The Gateway School Special Report: Volume II

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1 Language-Based Learning Disabilities 3 What is Executive Function Disorder? 6 What is ADHD? 8 Why is Language So Important for Learning? 10 Why is Language So Important for Social Development

and Emotional Growth?

11 Diagnosis and Treatment/Intervention


arenting for many is about bringing countless hopes and dreams to life for your children. We imagine them enjoying school, making friends, graduating from college, falling in love, finding a job, or – like us – starting the cycle of life with their own families.

Parenting for many is also about managing the unexpected. Despite all our hopes and intentions, children quickly develop into their own selves, complete with their own strengths and challenges. The greatest gift a parent can give their child is the capacity to understand how to move through the world in ways that play to those strengths and minimize those challenges. The purpose of this publication is to define a few of the issues that commonly arise with children, paint a few pictures of what these look like at various ages and stages, and offer guidance on what can be done to define and remediate them. We have come a long way in providing help to families. Fifty years ago, terminology and legal protections were just being formulated. Twenty-five years ago, mothers and fathers started to use the Internet to decipher the terms in their child’s neuropsychological evaluation. Today, there is an array of centers specializing in various disorders, plus schools, camps, and online resources. Languagebased learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and executive function disorder, in addition to the role of anxiety in a child’s functioning, are better understood. Diagnosis and remediation of all these conditions has evolved and improved. Yet, the parents’ dilemma has not necessarily changed. It remains very hard to know when to ask for help and where to turn. In these moments, it is important to realize you are not alone. For over 50 years, The Gateway School has provided expert instruction to bright children with language-based learning disabilities and attention deficits. It is my hope that after reading this publication you will have a better understanding of who our students are and how we use expert instruction to set them on the right path both academically and in life. There is a wealth of information and expertise to be harnessed to inform you and support you in securing the help your child needs. By offering some practical advice on how to proceed and to envision all the ways in which you can help your child, we hope you will feel empowered as you seek to bring your hopes and dreams to life. Warm regards,

Carolyn Salzman Head of School


Article 1: Language-Based Learning Disabilities

T Christy Brockhausen, Ph.D. Director of Lower School The Gateway School

o the casual observer, Jackie’s early childhood was relatively unremarkable. She was a happy, social child who got along with her peers and was curious about the world around her. By the time she reached preschool, she hit all of the expected developmental milestones for a child her age and was even ahead of the curve on a few. Aside from the occasional daydreaming, which sometimes led to missed directions, her teachers had no reservations about her classroom behavior and were confident she would thrive in elementary school. The summer before Jackie started kindergarten, her baby brother was born. She was a doting big sister who was quick to comfort the baby at any sign of crying and who never missed an opportunity to tell people how proud she was of her sibling. Surprisingly for her family, the transition to kindergarten proved challenging for Jackie. Conflict resolution with her classmates was difficult for her to manage, and her daydreaming became more frequent. Jackie’s parents were worried, but family friends reassured them that so much change in such a short time was bound to lead to some acting out. When she began to ignore their own directions at home, however, Jackie’s parents consulted with her pediatrician who recommended a hearing test. Jackie showed no signs of difficulty hearing, and her parents resigned themselves to the fact that she was simply moving through a “rough patch.” After all, Jackie was still on target academically, and she even showed a real passion for zoology and art. By the time of her parent-teacher conferences in first grade, Jackie’s teachers shared a new concern with her parents. Jackie was quickly falling behind her classmates in reading. Her inability to resolve conflict with her peers had also deepened, and she was prone to outbursts. Jackie’s parents reported that the tantrums were happening at home, as well. Taking all of this into consideration, Jackie’s teachers recommended she receive a neuropsychological evaluation from a consulting school psychologist. Jackie’s parents were taken aback. Sure, Jackie had developed a bit of stubbornness, but she was still the curious, social, and bright child she had always been. Why would she possibly need to see a psychologist? Jackie’s teachers confirmed what her parents believed: Jackie was still the curious, social, and bright

child she had always been. Their recommendation for a neuropysch wasn’t because of concerns about her behavior; they had suspicions that she might be showing signs of a language-based learning disability. The term “language-based learning disability” describes a spectrum of challenges and difficulties related to the use of spoken and written language. These challenges are the result of an individual’s neurobiology and the impact of their environment. In other words, the brain of a person with a language-based learning disability functions in a way that makes tasks like writing, reading, and speaking more difficult than they are for a person whose brain acts according to expected patterns, or neurotypically. When placed in a learning environment or setting that is designed only for neuro-typical learners, the difficulties faced by a child with a language-based learning disability can be compounded and become pronounced. Language-based learning disabilities can be receptive, expressive, or a mix of both. Receptive language delays cause difficulty understanding what others are saying. A person with expressive delays has difficulty expressing their own thoughts, emotions, and ideas. One well-known diagnosis within the spectrum of language-based learning disabilities is dyslexia. The International Dyslexia Association (IDA) describes dyslexia as, “... a specific learning disability that is neurobiological in origin. It is characterized by difficulties with accurate and/or fluent word recognition and by poor spelling and decoding abilities. These difficulties typically result from a deficit in the phonological component of language this is often unexpected in relation to other cognitive abilities and the provision of effective classroom instruction. Secondary consequences may include problems in reading comprehension and reduced reading experience that can impede growth of vocabulary and background knowledge.” According to the American Speech-LanguageHearing Association (ASHA), a language-based learning disability has nothing to do with how smart a child is, and most people with a language-based learning disability have average to above-average intelligence. Moreover, as Dr. Christy Brockhausen, Director of Lower School at The Gateway School, explains, “The term language-based learning

Language is the way we connect to our feelings, communicate with those in our lives, and express our ideas.


