No. 496
|Published in Cairo by AL-AHRAM established in 1875|
Hisham, 11, does well in oral quizzes, but fails consistently on written exams. He can spell the word "read" correctly out loud, but always makes mistakes when writing it.
A difficult childVery bright, but can't read or write? Many parents, writes Gihan Shahine, are discovering that their "problem children" -- often misdiagnosed, misunderstood and mistreated -- actually have learning disabilities. That, however, is where the real problem starts
photo: Khaled El-Fiqi
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Hisham seems just like any average, if slightly hyperactive, child. Obviously intelligent, he is described as "lazy and inattentive" in class.
"I knew there was something wrong with my son, but I couldn't figure out what it was," recounts Mona El-Toukhi, Hisham's mother. El-Toukhi first realised Hisham was having problems when he started learning to read and write. His teachers complained that he was too boisterous and inattentive in class. "I used to punish him for being lazy and try to help him study at home, but his academic achievement was still very low," El-Toukhi adds.
One incident in particular, however, clarified the problem. On the eve of a mid-year exam, she orally revised every single word in the syllabus with her son, who "appeared to understand the material very well." The exam included the same questions Hisham had answered so easily the previous night but, to his mother's shock, he failed the exam. El-Toukhi then quizzed her son on the same paper orally, and was surprised to discover that "he knew all the answers."
El-Toukhi decided to consult a paediatrician, who told her that Hisham was a typical boy and that I was worrying too much. He advised me not to force him to study so as not to make him hate school."
El-Toukhi, however, was not convinced. Hisham was obviously lagging behind. "A friend of mine who was living in England told me my son could be suffering from dyslexia. Dyslexia? What is dyslexia? I asked. We searched for an answer on the Internet and, sure enough, my son had all the symptoms of a dyslexic child."
DIGGING FOR DEFINITIONS: No one really knows for sure what dyslexia is or what causes it. But according to Ronald D Davis, author of The Gift of Dyslexia, it is "a severe reading and writing disorder characterised by reversals." Dyslexics, he writes, are "intelligent, bright or even gifted individuals, that for no obvious reason struggle to learn through the medium of written or spoken language."
Davis himself grew up "retarded" (today he would be diagnosed as autistic) until his early teens. Even though he failed miserably in school, he later took technical courses and became a successful engineer, businessman and artist. He was functionally illiterate until the age of 38, when he discovered how to "orient his perceptions." Thereafter, he dedicated his life to helping people with "the gift of dyslexia" achieve literacy and self-esteem. He founded the Reading Research Council in 1982 and he delivers lectures and holds workshops through the Davis Dyslexia Association International (DDAI).
According to Davis, dyslexic individuals appear bright, highly intelligent, and articulate but are unable to read, write or spell. They may be labeled lazy, dumb, careless, immature or "not trying hard enough." They can score above average on IQ tests, but fail academically; they may test well orally, but not on written exams.
A dyslexic person, according to Davis, typically has poor self-esteem, hides or covers up weakness with compensatory strategies and is easily frustrated and emotional about school reading or testing. Dyslexics are often talented in art, drama, music, sports, mechanics, story-telling, sales, business, designing, building, or engineering; but they seem to "daydream" frequently, get lost easily or lose track of time. They have difficulty sustaining attention, and learn best through hands-on experience, demonstrations, experimentation, observation and visual aids.
A RIDDLE AND A MAZE: In an Internet article titled "Education vs Child Development," Davis, who has worked with around 1,000 dyslexic children, explains how the syndrome develops. During early childhood, the dyslexic uses his or her cognitive talents in perceiving objects in the environment, then starts developing artistic and kinesthetic talents, with little need for development of verbal thought -- a slower mode of thinking characterised by an internal verbal monologue. He or she thus becomes a "conceptual thinker" who thinks in pictures.
Problems start when the child begins reading in kindergarten or early grade school. The alphabet is a puzzle. A dyslexic child views printed letters upside down or reversed, in an order that makes them less recognisable. He becomes increasingly perplexed, which leads to more disorientation. Everybody starts to get upset, especially teachers and parents, and so the "cognitively challenged" child gets upset too.
