Concept Demonstrated in Mouse Model

ROCHESTER, Minn. — Researchers at Mayo Clinic have shown that eliminating cells that accumulate with age could prevent or delay the onset of age-related disorders and disabilities. The study, performed in mouse models, provides the first evidence that these “deadbeat” cells could contribute to aging and suggests a way to help people stay healthier as they age. The findings appear in the journal Nature, along with an independent commentary on the discovery.

“By attacking these cells and what they produce, one day we may be able to break the link between aging mechanisms and predisposition to diseases like heart disease, stroke, cancers and dementia,” says co-author James Kirkland, M.D., Ph.D., head of Mayo’s Robert and Arlene Kogod Center on Aging and the Noaber Foundation Professor of Aging Research. “There is potential for a fundamental change in the way we provide treatment for chronic diseases in older people.”

Five decades ago, scientists discovered that cells undergo a limited number of divisions before they stop dividing. At that point the cells reach a state of limbo — called cellular senescence — where they neither die nor continue to multiply. They produce factors that damage adjacent cells and cause tissue inflammation. This alternative cell fate is believed to be a mechanism to prevent runaway cell growth and the spread of cancer. The immune system sweeps out these dysfunctional cells on a regular basis, but over time becomes less effective at “keeping house.”

As a result, senescent cells accumulate with age. Whether and how these cells cause age-related diseases and dysfunction has been a major open question in the field of aging. One reason the question has been so difficult to answer is that the numbers of senescent cells are quite limited and comprise at most only 10 to 15 percent of cells in an elderly individual.

“Our discovery demonstrates that in our body cells are accumulating that cause these age-related disorders and discomforts,” says senior author Jan van Deursen, Ph.D., a Mayo Clinic molecular biologist and the Vita Valley Professor of Cellular Senescence. “Therapeutic interventions to get rid of senescent cells or block their effects may represent an avenue to make us feel more vital, healthier, and allow us to stay independent for a much longer time.”

“Through their novel methodology, the research team found that deletion of senescent cells in genetically engineered mice led to improvement in at least some aspects of the physiology of these animals. So, with the caveat that the study involved a mouse model displaying accelerated aging, this paper provides important insights on aging at the cellular level,” says Felipe Sierra, Ph.D., Director of the Division of Aging Biology, National Institute on Aging, National Institutes of Health.

How They Did It

Dr. van Deursen and colleagues genetically engineered mice so their senescent cells harbored a molecule called caspase 8 that was only turned on in the presence of a drug that has no effect on normal cells. When the transgenic mice were exposed to this drug, caspase 8 was activated in the senescent cells, drilling holes in the cell membrane to specifically kill the senescent cells.

The researchers found that lifelong elimination of senescent cells delayed the onset of age-related disorders such as cataracts and muscle loss and weakness. Perhaps even more importantly, they showed that removing these cells later in life could slow the progression of already established age-related disorders.

The findings support a role of senescent cells in the aging process and indicate that chemicals secreted by these cells contribute to age-related tissue dysfunction and disease.

Other co-authors of the article are: Darren Baker, Ph.D., Tamar Tchkonia, Ph.D., Nathan LeBrasseur, Ph.D. and Bennett Childs, all of Mayo Clinic; and Tobias Wijshake and Bart van de Sluis, Ph.D., both of Groningen University, The Netherlands. The Ellison Medical Foundation, the Noaber Foundation, the Robert and Arlene Kogod Center on Aging, and the National Institutes of Health funded the study.

About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit MayoClinic.com or MayoClinic.org/news.

The admissions process can be stressful for even the most gifted, organized students. But to applicants with attention deficit hyperactivity disorder or learning disabilities, the path to college can feel like a maze. The Choice addresses some of the issues such students face.

1. Should a student who has struggled with A.D.H.D. or dyslexia disclose it when applying to college?

The answer, like so many aspects of college admissions, depends mightily on the particular student. (Testing companies keep confidential whether a student was given extra time on the SAT and ACT, so that’s not an issue here.) Edward de Villafranca, an independent consultant and former admissions officer and high school counselor, puts it this way: “The decision to disclose or not isn’t actually one of ‘Will it hurt my chances?’ but rather one of ‘Is it helpful to know?’ ”

Disclosure early in the admissions process is often recommended for applicants who need to provide context — a legitimate reason grades might have dipped uncharacteristically from 9th to 10th grade, or why a standardized test score seems abysmally low when compared with an otherwise stellar academic record.

On the other hand, an applicant with strong grades and test scores may decide not to raise a red flag — maybe learning issues were not an academic impediment, or are no longer relevant.

“The primary risk is having the essay read by someone who doesn’t understand learning disabilities, someone who thinks A.D.H.D. is a hyperactive kid in fifth grade bouncing off the walls,” said Rachel Masson, director of admissions at Landmark College in Putney, Vt., which offers an associate’s degree and is exclusively for students with conditions that impair learning. “Legally, of course, admissions officers are not supposed to hold it against a student,” she added. “The reality is, we’re all human and there is that human factor involved.”

However, Ms. Masson suggests that once admitted but before putting down a deposit, all candidates with issues seek out the campus office that coordinates support services. (Applying for special services is typically separate from the admissions process.) Students will want to ensure that the institution has the proper experience and sensitivity as well as a community of students wrestling with similar challenges.

2. Once the decision is made to tell, the question remains: where and how?

Students have several places to explain their learning issues on the Common Application: the main essay, short-answer portion or the very last portion of the application, where supplemental information is sought.

That’s where Rose Valliere, a 23-year-old who transferred this fall to Keene State College in New Hampshire from Landmark, chose to reveal her condition — A.D.H.D. and difficulty with reading comprehension. Ms. Valliere, who is studying to become a dietician, didn’t offer much detail. She decided, “Don’t make it the star of your application, even though it may feel that way for you.”

I asked Marybeth Kravets, co-author of “The K&W Guide to Colleges for Students With Learning Disabilities or Attention Deficit/Hyperactivity Disorder,” about Ms. Valliere’s approach. She didn’t disagree — some students “may not want to blow it up out of proportion.” But for many students, she said, the main essay, particularly where it asks about a critical experience and its impact, is a good place to introduce a learning disability.

She imagined how a student might construct an answer: “You might note that on my transcript, there was a struggle in mathematics. Understand that in third grade, I was diagnosed with dysgraphia. It took many years for me to understand how I learn. Now look at me. In senior year, I’m in A.P. Statistics.”

(For a college that does not accept the Common Application, a supplemental essay can be attached.)

3. How does one go about assembling a list of colleges known to provide supportive environments?

While finding an institution that’s a good fit is a concern for all applicants, it’s even more crucial to students who struggle to concentrate in a lecture setting or require extra time on tests or additional instruction.

Due diligence in collecting information is essential. “Research must be done and conversations must be had with learning support centers in any college or university that a student and family is considering,” Mr. de Villafranca said, adding the admonition that “not every place operates the same way.”

Among resources are the Learning Disabilities Association of America and Ms. Kravets’s “K&W Guide” (Random House/Princeton Review), an 800-plus-page encyclopedia that lists services at each college, admissions requirements and contact information for program administrators.

