Psychosocial Care for People with Diabetes. Deborah Young-Hyman

for remediation are based on general recommendations for children with learning disorders.

       Recommendations for Intervention

      1. Circumvention of the problem. Clinical experience suggests that it is better to teach to “strengths” rather than to drill to remediate “weaknesses.” For example, spatial weaknesses can be minimized by giving oral directions rather than a written or drawn map or by adoption of a phonetic versus sight word reading approach.

      2. Assistive learning devices. Dependent upon the problem, use of assistive learning devices can be helpful. For example, for isolated memory problems, use of a calculator can help compensate for memory difficulty with math facts and provide an opportunity for practice and recognition learning.

      3. Reduced psychomotor efficiency could necessitate untimed or supplemental time allowances on tests.

      4. Avoid stigmatization of children. All individuals have cognitive strengths and weaknesses; the peaks and valleys simply may be a little farther apart for a small percentage of children with diabetes who have diagnosable or subclinical learning disorders.

      5. Help the child, family, and academic providers to understand differences between transient cognitive deficits associated with fluctuations in glucose and diagnosed learning differences.

      6. Self-esteem difficulties may be present. If they are persistent or severe, psychological treatment should be sought with a school counselor or trained therapist to reassure a child of his or her strengths and to place relative weaknesses in perspective. Children with diabetes are already coping with an altered sense of self because of their illness, which could increase vulnerability to low sense of self-worth (see Chapter 14).

       Prevention or Minimization of Cognitive Difficulties

      The majority of youth with diabetes do not have learning problems that rise to the level of clinical or subclinical learning disorders. However, transient disruption of memory/attention or slowed psychomotor efficiency could occur relatively routinely in the classroom in conjunction with temporary changes in blood glucose concentrations. Subsequent frustration could impede academic performance. Long-term longitudinal study suggests youth with diabetes have higher dropout rates in secondary school compared with nondiabetic counterparts (Lin 2010), a finding that merits replication.