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Learning disabilities are a common concern that parents bring to pediatricians. I'll be discussing those on today's Scope.

I have a lot of parents coming to me to see if their child has a learning disability. Usually it's dyslexia, which is a reading disability. But sometimes is dyscalculia, which is a math disability, or dyspraxia, which is a developmental disorder that affects motor skills like writing. Parents normally notice that their child is struggling in only one subject and does fine in others, or they notice that their child is writing letters, words, or numbers backwards. The teachers may be the first to recognize if there is a problem and tell the parents to have their child see their pediatrician for an evaluation.

Now, here's where it gets tricky. Yes, most of us can identify if there is a learning disability. However, we as general pediatricians are not the ones who can do a full evaluation and diagnosis. Even behavioral and developmental pediatricians are not usually qualified. Why? Because there is a lot that goes into determining if this is truly a learning disability or if there are other reasons for the difficulty in a particular area. We as pediatricians are the right place to start the process though. Schools also. School psychologists can actually do a lot of the testing to start the process, and that is what most of us recommend. While schools start doing the initial learning evaluations, pediatricians do full physical exams to rule out other medical reasons, such as ruling in or out movement disorders, ADHD, anxiety, depression, or speech issues.

The final evaluation and where the actual diagnosis is made is with a neuropsychologist. These are specialists who will do a huge evaluation with a lot of specialized tests, including IQ tests, standardized tests in reading, math, language skills, things like that, to get a good idea of how the brain itself is working, or not working, and be able to come up with the exact diagnosis specific for the child. This can be a long process, but it is necessary to get the correct diagnosis.

Once a child has been diagnosed with a learning disability, the next step is to notify the school and have them come up with an IEP or individualized education plan. This is a written contract stating what the child's disability is and what the school is able to do to help the child learn successfully. It's drafted with the parents, teachers, and school psychologists all involved and goes off of the results from the neuropsychology report. This IEP should follow the child all the way through graduation. It should be reevaluated every six months to make sure that the child's needs are being met and that there are not new issues coming up.

There are no medications to help with learning disabilities. As pediatricians, we can help direct you to resources that can help your child. Our relationship with your child will not change. And we too, like the schools can adapt if your child has problems with learning.

What your child needs most is encouragement and a lot of positive reinforcement when they get something right. Let them know that this is something that they can totally be successful with. Let them know some of the famous people that have had dyslexia, such as Keanu Reeves, Albert Einstein, Steven Spielberg, even Ozzy Osborne. They've all been successful. Henry Winkler had both dyslexia and math problems. Even Ben Franklin was thought to have a math learning disability.

Having a learning disability will make things harder, but not impossible. And often those who have a learning disability in one area often have exceptional abilities in other areas. Encourage your child to focus on what they are good at while they work hard things out that don't come easy. Remind them that they are not defined by their learning disability only by their abilities.

When you are expecting a baby, you have so many hopes for the future of your child. What if you learn that your child will have physical or developmental disabilities? I'll discuss your pediatrician's role in your child's care on today's Scope.

Often parents will ask me if I'm able to take care of a future sibling of one of my patients. The answer always is of course. Some parents will then get a little more quiet and say, "But my baby isn't normal." And I'm like, "Are any of us normal?" Seriously, if you've ever studied embryology and seen all the things that can go wrong during development, it's amazing any of us come out okay. When it comes to seeing new babies who may have some physical or developmental challenges, I honestly tell them I would be honored to be their new child's pediatrician.

When I was five, we moved to a house where the neighbors behind us had a son my age. His older sister had Down syndrome. In the five years that we lived at that house, his sister became one of my best friends. We would play school together, go to the pool together. She actually became a swimmer on the Special Olympics team. We did all sorts of things that friends do. Our families have kept in contact this whole time. And I've been so proud to see all she's accomplished.

I learned early on that just because someone has an extra chromosome and has some differences as a result, they're still an amazing person. They still have so much to offer. I mean, I was the asthmatic kid, allergic to everything. And I was in the school nurse's office all the time. So I also felt like I was a bit defective. We all are a little off in our own ways.