Families without access to good school-based counselors can consult the Independent Education Consultants Association, whose Web site offers a searchable database (you want a counselor who has a track record of success with applicants with learning disabilities, and verifiable references from former clients; fees can be several thousand dollars).

Landmark graduates regularly go on to traditional four-year colleges, and Ms. Masson says the college has had especially good success placing them at American University, Lesley University, Lynn University and the University of Denver, whose Learning Effectiveness Program is widely considered to be strong. As is the University of Arizona’s SALT (Strategic Alternative Learning Techniques) Center. Note that Denver and Arizona, and some other programs, have a multistep application — one to the university, one to the program itself. This year for the first time, the online application to the University of Arizona asks students if they are applying to the SALT Center, and links to it.

As Mr. de Villafranca reminds, a learning disability “isn’t a black mark.”

“I think the Americans With Disabilities Act has really been instrumental in helping us talk more openly about various disabilities and differences,” he said. “We are much smarter about how we learn, and that has made this whole issue less of a clandestine, ‘Shh… say nothing’ kind of one.”

Jacques Steinberg, a senior editor of The Times, moderates The Choice blog on college admission.

By TARA PARKER-POPE

New research suggests dyslexia may be more than just a reading problem, but also an issue of how the brain processes spoken language.

A study published last week in the journal Science suggests that how dyslexics hear language may be more important than previously realized. Researchers at the Massachusetts Institute of Technology have found that people with dyslexia have more trouble recognizing voices than those without dyslexia.

John Gabrieli, a professor of cognitive neuroscience, and Tyler Perrachione, a graduate student, asked people with and without dyslexia to listen to recorded voices paired with cartoon avatars on computer screens. The subjects tried matching the voices to the correct avatars speaking English and then an unfamiliar language, Mandarin.

Nondyslexics matched voices to avatars correctly almost 70 percent of the time when the language was English and half the time when the language was Mandarin. But people with dyslexia were able to do so only half the time, whether the language was English or Mandarin. Experts not involved in the study said that was a striking disparity.

To learn more, read the full article, “Study Says Dyslexia May Have Auditory Tie,”

Published: September 5, 2011   New York Times

Who hasn’t struggled occasionally to come up with a desired word or the name of someone near and dear? I was still in my 40s when one day the first name of my stepmother of 30-odd years suddenly escaped me. I had to introduce her to a friend as “Mrs. Brody.”

But for millions of Americans with a neurological condition called mild cognitive impairment, lapses in word-finding and name recall are often common, along with other challenges like remembering appointments, difficulty paying bills or losing one’s train of thought in the middle of a conversation.

Though not as severe as full-blown Alzheimer’s disease or other forms of dementia, mild cognitive impairment is often a portent of these mind-robbing disorders. Dr. Barry Reisberg, professor of psychiatry at New York University School of Medicine, who in 1982 described the seven stages of Alzheimer’s disease, calls the milder disorder Stage 3, a condition of subtle deficits in cognitive function that nonetheless allow most people to live independently and participate in normal activities.

One of Dr. Reisberg’s patients is a typical example. In the two and a half years since her diagnosis of mild cognitive impairment at age 78, the woman learned to use the subway, piloted an airplane for the first time (with an instructor) and continued to enjoy vacations and family visits. But she also paid some of the same bills twice and spends hours shuffling papers.

Dr. Ronald C. Petersen, a neurologist at the Mayo Clinic College of Medicine in Rochester, Minn., described mild cognitive impairment as “an intermediate state of cognitive function,” somewhere between the changes seen normally as people age and the severe deficits associated with dementia.

While most people experience a gradual cognitive decline as they get older (only about one in 100 lives long without cognitive loss), others experience more extreme changes in cognitive function, the neurologist wrote in The New England Journal of Medicine in June. In population-based studies, mild cognitive impairment has been found in 10 percent to 20 percent of people older than 65, he noted.

Dr. Petersen described two “subtypes” of the condition, amnestic and nonamnestic, that have different trajectories. The more common amnestic type is associated with significant memory problems, and within 5 to 10 years usually — but not always — progresses to full-blown Alzheimer’s disease, he said in an interview.

“Subtle forgetfulness, such as misplacing objects and having difficulty recalling words, can plague persons as they age and probably represents normal aging,” he wrote. “The memory loss that occurs in persons with amnestic mild cognitive impairment is more prominent. Typically, they start to forget important information that they previously would have remembered easily, such as appointments, telephone conversations or recent events that would normally interest them,” like the outcome of a ballgame would a sports fan.

The forgetfulness is often obvious to those who are affected and to people close to them, but not to casual observers.

The less common nonamnestic type, which is associated with difficulty making decisions, finding the right words, multitasking, visual-spatial tasks and navigating, can be a forerunner of other kinds of dementia, Dr. Petersen said.

In general, Dr. Reisberg said, “mild cognitive impairment lasts about seven years before it begins to interfere with the activities of daily life.”

The Correct Diagnosis

Distinguishing mild cognitive impairment from the effects of normal aging can be challenging. Typically, new patients take a short test of mental status, provide a thorough medical history and are checked for conditions that may be reversible causes of impaired cognition. Problems like depression, medication side effects, vitamin B12 deficiency or an underactive thyroid can mimic the symptoms of mild cognitive impairment.

Other tests, like an M.R.I. or CT scan of the brain, can look for evidence of a stroke, brain tumor or leaky blood vessel that may be impairing brain function.

It is natural, Dr. Petersen said, for patients and their families to want to know whether and how quickly the disorder might progress. While patients decline by about 10 percent each year, on average, certain factors are associated with more rapid progression. Among these are the presence of a gene called APOE e4, more common among patients with Alzheimer’s disease; a reduced hippocampus, a region of the brain important to memory; and a low metabolic rate in the temporal and parietal regions of the brain.

Amyloid plaques in the brain, while a hallmark of Alzheimer’s disease and a predictor of progression, have also been found at autopsy in people with perfectly normal cognitive function.

Preserving Cognitive Function

Despite a number of clinical trials that tested various medications, no drug to treat mild cognitive impairment has been approved by the Food and Drug Administration. But experts like Dr. Reisberg and Dr. Petersen suggest several approaches that may slow the decline in cognitive function.

Although studies did not show that medications like donepezil (brand name Aricept) and memantine (Namenda), both used to treat Alzheimer’s disease, change the ultimate course of mild cognitive impairment, Dr. Reisberg said they can be useful temporary treatments that may stabilize patients for a few years.

Although the drugs are not approved for this condition, licensed physicians can prescribe approved medications “off label.” “Clinicians have to work with what we have,” Dr. Reisberg said.

There are people who think they are having memory problems, but tests do not show anything definitive. Some may be in Stage 1 of Alzheimer’s disease, Dr. Reisberg said, and perhaps could benefit from early treatment with the drugs.

It is also important to reduce cardiovascular risk factors like smoking, elevated cholesterol and high blood pressure; keep blood sugar at normal levels; minimize stress (which in animal studies can cause the hippocampus to shrink); and avoid anticholinergic drugs that can interfere with brain chemicals important to memory. These include Demerol to treat pain, Detrol to treat a leaky bladder, tricyclic antidepressants, Valium, and over-the-counter medications with Benadryl (diphenhydramine), like Tylenol PM, Dr. Petersen said.

