If you’ve ever wondered about the educational jargon and medical diagnoses surrounding children with learning difficulties in our schools, be assured that they often have a straightforward explanation: the elevator theory. The floor at which the child gets off while at the hospital or clinic evaluation center determines the diagnosis received. Simple. Easy to understand. It works. A child and parent seeking to understand the learning difficulties in order to get special help need only decide which elevator button to push. The choices are many: psychology, speech/language pathology, learning disorders, neurology/attention-deficit disorders, neuropsychology, and so forth. The appointment is made, the evaluation conducted. Eventually, the neatly typed multipage report comes back: “Johnny/Janie is an engaging/friendly/adorable, blue-eyed/brown-eyed boy/girl (the nickname is usually used) who presents with the diagnosis of ... " Voila! The elevator fills in the blank. Then, armed with the report, the child may become eligible for special-education services at school. Under both federal and state laws, parents (or school personnel) need these diagnoses to attain special education for children through the individualized education plan, or I.E.P., developed for children with diagnosable disabilities. Diagnosticians, acting as gatekeepers for services, play a pivotal role by writing evaluation reports with detailed prescriptions for the schools.
I am an attorney representing public schools in the special-education field. Formerly, I was a statewide hearing officer, making placement decisions for children with special needs. In my 15 years of reading these diagnostic reports for children whose placements were in dispute, I have rarely found a child who got off the elevator at the wrong floor.
Children who go for speech/language evaluations almost always come back with a speech or language deficit or weakness. When those same children get off on the neurology floor instead, they get a diagnosis of neurological deficits/weaknesses or attention-deficit disorder (with or without hyperactivity) for which therapy, or small classes, or whatever is popular at the time, is prescribed. Children who go for a diagnosis at the reading clinic instead, come back with a reading deficit or learning difference, requiring special help. And so on. Lest you doubt these observations, try it with own your “engaging, adorable, friendly blue- or brown-eyed child.”
It is well known that no consistency exists in diagnoses of these types of learning difficulties from state to state or city to city. While a diagnostician can usually correctly diagnose a blind or deaf child, or multihandicapped child, no such certainty exists in cases such as these. Sadly, often these diagnoses seem to relate more to the size of the parents’ wallet, how assertive parents are, or what side of the tracks the family lives on, than to the child. Thus, middle- and upper-class white children with difficulties in school may be “learning disabled,” while their lower-class or minority peers with similar difficulties may be diagnosed with less socially acceptable labels such as “emotionally or behaviorally disturbed” or “cognitively deficited.” Further, a child labeled emotionally disturbed in one city may be learning disabled in the next, attention deficited in the third, and average in the fourth. While much rides on these diagnoses, they are often imprecise and subjective.
Rarely is there a child for whom a diagnostician finds no deficit or no reason to re-evaluate in six months. And if there were such a child, her concerned parent would undoubtedly go to the next floor on the elevator and get another specialist to take a look-see. Surely, the elevator will work this time.
In the special-education world we have set up, diagnosticians are the gatekeepers. With a diagnosis, the child may be eligible for special services, such as smaller classes, individual attention, and a multitude of methods and procedural rights that go with them. It appears, therefore, that as diagnosticians usually like to help children, there is a thrust toward diagnosing deficits. Even learning differences seem to become ipso facto deficits, requiring a prescription for corrective services. Surely, if any of us adults went to such a clinic, we would come back with a label highlighting our weaknesses--particularly if extras were riding on that label.
Worrisome, is it not? Think about it. In order to provide services to children, we are encouraging them to believe something is wrong with them. We are creating children not allowed to view themselves as O.K., unique, special, yes, even different. The medical model reigns: Every difference is diagnosable and every diagnosis needs a fix. In our rush to help, are we not forgetting the obvious? While surely there are many children with disabilities who need special education, for many others, learning difficulties may be no more than learning differences. They may come and go. Learning difficulties may be caused by schools, not kids at all. They may have thousands of causes--none of which has a clinic elevator attached to it: hunger, lack of sleep, illness, drugs, alcohol, listening to parents’ fights, having no parents, abuse, TV watching, having a job after school or not having one, playing sports too much or too little, having a boy or girl friend, not having a boy or girl friend, LIFE.
Learning difficulties, in fact, may actually be strengths. Several years ago, newspapers carried the story of a baseball pitcher--a star making lots of money--who, as it turns out, had a visual-motor deficit. The connection between his hands and eyes was not within the “average range.” It was that difference which apparently allowed him to pitch so well. As I read this story, I could not help thinking how lucky the man was that no one had diagnosed and “fixed” his affliction during his school years.
Ironically, our rush to diagnose and fix many children belies the notion of “special” education. On the one hand, we are led to believe that all children are unique and special and are assured that those with unique needs will get help. On the other hand, we often provide them with a diagnosis that sets out the “fact” that they are flawed and a prescription that attempts to erase their uniqueness. By labeling children by deficits, we minimize their strengths and coping skills. Through these diagnoses, we define children by their deficits, not their strengths. What they can’t do becomes more important than what they can do. And all of this in order to get services. Why not just provide good services to all comers--labeled or not?
Many years ago, when I was a special-education hearing officer, I dealt with “Thomas,” a high school student who was extremely artistic and highly esteemed for this talent in his community. Thomas also had a learning disability for which he was placed at a private school for learning-disabled students outside the community. He attended and finished high school there, focusing on his weaknesses. I learned later that, while his reading skills improved somewhat (though still below grade level when he graduated), he no longer did any art. I have thought about Tom often. Did we help him?
These diagnostic labels have other pernicious and unintended effects. If the children don’t succeed as well as we’d like, the labels provide all the players--children, parents, and teachers --with a ready explanation. Well, Johnny can’t do that because he is learning-disabled, has a speech deficit, has neurological soft signs, or whatever. Sadly, too, these diagnoses allow all players to lower expectations for many children. Often, labels have replaced “motivation,” “hard work,” and “effort.” Individualized education plans for these children seem to avoid these terms, as if they were taboo. One is left to wonder: What could the human spirit accomplish against the odds if there were no label? If we instead raised our expectations for these children by focusing on their strengths? If we helped children through excellent teaching? If we taught toward differences, per se, without equating those with deficits? In our rush to do good, have we?
Finally, let’s remember that diagnoses are very costly. In New York City alone, as The New York Times reported last spring, one estimate holds that the costs of special-education evaluations alone could have paid for 10 extra teachers for each and every school. It’s time to ask which is the better expenditure--one for teachers or one for testers. Which helps more children more? Let us teach to the individual differences of these types of children without labels, empowering teachers to help children learn to compensate for their weaknesses, not use them as excuses for failure. Perhaps it’s time to leave the clinic elevators for the classrooms. Do we really need all those gatekeepers to tell us how to educate our children?
A version of this article appeared in the February 15, 1995 edition of Education Week as The Elevator Theory Of Special Education