Environmental and Cultural Assessment
Learning problems are attributed to cognitive deficits or behav-ior problems in the child or adolescent. Environmental factors involving the school or community, however, can also contribute to academic difficulties. Thus, the psychiatrist should be aware of how social, cultural, or institutional structures can influence learning.
A child or adolescent with specific needs may be further impaired because of a limited range of services offered by the school system.
The learning disabilities that result in learning disorders or mo-tor skills disorder may directly contribute to peer problems by interfering with success in doing activities required to interact with certain age groups (e.g., visual perception and visual–motor problems interfering with ability quickly to do such eye–hand activities as catching, hitting, or throwing a ball).
Many children and adolescents with learning disorders have difficulty learning social skills and being socially compe-tent (Hazel and Schumaker, 1988). These individuals do not pick up such social cues as facial expressions, tone of voice, or body language and therefore do not adapt their behaviors appropri-ately. Rourke (1987, 1988, 1989) and Rourke and Fuerst (1991), using the definition of learning disabilities, identified a specific subtype of learning disabilities, called nonverbal learning disa-bilities. These students do not have the difficulties with interper-sonal interactions found in pervasive developmental disorders. This pattern of learning disabilities includes deficits in tactile perception, visual perception, complex psychomotor tasks and accommodation to novel material as well as difficulty in simple motor skills, auditory perception and mastery of rote material. A small subset of these students show difficulty in social and emotional functioning that includes a predisposition toward ado-lescent and adult depression and suicide risk (Rourke and Fuerst, 1991).
The first neurologically based disorder recognized as frequently associated with a learning disability (learning disorder) was ADHD (Silver, 1981; Halperin et al., 1984). Studies suggest that there is a continuum of disorders associated with neurological dysfunction that are often found together. Thus, when one is diag-nosed, the others must be considered in the diagnostic process.
The specific constructs for understanding the probable cognitive and language bases for the specific learning disorders and motor skills disorder are discussed under each subtype in the section on treatment. The premise is that there are neurologically based processing problems that result in the disabilities