Identifying cognitive late effects

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State-of-the-art treatment for childhood cancer has increasingly resulted in greater numbers of long-term survivors, but not without cost. Some survivors suffer neurotoxic effects, which cause changes in their learning style as well as social behavior. These differences in school may be treatment related, may have been preexisting and aggravated by treatment, or may be caused by prolonged absences from school and friends.

It is important that parents and educators remain vigilant for potential learning problems to allow for quick intervention. The signs of possible learning disabilities are problems with:

• Reading or reading comprehension.

• Understanding math concepts, remembering math facts, comprehending math symbols, sequencing, and working with columns and graphs.

• Difficulty in using calculators or computers.

• Auditory or visual language processing. Children may have trouble with vocabulary, blending sounds, and syntax.

• Attention deficits. Some children become either inattentive or hyperactive or both. These behaviors are indicative of neurologically-based deficits in attention, which can cause children to be more impulsive and distractible than their peers.

• Short-term memory and information retrieval.

• Planning and organizational skills.

• Social maturity and social skills.

You should also suspect learning difficulties if:

Your child was an A student prior to cancer, and she is working just as hard now and getting Cs.

• Your child takes three hours to do homework that used to take one hour.

• Your child reads a story and then has trouble explaining the plot.

• Your child frequently comes home frustrated from school, saying he just doesn't understand things as well as the other kids.

• Your childs teacher complains that she "just doesn't pay attention" or "just needs to work harder."

If any of the above situations are occurring, take action to begin the evaluation process before your childs self-esteem plummets. It is often hard to take this first step because children affected by radiation and/or chemotherapy can reason well and think clearly and may be above average academically in several areas. They may fall behind their classmates, however, on tasks that require fast processing skills, short-term memory, sequential operations, and organizational ability (especially visual). Once identified, these differences can be addressed by strategies such as resource services in memory enhancement, eliminating timed tests, improving organizational skills, and providing extra help in mathematics, spelling, reading, and speech.

When she entered adolescence, my daughter became very angry about her learning disabilities. She used to be gifted, and now does very well, but it is a struggle for her. We honestly explained that the choices were life with the possibility of some academic problems versus death, and we chose life.

Numerous online sources provide reliable information on learning styles and parents' rights under special education law, but one that many parents find especially useful is at

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