disability captures the holistic impact of language on a child’s development. “Language is the way we connect to our feelings, communicate with those in our lives, and express our ideas. Any difficulty or delay in language has an impact on our participation in a group, our ability to understand information and follow directions, the amount of time needed to process and demonstrate understanding, and perceptions among our peers.” In young children, like Jackie, language-based learning disabilities make it difficult to communicate the challenges a child experiences in school. This, in turn, can lead to symptoms that appear to be behavioral, like difficulty resolving conflicts with peers. Similarly, a child with receptive language delays may need more time to process verbal instructions than a typically developing child. If these delays go undiagnosed, they can be mistaken for the same willfulness Jackie’s parents experienced. “If all a child has to rely upon to communicate his or her need is behavior, it can appear as though the child is being oppositional. Too often, the response in schools is to address a behavior instead of treating the underlying cause of the problem, the deficits in a child’s language skills,” says Dr. Brockhausen. “Oftentimes, people don’t begin to look for language-based learning disabilities until it becomes obvious a child is having difficulty learning to read or write. “Additionally, people underestimate the impact of these challenges on a child’s experience. Our society places great emphasis on the level of book a child is reading. The attendant social capital can evoke anxiety in the child coping with a language-based learning disability that inevitably affects their school experience and their perceptions of themselves as a learner.” The experience of a child like Jackie is not uncommon. It wasn’t until her reading assessments showed her below the expected developmental level that a language-based learning disability was considered. Many children make it to middle school or beyond by employing coping strategies to fill in gaps. Most children with language-based learning disabilities, however, only thrive in an academic setting that is structured to accommodate their needs. This is due in part to the fact that their challenges don’t change with age, although they may manifest differently in an older child. At The Gateway School, students with languagebased learning disabilities become skilled, strategic learners and confident self-advocates because of a research-based pedagogy and an empathetic approach to learning. Relying on direct, multisensory instruction and guided by an integrated curriculum, expert faculty teach students the language, literacy,


and critical thinking skills that are the foundations for success in mainstream educational settings and beyond. The program is strengths-based, but focused on remediating language, because it is the vehicle for understanding and self-expression. Consistency, a commitment to professional development, and a holistic approach to teaching make Gateway’s approach effective. Teachers at Gateway know that they can’t assume a student understands directions, and so they are trained to employ strategies that support student success. For example, every class, regardless of subject matter, is guided by an Aim and an Agenda. This outline specifies the lesson’s goal and the steps in the learning process that reaches that goal. The steps on the learning path are made obvious to students, and the teacher models the thought process involved with each step. This consistent approach helps students who struggle to process instructions stay on track and manage their anxiety. Through an ongoing professional development program, teachers are taught how to use language as they teach, how disruptions or delays in the development of students’ language abilities impact their thinking and learning, and how to integrate language instruction into all the content areas. Expectations for students always remain high, but lessons may be broken down into smaller parts, and teachers will be very deliberate in their own word choices and the level of complexity used. A student may be given additional time to process directions or be asked to repeat back steps to a teacher to ensure they fully understood the instructions. Gateway takes all aspects of a student’s development into consideration, in particular how language affects the student’s thinking, feeling, and learning. Taught according to a defined curriculum and in small classes, students participate in group learning led by faculty skilled in direct, explicit, and multisensory instruction who are able to individualize instruction in response to a student’s needs. All of this is meant to support a student’s understanding of how they learn best, a concept commonly referred to as metacognition. By actively teaching students how to manage their own learning, Gateway’s approach to education has a transformative effect on their lives. Once diagnosed with a language-based learning disability, the importance of a school setting like Gateway for a student like Jackie cannot be underestimated. By recognizing the importance of language in all areas of life, Gateway’s program can allow Jackie to experience academic and social success, recognize her strengths, and be empowered to become a lifelong and independent learner. n


Article 2: What is Executive Function Disorder?

W Eleni Siderias Associate Head of School The Gateway School

alter is entering his junior year of high school. He wants to apply to college next fall, and he knows an impressive transcript these next two semesters could really help expand his list of choices. In addition to his academic course load, he’s once again playing trumpet in the marching band and will be swimming for the varsity team this year. On any given day it’s a lot to manage, but he’s up to the challenge. In fact, Walter prides himself on being one of the most organized kids in his class. This was certainly not always the case. In elementary school, Walter was always described as a bright kid. He was also always described as forgetful. Whether it was a notebook left at home or a jacket left on the playground, barely a day went by without Walter losing track of some personal item. With an IQ well above average, he perfectly embodied the absentminded professor trope. Oftentimes, Walter’s forgetfulness was so acute that he could be in the middle of an assignment, become distracted by something a classmate said, and be completely unable to regain his focus on the lesson at hand. Other times, he would become so fixated on a minor detail he would lose track of the big picture and was often left to finish incomplete classwork at home. The problem was that by the time Walter got home, practicing his trumpet or a FaceTime call from his cousins would completely push his homework assignments out of mind, and they would go unfinished. By fifth grade, things really started to unravel. Walter’s desk was forever messy, his locker was a certified disaster area, and his backpack was essentially a black hole with papers shoved in at random moments of the day, never to be seen again. Homework didn’t get submitted, and Walter struggled to remain focused when transitioning

from class to class. When routines or plans changed, Walter could quickly become irritable, which was frequently causing conflict with his classmates. What was once laughed away as quirky and distracted was now presenting as symptomatic of something else: executive function disorder. The Center on the Developing Child at Harvard University describes executive function and selfregulation skills as “the mental processes that enable us to plan, focus attention, remember instructions, and juggle multiple tasks successfully. Just as an air traffic control system at a busy airport safely manages the arrivals and departures of many aircraft on multiple runways, the brain needs this skill set to filter distractions, prioritize tasks, set and achieve goals, and control impulses. Executive function and self-regulation skills depend on three types of brain function: working memory, mental flexibility, and self-control. These functions are highly interrelated, and the successful application of executive function skills requires them to operate in coordination with each other. Each type of executive function skill draws on elements of the others.” Working memory describes a person’s ability to process and use discrete amounts of information. It is part of our short-term memory system and is crucial to learning because it allows the brain to keep track of information until it needs to be used. Mental, or cognitive, flexibility describes a person’s ability to switch thinking between two or more topics, or to think about multiple things simultaneously. The capacity to switch back and forth between tasks and incorporate new instructions in the middle of a task is governed by a person’s mental flexibility. Self-control describes the individual’s ability to regulate their thoughts, emotions, and behavior. It allows for prioritizing and goal-setting and supports one’s ability to resist impulses and temptations.


