The Cost of Learning Disabilities

Helping a child cope them can cost thousands of shekels a month. In some cases the HMOs can help

Every tenth child in Israel has some sort of learning disability. But diagnosis and treatment is not part of the regular education system. Moreover, diagnosing learning disabilities is expensive and the education system budgets enough to diagnose only 700 children a year. All other parents have to resort to qualified private experts.

Ayala Tal
Ayala Tal

The bill starts at NIS 870 but could reach as much as NIS 3,000 - and that's just the beginning of the process, the diagnosis. Parents spent an average of NIS 1,600 a month on a child with learning disabilities, according to a survey by Nitzan (The Israeli Association of Children & Adults with Learning Disabilities ).

The high cost of the diagnostics is a serious problem because it makes many a parent think long and hard - mainly long - about whether it's necessary at all. That's a bad idea: Delay can cause irreparable damage to the child, rendering future treatment costs all the more onerous.

Frightened parents flood the forums and chat sites, seeking information on cheaper diagnosis options, which diagnostic options are actually necessary, how often the child should be reappraised and whether special education is the answer.

First of all, parents need to know that the Education Ministry has a division devoted to learning disabilities, which has published a comprehensive guide for parents with affected children.

A child is defined as having a learning disability if his scholastic achievements fall significantly short of the level expected of his peers, and if his scholastic achievements also fall significantly short of his intellectual capabilities based on objective intelligence quotient tests.

"Not every child who is struggling or under-achieving is necessarily learning-impaired," says Ketty Sanitsky Muller, who runs Nitzan's Holon branch and holds a degree in the field. Some may simply have troubles that can be addressed, solving the problem. A true learning disability on the other hand never disappears: The situation can improve but the gap will always be there, she explains.

The earlier the diagnosis is made, the better, she urges. The longer parents delay, the larger the gaps between the child and his peers become and the harder (and costlier ) they will be to bridge.

The diagnosticians' responsibilities include, among other things, recommending adjustments to scholastic tests to give the learning-challenged children a fair chance to demonstrate their knowledge and ability. This involves two types of diagnosis: didactic and psycho-didactic, which produce operative recommendations on the manner of intervention.

Didactic diagnosis involves the functions crucial to acquiring the ability to read, write and do math. Psycho-didactic is comprehensive, combining psychological and didactic elements, and measuring IQ. Didactic diagnosis suffices for levels 1 and 2 of test adjustment, but psycho-didactic is necessary for level 3, which involves changing the substance of the text, for instance replacing a math test with a science test.

Currently, a child diagnosed early will have to undergo reassessment at least once during his 12 years at school. Under Education Ministry guidelines, a diagnosis from 7th grade will remain in force through the end of 12th grade, and will apply when retaking matriculation tests (to achieve better results, hopefully ) until age 25.

However, many academic institutions accept only their own internal diagnostic process or that of a given institute. Their demands are not uniform. An applicant may have to pay out of pocket for a diagnostic process at the place of the institution's choice.

The trend today is to integrate special-needs children into the regular education system, while attempting to meet their needs. But the price of integration can be a heavier outlay by the parents. In special education frameworks, the classes are small, the staff is specially trained and sometimes, the parents are eligible for tax breaks. Regular schools are allocated some extra time for children with special needs, but not much of it, and certainly not enough to help each individual child advance with his peers. Special-needs children tend to be placed in small, heterogeneous groups to receive their special attention, and all the children in the group may have different kinds of problems, says Sanitsky Muller. Hence the need for tutoring, and expenditure.

Where some help can be found

Some children need drug therapy such as Ritalin or Concerta. Many are prescribed behavioral therapy such as horse-riding, and all need tutoring in school. The Nitzan survey found that 50% of the children with learning or attention disorders in the 2009-2010 school year had emotional difficulties as well, compared with 16% of the rest of the children.

Michal, mother of a special-needs savant boy in ninth grade, makes a list: a tutor for Hebrew, a tutor for English and a tutor for math, which cost NIS 2,400 a month. She is also anxious that her genius son learn to cope with the frustrations resulting from the gap between his extraordinary intelligence and his scholastic achievements.

A single chat with a psychologist costs her NIS 360. Ritalin costs NIS 250 a month, and that's through the health maintenance organization. Consulting a private doctor costs NIS 600 per visit. All in all she shells out up to NIS 4,000 a month and is thankful she can afford it.

What about parents who can't? Their only succor is partial subsidies through supplementary health-care insurance. Help is most substantial via supplementary services, such as speech therapy, and drugs to treat attention-deficit disorder: Parents need to get lists of institutes in the program from their HMOs and make sure they have the necessary paperwork in order.

Some local authorities have diagnostic and support systems for learning disorders; check if your council runs a diagnostic center.

Nitzan has a NIS 250,000 budget to help families that can't afford diagnosis and tutoring, mainly in peripheral areas.

Help for the needy, or perk for the rich?

Early this year, Hila, 16, sought recommendations for a private diagnostician. She wanted somebody whose recommendations for adjustments on scholastic tests were routinely accepted by the Education Ministry. It turned out that the teenager's friends knew of several known for their "understanding," meaning for a price, they would recommend easing the rules on scholastic tests, for instance by giving extra time, ignoring spelling mistakes, or providing a list of formulas during math test. If the diagnostician really has clout, the pupil can come to the English matriculation armed with an electronic dictionary.

In other words, it's a market. The Education Ministry says it rules out a third of the diagnoses submitted for "adjustment" permits and is presently working on clear rules to reduce the size of the phenomenon. There are three levels of "adjustment," says the ministry: the first two do not affect the material being tested, and the prevailing opinion is that they won't help "fakers." For instance, giving extra time won't help a kid who didn't study anyway. The third level does change substance, for instance replacing a math test with a science test, but such relief is granted only by a district committee with strict criteria.

In June, the Central Bureau of Statistics published a report on matriculation adjustments. It found that the number of children deemed eligible for such assistance, from 10th to 12th grade, had almost doubled from 2000 to 2007. The bureau also found clear socio-economic correlations: while only 5.7% of Arab pupils received relief on matriculation tests, almost a quarter, 23.9%, of the Jewish pupils received help.

Are rich kids more liable to seek relief, bloating the statistic? Or are the better off more aware of the importance of early diagnosis? Whatever the case, clearly there is a problem. "Children with learning disabilities from poor families in the periphery and in tough neighborhoods get lost," says Ofra Elul, president of Nitzan.