LD #1.

One interesting fact about people with a learning disability (LD) as they grow into adulthood is that their learning disability appears to get worse.  This is because as learning disabled people and non-learning disabled (“normal”) people develop, the cognitive abilities of person with a LD do not develop as well as the normal person.  Therefore, the same score today would be appear to be lower compared to peers as 10 years ago.  In other words, the gap between the LD and non-LD person widens with respect to some achievement measures.  This means that as the demands of education increase (such as going to graduate, business or medical school), a mild learning disabled person may find the work much more difficult that their same peers who are not learning disabled.

I once had to evaluate some who was finishing his 5 year of residency as an ophthalmological surgeon.  He was unable to pass his medical boards, which require mastering a stack of dense medical books several feet high.  He was able to go through college and medical school adequately, but when he had to master a great deal of difficult material, he was much slower at processing this material.  Only at this point did his learning disability  in reading kick in and become apparent.

 

TBI #1.  If you know a former hockey or football player

One colleague I know has a boyfriend who was a professional hockey player and probably has had a number of concussions.  I asked if he was impulsive, irritable, had poor concentration  and bad judgment (all yes).  His too frequent use of alcohol was causing problems in their relationship.   Sometimes alcohol is self-medication for brain problems, attention deficit disorder and other brain problems  I said to this (relatively sophisticated) healthcare professional, “I think you have a brain injury patient here.”  She looked stunned, but knew that I was right.  Let’s face it, news like this can be hard to swallow.  I told this colleague that her boyfriend was at risk for developing early dementia.  She looked very sober indeed, especially facing the possibility of taking care of someone in only a decade or so in the future.

 

LD #2.  Learning disability in  smart person

I was at a church coffee hour and I met another psychologist who started telling me about her troubled son.  We talked about him and I asked a few questions that I would ordinarily ask parents of learning disabled children.  He was not doing well in high school, even though the mom knew he was smart.  After hearing the whole story, I said to the mother, “I think he might be learning disabled.”  I could see a light go off in her head.  She was not in the field of testing for LD, but she knew enough to know that I was probably correct.  And you can’t be sure until you complete all the testing.

A full evaluation was done, and the learning disability was dramatic.  This young man was extremely smart (140 IQ, at the 99th percentile), but was reading speed at the 9th percentile.  He was also fairly depressed, and large part of his depression was due to his not being able to keep up with his school work, plus he had trouble completing his exams (this last factor is a big tip off).  The report made it so he could get extra time on the SAT and ACT exams, and this resulted in a dramatic leap in his scores.  His depression went away, and his self-esteem soared.  He got into Georgetown University, graduated at with honors, and went on to a very positive career.  Now it is 17 years later.  The mom recently notified of the above noted developments, and she said, “You saved his life.”  I have many such stories.

Whether you work with me or not, if you think someone needs a learning disability evaluation, please get it done.  Go with someone who has been in the field at least 20 years, because that time I began to realize I was good at this. (I have been at it for 38 years.)

 

TBI #2.  The Fragile Egg Syndrome.

I had a patient who got a head injury when a NYC bus smacked into him while he was at a stop sign.  The blow was strong enough to snap his head back.  There was no loss of consciousness (LOC) but he had an altered state of consciousness for several days.  In the brain injury literature, the amount of time of loss of consciousness was thought to be the best prognosis for the lasting symptoms in a brain injury.  But a more relevant measure is the amount of time starting with the accident until the patient has a reliable and consistent memory.  This is called Post Traumatic Amnesia, or PTA.  For this patient, there was no loss of consciousness, but his altered state of consciousness (PTA) was about a week.  Defense attorneys like to dwell on the common fact in mild traumatic brain injury LOC may not be very long, and therefore there should indicate a true brain injury.  I have won several cases in which the critical variable was a substantial Post Traumatic Amnesia but almost no Loss of Consciousness.