Attention-deficit/hyperactivity disorder (ADHD) is a type of disability that impedes a person’s ability to self-regulate. Someone with executive function disorder has a combination of challenges with working memory, cognitive flexibility, and self-control. Weaknesses in any of these three types of brain function have a meaningful impact on learning. If a task is automatic, then executive functioning and self-regulation skills are not engaged. With tasks like writing and speaking, however, the brain relies significantly on working memory, flexible thinking, and self-regulation. “In many ways, the three brain functions that executive functioning depends upon are essential to academics,” says Eleni Siderias, Associate Head of School at The Gateway School. “If a student has an executive function disorder, they may cognitively understand subject matter but can’t manage their thoughts, stay organized, recall information, motivate themselves to start their work, or manage the anxiety that attends all of that.” For any student with executive function disorder, the essential challenges of organization and planning interfere with language in several ways. These students struggle with spontaneous speech and have problems with self-expression (pulling ideas together in logical order, finding the right words), placing the burden of interpretation on the listener. The student, pressed to stick to his point and maintain organization, tends to be concrete or inflexible. This can result in misunderstanding with academic and social ramifications. Walter’s messy desk and disorganized backpack were classic symptoms of an executive function disorder. So too was his forgetfulness and his outbursts in the face of unexpected change. That’s because his working memory wasn’t helping him recall information correctly; he did not have the mental flexibility to switch between tasks easily, and he couldn’t regulate his emotions. For Walter to become such a successful student in high school, he would have needed an environment like Gateway to prepare him. “At Gateway, we have high but consistent expectations for all students,” says Ms. Siderias. “We want them to be strategic in their approach to learning, self-motivated, and have the metacognition necessary to manage their own learning challenges. Gateway is very intentional in this approach and individualizes it to each student.” Understanding that a child’s world is school, Gateway’s near-term focus is on teaching children how to navigate the academic and social aspects of the classroom so they can succeed there, as well as at other times throughout the school day. Students are taught self-awareness, the skills of


self-advocacy and social communication, and the essential qualities of good character: temperance and compassion. Gateway’s approach acknowledges that its students learn in ways that are different from their mainstream peers; as they benefit from instruction that truly meets their needs, they become skilled, strategic, independent learners increasingly ready to meet the demands of mainstream education and life. Helping students with executive function disorder regulate their emotions is a central feature of Gateway’s program. “For a child with a dual diagnosis of a language-based learning disability and ADHD or an executive functioning disorder, selfregulation becomes more complex,” says Dr. Christy Brockhausen, Director of Lower School. In the Lower School, students are introduced to the Zones of Regulation®, a framework developed by Leah Kuypers, MA.Ed., OTR/L, to help students foster emotional regulation and self-control. This program aligns with Gateway’s focus on explicit, systematic, and cognitive linguistic teaching. Lower School students first learn the language needed to identify, label, and categorize their feelings and then are explicitly taught strategies and methods that empower them to problem solve and, in turn, regulate their response to challenges. As they grow older, through one-on-one advising and small group work, students practice strategies that enable them to pause and reflect before responding or reacting. Academic instruction is also structured to meet the needs of students who struggle with executive functioning. Teachers employ direct, multisensory instruction and never assume that students know how to complete a task. By providing clear routines and explicit steps to follow, students stay on task and manage their stress levels, and learning proceeds. At the beginning of each day, students get an executive functioning “boost” in homeroom, when they review expectations and goals for the day. The Aim and Agenda reinforces this by providing structure for each class. Direct instruction supports students in knowing what to do, how, and why. In combination, these approaches to instruction assist a student with maintaining focus and anticipating learning that might require a specific strategy. Guided practice, thinking out loud, and using timers are all strategies employed to teach younger students how to maintain attention and strengthen their working memory. Story Grammar Marker® is an example of a framework used specifically to help students understand the structure of narrative text that is read out loud. An important feature of instruction at Gateway is that teachers always explicitly model the tasks they want students to complete. Skills are built incrementally. Teachers allow plenty of time for repetition. And, they are reinforced across subject SPECIAL REPORT

areas. Writing, for example, begins with the creation of an outline and is done collaboratively many times before a student is asked to write independently. Students at Gateway are also given practical tools to help them stay organized and focused. Older students are each issued a zippered binder to keep their schoolwork organized. They also receive colorcoded folders for each subject, with one side of the folder meant for completed assignments and the other for work that needs to be done. A student planner is used to practice organizing time and keeping track of due dates. Teachers, and eventually students, will estimate how long an assignment should take to be completed, so each student can track their progress against that expectation. Students receive immediate feedback that not only measures the quality of the work, but also assesses

how well the student demonstrated their use of strategies and skills to stay on task and manage their time. For a student like Walter, this approach can be transformative. By spending so much time developing consistent routines, Walter’s strategies became automatic, which reduced cognitive load and mitigated his anxiety. By the time he reached high school, he was better equipped to manage the demands of school than many of his typically developing peers. “What is most effective about an approach like Gateway’s for a student with executive function disorder,” as Ms. Siderias explains, “is that process is emphasized as much as product. Gateway knows that a student has to be aware of their challenges and gaps before they can begin to regulate them.” n