Parents are often overwhelmed when they have a new baby with special needs. And as their pediatrician, I serve as sort of a gatekeeper for all the specialists. My job is to take care of the well child visits, the usual colds and ear infections, and help manage some straightforward issues that most pediatricians are comfortable doing.

When a child needs a specialist, I know exactly who to refer them to. And the specialists and I coordinate together to make sure the child has all their healthcare needs addressed. It's called the medical home model. It's basically a community of doctors all working together, like a wheel with all the spokes of the wheel being the specialists, and the hubcap being the pediatrician. Depending on the needs of the child, the pediatrician also gets home health nursing involved or speech or physical therapists. Often we're the ones that fill out a lot of the paperwork for the insurance companies too and refill prescriptions for supplies if a child has a feeding tube or needs diapers long term.

Often one of the specialists is a pediatrician who has had additional training and certification in complex care management. That is someone I routinely refer my patients to, because they are an amazing resource and also help coordinate the specialists. They often try to make sure that a patient, if they are coming for a visit, have all of the specialists in the visit at once, so it's easier to make sure everyone is on the same page and can get extra help from dieticians, care manager nurses, and social workers if needed. Again, all part of the community of doctors caring for special needs kids.

Trust me, we as pediatricians love your kids as much as you do. And when they make certain milestones, we celebrate with you. I get so excited when I see my cerebral palsy kids walk into a clinic on their own. And I know that every child I see with Down syndrome means I'm guaranteed extra hugs that day. Special needs doesn't always mean limited, negative quality of life. Although their care will be certainly filled with challenges, it's our job as pediatricians to help you along your child's journey to reach their full potential.

Dr. Gellner: A lot of children have learning disabilities that can make school time tricky. What are learning disabilities, really, and how can you help your child? We'll discuss those on today's Scope. I'm Dr. Cindy Gellner.

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Dr. Gellner: So, many kids struggle in school. Sometimes it's because they don't understand the material or they find it boring, so they don't care to learn it. Sometimes it's because they're acting up or they don't like their teacher, so they don't pay attention. And sometimes it's because they have chronic medical conditions and miss a lot of school. These aren't learning disabilities. These are barriers to learning.

A true learning disability is a disorder that affects the way the brain receives, processes, stores, and responds to information. Learning disabilities usually involve problems with reading, writing, math, and information processing. We don't know what causes most learning disabilities, but we do know that they tend to run in families, and can also be attributed to circumstances before or surrounding a child's birth, such as being born premature or if mom used drugs or alcohol during the pregnancy.

Cultural differences and poor parenting are not causes of learning disabilities. There are many types of learning disabilities, and there is a big range of how they affect individual kids.

There's a language disability where kids may have problems following directions or may mix up words. These kids have a hard time telling stories, because the words get all jumbled up in their brains.

There's visual processing disability where kids see words backwards, such as seeing "was" where the word is "saw" or switch the b's and d's around if they're older than first grade. It's normal until then. They may also write very slowly as well.

There's auditory processing disability where kids have trouble focusing on people talking to them or listening to important sounds, because they cannot distinguish those sounds from background noise. They also have a hard time following instructions.

Another common disability is fine motor disability. These kids have a hard time with buttons, zippers, or even holding a pencil.

To find out if your child has a learning disability, you will need to talk to their school, as the school psychologists are often the ones who do the screening evaluations. If your child is not yet in school, your pediatrician can help you find a developmental pediatrician who can do the more in-depth screening. If your child does meet the criteria for a learning disability, then the school and you will put together an Individualized Education Plan, or an IEP. This IEP outlines goals for your child to meet, what services they qualify for, and who will provide them, and frequently measures and updates how your child is making progress.

What can you do as the parent of a child who has a learning disability? A lot. First, your child will probably feel self-conscious about having a learning disability. Remind them of all the things they are good at and that everyone has different ways of learning. You can even tell them about famous people that had learning disabilities like Walt Disney, Tom Cruise, Whoopi Goldberg, and even Justin Timberlake.