Some cognitive rehabilitation exercises, like computer games that enhance focus, may be helpful, Dr. Petersen said, but there have been few good studies to demonstrate a benefit. Compensatory techniques, like taking notes, creating mnemonics and making structured schedules, can be useful aids, he added.

But most promising is regular physical exercise, which in animal studies was found to reduce the accumulation of amyloid in the brain. An Australian study in patients with memory problems showed that brisk walking for 150 minutes a week improved cognitive function.

A version of this article appeared in print on September 6, 2011, on page D7 of the New York edition with the headline: When Lapses Are Not Just Signs of Aging.

Published: September 3, 2011  New York Times

Philip Schultz is a winner of the Pulitzer Prize for poetry and the author of the forthcoming memoir “My Dyslexia.”

I WAS well into middle age when one of my children, then in the second grade, was found to be dyslexic. I had never known the name for it, but I recognized immediately that the symptoms were also mine. When I was his age I’d already all but given up on myself.

Repeating third grade at a new school, after having been asked to leave my old one for hitting kids who made fun of my perceived stupidity, I was placed in the “dummy class.” There were three of us, separated from our classmates at a table in the corner of the room. One day, the teacher, who seldom spoke to us since it was understood that most of what she taught was beyond the reach of ourintelligence, placed books in our hands and whispered that we should sit there quietly “pretending to read.” The principal was coming.

It was not the most outlandish thing she might’ve said, given how little was known about learning disabilities in the early 1950s, and how little training a teacher in the poorest section of Rochester would have received. And her request seemed reasonable to me. I couldn’t tie my shoes, tell time or left from right, or recreate musical notes or words. I not only couldn’t read but often couldn’t hear or understand what was being said to me — by the time I’d processed the beginning of a sentence, the teacher was well on her way through a second or third. When I did have something to say I couldn’t find the words with which to say it, or if I could, forgot how to pronounce them.

My situation then seemed hopeless; I had no idea what a learning disability was, or that it had nothing to do with intelligence. Being asked to pretend I wasn’t as stupid as I feared made perfect sense. Only in recollection does the pain of such a moment make itself felt.

So this summer’s news that research is increasingly tying dyslexia not just to reading, but also to the way the brain processes spoken language, was no surprise to me. I found many ways around my dyslexia, but I still have trouble transforming words into sounds. I have to memorize and rehearse before reading anything aloud, to avoid embarrassing myself by mispronouncing words. And because learning a foreign language is sheer torture to dyslexics (even though it’s a requirement in many schools), to this day I can’t attend a High Holy Day service at my synagogue without feeling I don’t belong there, because I can’t speak Hebrew and must pretend to read my prayer book.

When I did finally learn to read, my teachers didn’t have much to do with it. I was 11, and even my school-appointed tutors had given up on me. My mother read the one thing I would listen to — Blackhawk comics — over and over again, hoping against hope that by some leap of faith or chance I would start to identify letters and then learn to arrange them into words and sentences, and begin the intuitive, often magical, process of turning written language into spoken language.

One night, lying in bed as she read to me, I realized that if I was ever going to learn to read I would have to teach myself. The moon glowing outside my window, I remember, seemed especially interested in my predicament, perhaps attempting its own kind of encouragement. Was it a dummy, too? I wondered. If only I could be another boy, a boy my age who could sound out words and read and write like every other kid I knew.

I willed myself into being him. I invented a character who could read and write. Starting that night, I’d lie in bed silently imitating the words my mother read, imagining the taste, heft and ring of each sound as if it were coming out of my mouth. I imagined being able to sound out the words by putting the letters together into units of rhythmic sound and the words into sentences that made sense. I imagined the words and their sounds being a kind of key with which I would open an invisible door to a world previously denied me.

And suddenly I was reading. I didn’t know then that I was beginning a lifelong love affair with the first-person voice and that I would spend most of my life inventing characters to say all the things I wanted to say. I didn’t know that I was to become a poet, that in many ways the very thing that caused me so much confusion and frustration, my belabored relationship with words, had created in me a deep appreciation of language and its music, that the same mind that prevented me from reading had invented a new way of reading, a method that I now use to teach others how to overcome their own difficulties in order to write fiction and poetry. (It’s perhaps not surprising that many famous writers are said to have struggled with dyslexia, including F. Scott Fitzgerald and W. B. Yeats.)

We know now that dyslexia is about so much more than just mixing up letters — that many dyslexics have difficulty with rhythm and meter and word retrieval, that they struggle to recognize voices and sounds. It’s my profound hope that our schools can use findings like these to better teach children who struggle to read, to help them overcome their limitations, and to help them understand that it’s not their fault.

We knew so much less when I was a child. Then, all I wanted and needed, when I learned so painstakingly to read and then to write, was to find a way to be less alone. Which is, of course, what spoken and written language is really all about.

But poetry should be a matter of passion, not survival.

Parents and teachers often tell children to pay attention — to be a “good listener.” But what if your child’s brain doesn’t know how to listen?

That’s the challenge for children with auditory processing disorder, a poorly understood syndrome that interferes with the brain’s ability to recognize and interpret sounds. It’s been estimated that 2 to 5 percent of children have the disorder, said Gail D. Chermak, an expert on speech and hearing sciences at Washington State University, and it’s likely that many cases have gone undiagnosed or misdiagnosed.

The symptoms of A.P.D. — trouble paying attention and following directions, low academic performance, behavior problems and poor reading and vocabulary — are often mistaken for attention problems or even autism.

But now the disorder is getting some overdue attention, thanks in part to the talk-show host Rosie O’Donnell and her 10-year-old son, Blake, who has A.P.D.

In the foreword to a new book, “The Sound of Hope” (Ballantine) — by Lois Kam Heymann, the speech pathologist and auditory therapist who helped Blake — Ms. O’Donnell recounts how she learned something was amiss.

It began with a haircut before her son started first grade. Blake had already been working with a speech therapist on his vague responses and other difficulties, so when he asked for a “little haircut” and she pressed him on his meaning, she told the barber he wanted short hair like his brother’s. But in the car later, Blake erupted in tears, and Ms. O’Donnell realized her mistake. By “little haircut,” Blake meant little hair should be cut. He wanted a trim.

“I pulled off on the freeway and hugged him,” Ms. O’Donnell said. “I said: ‘Blakey, I’m really sorry. I didn’t understand you. I’ll do better.’ ”

That was a turning point. Ms. O’Donnell’s quest to do better led her to Ms. Heymann, who determined that while Blake could hear perfectly well, he had trouble distinguishing between sounds. To him, words like “tangerine” and “tambourine,” “bed” and “dead,” may sound the same.

“The child hears ‘And the girl went to dead,’ and they know it doesn’t make sense,” Ms. Heymann told me. “But while they try to figure it out, the teacher continues talking and now they’re behind. Those sounds are being distorted or misinterpreted, and it affects how the child is going to learn speech and language.”

Blake’s brain struggled to retain the words he heard, resulting in a limited vocabulary and trouble with reading and spelling. Abstract language, metaphors like “cover third base,” even “knock-knock” jokes, were confusing and frustrating.