Article 3: What is ADHD?


magine yourself driving a car. You are making your way along a narrow, winding, mountain road. You steer the car around curve after curve high above the valley floor that stretches out below you. To your left is the mountainside, to your right a steep dropoff. There is no guardrail. You are driving at 60 mph, and your car has no brakes. Now, imagine the home screen of a laptop computer. There are dozens of windows open and dozens more files saved to the desktop. There are so many tabs and files open, that you struggle to read their labels. Among all of these, you have to find a single window, but your search function is disabled. You try your best to sort through it all, closing out what you know isn’t relevant. Every time you close one window, however, two more randomly open. Now, imagine you have a smart phone. Notifications for every single app on the phone have been turned on, and each has been assigned a unique ringtone. Every news alert, text message, social media like and follow, advertisement, and update sets your phone buzzing. It is a cacophony of ringtones, and the picture on your home screen is buried under a steady stream of notifications resembling a stock ticker. Although no metaphor can truly capture his dayto-day experience, each of these hints at what it is like inside the mind of Louis, a child with attentiondeficit/hyperactivity disorder, also known as ADHD. The National Institute of Mental Health (NIMH) defines ADHD as “a brain disorder marked by an ongoing pattern of inattention and/or hyperactivityimpulsivity that interferes with functioning or development.” Inattention describes a tendency for the mind to wander, to have difficulty focusing, and to be generally disorganized. These tendencies are involuntary. A hyperactive person is always moving around, without regard to (or understanding of) whether it is an appropriate time to do so. Fidgeting, restlessness, and excessive talking are also signs of hyperactivity. This feature of a person with ADHD can be particularly taxing on those around them and in children can lead to conflict with peers. Some children exhibit a mixture of inattention and hyperactivity. Impulsivity causes a person to act without thinking about potential consequences and to seek out instant gratification. The impulsive person often engages in risky behavior and does not pick up on social cues or norms. This was the experience of Louis. Even in preschool, he was a hyperactive child who found it


almost impossible to sit still for any extended period of time. While playing with his peers, his attention would dissolve quickly, and he would abandon one group for another unexpectedly, forcing himself into the middle of a game without being invited or waiting his turn. He would often run around the classroom during quiet play times, and frequently blurt out comments in the middle of story time, which were often off-topic. Louis also struggled with inattentiveness. He never seemed to be listening when spoken to, which was frequently interpreted as defiance. The fact that he often didn’t follow through on instructions reinforced the perception that he was willfully ignoring adults and authority figures. In fact, Louis’s mind was like the driver of that car on the mountain pass. At times it was so singularly focused on keeping the car on the road, so to speak, that it tuned out any input it considered a distraction. Louis avoided tasks that required sustained focus, like sitting down quietly in a circle with his classmates for story time, because his brain was already taxed by the amount of information it had to process in any given moment. While this and the other metaphors above attempt to capture the feeling of living with ADHD, the reasons behind it are more scientific. ADHD is a complicated neurological disorder. Studies have shown that people with ADHD have low levels of norepinephrine, which is a neurotransmitter

William Harrison, Ph.D. Social Development Psychologist Gateway’s Middle School


that works in concert with dopamine. Dopamine is the “feel good hormone” that controls the brain’s pleasure centers. Four regions of the brain have been shown to be impaired by ADHD: the frontal cortex, the limbic system, the basal ganglia, and the reticular activating system. The frontal cortex is responsible for high-level functions like attention and organization. This is also the region of the brain that manages executive function. People with ADHD also struggle with executive function disorder. The limbic system helps us regulate our emotions, something people with ADHD can have trouble doing. The basal ganglia are involved in a variety of brain functions. In the ADHD brain, this region will often malfunction, which results in inattention and impulsivity. The reticular activating system helps relay signals across the brain and the rest of the nervous system. Deficiencies in this region of the brain lead to impulsivity and hyperactivity. Attention-deficit/hyperactivity disorder has a real and sustained impact on neurological function. This is crucial to understand in order to avoid misdiagnosis in children. As Caroline Miller of the Child Mind Institute explains, “It’s important to keep in mind that not every high-energy or impulsive child has ADHD. Children are diagnosed with ADHD only if they demonstrate these symptoms so often that they are causing real difficulty in at least two settings—i.e., at school and at home. And the pattern that’s causing them serious impairment must persist for at least six months.” So much of the ADHD student’s experience is ‘discontinuous,’ all sorts of gaps in their language and learning develop, in addition to the observable behaviors that are disruptive in the classroom and/ or irritating to peers. Since all ADHD students also have executive functioning issues, they suffer from not only weak foundations, but also from an impoverished ability to demonstrate their conceptual understanding. It is difficult for a child like Louis to succeed in a classroom designed for neuro-typical learners without major supports. To extend the earlier metaphor, the student with ADHD needs guardrails put in place to help keep them on track.