"Now we see behaviour problems," Davis proceeds. "Unless there is proper intervention by someone who shows compassion and respect, the dyslexic child's self-esteem will suffer."
MIXED SIGNALS: In Egypt, where the media focuses on the problems of mentally and physically challenged members of society, there is little knowledge of what dyslexia is. Many still confuse it with Down's Syndrome or slow learning.
"Social awareness of the problem is severely lacking, which causes many children to suffer a lot," laments Dr Gihan El-Qadi, a paediatrician and head of a paediatric centre for learning disabilities in Maadi.
Dyslexia, El-Qadi points out, is only one type of learning disability (LD). All LD children are of normal, or even higher than normal, IQ, but their academic achievement is very low. This underachievement, however, is not due to a chronic disease, hearing or sight deficiency, social problem or emotional disturbance, any of which may result in a learning difficulty.
"People usually confuse learning disability with learning difficulties," notes Osman Labib Farrag, professor of psychology and environmental health at the American University in Cairo (AUC) and former counselor at UNICEF. "An emotionally disturbed child who comes from a broken family, or who suffers from anaemia, for instance, may have a learning difficulty. Learning disability, however, results from damage to some brain centres, and can be overcome through special educational care."
El-Qadi adds that a child with low academic achievement must undergo a comprehensive physical, neurological and psychological checkup, plus an assessment of IQ, hyperactivity and school achievement, before he can be diagnosed with a learning disability.
BORN THAT WAY? "LDs may have a genetic origin, but usually have to do with pregnancy and delivery problems," El-Qadi explains. "Haemorrhage during pregnancy, unhealthy delivery, lower oxygenation at delivery, or a brain trauma occurring in the first two years of life may all affect or damage some centres in the brain, resulting in a learning disability."
A correct diagnosis therefore requires specialists in psychology, neurology, paediatrics and education, which makes it relatively expensive. There are very few centres in Egypt specialised in LD diagnosis, which means that many cases are unreported or misunderstood.
"Learning disability is barely taught in faculties of medicine and education," El-Qadi says. "That is why many cases go undiagnosed by both doctors and schoolteachers."
In the mid-'70s, El-Qadi went to study at Massachusetts University where, to her surprise, she found a whole department dedicated to learning disability in the paediatrics unit. "This branch was never taught here in Egypt and I decided to study it," she recounts.
KEEPING COUNT: According to the American Board of Paediatrics, LD affects 15 to 20 per cent of all schoolchildren. In Egypt, however, there are no statistics. Nobody has been keeping records, simply because few are aware of what a learning disability is.
El-Qadi, however, has been trying to monitor LD cases since she came back from the US in the mid-'90s. She decided to open a kindergarten, which was later expanded into an all-grade school; then, in 1996, she established a centre where she could diagnose and provide support to "bright kids who were suffering."
"From personal experience I would say that learning disabilities may exceed 15 per cent of all schoolchildren in Egypt," El-Qadi remarks. "One in 10 pupils may be in need of special education. Dyslexia, I would say, is the most common of all learning disabilities."
Dr Joseph Ghali, rehabilitation physician and director of the Learning Support Centre (LSC), a branch of the American International School (AIS), concurs. LSC is a coeducational day school for students aged four to 14, which offers an individualised special education programme targeting students with mild learning disabilities.
"Over 10 per cent of all students suffer from mild learning disabilities that, most of the time, can be corrected through an inclusive approach in a regular classroom," Ghali says.
HAZARD OR BLESSING: Learning disabilities must be identified and treated early, otherwise children can develop emotional, social, and family problems, not to mention academic difficulties, according to El-Qadi.
Dyslexic children who find the acquisition of literacy skills difficult, for example, can also suffer anguish and trauma if they are mentally abused within the school environment because of their learning disability, Davis adds.
"LDs can have disastrous consequences in our society if undiagnosed and untreated," El-Qadi warns. "But they can also be a blessing when recognised."