Children with auditory processing problems often can’t filter out other sounds. The teacher’s voice, a chair scraping the floor and crinkling paper are all heard at the same level. “The normal reaction by the parent is ‘Why don’t you listen?’ ” Ms. Heymann said. “They were listening, but they weren’t hearing the right thing.”

The solution is often a comprehensive approach, at school and at home. To dampen unwanted noise, strips of felt or tennis balls may be placed on the legs of chairs and desks. Parents work to simplify language and avoid metaphors and abstract references.

The O’Donnell household cut back on large, noisy gatherings that were upsetting to Blake. Twice-weekly sessions focusing on sounds and words, using rhyme and body gestures, helped him catch up on the learning he had missed.

Help inside the classroom is essential. One family in Westchester County, who asked not to be named to protect their son’s privacy, met with his teachers and agreed on an array of adaptations — including having his teacher wear a small microphone that directed her voice more clearly to a speaker on the student’s desk so he could better distinguish her voice from competing sounds.

Nobody knows exactly why auditory processing skills don’t fully develop in every child, according to the National Institute on Deafness and Other Communication Disorders. Scientists are conducting brain-imaging studies to better understand the neural basis of the condition and find out if there are different forms.

Reassuringly, the disorder seems to have little or nothing to do with intelligence. Blake has an encyclopedic knowledge of animals — he once corrected his mother for referring to a puma as a mountain lion. The Westchester child is now a 17-year-old high school student being recruited by top colleges.

“He’s in accelerated Latin, honors science classes,” said his mother. “I remember I used to dream of the day he would be able to wake up in the morning and just say, ‘Mommy.’ ”

Not every child does so well, and some children with A.P.D. have other developmental and social problems. But Ms. O’Donnell says that treatment is not just about better grades.

“It definitely affected his whole world,” she said of her son. “Not just learning. It cuts them off from society, from interactions. To see the difference in who he is today versus who he was two years ago, and then to contemplate what would have happened had we not been able to catch it — I think he would have been lost.”

If you’re the parent of a child who’s having trouble learning or behaving in school, you quickly find yourself confronted with a series of difficult choices.

You can do nothing — and watch your child flounder while teachers register their disapproval. Or you can get help, which generally means, first, an expensive and time-consuming evaluation, then more visits with more specialists, intensive tutoring, therapies, perhaps, or, as is often the case with attention issues, drugs.

For many parents — particularly the sorts of parents who are skeptical of mainstream medicine and of the intentions of what one mother once described to me as “the learning-disability industrial complex” — this experience is an exercise in frustration and alienation.

These parents often don’t trust the mental-health professionals who usually treat children with “issues,” as we euphemistically tend to refer to problems like learning disabilities, attention-deficit hyperactivity disorder, autism or other developmental difficulties. They find offensive the prospect of having a child “labeled” when his or her development doesn’t correspond to what seem like random, overly restrictive norms. They find the notion of putting children on psychotropic medication frightening and unacceptable. They want to find concrete causes for their children’s diffuse, often difficult-to-understand problems and, ideally, to find cures. They want their children to achieve, and they’re dissatisfied with what they feel are the palliative half-measures offered by pediatricians, psychiatrists, psychologists and learning specialists.

That’s why some of these parents end up seeking the services of people like Stanley A. Appelbaum.

Appelbaum is a behavioral optometrist, part of a growing subspecialty of optometry that takes the traditional practice beyond its usual focus on eye health and eyesight. Through a practice referred to as vision therapy — a combination of in-office and at-home eye exercises — many of these optometrists claim they can offer significant help for problems that go far beyond the headaches, neck aches, eyestrain and poor posture typically associated with vision problems. According to Visionandlearning.org, a behavioral-optometry Web site, vision therapy can be used to treat reading problems, learning problems, spelling problems, attention problems, hyperactivity, coordination problems; it can also treat a child who experiences “trouble in sports,” who “frustrates easily,” displays “poor motivation,” and “does not work well on his own” — virtually anything that presents as an “impaired potential for achievement,” to borrow a phrase from the prominent late optometrist Martin H. Birnbaum. They can do this because for behavioral optometrists, vision isn’t just about eyes or eyesight but is also something more holistic — “how eyes work together and move together and process information and store information and do something with the information,” as Appelbaum puts it. Vision therapists caution that they cannot cure “real” cases of A.D.H.D., dyslexia or other learning disabilities. But since they say that such disorders in children are frequently misdiagnosed, the distinction often is moot.

To the uninitiated, vision therapy is a funny-looking endeavor. Practitioners’ offices are equipped with picture-viewing stereoscopes that look like something from the Victorian era. Some practitioners use a Visagraph — black goggles hooked up with infrared sensors — to measure and track children’s eye movements while reading and to test their fluency and comprehension. Depending on the practice, you may see children standing in hula hoops, dodging balls suspended from strings, looking through prisms that give them double vision and then trying to fuse the image, playing Wii-like games for balance and “visual thinking” or pointing to bright spots blinking on a light box for hand-eye coordination.

When I visited Appelbaum in January, I watched as a boy named Brian Dennis sat on a stool wearing prism glasses and struggling to see straight as he faced a spinning board covered with red and green lines and black squares. As the board turned and a metronome ticked, he worked to follow the shapes as they swiveled, keeping them clear, single and distinct, one eye at a time. Some young patients, Appelbaum noted with a laugh, leave their therapy sessions only to vomit on his waiting-room floor, which is why his entryway is now uncarpeted.

On the day that we met in that bare-floored vestibule, Appelbaum spoke animatedly with Brian’s mother, Francesca Dennis, who works in human resources and is from Silver Spring, Md. An affable man, Applelbaum has an enthusiasm for vision therapy that is boundless and infectious. As a child, he suffered from chronic headaches and hated to read. Then in optometry school, in the 1970s, he found out he had convergence insufficiency — a condition characterized by eyes that don’t turn in together, or converge, well for close work like reading — and was treated with eye exercises. His headaches disappeared, and his life was changed. “I went from a reluctant reader to this voracious, active reader,” he says.

Brian began vision therapy because he, too, hated to read. He was doing poorly in school, struggling to stay focused in class, and his teachers started suggesting he had attention-deficit disorder. His school, a private religious school, began intimating that he might have to leave.

“He was becoming more and more frustrated,” his mother recalled.

A psychologist diagnosed anxiety, saying that a toxic school environment was driving Brian to distraction.

But Dennis suspected another cause of her son’s difficulties. He was born walleyed, with one eye that visibly turned out. And although the condition largely disappeared over the years, and though a pediatric ophthalmologist who had followed Brian since infancy said the boy had perfectly normal vision, Dennis was sure that something was being overlooked. “I just kept thinking,” she told me in the waiting room, “he wasn’t paying attention in school because of that eye.”

Appelbaum agreed. He prescribed a range of exercises to get Brian’s eyes to stay straight and work together. He also gave Brian a pair of extremely low-power glasses to help reduce his “visual stress” — the fatigue he says accompanies trying to work with improperly aligned eyes.