The educational philosophy and curriculum of The Gateway School provides the type of structure and routine that helps a student like Louis thrive. At Gateway, the focus on direct, multisensory instruction dramatically improves the on-task behavior of students with ADHD. By engaging directly with a student like Louis, rather than assigning him independent activities, a teacher can help minimize inattentiveness. Lessons that engage the auditory, visual, and kinesthetic sensory receivers in combination also help keep students with ADHD focused and learning. The consistency of Gateway’s classroom environments, including a high level of structure, direct and explicit instruction, and teacher modeling, reduces the load placed on students’ executive functioning skills and scaffold their effort to implement strategies for selfregulation. As William Harrison, Ph.D., Gateway’s Middle School Psychologist, explains, “If a student has a question about what they should be doing, they can usually find it within the predictable structure and routine of the school day. You know where to hand in your homework because it’s always the same. This encourages self-regulation and autonomy and helps mitigate impulsivity.” Dr. Harrison runs social development groups for Gateway’s Middle School students. Consisting of about five students each, these groups meet once a week to discuss various topics and to address communication problems and learn new skills. By working in real time on aspects of communication, like using and reading non-verbal cues and perspective taking, students learn from their peers how to interact more effectively. This type of peerto-peer feedback suits the needs of learners with ADHD. A supportive academic environment, combined with early intervention, can set a student like Louis up for a lifetime of success in and out of school. As Ms. Miller notes, “It’s important for parents to get a good diagnosis from a mental health professional who takes the time to carefully consider the pattern of a child’s behavior and what it might (and might not) indicate. Being not only caring, but also precise about defining and treating a child’s problems when he is young, pays off many times over in the long run.” n

At Gateway, the focus on direct, multisensory instruction dramatically improves the on-task behavior of students with ADHD.


Article 4: Why is Language So Important for Learning?


s her students make their way into her class, settle into their seats, and pull out notebooks and tablets, the teacher poses a question for the students to consider: “How are we violating a person when we deny them the right to vote?” It is a provocative and effective conversation starter among a classroom full of school-aged children and a way for the teacher to assess whether or not her students can pick a position and convincingly substantiate their opinions. Participating successfully in a classroom discussion such as this requires a broad range of language skills. To actively and effectively engage in a classroom debate, a student must use their thinking skills (evaluation, judgment, reason), find the right words to articulate their position, create a series of clear sentences that capture their logic, hold on to the argument while listening critically to others, and support their argument when the classmates challenge it with questions and counterarguments. The demands of classroom discourse are not altogether different from what’s called for during a lively dinner table conversation or an exchange with teammates on the playing field. For a typically developing child, all of these experiences draw on and simultaneously reinforce the development of their language skills. For a child with language impairment, however, these skills do not develop at the same pace as their peers, which can have a deep impact on their school experience. “People hear the word ‘language,’ and they think French, German, Italian,” says Lydia H. Soifer, Ph.D., Assistant Professor of Pediatrics at Albert Einstein College of Medicine and the Staff Developer at The Gateway School. “Language is a remarkable gift given to us. Yet, we rarely think about it because no one’s parents teach the particulars, such as ‘add an “s” to a word when you mean more than one.’ Parents just talk with their children and correct the obvious mistakes. But when your child cannot learn the details of his or her language independently, it will lead to trouble learning in school. School is all about language no matter what subject is being taught.” In 1978, Lois Bloom and Margaret Lahey published their seminal book on language development. They conceptualized language as comprising three separate but overlapping components: content, form, and use.

Content encompasses our knowledge and ideas about the world, concepts, and words. Vocabulary and all that we know about words and their connections, called semantics, make up language content. For example, content includes everything from the items that belong on the dinner table such as ‘glass,’ ‘napkin,’ or ‘fork,’ and the purpose of a meal which might be ‘nutrition,’ ‘family,’ or ‘socialization,’ to what is learned in the Humanities class referred to earlier. ‘Violation’ is a word, a world issue, and a concept. The student who can’t understand the definition, “the act of violating someone or something,” won’t be able to distinguish or easily distinguish the magnitude of different types of violations (e.g., traffic ticket, hitting, denying a person’s rights). This limitation in understanding will be reflected in their world view. Ultimately, a child’s language content involves having something to say, to understand, to read, or to write. Form refers to the observable features of language, the parts that are easiest to hear and see. It describes the structure or rules for combining sounds into words and stringing words together to form sentences reflecting complete, logical thought. Language form is essential for speaking, listening, reading, and writing. Imagine, for example, taking a spelling dictation in a second grade reading class, writing an essay, or following homework instructions. Phonology, morpology (parts of words, e.g., ‘hats’), grammar, and syntax are central features of this domain. Form is the means by which we share our ideas when speaking, listening, reading, or writing. Use, also known as social or pragmatic communication, relies in part on the integration of content and form. It matters not only in a conversation with friends, but also in the academic setting. For example, it is important for comprehension when reading about a character’s intentions or analyzing an author’s purpose. When writing, it guides student intent, leading them to choose words for a persuasive argument that differ from those employed in a narrative. Language use is very complex and subtle. It is all the reasons we speak, attempt to understand, to read, or to write. As Heather Ironside, Director of Language and Literacy at The Gateway School, explains, “Use really draws the content and form together and is the highest goal of language to be an effective communicator.

Heather Ironside Director of Language and Literacy The Gateway School

The foundation of language and literacy upon which our mission was built has never faltered.



Lydia Soifer, Ph.D. Consultant The Gateway School

“Consider the statement, ‘Wow, it’s really cold in here!’ This comment correctly brings together vocabulary and grammar, but what is its purpose? Is it to get the listener to do something about the temperature? Is it just an observation? To the language-impaired student, the intent can easily be unclear.” Students with a language-based learning disability typically misuse pronouns (‘them’ vs. ‘he’), verb tenses (‘drawed’ vs. ‘drew’), and prepositions (‘to’ vs. ‘on’). Their sentence structures are awkward and their word-finding difficulties are pervasive. They overuse ‘do,’ ‘make,’ ‘go,’ and ‘thing.’ The neural network for higher-level vocabulary characterized by categorization, associations between synonyms, homonyms, and antonyms, meaning changes to root words with the substitution of prefixes or suffixes, and more does not develop. The absence of an expansive vocabulary and grammatical sentence structure caps a student’s ability to express themselves. Rather than describing someone as ‘kind’ or ‘fair’ depending on the situation, everyone is ‘nice’ or ‘very nice’ regardless of context. Similarly, a child may say that their parent always gets ‘mad’ at them, relying on this one word to represent a fuller range of emotions (disappointed, sad, frustrated, irritated) because their vocabulary hasn’t developed as fully as it might. Communicating wants and needs is hard for a student with a language-based learning disability, just as it is difficult to correctly perceive what others are doing or saying, because the student’s ability to make sense of their experience is compromised. The result is frustration and miscommunication. Often the student feels defeated. This lack of language can also cause a student to plateau in their emotional development. In the classroom, this lack of higher-order vocabulary does not just manifest in expressive language, but also in how they think about words and concepts. In the brain of a typically developing child, for example, ‘fire truck’ is linked to ‘red’; ‘red’ is also linked to ‘heart,’ ‘passion,’ and ‘danger.’ At higher levels of reading comprehension, a student doesn’t need to be told explicitly why Nathaniel Hawthorne chose to use a scarlet letter, as opposed to a blue one. The student is able to move from a literal understanding of text to an understanding of similes, the interpretation of symbols, or the identification of themes. When there are gaps in the development of this complex language network, the ability to progress to reading levels that require inferencing is impaired.

