pediatrics
Overview of Learning Disorders
Diagnosis of Learning Disorders
Cognitive, educational, medical, and psychologic evaluations Clinical criteria Children with learning disorders are typically identified when a discrepancy is recognized between academic potential and academic performance. Speech and language, cognitive, educational, medical, and psychologic evaluations are necessary for determining deficiencies in skills and cognitive processes. Social and emotional-behavioral evaluations are also necessary for planning treatment and monitoring progress. Cognitive evaluationtypically includes verbal and nonverbal intelligence testing and is usually done by a school psychologist. Psychoeducational testing may be helpful in describing the child’s preferred manner of processing information (eg, holistically or analytically, visually or aurally). Neuropsychologic assessment is particularly useful in children with known central nervous system injury or illness to map the areas of the brain that correspond to specific functional strengths and weaknesses. Speech and language evaluations establish integrity of comprehension and language use, phonologic processing, and verbal memory and can also assess pragmatic (social) language. Educational assessmentand performance evaluation by teachers’ observations of classroom behavior and determination of academic performance are essential. Reading evaluations measure abilities in word decoding and recognition, comprehension, and fluency. Writing samples should be obtained to evaluate spelling, syntax, and fluency of ideas. Mathematical ability should be assessed in terms of computation skills, knowledge of operations, understanding of concepts, and interpretation of "word problems." Medical evaluationincludes a detailed family history, the child’s medical history, a physical examination, and a neurologic or neurodevelopmental examination to look for underlying disorders. Although infrequent, physical abnormalities and neurologic signs may indicate medically treatable causes of learning disabilities. Gross motor coordination problems may indicate neurologic deficits or neurodevelopmental delays. Developmental level is evaluated according to standardized criteria. Psychologic evaluationhelps identify ADHD, conduct disorder, anxiety disorders, depression, and poor self-esteem, which frequently accompany and must be differentiated from learning disabilities. