Treatment is directed at the underlying
disabilities by use of educational interventions. Psychological interventions
are also directed at any existing emotional, social, or family difficulties. In
addition, social skills training may be helpful.
The goal of special educational interventions is to
help children and adolescents overcome or compensate for their learning
dis-orders or motor skills disorder so that they can succeed in school. These
efforts involve remedial and compensatory approaches and use a multisensory
approach that facilitates building on all areas of strength while compensating
for any areas of weakness. These efforts are to be provided in as close to a
regular classroom set-ting as possible. It is essential that the classroom
teacher knows how best to adapt the classroom, curriculum and teaching style to
accommodate each student’s areas of difficulty.
Learning disorders affect all aspects of the
child’s or adolescent’s life. The same processing problems that interfere with
reading, writing, mathematics and language may interfere with com-municating
with peers and family, with success in sports and activities, and with such
daily life skills as dressing oneself or cutting food (Silver, 1993b).
Lack of success in school can lead to a poor
self-image and low self-esteem (Black, 1974; Bryan and Pearl, 1979; Rogers and
Saklofske, 1985; Shaw et al. 1982).
These individuals might feel that they have minimal control over their life and
compensate by trying to be in more control (Silver, 1993c). Some individu-als
may become anxious or depressed, or a disruptive behavior disorder may develop.
Genetic and family studies show that in about 40%
of chil-dren and adolescents with learning disabilities (learning disor-ders),
there is a familial pattern (Johnson, 1988). Thus, from an early identification
perspective, each sibling must be considered as possibly having a learning
disorder. Also, there is a 40% likeli-hood that one of the parents may also have
a learning disorder. This parent may not have known of this problem. If this is
true, the parent for the first time may be able to understand a lifetime of
difficulties or underachievement. Further, when the psychiatrist offers
suggestions for this parent, the parent’s areas of difficulty must be
considered. Do not ask a mother to be more organized when she has been just as
disorganized as her child all of her life.
Some children or adolescents may need specific
individ-ual, behavioral, group, or family therapy. If so, it is critical that
the therapist understand the impact that the learning disorder has had on the
individual and how these disabilities might af-fect the process of therapy
(Silver, 1993a). As noted earlier, many students with a learning disorder have
difficulties with peers and social skills problems. Social skills training
might be helpful.
No medication has been found to be effective for
treating the learning disorders or motor skills disorder. If the individual with
these disorders also has ADHD, it is important that medication be used to
minimize the hyperactivity, distractibility, or impul-sivity so that the
student can be available for learning.
In ICD-10, DSM-IV-TR Reading Disorder is referred
to as “Spe-cific Reading Disorder” and DSM-IV-TR Mathematics Dis-orders as
“Specific Disorder of Arithmetic Skills”. For both of these learning skills
disorders, the ICD-10 Diagnostic Criteria for Research suggest that the cutoff
be two standard deviations below the expected level of reading achievement and
mathemat-ics achievement respectively. In contrast, DSM-IV-TR does not specify
a score cutoff, instead recommending that the score be “substantially below
that expected given the person’s chronologi-cal age, measured intelligence, and
age-appropriate education”. Furthermore, in contrast to DSM-IV-TR which permits
both to be diagnosed of present, ICD-10 Reading Disorder takes prec-edence over
Mathematics Disorder so that if criteria are met for both, only Reading
Disorder is diagnosed.
ICD-10 does not include a Disorder of Written
Expres-sion (as in DSM-IV-TR), but instead includes a Specific Spell-ing
Disorder. DSM-IV-TR includes spelling problems as part of the definition of
Disorder of Written Expression but requires writing problems in addition to
spelling in order to warrant this diagnosis.
Finally, DSM-IV-TR Coordination Disorder is
referred to as “Specific Developmental Disorder of motor function” in ICD-10.
Furthermore, the ICD-10 Diagnostic Criteria for Research suggest that the
cutoff be two standard deviations below the expected level on a standardized
test of fine or gross motor coordination