language-impaired students? At The Gateway School, the core of the curriculum is instruction in language and literacy. “Facility in the use of language—whether thinking, listening, speaking, reading, studying, or writing—is prioritized across the grades. These are the foundations of the cognitive linguistic approach utilized in class instruction. Cognitive linguistic instruction entails instruction in how to use language for thinking and learning,” says Ms. Ironside. In a language-rich environment, Lower School students acquire fundamental academic and organizational skills, along with the interpersonal skills essential for success in school and in life. During the elementary school years, the emphasis is on how to learn, and the acquisition of language and literacy skills is paramount. Through their successes in the classroom and as they participate in school life, students develop the self-confidence that inspires them to assume responsibility for their own learning. As awareness of their unique learning needs emerges, Lower School students develop the early skills of selfadvocacy and are ready to meet the challenges of Middle School. With readiness for college-preparatory high school as their goal, Middle School students continue to focus on language and literacy, as well as applying academic and organizational skills and strategies. This progression enables them to apply the skills and strategies necessary to tackle more complex academic material, learn the value of good study habits, develop sound social values in the face of complicated social experiences, and realize the benefits of contributing to a community. Students reflect regularly on how they learn and become more self-aware. As real accomplishments begin to define Middle School students, their self-confidence grows, and they display greater curiosity and motivation to learn. On the path to becoming strong self-advocates, Middle School students learn how to ask for the specific supports or accommodations that allow them to do their best work. The foundation of language and literacy upon which our mission was built has never faltered,” explains Sharyn Lico, Gateway’s Director of Academic Support. “A commitment to this approach, consistency in its delivery, and acknowledgment of the importance language plays in all learning has made the school particularly adept at serving the needs of language-impaired students.” n

Since language is so central to the learning process, how then can schools accommodate the needs of


Article 5: Why is Language So Important for Social Development and Emotional Growth?


hen we think of school, we most often think of it as a place that supports the intellectual development of children. Great schools, however, understand that cognitive development is only one facet of a child’s growth. Other important features include language development, social development, emotional development, and physical development. Each has its own markers and stages of progression. They are all, however, profoundly connected. “The various aspects of child development are like strands in a braided rope,” says William Harrison, Ph.D., Middle School Psychologist at The Gateway School. “It’s almost impossible to talk about one without referencing the others.” Intellectual development describes the kinds of cognitive skills that children develop at various stages of life. These include memory, problem solving, creative thinking, and learning. Physical development describes the growth of a child’s body and the development of fine and gross motor skills. It also marks a child’s ability to move about and interact with the world around them. Language development describes the process of understanding and communicating. Typically, receptive language skills develop before expressive language skills. Social-emotional development describes how children develop the ability to express and control their emotions and to interact in appropriate and satisfactory ways. These last two facets of child development– language and social-emotional growth–are inextricably linked. Social interactions are the basis for language development, and effective social interactions depend on language. Early language development is primarily based on the relationship between a child and caregiver. Babbling is the initial stage during which a child tries to use verbal sounds to communicate thoughts and emotions. Language is not formally taught. Instead, the adult labels the child’s experiences and emotions, and they learn vocabulary, syntax, grammar, and tone through trial and error. Lydia H. Soifer, Ph.D., Assistant Professor of Pediatrics at Albert Einstein College of Medicine and the Staff Developer at The Gateway School, recounts the time when upon seeing her sons sitting in a twin stroller, a child described them as “a baby and a co-baby.” On another occasion, a child explained the positioning of a couple of objects as “side by


each.’’ Such mistakes are commonplace, frequently endearing and, once gently corrected, fleeting. The exchanges between a caregiver and child, known as reciprocity, teach the child language and how to use it in a social context. According to American Speech-LanguageHearing Association (ASHA), pragmatics refers to “the rules associated with the use of language in conversation and broader social situations.” In social situations, pragmatic language describes a person’s ability to know what to say, how to say it, and when to say it. For reading comprehension, it refers to comprehending the author’s point of view, the audience’s needs, or the intention of a message. Eleni Siderias, Associate Head of School at Gateway, explains, “It is common for students with language-based learning disabilities to encounter conflict due to the misuse or misunderstanding of language.” Harry will excitedly tell Dylan, “You must go to Space Mountain!” Dylan’s grasp of language is concrete, so he misses tone. He exits the conversation angry and indignant. He believes Harry is bossing him around. Before the weekly art class, Kerry appears in the division director’s doorway repeating, “It’s time for art. It’s time for art.” She sends her on to class where Kerry drops her head to the table and after the teacher finishes giving directions, stands up and storms out. Kerry is so embarrassed and scared, she is unable to explain that she cannot follow the directions and is haunted by the terrible experience she had with last year’s art teacher. A student with a language-based learning disability may misuse language unintentionally, struggle to describe emotions, misperceive others intentions, and more. Not only is language at the heart of social interactions, meeting the child’s need to communicate, to express ideas and emotions, and to engage socially, it also plays a role in their internal development. Language is crucial for the self-reflection that is the basis for self-regulation and maturation. It is the tool a child uses to process experiences and learn new behaviors. “As a child matures, so do language expectations,” says Heather Ironside, Director of Language and Literacy at Gateway. “There are milestones within language that call for more sophisticated usage as children grow older.” For example, sarcasm and slang emerge in adolescence alongside the ability to distinguish when it is appropriate or not. Peers, teachers, and

