Excerpts

Introduction: Only the Best Is Good Enough for Your Child I have written this book for you, the parents and teachers of children with learning disorders, because I have something in common with you. What we share is a feeling of frustration. Parents get frustrated when their clearly intelligent child seems to be unable to learn to read or write. Teachers get frustrated when a child cannot settle down in the classroom or does not achieve what he or she is capable of achieving. I get frustrated when I see a child with a learning or attentional problem who is not being treated or helped using the best, most effective methods available. I want to state my position clearly at the outset. I believe that the only responsible and ethical way to treat children with learning disabilities is to use methods that have been proven to be effective in scientifically conducted tests and trials. Once a child has been diagnosed with a learning or attentional problem, the appropriate treatment should be started immediately. Experimenting with unproven therapies not only wastes parents' money-in some cases, parents have spent many thousands of dollars on ineffective treatments-but also wastes valuable time. There is a saying in legal circles: "Justice delayed is justice denied." I believe that a similar statement could be used in medicine: "Effective treatment delayed is effective treatment denied." No child should have to wait for effective treatment when it is available. The good news is that proven, effective approaches do exist for learning and attentional problems. Most of them are widely available, do not involve heavy expenses for the parents, and can be implemented in any school. The bad news is that it may take some time before you see an improvement. There are no "instant cures" in the field of learning and attentional problems. The desire for a quick solution is what drives many parents to waste money on unproven therapies. Unfortunately, there are plenty of people who are prepared to exploit that desire by offering "miracle" remedies that claim to solve learning and attentional problems instantly. In this book I will help you distinguish between proven treatments based on solid research and therapies that are based either on unsubstantiated theories or on someone's ambition to make money from the parents of children with learning or attentional difficulties. But, first, I should explain what I mean by "proven" treatments. I am a skeptical person; always have been. When I graduated from McGill University with my B.A., the quotation I submitted to the yearbook was: "Absolutely everything is relative -- probably." I don't take things on faith. I'm not impressed by statements such as "We've always done it this way" or "So-and-so uses this approach, so it must work." I like to check my facts, and subject what I have learned to critical review. I want to know the scientific basis of any proposed treatment, and I want evidence that any approach to patient care will be effective before I recommend it. When I went to McMaster University to teach pediatrics, I worked with Dr. David Sackett, one of the pioneers of evidence-based medicine. Evidence-based medicine could be described as the systematic use of skepticism in medicine. Those who use this approach search medical research data to ensure that there is solid evidence that a treatment has been shown to do more good than harm, and that it is demonstrably better than no treatment at all. Proof of a treatment's effectiveness can be determined only by rigorous, controlled scientific testing with a large group of patients. Tests that do not use a carefully controlled procedure or that use a small group of patients don't qualify as proof of effectiveness. Doctors who use the evidence-based approach examine medical literature for this kind of proof before they recommend a treatment or procedure. Now, you might well assume that anything published in a reputable medical journal has been scientifically verified using carefully controlled methods. This is not the case. Some medical journals publish all kinds of research, but evidence-based medicine accepts only certain kinds of research as definitive proof that a treatment is effective. If it's any comfort to you, it's not just laypeople who make this assumption. One of the challenges of medical education these days is, in the words of Dr. Sackett, educating "medical students in how to separate the wheat from the chaff of medical literature." Well-intentioned doctors sometimes make the same mistakes as laypeople in choosing treatments. Fortunately, evidence-based medicine is gaining ground. Centers in Canada, the United States, the United Kingdom, and other countries now evaluate published research and identify technologies, therapies, treatments, and devices that meet the criteria of evidence-based medicine. After all, doctors need help to sort through the ever-increasing volume of medical literature. McMaster University in Canada is a center for this type of research. The Duke Clinical Research Institute at Duke University in North Carolina is an important center for evidence-based medicine in the United States. In England, the National Institute for Clinical Excellence (which has the wonderful acronym NICE) acts as an advisory group for the National Health Service there. Journals of evidence-based medicine have been started, and Web sites offer access to information about best practices. More and more medical institutions are adopting the evidence-based approach, for both philosophical and practical reasons -- philosophical, because many physicians and administrators feel that medicine should be a more exact and consistent practice, not subject to the vagaries of physicians' experiences and attitudes; practical, because administrators want medicine to be cost-effective. I think the same reasons would appeal to you, the parents and teachers of children with learning and attentional problems. You want the best available advice, and you don't want to throw money away on ineffective treatments. You are therefore entitled to the same information that is available to doctors who work in the area of learning and attentional difficulties. If you are a parent, you want to be fully informed about your child's condition and about the best treatments available. If you are a teacher, you need to know about the best possible practices for working with children with all types of learning and attentional disorders. This book contains the most up-to-date information about treatments for learning and attentional problems, based on the best available research. Although I explain conditions and treatments in non-technical language, I also provide references for the most important studies, so that, if you want to read them for yourself, you can do so. I also want to help you learn how to judge information for yourself. If you have a child or a student with a learning or attentional problem, you will no doubt want to read everything you can get your hands on about the child's condition and the therapies available. Other books do not use the evidence-based approach to treatment, but they may help you understand how common these problems are. It is always comforting to know that many other people are facing the same problems that you face. You will receive advice, whether you ask for it or not, from relatives, neighbors, and acquaintances, much of it based on hearsay. You will be bombarded with advertisements for products that claim to "cure" all manner of problems instantly -- for a price. The treatments and theories that I will describe in this book fall into three categories: treatments that have been demonstrated to be effective or theories that have been shown to be valid in well-designed scientific studies; treatments that have been demonstrated to be ineffective or theories that have been shown to be invalid in well-designed scientific studies; treatments and theories that have not been the subject of any scientific studies and that are not known to be either effective or ineffective, valid or invalid. As a physician and a proponent of evidence-based medicine, I recommend treatments and endorse theories that fall into the first category only. I mention treatments and theories in the second category and describe the studies that have shown them to be ineffective or invalid. I also identify treatments in the third category, but I cannot recommend them. I would never endorse an unproven treatment for any condition, because there is always the possibility that the treatment may one day be found to do more harm than good. I hope that, in this book, I can impart some o my skepticism to you, so that you do not automatically follow advice or fall for hype without asking some searching questions about the effectiveness of any proposed treatment. You need to critically evaluate other sources of information for yourself, so that you can sort out "wheat from the chaff." You owe it to your child or student, and to yourself. Excerpted from Learning Disorders: A Guide for Parents and Teachers by William Feldman All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.