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Chapter: Essentials of Psychiatry: Childhood Disorders: Learning and Motor Skills Disorders

Childhood Disorders: Learning and Motor Skills Disorders

For children and adolescents, school is their “workplace”.

Childhood Disorders: Learning and Motor Skills Disorders


For children and adolescents, school is their “workplace”. Success-ful school performance is essential for psychological growth and development. Social competency and social skills are developed and then shaped within the family and in the school but practiced and mastered in the school. The development of self-image and self-esteem is based on successes in school. Feedback from the school concerning academic performance and social interactions influ-ences the parents’ image of their child or adolescent. Thus, if some-thing interferes with success in school, the impact will affect the emotional, social and family functioning of a child or adolescent.


Academic performance requires the integrated interac-tions of the cognitive, motor and language functions of the brain. As detailed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), if brain dysfunction results in cognitive difficulties, it is called a learning disorder; in motor difficulties, a motor skills disorder; and in language difficulties, a language disorder.


Key for the mental health professional is the understand-ing that the underlying neurological dysfunctions that result in learning disorders and motor skills disorder have an impact on more than academic performance. These disabilities affect every aspect of the individual’s life during each stage of psychosocial development (Silver, 1989, 1993b).




Public education laws use the term learning disabilities. DSM-IV uses the terms learning disorders and motor skills disorder. It is helpful to understand that these terms reflect the diagnostic sys-tem used but refer to the same set of difficulties.


Public school systems use the federal definition based on Public Law 94–142, Education for All Handicapped Children, and its revision, Public Law 101–476, Individuals with Disabili-ties Education Act. In the latter, a learning disability is defined by the following inclusionary and exclusionary criteria:


Specific learning disabilities means a disorder in one or more of the basic psychological processes involved in understanding or in using language, spoken or written, which may manifest itself in an imperfect ability to listen, think, speak, read, write, spell, or to do mathematical calculations. The term includes such con-ditions as perceptual handicaps, brain injury, minimal brain dysfunction, dyslexia, and developmental aphasia. The term does not include children who have learning problems which are primarily the result of visual, hearing, or motor handicaps, of mental retardation, of emotional disturbance, or of environ-mental, cultural, or economic disadvantage.


DSM-IV-TR Criteria


The criteria in DSM-IV-TR for establishing the diagnosis of a learning disorder are shown as a summary of three criteria sets. For each of these diagnostic categories, the criteria in DSM-IV-TR is that if a general medical (e.g., neurological) condition or sensory deficit is present, the disorder should be coded on Axis III


Educational Criteria


The most recent federal guidelines for determining whether a student in a public school is eligible for special programs for learning disabilities list four criteria (Silver and Hagin, 1992):


·   Documented evidence indicating that general education has been attempted and found to be ineffective in meeting the stu-dent’s educational needs.


·   Evidence of a disorder in one or more of the basic psychologi-cal processes required for learning. A psychological process is a set of mental operations that transform, access, or ma-nipulate information. The disorder is relatively enduring and limits ability to perform specific academic or developmental learning tasks. It may be manifested differently at different developmental levels.


·   Evidence of academic achievement significantly below the student’s level of intellectual function (a difference of 1.5 to 1.75 standard deviations between achievement and intellectual functioning is considered significant) on basic reading skills, reading comprehension, mathematical calculation, mathemat-ical reasoning, or written expression.


·   Evidence that the learning problems are not due primarily to other handicapping conditions (i.e., impairment of visual acuity or auditory acuity, physical impairment, emotional handicap, mental retardation, cultural differences, or environ-mental deprivation).


The presence of a central nervous system processing deficit is essential for the diagnosis of a learning disability. A child might meet the discrepancy criteria, but without central processing def-icits in functions required for learning, he or she is not considered to have a learning disability. The question of the significant dis-crepancy between potential and actual achievement determines eligibility for services. Different school systems use different models for determining the extent of discrepancy (Silver and Hagin, 1992, 1993).


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