Lauren Feiden, Ph.D. Social Development Psychologist Gateway’s Lower School


other adults employ increasingly nuanced language that also becomes more abstract and demands the listener infer meaning. Discussions in class, like conversations by the lockers, assume an ever more sophisticated language system. A treasure trove of words that are organized and associated, convertible to alternate forms or meanings, is employed flexibly. The norm is facile use of grammar and syntax to sequence words and create sentences that express simple to complex thoughts. As language develops, the ability to name and analyze one’s own feelings and the feelings of others, and to adjust self-expression and behavior to suit social situations, expands. “For a child with a dual diagnosis of language-based learning disability and ADHD, self-regulation can be even more difficult,” says Dr. Christy Brockhausen, Director of Lower School. “If all a child has to rely on to communicate his or her need is behavior, it can appear as though the child is being oppositional. Too often, the response in schools is to address a behavior instead of treating the underlying cause of the problem, the deficits in a child’s language skills.” The Gateway School recognizes the importance of language skills for social and emotional growth. “We think about language–not just the language needed for academics, but also the language children need to understand and express themselves in various social contexts,” says Ms. Ironside. In small groups, students participate in discrete language therapy

and social development sessions. These classes directly connect language with social-emotional development. Students are seen in the same groups so they learn skills in each developmental strand in a consistent and coordinated fashion. For example, in Lower School, a group will be directly taught the language for a conversation and then practice reciprocal conversation. In social development, they will approach conversation by learning what to talk about, examining the impact of their word choices and phrasing, and how to manage their impulses and emotions. Through adult modeling and by reconstructing conversations, students ensure the intended meaning is clear and their understanding of what was said is clear. In Middle School, the language therapist and school psychologist address skills such as taking perspectives, how to joke appropriately, and how to self-advocate and advocate for others. To foster healthy social-emotional growth, teachers do not merely encourage students to treat each other with respect; they explicitly show them how to empathize or self-advocate. At Gateway, the approach to socialemotional learning revolves around the idea that the school has to teach skills directly. “By graduation,” says Dr. Harrison, “our students are self-reflective, know who they are and where they came from, and can handle themselves well in lots of situations they would have found challenging.” n

Article 6: Diagnosis and Treatment/Intervention

I Carolyn Salzman Head of School The Gateway School

n a widely circulated essay, Emily Perl Kingsley compared her experience of raising a child with a disability to planning a much-anticipated trip to Italy, only to find that her plane had landed in Holland. At first, there was surprise and anxiety that she hadn’t reached her desired destination. But soon, she came to realize all of the joys and wonders that Holland has to offer. For a parent with a child who has a learning disability, this sense of surprise can make it hard to figure out how to begin to support a child’s needs. With a first or only child, parents don’t have a reference point, so they may not even know if anything is amiss. When it comes to language-based learning disabilities, attention-deficit/hyperactivity disorder (ADHD), and executive function disorder, many children don’t present symptoms until preschool or later. A bright child can mask their difficulties for years.

“Despite the presence of specific disorders that are readily apparent to the trained eye, parents can be so successful at scaffolding and intervening in support of their child, it becomes harder for them to embrace the extent or implications of their child’s issues,” says Carolyn Salzman, Head of School at The Gateway School. “Often, it is not until the demands of homework, the inability to solve word problems in math, or the struggle to write a three-paragraph essay are so overwhelming for the child that parents are persuaded to take a close look. The loss of time on the field with a beloved sports team can also motivate parents to seek answers because suddenly it’s clear the child doesn’t understand the coach or cannot remember the rules and plays.” If a parent suspects there are issues affecting their child’s development, a first step is a conversation with their child’s pediatrician. The child’s doctor can measure their progress against expected developmental markers and highlight any areas of concern.


Often, it will be a child’s teachers who notice delays and communicate these to parents. At this point, an important step is to schedule a neuropsychological evaluation with a licensed school or clinical psychologist. This evaluation and a language evaluation are valuable tools for parents advocating for their child and the schools dedicated to teaching them. The Division of Child and Adolescent Psychiatry at the Department of Psychiatry of Columbia University’s College of Physicians and Surgeons, defines a neuropsychological evaluation (also called neuropsychological testing) as an in-depth assessment of skills and abilities linked to brain function. This type of evaluation measures such areas as attention, problem solving, memory, language, intelligence, visual-spatial skills, academic skills, and social-emotional functioning. Its purpose is to identify a child’s strengths and weaknesses across a range of skills and propose strategies to support development or remediate weaknesses. A psychologist will administer a battery of tests and using standardized measures, assess and report on quantitative and qualitative information gleaned over the course of several sessions. The psychologist assesses not only specific strengths and weaknesses, but also the child’s behavior throughout. The typical report is long and describes the results and observations and discusses the linkages between any deficits it uncovers. In addition to a diagnosis, the psychologist will note behaviors that are possibly indicative of a disorder. While they may not meet the criteria for a diagnosis, they may be something parents should track. Parents are well advised to repeat this testing periodically. As children age, a disability can emerge more fully. Moreover, the tests change. The tests for older children are more language laden than those for preschoolers, reflecting the normal developmental arc of children. A neuropsychological evaluation can be a valuable resource for parents because it offers insight into a child’s difficulties at school and at home by identifying areas of weakness, explaining their academic and social implications, and recommending therapies,

