Late Diagnosis of Learning Disabilities

Ronald Arky is a physician and educator who spoke at last year's meeting of the Massachussets Medical Society, giving the Lecture.  His comments on high-achieving individuals with learning disablities, diagnosed late in their academic careers, is worthy of reading.  The Family Business -- To Educate.

These studies provide new insights into the molecular mechanisms of learning and memory and place learning among the biologic processes to which we can relate specific cellular functions. Learning, conceived as a muscular contraction, has a molecular, cellular, and physiological structure. Moreover, there are conditions in which these physiological states are flawed or disordered. Thus, the science of learning has given rise to the physiology and pathophysiology of learning. We now understand that different people learn in different fashions and that some have difficulties in learning, or learning disorders. The taxonomy of these disorders or disabilities is still in the early stages, and the diagnosis of learning disabilities in adults is complex. But recognizing that these disorders can be present in adults and understanding their pathogenesis will enable educators to tailor instructional material to individual students.

 

My experience with medical students during the past 18 years has included a number of surprises related to learning disorders. Dyslexia and attention disorders that come to the fore when students are challenged by the stresses of clerkship and board examination are not exceptional, although the efforts whereby these students have previously compensated for their disabilities are extraordinary. Most striking has been a small group of students who have earned such kudos as Rhodes Scholarships, election to honorary societies, and the highest awards for undergraduate studies yet who have difficulty taking standardized examinations. Both short-term and long-term learning and memory may be intact in these students, but they have not developed the ability to integrate and apply their knowledge in the highly structured environment of complex multiple-choice examinations. How this lack of development influences their ability to function as physicians is not known. Among the most challenging students are those who grew up in an environment in which English was not the primary language. It is unclear why some such students report that they must translate every question they are asked into their native language before responding, whereas others who grew up in similar environments seem to adapt easily. As it faces such questions, the science of learning is progressing rapidly.