A learning disorder is an information-processing problem that prevents a person from learning a skill and using it effectively. This episode features Dr. Maryna Mammoliti, a Psychiatrist, answer questions about learning disorders, ADHA, and how to speak with your physician about identifying and diagnosis.
A learning disorder is an information-processing problem that prevents a person from learning a skill and using it effectively. This episode features Dr. Maryna Mammoliti, a Psychiatrist, answer questions about learning disorders, ADHA, and how to speak with your physician about identifying and diagnosis.
OMA Podcast Episode 33 – Learning Disorder with Dr. Maryna Mammoliti
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Voice-over: In this podcast the Ontario Medical Association looks at current health issues that are on everyone’s mind. Spotlight on Health gives you the straight talk. We’re Ontario’s doctors and your health matters to us.
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Anne Marie Flanagan: I’m Anne Marie Flanagan, and I’m the Director of Media Relations and Social Media with the Ontario Medical Association.
Dr. Maryna Mammoliti: I'm Dr. Maryna Mammoliti. I'm an adult psychiatrist who practices between London, Ontario and Toronto, Ontario, and I focus on ADHD, trauma, attachment disorders, eating disorders, as well as anxiety and depression.
Flanagan: And we're here today to talk about learning disabilities.
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Flanagan: Dr. Mammoliti, what exactly is a learning disability?
Dr. Mammoliti: Learning disabilities is usually an umbrella term; it describes a number of learning disorders. Learning disorders are a neurodevelopmental disorder, meaning that people are born with it, and it affects cognitive and behavioural components—and, when I mean cognitive and behavioural, meaning that it will affect how people think, how people process information, and also might impact the behaviour of that person in their environment. The brain is altered in the way we process information, learn, absorb, and how we express that information towards other people as well as how we behave.
Learning disabilities affect an individual, not in just academics—you know, it's not just about school performance and how far you go and whether you're getting 80s—they can also interfere with higher level skills such as organization, time planning, abstract reasoning, long-term and short-term memory, and attention. They also affect their relationships with family and friends, workplaces as an adult, parenting as an adult with learning disabilities, ability to do everyday activities such as calculating your bills, understanding your bills, following doctor's instructions, helping your child with homework, managing your own finances, and your own mental health.
The key about learning disabilities is that they're often invisible and hidden. A learning disability cannot be fixed. They're accommodated. And, often, people around the person with learning disability does not see it, and that can become very frustrating.
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Flanagan: What are the different types of learning disabilities? What are some of the most common ones?
Dr. Mammoliti: A reading disability, which is sometimes known as dyslexia, when people struggle with characterizing, reading and word recognition, word decoding, and spelling abilities. There's also a written expression disability, and also mathematics, dyscalculia. And, ADHD can be considered a learning disability. And, with ADHD, there is the inattentive and combined and hyperactive subtypes, so there's three subtypes. In the past, it used to be known as ADHD and ADD, now it's known as one. It's a spectrum.
Often, people with a learning disability are of above average or average intelligence, and yet they struggle with certain aspects of their cognitive functioning. Again, you're born with this condition, it runs in families, and ADHD can be seen as a learning disability when it affects the learning aspect.
However, with ADHD there's many other symptoms that are quite impairing besides just the learning. Learning impairment is just only one of those, but there's other things that ADHD can affect. It can become a very impairing condition if not recognized or addressed appropriately and professionally.
It affects one's emotional regulation, which means you don't know how to express emotions, how they feel emotions, and people ADHD could be very intense with their emotions, their emotions change very quick. There's also impact on the executive function, such as attention, concentration, time management, information processing, if you're not able to pay attention, procrastination. There's also the impulsivity. There's also the risk-taking. There's also the hyperactivity, for some people, and the fidgeting. So, there's a lot bigger picture of an impairment with ADHD.
There's this whole conversation about adult ADHD. What I'm seeing is that it's, often, the person has always had ADHD, they just over accommodated in one way or another and it wasn't recognized. And, they managed until something changes—whether the cognitive demand, meaning how much the environment requires of them to use their cognitive abilities, or there's a change in the structure, or there's more distractions on their plate—and all of a sudden, the person is struggling, not realizing that they probably always
struggled. They managed to compensate without realizing what they've compensated.
