Early screening for learning disabilities ‘would make a huge difference’

By Aileen Delgado, Courtney Curtis and Rick Hampson

Urban Health Media Project 

            WASHINGTON -- Frank Pinckney wonders what his life could have been like if his parents and teachers had believed what he now believes: that as a child he had a learning disability, attention deficit disorder (ADHD) and suffered from trauma after a sexual assault.

As it turned out, none of these problems were diagnosed, which may help explain why Pinckney’s life spiraled into mental illness, crime and substance use disorder. 

“The older I got, the more my drug habit escalated,’’ he says. He recalls his attitude: ‘’‘Man, what you smoking? Let me hit that! Man, what you keep putting in your nose? Let me try that!’’’

The spiral ended at age 32 with a three-year prison term.

The case of Pinckney, a 62-year-old Black man who grew up in a poor neighborhood in Washington, D.C., illustrates why some experts are calling for universal early testing and screening of children for learning disabilities and differences.        

“If we could do this for kids when they’re little, when they still love to learn, when they're excited to go to school, before the love of learning has been beaten out of them, it would make a huge difference,” says Teresa Giral, a clinical psychologist who heads a counseling and assessment center in the Maryland suburbs of Washington.

Instead, she says, “we wait for them to fail before we intervene.” 

And Giral says the need is greatest where kids are poorest. “Every child in every community should have the same access to the same kinds of things that kids have in wealthy communities,’’ she says. It is, she adds, no less than “a civil rights issue.’’

A feeling of helplessness

Frank Pinckney says he was a hyperactive, unfocused child. But due to the lack of a diagnosis, such as ADHD, he was never treated. 

From the beginning, he struggled in school. He had trouble reading, and even comprehending the material presented by the teacher. 

At 9 years old, Frank was sexually assaulted in an apartment building basement by some older boys in his neighborhood. But he said nothing to his family about the trauma; instead, he began to think secretly and constantly about revenge.

He also began to fight. He estimates that by the time the school year ended, he’d been in 15 to 20 fights – suicidal behavior, he says in retrospect.

It was bad enough that his parents and teachers didn’t understand his problems; he didn’t understand them himself. He felt helpless, which is why he says he turned early on to marijuana and alcohol when he was 9, and later to crack, PCP and heroin.

It wasn’t until Pinckney was well into adulthood, and sought help at the McClendon Center, a Washington social service agency that treats and supports people with mental illness, that he got a diagnosis of ADHD and of mental illnesses, including bipolar disorder and schizophrenia.

Experts say it shouldn’t have taken that long for Pinckney to find out what was wrong. But they say he’s far from unique.

The concept of learning disabilities, along with the term itself, originated in the U.S. during the early 1960s. A child of the era – like Frank – with learning difficulties in school was often labeled as brain-damaged, a slow learner, or dyslexic. 

Screening for learning disabilities has improved significantly since then. Children should receive behavioral and developmental screenings at  9 months, 18 months, and 30 months, according to The American Academy of Pediatrics.

But not all children even see a pediatrician during these months, for reasons ranging from lack of transportation to a caregiver’s work schedule to – most recently – the pandemic. And some pediatric offices lack the time or staff for the recommended screenings.

Children may also receive developmental screenings through early childhood education programs, such as the federally-funded Early Head Start (for kids from birth up to 3 years) and Head Start (children 3 and older), which are for low-income families, but regularly have long wait lists. Its programs are required to either administer or obtain record of a developmental screening within 45 days of a child’s enrollment.

But studies show that many of the nation’s two million children or young teens with a learning disability -- which include dyslexia, and other language or number-processing disorders -- are diagnosed only in second or third grade, after they’ve fallen behind their classmates. Many are never diagnosed or treated at all  – especially, according to experts, among children in poor communities of color. 

The symptoms of learning disabilities include difficulty reading, writing or understanding instructions, lack of concentration, poor memory, and low academic achievement . But – absent screening or testing – even alert teachers or other school staff often don’t spot the need.

The problem is most severe in low-income communities, whose schools -- unlike those in more affluent communities – often lack funds for screening and early intervention. In such schools, “kids with learning differences are often not identified,” says Giral.

Giral is working on a study of undiagnosed learning differences, including dyslexia and ADHD, and the mental health consequences for middle school children from low-income areas of Maryland and Louisiana. Although it is well known that many students’ learning disabilities “have not been caught by the time they're already in middle school,” Giral hopes shining a light on it will spur government action on early childhood screening legislation for more than dyslexia. This, she says, would help more children feel competent in school settings. 

Trauma also often goes undetected. Lisa Tropez-Arceneaux, a Louisiana-based child psychologist who is co-leading the study with Giral, says that trauma can stem from life in a violent community or exposure to violence via the media. But such trauma can be hard to detect; it can look like the more easily diagnosed and treated ADHD, she says.

“How,’’ she asks, “can a child sit still and attend to a teacher if they’re thinking about what has happened to them?’’

Learning disabilities and crime

Approximately 60 percent of adults who struggle to read and write have either undetected or untreated learning disabilities, according to the Learning Disabilities Association of America. Many grow up without realizing the educational system has failed them, and believe they simply can’t learn.

Living with undetected childhood disabilities can have serious, and lifelong implications: Experts estimate that between 20% to 60% of detained or incarcerated youth have a disability, most often a learning disability.

Giral, who runs Bethesda Chevy Chase Counseling and Assessment, worked for a year in the mid-2000s in the D.C. Superior Court Child Guidance Branch doing court-ordered psycho-educational assessments and treatment for young people in the juvenile justice system.  The experience confirmed many have undetected cognitive challenges. 

“Whether it was an actual learning difference or lower IQ,” she says, it “explained a lot of what was happening.”

“If that was caught when they were younger, they might have had a better chance at a different outcome,’’ she says. “I really believe that if we were to assess at the earliest possible moment for all children…criminality itself would decrease.’’ 

Many studies have confirmed the connection between learning differences, mental health issues and criminal involvement, she said. 

A story to tell

Frank Pinckney has come to realize that he wasn’t unique in his childhood struggles. As a result, he feels connected to others suffering from the same problems, and wants to stand up for them.

He’s all for universal early childhood testing and screening for problems like his, no matter a person’s race or economic status.

He was failed by the system when he was too young to understand what was happening to him, but now he says he gets it: “I ran around for 40-something years doing drugs, the whole time, running from myself.’’

He’s learned a lot from his own story – including the importance of telling it.  

Aileen Delgado, a UHMP intern, is a first-year student at the University of Central Florida. Courtney Curtis, a UHMP alumna and contributor, graduated in June 2021 with an associate’s degree from Washington’s Bard High School Early College and plans to attend Temple University this fall.