Brian did the exercises and, at home at least, wore the glasses. And after four months, his mother said, he “just blossomed.” He became happier in school. He improved in sports. “Now he just has so much confidence,” Dennis told Appelbaum, as she waited for Brian to finish a therapy session.

Appelbaum then told Dennis about Larry Fitzgerald, the Arizona Cardinals wide receiver, who started life appearing to be a not-particularly-gifted athlete. He didn’t like reading. He didn’t do well in school. But then he got vision therapy — help that, Fitzgerald has said publicly in recent years, changed everything. And he went on to become a star.

This is one of Appelbaum’s favorite stories.

“This is gonna be Brian,” he said.

“Whatever it costs, whatever we have to do,” Dennis declared. She and her husband were committed, she said.

The ground-floor hallway of Appelbaum’s homey practice is hung with framed statements from ecstatic parents and former patients who say their headaches, reading problems, clumsiness, low self-esteem and school misery evaporated once they began to do vision therapy.

Appelbaum keeps scores of additional happy stories in a folder. There is one from a family in San Francisco who flew cross-country one summer and stayed three weeks so that their third-grade son could do two hours of vision therapy a day. Subsequently, they write, he went up two grade levels in reading and started to play sports. There is also a note from the family of a girl whose struggles in school were so terrible that her mother quit her job in order to have the time and energy to help with homework. After vision therapy, she reads without help, is first-chair violin in the school orchestra and is now volunteering to work with a blind child.

These glowing reports are echoed on the Internet, where sites like the Optometrists Network and Parents Active for Vision Education are filled with tributes to the life-changing effects of vision therapy and tales of unfortunate encounters with mainstream medical specialists who either overlook important vision issues in children or misdiagnose them as learning disabilities, emotional problems or A.D.H.D. They refer readers to studies showing links between vision problems like convergence insufficiency and reading and attention issues.

According to a press release by the American Optometric Association, “studies indicate that 60 percent of children identified as ‘problem learners’ actually suffer from undetected vision problems and in some cases have been inaccurately diagnosed with attention-deficit disorder or attention-deficit hyperactivity disorder.” Many behavioral optometrists say that 20 to 25 percent of children overall have vision problems that can impede their ability to reach their potential. These problems commonly include: poor eye-movement control or “tracking issues,” problems with accommodation (when the eyes don’t focus well together or sustain focus at various distances), convergence insufficiency, difficulties sustaining visual attention, poor visual-motor integration (bad hand-eye coordination), weak visual form perception (the ability to reproduce and generalize shapes) and poor visual memory. The symptoms of these eye problems, the vision therapists say, commonly include getting lost on the page while reading, difficulty copying from the blackboard or from one page to another, skipping or omitting words while reading, an avoidance of close work, difficulty in remaining focused, poor handwriting and sports performance. With vision therapy, in most cases, these problems can be fixed, they say. And through more holistic, more natural, more humanistic methods than those offered by mainstream medicine.

Or, as Appelbaum puts it: “There are a lot of doctors and therapists who have a vested interest in teaching the child how to deal with their problem. Then there are people like me . . . who want to get rid of the root of the problem.”

The claims that many make for vision therapy are controversial. In fact, vision therapy is a practice that many doctors say lacks a solid grounding in good science. “It has no validity,” says Marshall Keys, a Rockville, Md., pediatric and adolescent ophthalmologist who is an outspoken critic of vision therapy.

Pediatricians do not generally refer patients to vision therapy. Ask about vision therapy at the National Institute of Mental Health (the branch of the National Institutes of Health that includes learning disabilities and A.D.H.D. in its purview), and they draw a blank. The same is true at the National Institutes of Health’s National Center for Complementary and Alternative Medicine, where you might assume vision therapy would be a subject of interest. Query the National Eye Institute, the branch of the N.I.H. that conducts vision research and you get one study — one single randomized, placebo-controlled “gold standard” study — that recommends in-office vision therapy for the treatment of convergence insufficiency, the condition for which Appelbaum was so successfully treated back in optometry school. Beyond that, you get the sense that doctors speaking in an official capacity don’t much like to offend their colleagues. “The kind of proof we look for in terms of things we want to uniformly refer to people is really at the level of science,” Brian Brooks, an investigator and the chief of the unit on pediatric, developmental and genetic ophthalmology at the National Eye Institute, told me. “The N.E.I. is here to do science — we want to encourage science. . . . That’s the area of discomfort.”

Vision therapy’s critics argue that the published research in its favor is largely anecdotal, often derived from studies in which the practitioners had a vested interest in positive results, where disorders were badly defined and therapies inconsistently practiced and during which children were usually receiving other kinds of therapy.

All of that renders the research “useless scientifically,” says Walter Fierson, a pediatric ophthalmologist in Southern California and a former chairman of the American Academy of Pediatrics’ section on ophthalmology.

Critics say that behavioral optometry rests upon some very basic misconceptions about the way the brain operates, particularly regarding the processes involved in paying attention and reading. They point out that recent advances in brain imaging have shown that most reading problems are not vision problems but instead involve glitches in language processing in the brain.

Some behaviors, they say, appear to be caused by problems with vision but really aren’t. Children with dyslexia, for example, may often lose their place while reading, but this isn’t because they have eye issues — many studies have shown that ocular coordination, movement and visual processing are normal in these children — but because they are struggling to decode letters and word combinations. Some critics do acknowledge that eye problems like convergence insufficiency and accommodation disorders can cause serious problems with reading. But they argue that behavioral optometrists grossly overdiagnose these conditions, which pediatric ophthalmologists say occur in only a small percentage of children — perhaps 1 percent of the patients he sees, says David Guyton, a professor of pediatric ophthalmology and the director of the Krieger Children’s Eye Center at the Wilmer Eye Institute, at Johns Hopkins Hospital.

“Ophthalmologists as a rule do not test for convergence insufficiency or accommodation disorders,” Appelbaum responds. “If you don’t test for a problem, you won’t see it at all.”

At base, the dispute comes down to the fact that behavioral optometrists and pediatric ophthalmologists define what constitutes a diagnosable level of problems like convergence insufficiency differently. “The two professions can’t talk to each other because their basic definitions are so different,” Guyton says.

Guyton says that many of his colleagues in ophthalmology can be too categorical in condemning vision therapy, which he says can be of real value in helping patients overcome a number of eye problems. The trouble is, he says, behavioral optometrists overstate their claims, generalizing, for example, from the evidence that vision therapy works for convergence insufficiency to validate all that they do. “You really can’t validate by association,” Guyton says.

He and other critics say, for example, that the low-power glasses that behavioral optometrists prescribe to reduce stress are so weak that they can’t actually have any effect on a child’s vision — except to make the child believe that they are helping his vision (or to please a parent who believes they are helping the child’s vision).

And A.D.H.D. specialists argue that the symptoms behavioral optometrists attribute to problems with vision (problems with “visual attention,” specifically) are primarily problems of self-regulation and executive function. It may look as if these kids are having problems with their eyes — they’ll look away from what they’re supposed to attend to; they’ll lose track of where they are while reading, or jump over words on a page — but the problem is occurring in the part of the brain that controls attention, not vision, says William Stixrud, a neuropsychologist in Washington. The behavioral optometrists, Stixrud notes, often confuse association and causation. These kids “do have problems with things like visual memory, but that’s because those parts of the brain that do that also control attention.” Stixrud adds that he does refer some children to vision therapy, but only if they have “adequate reading skills but it’s uncomfortable for them to read, they have headaches or words bounce around on the page.”