When new discoveries challenge long-established prejudices, there is always a tendency to emphasise the advantages of what was previously disparaged. An ever-growing list of famous individuals who have been described as dyslexic -- published in a book titled Dyslexia: A Research Guide by Carol Sullivan and George Grosser -- includes Winston Churchill, George Patton, Woodrow Wilson, Charles Darwin, Thomas Edison, Emile Zola, Hans Christian Anderson, Albert Einstein, Galileo, Leonardo da Vinci, Carl Jung, and Michaelangelo.
THE PRICE OF UNDERSTANDING: In Egypt, most media attention, government and non-governmental efforts have been geared to helping the mentally and physically challenged. Very few private facilities provide educational and diagnostic services for those with learning disabilities. Their services, furthermore, are unaffordable for a large strata of society (an hour-long session can cost LE50).
"Fees are high because we provide highly professional services," maintains El-Qadi. Diagnosis alone, she explains, is very expensive because it requires check-ups by a number of experts.
The centre helps children cope with the school environment through an intensive specialised US-developed course delivered after the school day. This one-on-one course uses all the child's senses through experimental and multi-media learning techniques and hands-on experience.
"We advise that children with learning disabilities attend regular schools, so that they do not feel different and frustrated," El-Qadi says. "But because these children cannot concentrate in large groups, we draw them out of school in the afternoon and teach them the same syllabus in a way geared to their special needs."
Will this course help a dyslexic child, for example, read and write fluently? Can children with learning disabilities reach the university level?
At the Learning Support Centre (LSC), a branch of the American International School (AIS) where a minimum two-year course is applied to help students with mild learning disabilities embrace the knowledge and skills needed to adapt in a mainstream setting, five out of 19 students have already been integrated, mostly in regular American schools. Eleven out of a current total of 40 students are scheduled to be mainstreamed in the 2001-2002 academic year.
Vartan, a 14-year-old with a moderate LD, is a case in point. He joined the LSC two and a half years ago. He was in middle school at the time, but his academic achievement testing revealed an elementary school level. This year, having completed an intensive individualised course, he will enter 10th grade at the AIS. A teacher who examined Vartan recently said his general knowledge is intimidating to his regular-class peers.
Willing and able: Children with learning disabilities are bright, but require educational facilities geared towards their special needs. They excel in many fields, especially art. At right, is a sample of LD children's drawings. Lack of social awareness, however, has led many of them to suffer in silence
"My reading and writing were very bad when I first came here," Vartan concedes. "My English was also very poor. I used to fail in written exams although I knew all the answers very well orally."
Today, Vartan speaks correct English and reads fluently. His mother, Araxi Caloustian, is happy. "Vartan has made significant progress," she says proudly. "But I have to admit other parents are not equally satisfied. They complain that their children are not improving as expected."
An 11-year-old girl who entered the school two years ago with a severe writing and reading problem is still slow at reading and very shy. She was scheduled to start mainstream school this year, but that has been postponed.
Joseph Ghali, rehabilitation physician and director of the LSC, feels that Vartan has done better than his schoolmates because of family support. Other students, he adds, have the same IQ as Vartan and have not made the same progress "due to lack of family involvement."
"Closing an age and grade gap in all subjects, especially in math and language arts, will require a minimum of two years, depending on the severity of the case, the child's cognitive abilities, emotional state and family dynamics," Ghali notes. "Some students learned to read and write in a year or a year and a half; others may take longer, depending on the criteria we mentioned before. But in all cases we recommend that those students be mainstreamed in American schools where the educational system is less complicated and thus more appropriate for their needs."
Many parents and experts, however, insist that the government should design specialised courses, examination and grading systems for children with learning disabilities.
"It costs a fortune to enroll LD children at one of the specialised centres or schools where tuition can cost as much as LE15,000 or LE20,000 a year," Mona El-Toukhi, whose son is dyslexic, complains. "The centres where LD children receive special care cannot help them cope with a regular school environment in the absence of an accredited syllabus, examination and grading systems geared to their needs. The existing curricula are very complicated and it will take these children long years to graduate, if they ever do. And, of course, only a few can afford to enroll their children at American schools."