And so, that's why ADHD is very complex.
Other thing about ADHD is that, again, when we talk about mental health, most things run together. So, it's common for a person to have a diagnosis of ADHD, as well as potentially a reading learning disability or written learning disability or a math learning disability. So, some people can have more than one learning disability.
Sometimes we really have to look at the person as a whole and to see what else is contributing, because it might not be just ADHD alone that's impacting somebody's cognitive function.
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Flanagan: What age do people normally get diagnosed with learning disabilities? Is it more common for them to get diagnosed as children, or has that changed over the years since our awareness of learning disabilities has grown?
Dr. Mammoliti: Unfortunately, I, as adult psychiatrist, sometimes may be the first person who even brings this up or discussed it with the patient in their adulthood, because, in their childhood, this was not something that was noticed or understood.
Teachers are often starting to identify concerns and bringing it up to the attention of the parent or the psychologist at school. So, realistically, in 2020, quite a lot of learning disabilities are being identified by the teachers in school, as they see these children struggling, not achieve potential, and they're being picked up in childhood, and often they are something that a child and adolescent psychiatrist would see, and a psychologist who specializes in that age group would be diagnosing and see.
As an adult psychiatrist, I have to think about people who are in their 30s, 40s, 50s, 60s, and even 70s. When they were going through school, we didn't have the same understanding of learning disabilities, or they didn't have the same resources. We do have to look at adults who would have slipped through the system.
As an adult psychiatrist, I often encourage my resident doctors, my medical students, to always keep that in mind in every setting. Could your patients’ difficulties be explained by a learning disability that we did not identify before? And you know, this is more common than you can imagine. I have patients,
sometimes, who get really overwhelmed by my instruction. And instead of thinking, why is this person—look, they're an adult, why are they not understanding it?
I need to understand what's getting in their way. And sometimes it opens up conversation into lifelong difficulties with following instructions, getting overwhelmed by too much text, not being able to do some of the calculations, or some of the things that I would ask.
So, looking at patients’ behaviour with curiosity might actually lead you to identify a learning disorder that the patient previously did not have identified across the lifespan.
And as I mentioned to you before, these conditions are highly genetic. So, if you're seeing a child in front of you, chances are other family members had similar difficulties. And so, sometimes they see the diagnosis being made after the child in the family has actually been diagnosed.
And, sometimes untreated or undiagnosed learning disabilities and ADHD leads to people feeling depressed and anxious. They might develop anxieties about interactions that require some of these cognitive abilities that they've always struggled with, and it just keeps causing so many consequences. They're more likely to be depressed. They’re more likely to be anxious. They're more likely to have very low self-esteem, very low confidence. They're more likely to struggle with parenting as an adult—just perpetuates so many problems. That's why we really have to pay attention to learning disorders and ADHD across the lifespan.
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Flanagan: Do you think there's still some stigma associated with learning disorders? Are people sometimes nervous to consider them because of the stigma? Are parents reticent to see them in their children?
Dr. Mammoliti: Absolutely. Absolutely. There's so much stigma and misunderstanding with learning disorders; that if you have a learning disorder, that you are somehow stupid, or defective, or the word "retarded" is often thrown around in my office. Because, when people think of learning disorder, they don't understand that learning disorder is actually a small part of how their brain functions. They often have a lot of shame; they often want to hide and compensate for this. And again, because they often had their entire life, they don't know how to live differently. They don't know how to explain this.
If you're an adult, sometimes if you encounter a physician who's not familiar with learning disorders or ADHD, they might be dismissed. They might say, you know, “but you're a teacher,” “but you're a doctor,” “but you're this, you can’t have ADHD.” That stigmatized, antiquated view that ADHD means you can't be successful, you can't do anything—which, in itself, is very stigmatizing; to think that people that ADHD can't achieve much—but it does often discourage people for further exploration.
There's also the guilt that comes along with a parent who has a child with ADHD because often the parent has ADHD. Because they remember their own childhood struggles, they remember how they struggled with the self-esteem, the confidence, or if they were dismissed or blamed and told things like, “You're not trying hard enough.” “What's wrong with you?” “You're not paying attention.” “Why don't you care?" And now, they see their own child, right now, struggling the same way, and the child hearing the same comments, you know, "You're not trying hard enough," "how could you forget this homework?"
