practical judgment, and common sense, his abilities to understand spatial relationships, to put things in proper sequence, and to repeat from memory a series of digits or words were very poor.
In the Block Design subtest of the Wechsler Intelligence Test, he pushed the blocks across the desk in frustration and banged his head with his hand, shouting, “Stupid kid!”
When he couldn’t remember more than two numbers and none at all backward on the Digit Span subtest, he began bouncing up and down and finally out of his chair.
During the third testing session, Joey told me that he thought maybe he “saw things funny.” He was right, or at least when he tried to reproduce what he saw with paper and pencil they came out “funny” and bore little resemblance to the original. Joey continued to use his left hand consistently, and some designs were drawn sideways, some upside down; angles looked like double dog ears.
Joey had other troubles. He read 41 as 14; the letters he meant to be d’s turned out as b’s. He had memorized twenty sight words, but when he came to a word he wasn’t sure of, somehow the letters twisted around and he read “cliff” as “calf” and “felt” as “fleet.” When he read out loud he skipped lines and made up words, but if I read to him, he could answer every comprehension question in detail.
Joey was not only smart, he was aware and sensitive. As we started a spelling test he said, “Okay. I’ll do it, but could you please not put that big circle on the front that tells how many I got wrong, like they do in school.” Joey demonstrated:
It wasn’t only letters and numbers that Joey mixed up. He jumbled his own thoughts as well. I asked him to write a few sentences about whatever interested him. He thought hard and then took a long time to write. “I’m going to make this neat,” he told me as he worked.
When I asked him to read out loud what he had written, he read, “I like to go fishing because we always win.”
“Wait a minute here,” he interrupted himself. “That’s not right. See, I began about fishing, but then somewhere, about here” – Joey put a line after fishing, which was written “fsihign” – “I must’ve begun thinking about soccer.”
I didn’t have a test to measure the restlessness inside Joey. But observation made it clear that he was much more active, tense, and distractible than the usual seven-year-old. I even wondered if the neurologist’s decision against medication was correct.
I had worked with other children who were labeled hyperactive or as having a “hyperkinetic syndrome” – and I had seen medication such as Ritalin work for some, although not for all. Originally, the thought of medication of any kind repelled me, but I learned that it did work for some children as long as it was carefully monitored by a pediatric neurologist or experienced pediatrician. Often hyperactivity and learning disabilities are considered one and the same, but they are actually two separate conditions. When they occur together I think of it as “dyslexia plus,” the plus being hyperactivity. Both teaching and rearing these children takes a great deal of energy and love. Just to get them to tune in so that they can hear what you are saying is a big job in itself – to sustain their attention minute after minute so that they can learn is a tremendously difficult task. These are vulnerable children – their sensations heightened, their motors always running a little too fast, never quite in time with the rest of the world. They are exhausting children. They need more supervision than most. They need more loving. They also give it back in quantum measure.
The Stones arrived at the same time but in different cars, coming straight from work to my office. Mr. Stone was well over six feet tall, lean, with hair just slightly darker than Joey’s.
“Did you get a sitter?” Mr. Stone asked his wife.
She shrugged, a small frown crinkling her forehead. “I tried three, but no luck. I think they were making excuses.” She turned to me. “Ours isn’t the easiest house to baby-sit. When I went back to work last year I tried to make arrangements to have someone there when the boys got home from school. Nobody lasted longer than a week. They all said they couldn’t take Joey. They never knew where he was or what he was up to – and if he was there, he was into something he shouldn’t have been into. So now the boys look after themselves. Joey, and Bill, he’s our eleven-year-old, fight constantly, but Richard, the oldest, is thirteen and responsible, and he can handle Joey better than most. My parents live across town, so Rich can call them if anything serious comes up. My mother is ill, but my father can drive over.”
“Which usually makes things worse rather than better,” Mr. Stone added.
Mrs. Stone turned her head toward her husband. “Don’t start,” she warned.
“Shall we begin, then?” I asked, wanting to interrupt the tension that was building between them. “I’ve read everything you sent,” I continued. “The Child Study Team reports, the teacher’s comments, the neurologist’s report, the background information form that I asked you to fill out. I’ve scored the dozen tests that I gave Joey, and I’ve reviewed them with Dr. Golden, the psychologist and learning disabilities professor I mentioned.
“Now, I’d like to go over it all with you and see if we can pull it together and come up with a plan of action. Let’s begin at the beginning.”
I began to summarize. “Joey was a full-term baby, born October twenty-ninth with a birth weight of six pounds, ten ounces. The pregnancy was a difficult one in contrast to earlier pregnancies with Joey’s brothers. Toward the end of the third month staining was severe enough for the doctor to advise complete bed rest for several weeks …”
For the next hour we went over each of the tests. I read them Joey’s intelligent, sophisticated answers, and they were surprised and pleased at how much he had learned about his world in spite of all his troubles. One by one I showed them the intelligence tests, academic tests, visual and auditory processing tests, puzzles, drawings, and Dr. Golden’s comments.
I summed up Joey’s strengths: his intelligence; his excellent verbal skills, including both word knowledge and speech; his love of people and ability to make friends; his excellent physical coordination; and his intelligent, supportive family.
I also went over Joey’s weaknesses: the large gap between his intelligence and his achievement in academic areas; his difficulty in “sitting still”; the sleep disturbances that Mrs. Stone mentioned; his difficulties with spatial relationships; his reversals in both reading and writing; his left-right confusion; his inability to sequence digits, letters, days of the week, months of the year; his difficulty with all forms of writing; his lack of understanding of decoding skills, which resulted in wild guessing; his pattern of disorganization; his lack of confidence in his ability to learn; and an overriding factor of distractibility and frustration.
“Joey has various learning disabilities and also a certain amount of hyperactivity,” I said. “It’s possible to have either of these conditions without the other, but in Joey’s case both are present, each compounding the other.
“From reading his report it seems there may have been some tiny damage to neurological pathways before Joey was born,” I continued.
Mr. Stone looked at his watch and cleared his throat. “All right, I can accept that. The neurologist said the same thing, and also my brother claims he has dyslexia himself – but the main thing is, what are we going to do about it?” He looked directly at me.
“Tell me the two things about Joey that are causing the most trouble,” I said.
They both spoke at once. Mrs. Stone said, “I don’t want him to go to a special school. Everyone will think he’s retarded.”
“I don’t care what other people think,” Mr. Stone said. “But Joey is sure to get even more down on himself than he already is if he isn’t allowed to go to the school where his brothers went.”
“How about his teacher? What do you think she finds most difficult