Learning Disability - Paediatrics

Learning Disability

·        History:

o  Start with things he is likely to be able to do and work up

o  Questions over traditional domains for learning:

§  Reading: „what is she reading now‟, „can she read three letter words‟

§  Spelling

§  Numeracy

§  Writing

§  Drawing, art, craft

§  Social skills

o   Strengths

o   Collaborative history:

§  Previous assessments, IQ tests

§  Talk to the teacher

o   Comorbidity screen:

§  Is the norm in developmental paediatrics

§  Can be: 

·        Primary: eg biological morbidity such as learning and co-ordination difficulties, ADHD and clumsiness 

·        Secondary: eg acquired psychological and behavioural problems such as loss of self-esteem, non-compliance, etc

§  Differential:

·        Behaviour: aggression, attention seeking, school refusal

·        Mood, anxiety, attention

·        Relationship with peers, teasing, bullying

·        Family issues – get good social history

·        If adolescent then HEADDSS assessment

o   School factors: teacher skills, interest/ability to manage the child‟s needs, available skills

o   Parental insight: are they helping or hindering 

o   Use questionnaires: eg Child Behaviour Checklist (screen for anxiety, depression, etc) or Connor‟s

o   (specific for ADHD) to provide diagnostic information and provide a pre-treatment baseline

·        Exam:

o   Screen for gross and fine motor delay

o   Refer for vision and hearing tests

·        Possible differentials:

o   Hearing and vision

o   Medical: hypothyroid

o   Intellectual disability

o   Specific learning disabilities

o   Head Injury

o   Psycho-social: Abuse, stress, etc

o   Psychological: depression, anxiety, ADHD

·        Principles for management:

o   Review and follow-up (eg 3 monthly), especially at times of transition (eg changing schools)

o   Multidisciplinary approach: OT, Physiotherapist, SLT, VNDT, Educational Psychologist

o   Excellent communication between professionals

o   Helping parents to create realistic goals

o   Dealing with normal parent grief

·        Strategies for management: 

o   Demystify: Explain strengths and weaknesses to the child, parents and teacher. Removes guilt, pejorative labels (eg lazy), gives optimism

o   Bypass strategies: adjust rate, volume, complexity, format or use devices to make the task easier

o   Remediation of skills: focus on study skills, organisation, use strengths to remediate weaknesses 

o   Developmental therapies: Eg speech therapy, gross and fine motor, etc. More effective when skill deficits reflect lack of opportunity, and when instituted earlier

o   Modify the curriculum: Eg drop subjects they‟re not succeeding in

o   Strengthen strengths: sport, art, mechanics, etc

o   Individual/family counselling: especially with behaviour management, family dysfunction

o   Advocacy

o   Medication

o   Longitudinal case management

·        Check whether parents get the child disability allowance. Can get a needs assessment done for respite care, home help, etc