And so, there's a lot of grief that a lot of the parents have towards their own child that might have the same struggles. A lot of the parents will grieve of all those things they could have achieved if they've gotten help when their child's getting the help now, or identifying it, and when they’re actually able to put the words to what they struggled with for 20, 30, 40, 50 years.
I hear this all the time. "I wasn't smart enough.” “I wasn't good enough.” “I never thought I could do this." That is the disability. They struggled with the disability, which led them to assume that they're not smart, and they're not capable. And that prevented them from trying and achieving a potential that, now, they might not be able to achieve if they're in their 40s and 50s.
So, there's a lot of grief that comes—a lot of the times—in adults, when they realize they've had a learning disability. There's a lot of anger that sometimes will come as well, because they feel let down by previous people.
There's definitely a lot of stigma. There's definitely a lot of shame and guilt that goes along in adult, and a lot of wanting to prevent their own children from a lot of disappointment and suffering they have.
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Flanagan: When would you recommend people speak to their doctor, if they have a concern, maybe, that they have a learning disorder?
Dr. Mammoliti: You might start noticing; wait, your child might not be able to read the sentence, or your child's struggling, or your child's struggling with the math. They might start telling you that they don't understand, or they thought they did it right, or there is a mistake and they're struggling. That's where I would ask you to start thinking about, could there be a disability? Because it's invisible.
Just noticing the discrepancy, and asking yourself what is getting in the way instead of blaming. Then, I need you to ask, "who should I talk to about this?" And that might be your child's family doctor, that might be the pediatrician. Those are physicians who are very well equipped to talk to, and they might do further referral for a specialist.
The Learning Disability Association of Ontario website as well as CADDRA, c-a-d-d-r-a, and CADDOC, c-a-d-d-o-c, those two resources are mostly about ADHD.
Unfortunate that a lot of the services of testing and whatnot are not covered by OHIP. And often people encounter a barrier in testing to actually have this diagnosis as an adult. That's another barrier that we have to acknowledge in terms of managing and understanding learning disabilities and disorders.
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Flanagan: And what types of treatments or therapies are available?
Dr. Mammoliti: Step one is actually diagnosis, because diagnosis is almost the treatment. Identifying what it is that you have, identifying what are the specific deficits for one particular person, what are the strengths, and coming up with a particular plan on managing and accommodating that person.
So, part of the treatment is diagnosis, identification, and accommodations. Treatment, when we talk about medication, is really available more for ADHD.
Medications could be very helpful for ADHD and skills training for ADHD. So, it could be your managing time, managing organization, emotion regulation skills, social skills, as well as, again, accommodations at a workplace, in a classroom. It could be tools, sometimes it could be apps, reminders. So, a lot of treatment for learning disability is actually identification, understanding, and accommodation.
Occupational therapists are health care providers who are highly educated in figuring out accommodations, and that could be cognitive and physical
accommodations. Sometimes the cognitive accommodations are found after doing a neuropsychiatric testing or neuropsychological testing on somebody.
The good news is that ADHD is a clinical diagnosis, you don't have to pay for it. If you see a psychiatrist who treats, understands the diagnosis ADHD, you can be diagnosed without having to pay outside of pocket as that assessment is covered by OHIP.
However, if there needs to be more assessment to figure out the reading disability, to figure out the other learning disabilities, that becomes very complicated because usually we need a psychoeducational assessment. Usually, as a psychiatrist, I cannot diagnose that just on clinical conversation. I might have a strong suspicion, but I can't do the diagnosis by history.
Fortunately for children, there is often psychoeducational testing available from the school board, or particular specialized centres where there's a psychologist and occupational therapist and a speech language pathologist who might be part of the assessment to make sure there's no other coexisting conditions that get in the way.
So, ideally, we recognize this in a child, because the more we can acknowledge it, the more we can understand it and accommodate, the more we set up the child for success, not only in achieving their potential, but also their self-esteem.
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Voice-over: This podcast is brought to you by the Ontario Medical Association. It is produced and edited by Jodi Crawford Productions. This podcast is not intended to provide medical advice for specific situations and is for general educational purposes only. Please consult your doctor if you have symptoms or questions about your health.
For more information, please visit our website at oma.org.
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