It isn’t just ophthalmologists, arguably the natural business rivals of optometrists, or learning or attention specialists (also competitors for clients), who dispute many of the claims of behavioral optometry. Eager to assess the validity of the practices of a growing number of their colleagues, the U.K. College of Optometrists, an association of optometrists, commissioned major reviews of the literature on vision therapy in 2000 and 2008. The studies came out in favor of in-office exercises for convergence insufficiency and also found there was valid research to indicate that vision therapy may help rehabilitate the vision of stroke and trauma patients. But regarding the assertions of behavioral optometrists — that vision therapy can make a meaningful difference in the kinds of children who are commonly given diagnoses of conditions like learning disabilities, A.D.H.D., autism spectrum disorders or problems with coordination — the group issued a vote of no confidence. “The continued absence of rigorous scientific evidence to support behavioral management approaches, and the paucity of controlled trials in particular, represents a major challenge to the credibility of the theory and practice of behavioral optometry,” Brendan T. Barrett, an optometrist, concluded in the second College of Optometrists report.

The American Academy of Pediatrics also essentially declared war on behavioral optometry last summer. It reviewed 35 years of the literature in support of vision therapy and issued a statement — in conjunction with other ophthalmological associations — condemning the therapy and its contention that it could help with learning disabilities. Visual problems, it claimed, are not the basis for learning disabilities.

It issued a stern warning about the seductions of treatments that sound convincing but aren’t based on science: “Ineffective, controversial methods of treatment such as vision therapy may give parents and teachers a false sense of security that a child’s learning difficulties are being addressed, may waste family and/or school resources and may delay proper instruction or remediation.”

All this has done nothing to dampen the enthusiasm of vision therapy’s parent backers and practitioners. If anything, the constant chorus of negativity from mainstream medicine has fueled a crusade to help vision therapy spread from the rarefied realm of those who can afford it (treatment typically costs thousands of dollars out of pocket each year) to the population at large.

To that end, advocacy organizations have worked hard to publicize and gain acceptance for behavioral-optometry techniques. Some behavioral optometrists make visits to elementary schools, offering free optometric screenings. They offer continuing-education seminars for teachers and school counselors. Around the country, advocates of behavioral optometry have been pushing state legislatures to mandate that every child have a complete eye exam beyond the screening routinely performed by pediatricians before kindergarten and to require insurance companies to reimburse vision therapy. The National PTA in 1999 passed a resolution calling upon all public schools to screen for the kinds of “visual skill deficiencies” behavioral optometrists treat. (Even the N.A.A.C.P. passed a resolution, at its 100th convention last year, endorsing vision therapy as a way to help some prisoners become productive members of society.)

“It’s a big problem,” Fierson, the former chairman of ophthalmology says of the spread of vision therapy, “and it’s not going away.”

Why, given the near unanimity of the medical opinion arrayed against it, do so many parents swear by vision therapy? Why are they moved not just to pay for it but also to advocate, even evangelize for it, helping optometrists spread their influence in greater numbers of communities and schools?

The reasons have as much to do with the very appealing promises of vision therapy as with the culture of parenting today — and with the peculiar culture of parents of children with issues in particular. Vision therapy is noninvasive, nonjudgmental and logical-seeming. (If a kid has problems with reading, copying from the board, tires easily during homework and loses focus, wouldn’t it stand to reason that there’s something wrong with his eyes?) The fact that virtually no medical doctors endorse the wider claims of vision therapy means little to those who, whether because of temperament, philosophy or discouraging experience with the medical establishment, are used to going it alone when it comes to their child’s treatment.

“Vision makes sense,” says Shelly Galli, a Washington mother whose daughter, Camille, is autistic and who has spent much of Camille’s life being told by doctors that the treatments she wants to pursue won’t work.

What makes sense, too, to many parents today is that vision therapists often see children’s learning and attention problems as part of the high-pressure society that kids are forced to grow up in. While problems like A.D.H.D., dyslexia and other developmental or learning disorders are now seen by mainstream medicine as related to differences in brain structure, wiring and chemistry, the behavioral-optometry model conceives of achievement-related problems as resulting from the environment: notably, the stress of growing up in an unnatural and overly visually demanding world.

This idea — however contemporary-sounding in an era of ubiquitous computers, video games and preschool reading programs — is far from new. In the late 19th century, the ophthalmologist William Horatio Bates proposed that conditions like nearsightedness and astigmatism arose from eye and mental strain. Bates believed they could be addressed through deep relaxation of the eye induced by “palming,” or covering closed eyes with one’s palms. In the early 20th century, Arthur Marten Skeffington, an English optometrist generally considered the founding father of behavioral optometry, developed his theory of vision and described reading and other close work as “socially compulsive” and “biologically unacceptable.” A person who is “constrained” to read, he wrote, becomes “an impaired organism.”

When modern-day behavioral optometrists put this theory into practice, they talk about the demands of universal literacy. They talk about children who spend too much time indoors and not enough time outside, letting their eyes roam as their ancestors’ did, hunting and scanning the horizon for predators.

This overarching theory of eye and brain dysfunction resonates with parents, many of whom believe, as does Jeffrey Kraskin, an optometrist in Washington, that children with issues are merely canaries in the coal mine for the pathologies of our time, being labeled as “sick” when their bodies and minds can’t adapt to the accelerated demands of our era.

“A human problem becomes apparent when a demand is greater than the ability,” Kraskin says. “We’re making our demands on human beings earlier. If you push a person to do something before they’re ready, something’s got to give. And I think that when that thing gives, you see attention-deficit disorder.”

In this schema, vision therapy just undoes what culture has created. There’s nothing actually wrong with the child who’s struggling to learn or pay attention — his or her dysfunction has been caused by the outside world. This reasoning is filled with the promise that, with the right kind of care, any child can rise to any sort of opportunity. Its logic is particularly well suited to parents who believe that if they have the time and money they can — indeed, must — do all they can to give their children the best shot in life. If they have a child with issues, they must try everything, wrestle with fate and take it upon themselves to research, create and organize a treatment program for their child — no matter the personal or financial cost.

That goal, that sense of possibility, is what for the past 18 months has driven Jennifer Allred, a construction lawyer turned stay-at-home mom, to fly from her family’s home in Atlanta to Washington to take her 8-year-old son, Jack, to the Vision and Conceptual Development Center, a vision-therapy practice that operates out of a first-floor office suite downtown.

Jack was given a diagnosis at age 2 of a mixed expressive and receptive language disorder. “He was difficult but not impossible to engage,” Allred recalled one Wednesday this winter while Jack did his exercises. “He met all his developmental milestones but not as robustly as you would have expected him to. You could get him laughing and playing but only if you were, like, Bozo-the-Clown-animated. He was scared of crowds, of noise.”

