Diagnosis of a Learning Disorder or Motor Skills Disorder

Diagnosis of a Learning Disorder or Motor Skills Disorder

If a child or adolescent is experiencing academic difficulty, she or he would normally be referred to the special education profession-als within the school system. However, the student with academic difficulties often presents with emotional or behavior problems and is more likely to be referred to a mental health professional. It is critical to understand this potential referral bias. This mental health professional must clarify whether the observed emotional, social, or family problems are causing the academic difficulties or whether they are a consequence of the academic difficulties and the resulting frustrations and failures experienced by the in-dividual, the teacher and the parents (Silver, 1989, 1993b, 1998; Bender, 1987; Hunt and Cohen, 1984; Valletutti, 1983).

The evaluation of a child or adolescent with academic dif-ficulties and emotional or behavior problems includes a compre-hensive assessment of the presenting emotional, behavior, social, or family problems as well as a mental status examination. The psychiatrist should obtain information from the child or adoles-cent, parents, teachers and other education professionals to help clarify whether there might be a learning disorder or a motor skills disorder and whether further psychological or educational studies are needed. Descriptions by teachers, parents and the child or ad-olescent being evaluated will give the psychiatrist clues that there might be one of the learning disorders or a motor skills disorder.

Children who experience problems in reading typically have difficulty in decoding the letter-sound associations involved in phonic analysis (Rourke and Strang, 1983). As a result, they may read in a disjointed manner, knowing a few words on sight and stumbling across other unfamiliar words. They may guess. If they have difficulty with visual tracking, they may skip words or lines. If comprehension is a problem, they report that they have to read material over and over before they understand.

Children with mathematical difficulties may have prob-lems learning math concepts or retaining this information. They may make “careless mistakes” when doing calculations. Math is a written language in that one is graded on what is put on paper. Thus, problems with visual-spatial tasks or with sequencing might interfere with producing on paper what is known. A problem may not be completed or steps skipped. They might have difficulty shifting from one operation to the next and, as a result, add when they should subtract. A visual–spatial difficulty might result in misaligned columns or rows, or decimals put in the wrong place.

Children who have difficulties with writing may have a problem with handwriting. They grasp the pencil or pen differently and tightly. They write slowly, and their hands get tired. Often, they prefer printing rather than cursive writing. Most also have problems with the language of writing. They have difficulty with spelling, often spelling phonetically. They may have difficulty with grammar, punctuation and capitalization (Poplin et al., 1980).

Many if not most students with a learning disorder also have difficulties with memory or organization. The child or ado-lescent with a memory problem has difficulty following multistep directions or reads in a book but forgets what was read. Others might have sequencing problems, performing instruc-tions out of order. In speaking or writing, the facts may come out but in the wrong sequence. Students with organizational dif-ficulties may not be able to organize their life (notebook, locker, desk, bedroom); they forget things or lose things; they have dif-ficulty with time planning; or they have difficulty using parts of information from a whole concept or putting parts of information together into a whole concept.

Children and adolescents with a developmental coordina-tion disorder may show evidence of gross motor or fine motor dif-ficulties. The gross motor problems might result in difficulty with walking, running, jumping, or climbing. The fine motor problems may result in difficulty with buttoning, zipping, tying, holding a pencil or pen or crayon, arts and crafts activities, or handwriting. Both gross and fine motor difficulties may result in the individual performing poorly in certain sports activities.

Ostrander (1993) and Silver (1993a) suggested a set of “systems review”-type questions (Table 25.1) to be used during an interview with parents or the child or adolescent with aca-demic difficulties suspected of having a learning disorder (learn-ing disability) or a developmental coordination disorder. These questions focus both on the specific areas of skills and on the possible underlying processing problems.