Hiding in Plain Sight

August 2007 Special Sections

Susan Thomson’s daughter, Bridget, was two years old when her parents noticed she was having trouble communicating. Bridget could follow directions and understand complex sentences, but she had difficulty expressing what she wanted to say and spoke only in ambiguous fragments. As her mother recalls, “I could say, ‘Where is Daddy?’ and instead of saying ‘upstairs’ or ‘outside,’ Bridget would say ‘He go.’ It was perplexing.”

By the time Bridget was seven, her  verbal skills had improved thanks to year-round private speech lessons and special education services at school, but she was now struggling to read. “Intuitively, I knew that something was just not right, Thomson says. “I knew she needed help.” Two years later, a specialist performed an educational assessment and concluded that Bridget had dyslexia, a learning disability that is marked by difficulty with accurate and fluent word recognition and by poor spelling and decoding abilities.

The Thomsons, whose twelve-year-old son has attention deficit disorder, are certainly not alone in their struggle to help their children navigate their mental health issues and learning disabilities. The Minnesota Children’s Defense Fund Kid Count Data Book estimates that 145,000 Minnesota children have diagnosable mental health issues (anxiety, disruptive, and mood disorders are the most common) and the Minnesota Department of Education estimates that between 3 and 3.5 percent of school-age children in Minnesota have a learning disability.

Given the nature of these disabilities, they’re often overlooked. “Both mental health disabilities and learning disabilities are often regarded as hidden disabilities,” says Virginia Richardson, manager of parent training at Minneapolis-based PACER Center, a national and statewide resource, information, and training center for parents of children with all disabilities. “If you just look at a child sitting in a room with his or her classmates, you wouldn’t instantly identify the child as having a disability.”

Making Sense
Like many parents, the Thomsons found the path to Bridget’s diagnosis long and at times circuitous. “Once Bridget showed improvement in her expressive language, the school system said that she no longer needed special education, but I kept telling them, ‘She is not reading,’” her mother recalls. “It took another two years before she was re-assessed by the school.” But even then the school didn’t discover her dyslexia—a private specialist did. Bridget worked with a tutor from age five to fifteen; when she was fourteen she finally received special reading instruction at school that was customized to her needs

The Thomsons’ experience, while agonizing, is unfortunately not unique. “Many families can go through years of testing before they arrive at an accurate diagnosis,” Richardson says.

Many mental health issues and learning disabilities have overlapping signs and symptoms. Combine this with the rapid physical, emotional, and developmental changes children experience and finding a precise diagnosis can be a challenge.

The warning signs often surface at school. “When a child is troubled in any way, you see changes in the school setting,” says Barry Garfinkel, MD, a child psychiatrist with a private practice in Minneapolis. “Absenteeism, a drop in grades, physical illnesses, and complaints such as headaches and stomachaches have all been attributed to mental health issues and even learning problems.”

Of particular concern to mental health experts is the cascading effect of a problem that remains unaddressed. Left undiagnosed, for instance, even mild learning disabilities can cross over into challenges with emotional and behavioral health.

“Kids can’t understand why they are not learning, but they know they are not doing well,” Richardson says. “The longer a child with a learning disability goes without getting diagnosed, the more likely it is that he or she will spiral into that self-esteem abyss, and then possibly to the emotional and behavioral issues as well.”