Learning Difficulties Notes

Learning Difficulties

Dyslexia

= Most common type of specific learning difficulty

• A dyslexic child is one who is unable to process effectively the information required in order to read

• Result = reading ability below that expected for the child’s level of intelligence

• Must be differentiated from slow reading due to limited intellect or inadequate teaching

• More common in boys

• Often a family history

• May be delayed in learning to talk

• Spelling also affected

• If unrecognized, the child is likely to fail at school

  • Child commonly responds by withdrawing or exhibiting disruptive behavior

• Diagnosis must be confirmed on testing by an educational psychologist

• Individual help is required to overcome difficulties

Dyspraxia

• Fine motor incoordination leads to untidy writing, gross motor incoordination and difficulty with sports

• The academic and social difficulties this causes can often result in considerable unhappiness and behavioural problems if not recognized and dealt with

• An occupational therapist can assist in devising a programme to help overcome difficulties and build self confidence

Developmental delay

Overview of causes

Evaluation of developmental delay

• Children often uncooperative so parental report is important

• Developmental milestones

  • Enquire systematically about milestones for the 4 developmental areas

    • Gross motor (sitting, standing, walking)

    • Fine motor (pincer grasp, feeding self, transferring toys)

    • Speech and language (babbling, talking, words, sentences)

    • Social (smiling, play)

Pregnancy history

• Alcohol consumption, medical problems, infections, medication during pregnancy

• Prematurity and perinatal complications

Family history

• Ask about LD and consanguinity

Examination

• Developmental

  • Assess each of the four areas in turn

• Attempt to examine vision and hearing

• Assess factors such as alertness, responsiveness, interest in surroundings, determination and concentration – all have positive influences on child’s attainments

• General examination

  • Dysmorphic signs suggest genetic defect, chromosomal anomaly or teratogenic effect

  • Microcephaly at birth suggests foetal alcohol syndrome or intrauterine infections

  • Poor growth is common but may be due to hypothyroidism or non-organic failure to thrive (look for signs of neglect)

  • Look for café-au-lait spots, depigmented patches and portwine stains which are indicative of neurocutaneous syndromes

  • Hepatosplenomegaly suggests a metabolic disease

• Neurological examination

  • Look for abnormalities in the tone, strength, coordination, deep tendon reflexes, clonus, primitive reflexes and ocular abnormalities

Investigations

• Bloods

  • Chromosomes, TFT

• Urine

  • Screen for metabolic defects

• Metabolic investigations and brain imaging may be indicated

• Hearing test is mandatory in language delay

Global Developmental Delay

• Delay in all milestones (particularly language, fine motor and social skills)

  • Worrying as it indicates significant learning disability

• Delays in a single area are less concerning

Warning signs for developmental delay

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