Many experts agree that an examination companion can be a boon in the absence of a tailor-made, state-funded system. The current grading system relies exclusively on written exams, which may require the comprehension of diagrams or illustrations a dyslexic cannot handle alone. A companion, however, can help a dyslexic examinee, who will probably know the answers orally, by handling the reading and writing.
The current system, however, does not allow for such cooperation. "I have tried to convince officials that my son is dyslexic and needs an examination companion, but they refused, simply because they don't know what dyslexia is," El-Toukhi says. "They advised me to enroll him in the government's specialised school for Down's Syndrome. I tried to explain that a dyslexic is different because he has a normal or above-normal IQ, but they were not convinced. The real problem we are facing is not dyslexia, but the fact that neither officials nor teachers are acquainted with the gifts those children have."
NUMBERS MATTER: Ragab Sharabi, first deputy minister of education, told Al-Ahram Weekly he is willing to listen to experts and provide whatever is needed to help children with learning disabilities. "But we need to study the problem first," he argues. "We need a clear-cut definition of what a learning disability is, a record of the number of children affected, and a study of the services they need."
This preparation is crucial, Sharabi adds, because many children may achieve poorly due to social, psychological or health problems that will require different care.
The Ministry of Education recently formed a committee of specialists to study the problem. The committee will record the number of learning disability cases in schools, while ministry experts have suggested a pilot project to help integrate LD children into regular schools through extra support sessions provided during the regular school day.
"This project will entail training teachers in handling these cases and will be tried out first in three main subjects: math, science and English," Sharabi told the Weekly.
Will the ministry consider designing new courses or a different grading system for LD children? "If we design special courses, we will have to enroll such children in specialised schools, which can negatively affect their morale," Sharabi argues. "We want to integrate these children in mainstream schools and help them cope with the school environment.'
What about examination companions? Sharabi retorts: "The system does not allow that."
"If a child cannot read or write by sixth grade, he should be enrolled in one of the specialised schools for the mentally challenged," Sharabi maintains. When informed that LD children have average IQs, he repeats that he is "ready to help," but would prefer to "listen to therapists and experts who can provide a better explanation of what those cases need."
The ministry's study, however, has ground to a halt because two of its committee members have gone to work abroad.
WORKING IN A TRIANGLE: El-Qadi has already managed to establish a non-governmental organisation, the Egyptian Learning Disability Association (ELDA), licence number 4689, which will be dedicated to "helping LD children reach their full potential."
"Most importantly, it is committed to addressing parents, teachers and society at large," El-Qadi explains enthusiastically. "We plan to start working within this triangle before we start to address officials. We also want to set up a statistics and research institute to record the number of children with learning disability."
One of ELDA's main goals is to teach parents how to identify and manage LD children educationally and socially.
"It is always very difficult to convince parents that their child may need special care," El-Qadi maintains. "Many of them punish their children for being unable to learn simply because they don't understand."
Teacher training is also crucial. Teachers are often confused by students whose consistent underachievement seems due to "carelessness." In a positive and encouraging environment, a child with a learning disability will experience feelings of success and self-value.
"We have already started training teachers and hosting Egyptian and foreign experts," El-Qadi says. Training workshops were on the agenda of a recent conference she organised to increase social awareness of learning disability. Around 17 private schools took part in the workshop, where teachers listened to educational specialists, psychologists and paediatricians from Canada and the US.
"The workshops were extremely interesting, but also very short and hectic," says Heba El-Saadi, a kindergarten headmistress who attended the workshops. The training course, El-Saadi explains, provided teachers with a superficial idea of what learning disability is, but they need more in-depth information to avoid misjudging students.
"Still, when I took the course, I realised I had many LD cases I had not diagnosed," El-Saadi admits. She plans to give all kindergarten teachers a general idea about the subject. "Such awareness will help teachers monitor suspected cases of LD and consult a therapist for a proper diagnosis. If we are sure a child is an LD case, we will start talking to the parents and help teachers handle these children in class. We may also request the help of one of the specialised LD centres."
But will the school provide special classes and exams to help LD children cope?
"We cannot do anything of the sort unless the ministry gives us the green light," El-Saadi replies. "We may provide LD students with a companion in quizzes, but in general certificate exams, we will need the ministry's approval."