Contacts: Sarah Goodwin Kathi Ovnic Holly Korschun

June 2, 1999

GOOD FOR BUSINESS:DIAGNOSING ADULTS WITH LEARNING DISABILITIES What does one do about a valued employee who is not measuring up to expectations? Employers, human resource administrators and employees themselves are taking a harder look at the role undiagnosed learning "differences" may play in job performance, says Carole Kant, Ph.D., assistant professor of psychiatry and behavioral sciences at the Emory University School of Medicine. "We often see individuals at Emory's Adult Cognitive Assessment Services who want to advance in their jobs, go back to school or change careers but find that something is making it difficult for them to accomplish these goals," says Dr. Kant, who oversees the assessment services. Individuals from upper echelon corporate managers to medical or graduate students who are find it difficult to achieve at expected levels have all been evaluated at the Emory program."Many of the patients we see survived high school or college in spite of problems with attention / concentration or weaknesses related to reading comprehension, math computation or any type of 'on demand' task performance," Dr. Kant says. Workers are often referred by their employers or by school administrators who realize that, in spite of motivation and many positive assets, the individual is struggling with certain aspects of daily performance, she says. These difficulties often manifest as poor organizational skills, problems following tasks through to completion, inconsistent quality of work or interpersonal difficulties with co-workers or superiors. Although schools are now more sensitive to the needs of students with learning differences, often providing testing and remedial services, many adults "slipped through the cracks," she says. These adults are typically high achievers and are often creative, diligent workers who, nonetheless, have experienced increasing difficulty as demands have escalated. LEARNING DISABILITIES According to the National Institute of Mental Health (1993), "Learning Disabilities is a disorder that affects people's ability to either interpret what they see and hear or to link information from different parts of the brain. These limitations can show up in many ways -- as specific difficulties with spoken and written language, coordination, self-control, or attention." The good news, according to Dr. Kant, is that once the exact nature of a person's learning disability has been diagnosed, a number of options become available. These range from suggesting relatively minor accommodations, such as assigning the employee to a mentor or group project, giving more frequent feedback and positive reinforcement, or engaging assistive technology, such as electronic date books or computer grammar checks. Individual counseling is may be effective in improving self-esteem which often has been eroded by years of unexpressed frustration, Dr. Kant says. Behavioral techniques, such as stress reduction, anger management, organizational skills and time management are frequently very effective interventions. Medication is also recommended for treatment of mood disorders, such as depression, or for symptoms indicative of attention deficit disorder (ADD).According to the National Center for Learning Disabilities Inc., between 15 and 20 percent of the U.S. population has some form of learning disability. CHADD, the organization for Children and Adults with Attention Deficit Hyperactivity Disorder, estimates that one to three percent of children have the full "ADHD syndrome", and nearly half will continue to experience symptoms as adults. According to CHADD literature, adults experience symptoms similar to those seen in ADHD children, including restlessness, distractibility, impulsivity, impatience and low tolerance for frustration. They may also have difficulty inhibiting their emotions and thus have more volatile relationships with staff and co-workers. Within the workplace, these individuals may not achieve vocational position or status commensurate with their peers or with their intellectual potential, Dr. Kant says. THE ASSESSMENT Once patients have completed an initial interview at Emory, they may choose to schedule a comprehensive test battery. Staff administer measures to evaluate cognitive functioning and academic abilities, as well as visual, auditory and "executive" processing skills. The evaluation also incorporates measures which "tap" memory, as well as attention / concentration and social-emotional status. Through this very thorough process, the clinician is able to look for "themes", or repeatedly-observed areas of strength and weakness. The process also helps clarify to what extent ADD (with or without hyperactivity), anxiety, depression, substance abuse or medical conditions may be contributing the patient's difficulties. The evaluation includes a feedback session which may involve the a spouse or family, as well as a detailed written report and consultation, if requested, with other professionals. "We all struggle with procrastination, distractibility and unfinished projects," Dr. Kant says, "...but for adults with learning disabilities, these problems have been escalating and are often profoundly affecting their performance at work. We prefer to interview patients, as well as their spouses or other immediate family members, and to obtain information from friends, co-workers, employers, as well as academic records and details about current functioning at work and at home. Just as important, we gather insights about a person's strengths, since the treatment often centers around building positive assets in order to compensate for deficits." The Adult Cognitive Assessment Clinic at Emory filled a clinical need that grew out of the department's ground-breaking ADHD research. A team of investigators, led by Julie Schweitzer, Ph.D., verified in 1997 through brain imaging techniques that aberrant cerebral blood flow occurs in adults with ADHD. In 1998, the team initiated one of the first research projects to evaluate the role Ritalin plays in improving working memory in persons diagnosed with ADHD. Information on Adult Cognitive Assessment Services at The Emory Clinic is available at 404/778-5526.   ### (Editor's Note: Dr. Kant and patients are available for interviews. Contact Sarah Goodwin at Emory Health Sciences Communications at 404/727-3366 or sgoodwi@emory.edu.)