Introduction:Learning disabilities are developmental disorders where there is a discrepancy between the learning potential and the current level of school performance. This is measured by tests that evaluate both the present knowledge and the intellectual capabilities. Learning disabilities are more common in boys than in girls (ratio of 5:1). There are a number of different types of learning disabilities. A learning disability may affect concentration and attention; it may affect the processing of visuals or sounds; or it may affect language development. Diagnostic tests require a battery of tests including psychological and medical tests. Treatment is directed against the weaknesses that were identified by the testing and usually consists of a combination of special educational approaches, management skills and psychological counseling. About 5% of the school population in the US receives special needs education (Ref.1), but when minor learning problems are included, there likely are about 10% of children and adolescents who have some form of learning disability. In many development countries about 30% of children under the age of 15 have learning disabilities. The reason for this is that many of these children are exposed to iron deficiency. Also, in many regions of China, Central Africa and in South America iodine deficiency is common (untreated hypothyroidism interferes with the capacity of learning). When children are exposed to malnutrition, which interferes with normal brain development, they are particularly vulnerable to getting learning disabilities. It has been shown that exposure to malnutrition during the first year of life will cause reduced school performance in up to 70% of these children (Ref.2). Children with learning disabilities have usually normal intelligence, but there are areas of weaknesses where they need help. Symptoms: Usually it is early on in the school system that learning disabilities are recognized. The teacher is most likely the one to suggest that there could be a learning disability. Affected children may have problems memorizing the alphabet. There may be limited speech perception and a limited vocabulary. The teacher may observe that the child does not understand what is read. The handwriting may look messy; the child may have a problem retelling a story in the same sequential order. In math there may be a problem with misreading numbers or confusing math symbols. Any of these problems, a delay in reading skills or a delay in listening skills is a powerful predictor that the person will have problems in higher grades. It is in these higher grades that the child with a learning disability will have more serious problems and likely will drop out of school. The child simply cannot keep pace with the more demanding tasks required such as more abstract thinking, reasoning, organizational skills, spatial memory, visual memory etc. Other symptoms may be present that come from associated other conditions. Frequently there are various degrees of other psychiatric conditions present such as depression, anxiety, attention deficit disorder (ADHD), conduct disorder and others. Each of them have their unique set of symptoms that is interwoven with the symptoms of learning disabilities. Diagnosis: In order to measure the deficiencies in skills and cognitive functions comprehensive testing is required. This includes testing of speech and language, doing educational and intellectual tests as well as psychological and medical tests. In children with a brain injury neuropsychological testing is required, which will be able to pinpoint what area of the brain is not functioning. To measure intelligence the Wechsler test is used. Three types have been developed for various age groups. The WPPSI-R is for the ages of 3 years to 7 years. The WISC-III test is for the ages of 6 years to almost 17 years. The WAIS-III test is for the age of16 years to almost 75 years. With the Wechsler test Verbal IQ, Performance IQ and Full Scale IQ are determined. Another intelligence test for verbal ability is the Peabody Picture Vocabulary Test-Revised, where the person is asked to identify which of 4 pictures best summarizes a spoken word. The Raven's Progressive Matrices Test is a test for nonverbal abstraction; abstract principles and rules need to be deducted from patterns that are shown. Academic achievement is checked by testing skills in reading, writing, arithmetic skills, and spelling. Neuropsychological and educational abilities are assessed in this way. One of the routine tests for this is the Peabody Individual Achievement Test-Revised (PIAT-R). In addition the Wide Range Achievement Test-Third Edition (WRAT-III) is used for that purpose. There is a whole array of further tests available that are used depending on the special circumstances. Details can be found under Ref.3. Treatment: The treatment of learning disabilities has to be individualized, but at the same time needs to be comprehensive. The test results are a guide to individualize treatment. Weaknesses have to be acknowledged and strengths need to be strengthened more. Curriculum modifications are done in special education classes. Individual and family counseling is done. Some children who have attention deficit disorders will benefit from stimulant medication. When depression or anxiety is part of the symptom complex, antidepressants and anxiolytics may have to be used parallel to the educational and counseling interventions. A pediatrician likely should supervise the treatment protocol of the youngster. The parents need to be warned about ineffective treatments that are often offered by alternative medicine practitioners. Dietary regimens, neuromotor programs, eye exercises, biofeedback and others are only some of the controversial therapies that are offered, but have been found to be ineffective (Ref.4). Consult a pediatrician to get advice whether or not a certain treatment would be effective. ADVERTISEMENT
This is a primary reading disorder where the person has problems with written language, both in the production (writing) as well as in the understanding of it. This is a complicated area as it involves auditory memory, word finding, speech, naming items etc. Dyslexia tends to run in families, so there seems to be a genetic predisposition. About 15% of public school children need help for reading problems. If the problems persist (and they do in about 50% of these children) they likely have a dyslexia problem. Newer scientific studies have shown that in people with dyslexia there are connection problems between Broca's area of the brain, where language processing, speech production and comprehension are located, and the other functional areas. Here is a modified table of clues
that should alarm educators and parents that dyslexia may be present (Ref.7):
These have to do with spacial orientation, visualization, problem solving or motor action. Genetic studies with twins have shown that there are several loci on chromosomes 1, 2, 3, 6 and 15 that seem to code for dyslexia. There was a concordance rate of 25% for dizygotic twins and of 75% for monozygotic twins. This supports a genetic cause in at least 50% of dyslexia cases (Refs.3, 7). Symptoms: ADVERTISEMENT Words are skipped or other words that are not on the page are substituted. Letters or words may be reversed, e.g. “b” instead of “d” or “top” instead of “pot”. Reading comprehension is often limited, when reading out a paragraph with the affected children often being unable to repeat the content in their own words. However, when the teacher reads the paragraph out loud, they often will have no difficulties repeating the content in their own words. Children with dyslexia can be very frustrated by this problem. The may disguise their problem. They may memorize any passages that have to be read out loud and pretend that they are reading this out loud when in reality they are reciting it from memory. Other disorders that often are associated such as ADHD, dysgraphia (difficulties with spelling, hand writing and written expression) or dyscalculia (difficulties with mathematics and problem solving) will add their symptoms. Diagnosis: Tests are aimed at demonstrating “phonologic processing problems”. This tests how the child translates sounds into visual images and how accurately spoken words are translated into writing. Families with a child who is suspected to have dyslexia or the child’s teacher can under the Individuals with Disabilities Act (IDEA) request testing for dyslexia. This US special education law attempts to ensure that children will get individualized teaching according to the identified weaknesses and strengths and that their preferred learning style is taken into consideration. There are a number of test methods for early school children. The Nelson-Denny Reading Test is a standardized test for young adult readers (Ref. 6). Treatment: Dyslexia is a lifelong condition. However, with appropriate remedial special training the dyslexic patient can learn functional reading skills and gets through life as any other person. Those individuals who do not receive this training in time likely will have major problems regarding dyslexia for the rest of their lives. Unfortunately this leads to dropping out of school, lack of secondary training and they tend to end up with below average paying jobs, despite otherwise normal intelligence. Treatment concentrates on word recognition (phonics skills) and integrating this into a reading program. Whole word recognition is taught and how the sound units form a word and eventually a sentence. Repetition of these methods leads to fluidity. Eventually this can be done automatically as it is in people without dyslexia. Multi sensory approaches include sounds, tactile and visual signals in association with words and sentences. With the latter approach the computer has been a valuable tool. A number of alternative treatment modalities are not recommended: optometric training, drug treatments and perceptional training. More info about learning disabilites in the US. Link regarding dyslexia organizations worldwide.
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