Paediatrics: Specific learning difficulties

Specific learning difficulties

Dyslexia

Children of normal intelligence who have not learned to read despite exposure to adequate instruction:

•   Aetiology uncertain; often family history, M:F 4–8:1.

•   Cognitive processes involved include decoding (converting letter strings into sound sequences), encoding (spelling), and linguistic comprehension.

•   Diagnosis is educational but a child may have language difficulties and/ or co-ordination difficulties.

•   If severe, can lead to low self-esteem and school refusal.

•   Dyslexia support societies (national and local) are often helpful.

•   Specialist advice and support required from education.

•   Paediatrician’s role is limited to consider the diagnosis and exclude other conditions.

Dyscalculia

A specific learning disability affecting the acquisition of arithmetic skills. Less commonly recognized than dyslexia. Can co-exist with writing dif-ficulties and DCD.

Developmental co-ordination disorder

Previously referred to as dyspraxia or clumsy child syndrome. Defined as marked impairment in the development of motor abilities not explained by mental retardation and not due to a physical disorder. The diagnosis is only made if this impairment interferes with academic achievement or with activities of daily living:

•   Prevalence: 10% of 8–12-yr-olds; 1–3% of all children. M:F 4:1.

•   Presenting features and signs.

•   Characterized by perceptual difficulties that impede academic progress. For example:

•   poor motor planning;

•   poor visual perceptual skills (discrimination, memory, visual spatial).

•   Clinical assessment:

•   neurological examination to exclude other conditions (mild CP, muscle disease);

•   overlapping with other conditions including autism and social skills problems;

•   may have additional learning difficulties.

·  Treatment:

•   physiotherapy;

•   occupational therapy.

Advice to school as well as parents is vital