Have them meet other children with learning disabilities, so they understand they're not alone. Make sure you have a nice quiet place for your child to do homework, and don't overload them with extracurricular activities. Most importantly, be an advocate for your child with their school, and remind your child that they may learn a little differently than other kids, but with the right help, they can achieve anything they set their mind to.

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Interviewer: Technology can help individuals with disabilities live a full and rewarding life. That's next on The Scope.

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Interviewer: Dr. Richard Kendall is with the Rehabilitation Center of University of Utah Health Care and we're talking about the Americans with Disabilities Act 25 years later, which really kind of changed a lot of people's thinking about including people with disabilities in life. Tell me about some of the work that you do to include people with disabilities in recreation.

Dr. Kendall: Well, not just including people with disabilities in recreation, but people who have a disability, like everyone else, want to recreate, wants to socialize, wants to get out of their house and out of work and do things that are fun. Our program, here at the University of Utah and TRAILS does just that for people with spinal cord injuries.

Interviewer: And some of the equipment, the technology, and some of the things technology allows people with spinal injuries to do is amazing. Tell me about some of the things you have in your trailers. You have a whole bunch of trailers filled with lots of fun.

Dr. Kendall: Yes. Our program has three trailers full of equipment that are around the valley at any certain time. We have cart skis, we have robotic skis, kayaks that you can operate through sip and puff so really accessible to anyone with any level of any injury.

Interviewer: Let's take a little bit of a turn here and talk about technology and how technology has really changed the game for accessibility and socialization as well. There's something you have that I call robot legs, but you call it something else. Tell me a little bit about the robot legs.

Dr. Kendall: Yeah. The robot legs are exoskeletons, as they're called. They allow individuals with spinal cord injury, and soon strokes, to be able to stand and walk with the use of the robotic arms and crutches. This really is going to open a lot of opportunity for individuals with spinal cord injuries so they can stand, so they can walk, talk to their peers eye to eye. All of those are going to be very important. Technology, in general, is really opening the world and we have Bluetooth controlled prosthetic knees now. People can snowboard, people can walk in them. The technology of carbon fiber allows people to run pretty quickly if you think of Oscar Pistorius. So technology is changing and really is going to open up a lot of access for individuals with a disability.

Interviewer: I'm guessing you're about the same age as I am. When I grew up, I watched "The Six Million Dollar Man." At that point of your life, did you ever dream that that would become reality? I mean, as a physician that's pretty amazing to watch that.

Dr. Kendall: Yeah. It certainly is. While "The Six Million Dollar Man," if you think back in, I think that was the '70s, how much $6 million would have cost. If you think about it now we have neural interphases that people have an electrode put in their brain and can operate robot arms just with their thoughts. So yes, technology is coming to life and I think these are going to be things that as computer and softwares develop further, we're going to see really tremendous growth.

Interviewer: What's on the horizon? What's in the future? What next thing that we can imagine now is going to happen?

Dr. Kendall: Well, the exoskeletons are really in, what I would say is an infant stage at this point. I think that as the computer algorithms develop, you're going to be able these develop where you can stand and walk on their own. I mean, a number of companies have drones that can stand, walk, walk over rocky surfaces with no tethering devices for balance on their own. So I think you're going to see these develop into where somebody can put on the exoskeleton legs and walk even without the use of crutches, and balance, and not fall over.

Interviewer: Will that replace a wheelchair eventually?

Dr. Kendall: For many people, I think it will replace it for many things that they do and I don't think it'll be 100%, but certainly give them accessibility to be up and moving around.

Interviewer: That's incredible. I want to jump back quickly. What's a Bluetooth knee do, by the way?

Dr. Kendall: A Bluetooth knee, basically it's a knee that you can program through your smartphone and tell it to be more rigid or less rigid, depending on what activity you're doing. If you're using it for snowboarding, you can program it so it takes a real big hit and doesn't collapse easily, whereas if you're walking and you want a little more subtle joint play, then you can program for walk mode.

Interviewer: With your interaction with people that use this technology, your patients and what not, tell me the benefit. Tell me a story about how it affects their life.