Jack began occupational therapy and did a lot of floor-time therapy, a one-on-one intervention developed primarily for children with autism by Stanley Greenspan, a prominent child psychiatrist in Washington. Ultimately, Jack’s developmental psychologist judged that it was time to look at “the vision piece.” After a stint in therapy in Atlanta, mother and son began traveling to Washington.

They met with Harry Wachs, the founder of the vision center, who is considered a pioneer for having tied optometric practice to Piagetian concepts of cognitive development. Wachs met for a half-hour with Jack, who at 6½ “wasn’t reading — not close to reading,” his mother says. She recalls that Wachs told her, “There’s no reason this kid shouldn’t go to Harvard.”

Allred and Jack have flown to Washington for vision therapy every 8 to 12 weeks ever since. Jack has, at the same time, attended a mainstream private school with an adult facilitator to help him navigate the day. He recently graduated from occupational therapy and from floor-time therapy. But vision therapy remains in the mix, his mother says, even though it requires a plane ride and a hotel stay and a “ridiculous, insane cost” for the family.

Such a believer is Allred, in fact, that on the day I observed Jack’s vision therapy, she’d brought along her younger son, Wyatt, a sandy-haired 5-year-old, for a consultation.

“Wyatt’s teachers think I’m crazy,” she explained afterward. “He’s a normally developing kid. But I noticed with Wyatt, doing floor time with him, the richness of the language and the play were not there with him. I wanted to know how he was visualizing. I’m kind of probing. That’s my thing with my kids: they need to learn to be thinkers. Vision therapy is also for this.”

Some doctors suspect that what really lies behind parent and optometrists’ reports of vision therapy’s success is something called the Hawthorne effect — the fact that many problems, and mental-health problems in particular, tend to get better when they receive intensive positive attention of pretty much any kind. Working with a warm and caring specialist, getting extra parental attention, concentrating on skills that can be improved (even if it’s just a matter of performing better on repetitive tests) is self-reinforcing. Under these conditions, you can certainly see great “vision” results in kids who, physicians say, didn’t have anything wrong with their eyes in the first place. And, notes Eileen Costello, a pediatrician in Boston and co-author of the book “Quirky Kids: Understanding and Helping Your Child Who Doesn’t Fit In,” spending time and money on noble-minded alternative remedies like vision therapy may have a positive, ancillary effect on parents. “I think they’re maybe alleviating their own anxiety,” she says.

Shelly Galli, the mother of Camille, is used to dismissive attitudes from doctors. There was a time when medical specialists told her to all but give up hope that Camille would ever be able to communicate. “When my daughter was diagnosed, they told me, if she doesn’t talk by 5 or 6, she probably won’t,” she recalls. Camille didn’t. But Galli refused to give up.

Camille spent years in applied behavior analysis, the intensive one-on-one behavior training technique recommended by the National Institute of Mental Health as a therapy of proven value in helping autistic children. She did speech therapy, occupational therapy, physical therapy — plus a host of scientifically unproven, even highly controversial treatments, like chelation (intravenous infusions aimed at removing mercury and other heavy metals from her body). She now eats a special organic diet and every afternoon drinks small cups of acidophilus and vinegar to counter internal yeast. She spends 35 hours a week in a one-girl schoolroom that her parents have created for her in an unused portion of a local religious school, working with a former preschool teacher with expertise in special education. She works with an art teacher and does speech therapy twice a week, works out at a gym with trainers every day and goes to vision therapy twice a week at the Vision and Conceptual Development Center, where she does jumping jacks on a trampoline and animal walks, throws and catches a beanbag and “fixates” on pictures.

All this costs well over $100,000 a year. But now, at age 11, Camille is talking. “Talking more every day,” Galli says. And Camille is reading. “And I’m glad we didn’t listen to those people,” Galli adds. In addition to twice-weekly sessions at the vision center, Camille does follow-up exercises at home or in school. She also does additional computer exercises, which help her with “tracking” skills, according to her teacher, Colleen Bane, and also — according to the computer program’s Web site — help her develop eye-muscle strength and letter recognition and activate the visual processing center of her brain. On the day I came to see her in her classroom, she was doing a set of those exercises on her laptop computer. She kept looking away from the screen, where words flashed quickly, requiring her to track with her eyes and point with her finger. As the exercise changed to one that required her to quickly memorize a short stream of letters and type them on the keyboard, she closed her eyes entirely. She twisted around constantly, trying to get a good look at the wall clock, where the minute hand was ticking, ever so slowly, toward 3 o’clock and the release for home. This was new. In recent months, her teacher, Colleen Bane said proudly, Camille has made great progress in telling time.

Though Camille has been taking part in many types of therapy, Galli attributes much of Camille’s progress in reading, and conducting herself in the world generally, to vision therapy. The same is true for Francesca Dennis, Brian’s mother, even though during the time her son was doing vision therapy he also switched schools, a change that, Dennis told me, vastly improved his life. And Jack, the boy from Atlanta with the language disorder, began for the first time to receive speech therapy while he was doing vision therapy. When I asked Allred whether Jack’s progress might just as well have been because of his speech therapy, she said: “To be honest with you, I don’t think you can tell. From my perspective, I don’t care. Are you going to deny your kid a therapy just to see if another therapy works? I’m mostly going on my gut.”

Galli also said it was possible that Camille’s progress might be a result of her other, more proven therapies, but she added that it didn’t really matter: “We never know what it is that’s really helping. But we’re not going to take any chances. You just don’t want to lose time.”

The first sign may be that your bright child is having trouble reading, or organizing school assignments, or concentrating on homework. Your child may be frustrated with school, and you may find yourself frustrated with what looks like a lack of effort. And a teacher may also notice that something is amiss.

If you suspect that your child has a learning disability, and you’ve ruled out distractions like bad chemistry with the teacher or a social issue, your best recourse is to have the child tested.

The cost of getting a thorough assessment by a trained professional can be steep, often as much as $5,000. But that financial burden is not necessarily yours to bear: under federal law your local school district is obligated to assess your child free of charge, even if he or she attends a private school. That said, if you go through the process with a school district, it might take a bit more effort than hiring a professional. Below, we discuss both options.

First, though, some context. By some estimates, about one in seven Americans has a learning disability, a neurological disorder that can make a basic task like reading, writing or organizing information more difficult than usual. Disabilities cannot be cured, but if identified early they can often be ameliorated. Parents, teachers and specialists can help children develop strategies for dealing with them.

The federal Individuals with Disabilities Education Act, enacted in 1975 and updated frequently since, is meant to ensure that all children receive an “appropriate” education. The law, generally known by its acronym, IDEA, states that local schools are obliged to help identify children who may have learning disabilities and then have them assessed, with the parents’ consent.

But what the law promises and what the schools can realistically provide are sometimes at odds.

“The law was created with the idea that parents and schools would collaborate on their child’s education,” says Neal Rosenberg, an education lawyer in Manhattan who worked for the New York City Board of Education when the law was first drafted. “But the relationship can sometimes turn adversarial.”

In this column, I will discuss how to determine whether your child has a learning disability and help you navigate the local school system’s obligations in that assessment. In next week’s column, my colleague Walecia Konrad will explain how to help learning-disabled children get the education they need.

GETTING STARTED If your child is having difficulty in school, don’t delay in arranging a meeting with your child’s teacher and the school principal.