supports, or medications. Lauren Feiden, Ph.D., Lower School Psychologist at The Gateway School, compares this type of evaluation with a psychoeducational assessment completed by a Board of Education. “While the latter gives a basic understanding of a child’s intellectual capacity and learning differences, a neuropsychological evaluation offers parents the full picture. It can help them understand how their child learns and why, what they are capable of, and how they can help their child be and feel successful in school.” By middle school, some children are sufficiently aware of their problems that hearing the test results from the psychologist demystifies their school experience and is a source of relief. Speech and language therapy addresses the needs of people with speech and communication disorders and is administered by a speech-language pathologist. According to the American Speech-Language-Hearing Association (ASHA), speech-language pathologists (SLPs) work to prevent, assess, diagnose, and treat speech, language, social communication, cognitive communication, and swallowing disorders in children and adults. Counseling or psychotherapy addresses the child’s emotional and behavioral symptoms with the goal of increasing self-awareness, coping skills, and stamina. Through counseling, the child learns how to self-reflect and control their impulses. Parents can learn how to manage the child at home and to collaborate with the school on behalf of their child. Medications are sometimes recommended for children who have been diagnosed with conditions like ADHD. When medication is introduced, parents are often encouraged to also engage counseling. The Multimodal Treatment of ADHD (MTA) study, funded by the National Institute of Mental Health (NIMH), showed that children receiving a combination of medication and counseling demonstrated significantly higher improvements in problem behaviors, and that these benefits lasted longer than treatment or medication alone.

Open communication and regular meetings between parents and their child’s team guide a family to a better understanding of how their child learns.



Occupational therapy can help children with physical, cognitive, or sensory disabilities. According to the American Occupational Therapy Association (AOTA), in addition to dealing with someone’s physical well-being, OT practitioners address psychological, social, and environmental factors that can affect functioning in different ways. Recommendations can also include participation in remedial programs, enrollment in special school settings, and a range of study skills or learning strategies that will support the student academically. Once a diagnosis has been confirmed and a psychological evaluation is completed, an important next step for a child in a public school is the development of an Individualized Education Program, or IEP. The Individuals with Disabilities Education Improvement Act of 2004 (IDEA) requires public schools to create an IEP for every student with a disability who is found to meet the federal and state requirements for special education services. Once completed, the IEP will include which services are mandated in order to ensure that student can progress in the least restrictive school setting. In addition to being an academic document, the IEP is also a legal document. A second type of evaluation, a language evaluation, provides a specific analysis of a child’s language system. The state of a child’s language system governs how they will use language to process information and learn. For example, limited working memory can influence language-based tasks such as sentence repetition or recalling details of an instruction or a story. The disorganization typical of executive function disorder will reduce a child’s ability to answer an open-ended question (“Tell me all about the birthday party.”) but have more limited impact on responses to multiple-choice questions. A language evaluation can illuminate where the underlying breakdowns are in aural comprehension, acquiring basic and more mature literacy, as well as in other academic skills. Additionally, the results of a language evaluation can guide both therapists and teachers. Lydia H. Soifer, Ph.D., Assistant Professor of Pediatrics at Albert Einstein College of Medicine and the Staff Developer at The Gateway School, stresses the importance of language evaluations “that analyze and interpret test demands as well as the quality of student responses for their potential impact on learning, versus simply providing test administration and score reporting.” A licensed language therapist conducts the evaluation, which is structured and administered

in very much the same way as a neuropsychological evaluation. In this instance, the focus is exclusively on language: vocabulary, syntax, listening skills, verbal reasoning, discourse, etc. To fully understand the impact of the child’s developing language on academics, the therapist will likely take aspects of the neuropsychological evaluation into consideration. In some cases, the consulting psychologist and/ or language therapist conducting the evaluation will recommend that a child attend a specialized school, like The Gateway School. This type of school usually targets a specific population and designs its program to remediate their particular learning disabilities and educate them. The student-teacher ratios are often low and classes are small. This means students receive a lot of teacher attention and, depending on the school, individualized programming. To be sure the school can meet a student’s needs, the admissions process frequently includes additional assessment by the school’s own educational and therapeutic experts. Once a student is admitted, Gateway has many supports in place to ensure they are successful. Teachers employ direct, explicit, and multisensory instruction, use language carefully so as to not overwhelm them, and breakdown skills so the student is motivated by incremental successes. Several related services are provided by in-house staff. These include language therapy, occupational therapy, and counseling. Importantly, these services are done during a therapy block so that students aren’t pulled out of other academic classes, as may be done in a typical mainstream public school. Above all, Gateway’s placement of students within its program is driven by the learning profile of the student, and it stresses partnership with the family. In a program that meets students at their level and teaches skills, strategies, and content incrementally, sequentially, and consistently using instructional approaches validated by research, students become skilled and strategic independent learners. Open communication and regular meetings between parents and their child’s team guide a family to a better understanding of how their child learns. With time, families are able to recognize how their child’s disabilities manifest themselves in and out of school and the kinds of age-appropriate, effective strategies that can support them. Fortified, parents are able to fully enjoy all the wonder their child has to offer. n


The Gateway School is a K-8, independent day school that transforms the lives of bright students with language-based learning disabilities and attention deficits. At Gateway, our students become skilled, strategic learners and confident self-advocates. Relying on direct, multisensory instruction and guided by an integrated curriculum, expert faculty teach students the language, literacy, and critical thinking skills that are the foundations for success in mainstream educational settings and beyond. Gateway believes a close relationship between the school and parents provides essential support as students grow and seek to realize their potential. In small classes and as members of a diverse and inclusive community, Gateway students experience academic and social success, recognize their strengths, and are empowered to become independent learners.

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