Treatment, Educational, Psychotherapeutic Interventions - Learning and Motor Skills Disorders

Treatment

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.

Educational Interventions

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.

Psychotherapeutic Interventions

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.

Use of Medications

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.

Comparison of DSM-IV/ICD-10 Diagnostic Criteria

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