Dr. Kendall: One of the things that when you see somebody stand and walk, who's been on a wheelchair for a number of years, just the look on their face and really their desire to be able to talk to you while they're standing up, it's really something that is hard to describe. It really brings a whole new phase into their life and gives them hope for the future and further access. Then there's the person who used the sip and puff kayak for the first time, had been living mostly in a nursing home or assisted living facility for many, many years. And he is a ventilator-dependent quadriplegic, can't use his arms or legs, but operated the sip and puff machine very well. The only problem was because he would laugh a number of times, couldn't use the sip and puff]to correctly steer.

Interviewer: Because he was so excited that he was laughing.

Dr. Kendall: He was so excited, he was laughing, being out on the lake in the kayak.

Interviewer: If somebody was interested in learning more about this type of technology to make their life better, what would they do? What would be the first step?

Dr. Kendall: Well, the first step is to go to our website here at the University of Utah Rehabilitation Center and look for theTRAILS program.

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Interviewer: It's summertime, and pool safety can be a big enough challenge, let alone if you have a child with developmental disabilities. We're going to find out what you need to look out for coming up next on The Scope.

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Interviewer: Pool safety. We're with Dr. Kyle Bradford Jones. He's at the Neurobehavioral Home Program here at the University of Utah, Family Medicine doctor. And for a parent that has a child with developmental disabilities, pool safety is a little bit more of a challenge. Let's talk about some of those things. These are conversations you have with most of your patients?

Dr. Kyle Jones: Absolutely. All the time. You know, individuals with developmental disabilities such as autism or intellectual disabilities, etcetera sometimes have a harder time around the pool. They need to be watched a little bit more closely because sometimes they don't understand the risks. They don't understand the dangers. So, it makes it much more important to keep a close eye on them as they're playing around the pool. Do your best to either avoid the deep end or to stay close by them when they are there.

Interviewer: What about even the shallow end?

Dr. Kyle Jones: You know, even the shallow end, it's true. Make sure that they're playing appropriately. What I mean by that is that they're playing safely. They're not continually hitting other children. They're not causing problems in that sense. They are able to play with others and play safely within the water environment.

Interviewer: Gotcha. What's one of the hidden dangers that a parent might not realize?

Dr. Kyle Jones: Individuals with autism, specifically, have difficulty with sensory issues. So they may not want to wear a floatation device or a life preserver. So you may put it on them and they go out to play, and then they don't like the way it feels, so they take it off.

Interviewer: That's pretty common?

Dr. Kyle Jones: Exactly.

Interviewer: Yeah. Excuse my ignorance. Is it an inability to swim that makes it a big danger for individuals with developmental disabilities around the water?

Dr. Kyle Jones: That's part of it. Especially at large pools where there's lots of other kids or lots of other people, sometimes they don't understand exactly how to interact with others. They can sometimes get into trouble in that sense.

Interviewer: So, for example, they don't understand the dangers of water, so they might put somebody under the water?

Dr. Kyle Jones: Exactly.

Interviewer: And not even realize that, that could be a dangerous situation?

Dr. Kyle Jones: Exactly.

Interviewer: Okay. Other situations like that?

Dr. Kyle Jones: Beware of the diving board or the slides for the same reasons: to watch out for other people but also make sure they can swim so that they can do OK once they're in the water.

Interviewer: What other concerns?

Dr. Kyle Jones: Obviously, sun safety, so making sure they're wearing sunscreen, keeping the skin covered up as much as you can while still allowing them to go out and have fun.

Interviewer: What's one of the most common injuries you see as a result of individuals with developmental disabilities at the pool?

Dr. Kyle Jones: One other safety thing to watch out for is it being slippery around the pool. Sometimes they don't understand that they need to slow down in order to keep from falling. And sometimes you see them come in with anywhere from a scrape to falling and hitting their head and having a head injury. So that's something to be very careful with.

Interviewer: What's the one take away that you would want to have somebody after they heard this walk away from?

Dr. Kyle Jones: If you have a child who has a developmental disability such as autism, keep a close eye on them and try to be as patient as you can with them in the pool so that they can play safely. If you don't have a child with a developmental disability and you're at the pool with one, again, please be patient and do the best you can to let them have some fun, too.

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