At this meeting, explain your concerns about your child’s uneven academic performance. Perhaps your child is bright, but is reading below grade level. Or he reads fluently but is a poor speller. (Eighty percent of people with learning disabilities have problems with reading.) The school may first want to gather more data about your child’s performance and even try adjusting the classroom instruction before formally assessing him or her.

At this point, it is crucial to know your legal rights. Every state has a Parent Training and Information center that is financed by IDEA. Contact your state’s center to learn your school’s responsibilities and your child’s rights under the law.

To find the center in your state, go to the Technical Assistance Alliance for Parent Centers Web site. Wrightslaw.com, a Web site focused on special-education law and advocacy, is another good resource.

SPURRING ACTION A common complaint among parents is that the school is not moving swiftly enough to address their children’s problems or is reluctant to provide testing at all. Given the budget challenges for most schools, that reluctance is understandable. Besides the cost of testing, a finding that your child requires specialized instruction can lead to additional expenses.

But this is your child you’re talking about. If the school seems to be dragging its feet, make a written request to the school’s director of special education saying that you would like a comprehensive assessment. And provide reasonable evidence to support your request.

That’s the advice of Kyle Karen, a parent with a learning-disabled child who also volunteers as her school’s parent-teacher liaison for special education in Shelter Island, N.Y.
“The only thing a school district wants to do less than pay for an evaluation is to be involved in a lawsuit,” Ms. Karen said. “So if the school is aware that you have a paper trail, they tend to be much more responsive.”

DIAGNOSIS As with any health condition, an accurate diagnosis is crucial to developing an accurate treatment, which in this case is an education plan. Yet learning disabilities are notoriously tricky to uncover and identify. If your child has trouble reading, for instance, more than one issue could be at play.

“People often think of reading as one thing,” says Nanci Bell, co-founder of Lindamood-Bell Learning Processes, an education testing service. “But it takes a cascade of skills to read. You have to be able to integrate imagery and language.”

Ideally, then, you want the school to perform a comprehensive psycho-educational evaluation. This workup should include an I.Q. test to determine a child’s strengths and weaknesses, tests that measure your child’s academic skills and interviews with the child, the parents and the teacher.

If the evaluation confirms that a child indeed has a learning disability, the school principal should arrange a meeting with the parents and teacher to describe the results and to discuss a course of action.

If the diagnosis sounds inaccurate or incomplete, you should say so. You have the right under IDEA to request an independent educational evaluation, a type of second opinion, conducted by an examiner who is not employed by the school district.

“You must have a very good reason for the request,” Mr. Rosenberg said. The test results must seem wildly inaccurate or you must be able to demonstrate that the examiner was not competent or not objective.

And even if you do have a good reason, it might take months for the school to agree to your demand, if it does at all.

If you are getting resistance from your school, talk to an education lawyer. Many lawyers will provide you with a free initial consultation and can advise you how best to proceed with your complaints.

You can request a list of free or low-cost legal services in your area from your local public school; by law the school must supply you with this information. If you want to hire a lawyer on your own, ask other parents or even your pediatrician for names.

HIRING AN EVALUATOR Some parents simply bypass the school system altogether and hire a private evaluator to test their child, or to augment the tests the school has completed. Ask your pediatrician and other parents who have had their children tested for recommendations. The benefit of hiring your own evaluator is that you can be more involved in the process and are likely to receive a more in-depth, nuanced diagnosis. Independent testers are likely to spend more time with your child and may be more creative in their approach.

“I recently was testing a very bright 5-year-old who could only pay attention for 10 minutes at a time,” Laura Solomon, a special-education consultant, recently told me. “So we did 10 minutes of testing and five minutes of play. It took us three mornings to finish the tests.”

Dr. Solomon, who has been assessing children for 27 years, said “testing is an art and a science.”

Ms. Karen, for instance, arranged for her son to have additional functional vision testing — which can help determine how well the eyes converge, track and scan — for about $800, including a report.

Private evaluators provide parents with a lengthy report that explains their findings and their suggestions for educational interventions. Some will even go into the classroom to observe your child.

Private assessments, though, are expensive. Fees can range from $500 to as much as $5,000 for a comprehensive evaluation done by a top-notch professional or at a well-respected institution. Some health insurers — but not all — will reimburse you for tests that are conducted by a psychologist or psychiatrist and that have a psychological component.

In general, your school should be responsive to the report created by a private evaluator. If the school disagrees with the report, you can request a hearing with the board of education. You should definitely include your lawyer in this process.

Next week: Walecia Konrad will offer advice on how to match a diagnosis with an education plan that will help fulfill your child’s potential. The earlier that can be done, the better for your child.

First any students who take the SAT’s (Scholastic Aptitude Test) with testing accommodations, such as extended time, will no longer have their scores “flagged” for colleges indicating that the “scores were obtained under special conditions”.

The admirable idea is to create a level playing field for those students with learning disabilities and prevent colleges from discriminating against them. Accommodations are granted to those students with learning disabilities who demonstrate a need based on psycho-educational testing and teachers input. A learning disability is defined as a significant disscrepancy between a child’s ability (or IQ) and his school performance. Such students may need a little extra time on tests, not because they’re not as bright as other students, but because their brains process information differently. Many children receive some accommodations throughout their academic careers. Often this makes the difference between frustrated, under performing children with low self esteem and well adjusted, happy, high performing ones.

This change is great news and long overdue for students with learning disabilities, which make up 6% of the national student population. At present only 2% of students seek test accommodations from the College Board. This low number may be partially due to concerns about the past flagging of scores and fears that schools might be hesitant to accept them. Now perhaps more students with learning disabilities will request and receive proper and appropriate SAT accommodations.

The second important change concerns how such accommodations are granted. Comprehensive psycho-educational evaluations older than 5 years will no longer be accepted. On the national level, public and private primary grade schools use varying criteria for assessing and granting accommodations to students. One such accommodation is called a 504 which is given to students who do not fit the classification of Special Education, but have learning difficulties and therefore receive some modifications in their school program. These modifications can include extended time for testing, a structured learning environment, modified homework or any other modification that will help the student to succeed.

But the College Board exams are all nationally standardized and therefore eligibility for accommodations must also be nationally standardized. Students who have been receiving accommodations at their school for less than 4 months will not be eligible to receive test accommodations on the SAT. They can however go through the SAT Appeal Process and challenge it. Even students with long term accommodations at their school are not guaranteed accommodations for the SAT. All students requesting accommodations for the SAT must submit documentation to the College Board at least 5 weeks prior to the SAT test date and for those going through the Appeal Process a minimum of 7 weeks is needed.

Documentation required for SAT testing accommodations must: 1) State the specific disability; 2) Be current (within three years; one year for psychiatric disability); 3) Provide relevant educational, developmental and medical history; 4) Describe the comprehensive testing and techniques used to arrive at the diagnosis (including evaluation dates and test results with subtest scores from measures of cognitive ability, academic achievement, and information processing); 5) describe the functional limitations supported by the test results; 6) Describe the specific accommodations requested; and 7) Establish the professional credentials of the evaluator, including information about license or certification and area of specialization.
For more info visit: www.collegeboard.com/ssd/