Learning Disorders and Disorders of the Self in Children and Adolescents

Abstract

As stated in the preface, the major thesis of this book is that psychological deficits that children and adolescents with learning disorders have, play a critical role in their development of a “sense of self”, as well as in their creation of a “self-narrative”. In this book the author argues that the presence of learning disorders and specifically of the neuropsychological deficits at the core of learning disorders create disorders of the self in the process of the child’s unsuccessful attempts to cope with some developmental challenges. The author includes the following in learning disorders: attention deficit hyperactivity disorder, dyslexia, non-verbal learning disability, and Asperger’s Syndrome, as well as disorders of executive function. All of these are presumed to have characteristic neuropsychological deficits at the core. The book is arranged in three sections titled, Developmental Considerations, Diagnostic Considerations, and Treatment Considerations, which are preceded by an introductory chapter. In the Introduction, the author summarizes the central three themes of the book, which are then fully elaborated in the body of the book. He points out that neuropsychological deficits in learning disorders have a deleterious impact on the child’s development. There are factors that give rise to a disorder of the self when a child has such deficits or weaknesses. The presence of these deficits or weaknesses also requires modifications of the way the treatment process is conceptualized when a child has a learning disorder. He points out the inadequacy of psychoanalytic theory in the area of cognitive development and its failure to incorporate the findings of neuropsychology until the work of Daniel Stern in 1985. The syndrome-associated neuropsychological deficits leave children and adolescents with learning disorders more susceptible to one or more disorders of the self. This may be as a result of the lack of provision of “complementary functions”, “compensatory functions”, and “adjunctive functions”. Significant space is devoted to the explanation of these concepts with case material. ‘Complementary functions’, for example, includes experiences within close relationships that affirm one’s sense of self and lead to feeling valued. In such “self-object” relationships one is provided with experiences of protection, external regulation and self-affirmation that include a sense of kinship while being separate. Palombo points out that these needs, while important for healthy development in all children, are exaggerated in learning disorders. Compensatory functions include the activities and processes through which the individual draws strengths from other sources and relationships besides the self-objects. ‘Adjunctive functions’ includes the appropriate use of various technologies and prosthetic devices that extends the individual’s cognitive and physical capabilities. The six chapters of the first section describe disorders of the self that may occur in learning disorders; disorders of the “sense of self”; disorders of self-experience; and disorders of self-cohesion. Two opening chapters discuss learning disorders and two fundamental elements of selfhood, the sense of self and the self-narrative. The next two chapters discuss disorders of the self that occur in learning disorders, which are disorders of self experience and self cohesion; and disorders of the incoherent narratives. I found the distinctions not as clear here, but it would seem that essentially there is a distinction between how the individual experiences him/herself subjectively and how the individual thinks and talks about him/herself at the lexical level. The fifth chapter discusses the influence of adolescence on this picture. Palombo devotes a great deal of space to providing definitions and clarifying concepts. Diagrams and outlines help to organize the material and to facilitate its comprehension and integration. Section II comprises five chapters that discuss the five learning disorders, the explanatory paradigms, and the types of self-disorders most characteristically associated with each. Palombo’s review of explanatory models of these disorders is helpful. In Section III, the author describes detailed and comprehensive treatment covering: Deciding When to Treat; The Therapeutic Process; Working with Patients; followed by Summary and Conclusions. The chapter on The Therapeutic Process is most instructive. This is where Palombo has most to teach us. He states two goals of therapy: to engage the child in an experience “in which he can relive an old pattern of interaction and create a new pattern in which feelings are deeply engaged and made more meaningful”; “to co-create a narrative with the child”, to help her understand her strengths, weaknesses, and her history and “how to use that knowledge in dealing with future situations”. His discussion of various aspects of the interaction between the therapist and the patient portray an experienced clinician and theoretician. Therapy is different with these children in that it requires a perspective informed by “the contributions that the context, and the child’s competencies make to the child’s psychodynamics”. Therapy must be supplemented by appropriate school programming, social skills teaching and etcetera for appropriate rehabilitation. This book is well referenced. The terms and concepts may be elusive without working knowledge of psychoanalytic theory and especially of self-psychology, however, the use of case material helps. In a climate in which behavioural strategies, rating scales, check lists and attention to target symptoms and side effects dominate the treatment interaction with learning disordered children and adolescents this book is very helpful in refocusing on the personhood of the patient, and in ordering the clinician’s understanding and his therapeutic interventions. I highly recommend it.

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