Review of “Hanging By A Twig: Understanding and Counseling Adults with Learning Disabilities and ADD,” by Carol Wren, with Psychotherapeutic Commentary by Jay Einhorn

(Reviewed by Delores S. Doherty, MD, FRCPC, St. John’s Newfoundland, in the Journal of the Canadian Academy of Child and Adolescent Psychiatry, 2006, 15, 95-6)

This book could not have come into my experience at a better time.  My patients are growing up, and lo and behold, they are still disabled!

Hanging by a Twig is the way one disabled adult described her life, i.e., just hanging on and always precariously.  Mary’s story is told in chapter 2, intermingled with information on the historical context of our current understanding of learning disabilities, learning styles, cognitive strengths and weaknesses.  Each chapter in this book is built around the story of an adult with specific learning issues.  Carol Wren moves us through the stated purpose of the chapter while Jay Einhorn gives us a psychotherapeutic commentary on the issues described.  Together they take us through development of self, coherence of self, adult skill set, self-esteem, addiction, and other co-morbidities, looking at the issue and its impact on the individual.

The pervasive nature of these impairments of cognition on the overall functioning of the individual becomes very evident as we read these real life stories.  In addition, the challenges for doing therapy with these people, who are intrinsically at heightened risk for personality distortions, jumps from the pages.  The authors make clear the need to help these adults understand their own strengths and limitations.  Then they are better able to make informed choices in regard to further education and career, to seek appropriate supports for themselves, and to begin to consider the impact of their disabilities might make on personal relationships.

As a group involved with children and adolescents, I believe that we also have an obligation to attempt to help our adult colleagues understand that these individuals suffer.

This book is a resource that we can recommend with enthusiasm.  It is well written and provides clear descriptions of a number of possible scenarios as well as suggestions for management.  I will be encouraging those I know who counsel adults with residual developmental concerns to read and learn from Hanging by a Twig.  I have already recommended it to our local chapter of the Learning Disabilities Association.  It is an excellent resource and an enjoyable reading experience.

(published by Norton and Co., New York, 2000)

Nine Criteria For Usefulness in Evaluations of Learning and Attention Issues

(As consulting psychologist, I am asked to review private evaluations of learning and attention issues in students, and explain them to administrators, teachers, and even the parents whose children have been evaluated.  Since the quality and usefulness of evaluations varies, I prepared this memo as a guide for parents, as consumers, and evaluators, as providers.)    

This memo is prepared for parents who are considering seeking evaluation of learning and attention issues in their children, and also for potential providers of such evaluations.
Methods for evaluating learning and attention issues and disorders, and for reporting on evaluations, have evolved over the years, not necessarily in a consistent or integrated way. Professionals from several fields, with varied backgrounds, have entered the marketplace as evaluation providers. As a result, we have seen evaluations of varying quality and usefulness. Here are nine criteria that characterize a more useful evaluation:

1A specific problem statement provides the focus for the evaluation. It tells the readers what this evaluation is about, and why it is important for this child to be evaluated for this problem at this time.

2. A detailed case history places the referring problem within the context of the child’s developmental and family history. Part of understanding a learning and/or attention disorder is understanding its history in this child’s life, and whether it might also be reflected in this child’s family history.

3. Information from the school, from teachers and other staff who may have useful information to report, tells readers how the school sees the child and the referring problem. Detailed descriptions by teachers and staff help to clarify the the referring problem. Observations by the evaluator of the student in school can also shed light on the referring problem, especially where classroom behavior is contributing to the referring problem.

4. Information from other sources, which may include therapists, tutors, former teachers, etc., who can contribute to the evaluator’s, and the readers’, understanding of the child.

5. Behavioral observations of the child during the evaluation process, with specific reference to the referring problem. The evaluator’s astute observations of the child’s behavior can contribute to the evaluator’s, and the readers’, understanding of the child.

6. Selection of tests that are specific enough and comprehensive enough to address the referring problem. Selecting tests that focus on the child’s cognitive functioning with reference to the referring problem will help the evaluator and readers understand the child’s cognitive functioning with regard to the referring problem. Where multiple explanations of a child’s problem are possible, it can be important to have testing across different areas in order to rule some out and establish others as associated with the problem.

7. Report of test results, including all scores. Reporting all scores supports the evaluator’s conclusions and provides professional readers with the information necessary to understand the basis of those conclusions.

8. Discussion of all the foregoing information leads to an impression about why the child is having the referring problem, in the context of his or her developmental history and cognitive processes, including a diagnosis, if appropriate. By discussing all the foregoing information, the report makes sense of the child’s referring problem, and helps readers make sense of it also.

9. Recommendations that are specific to the referring problem, the specific child, and the child’s situation, will help insights in the report find integration and application in the child’s educational program. When multiple recommendations are included in a report, prioritizing recommendations helps educators and parents determine the most appropriate next steps in supporting the child’s education.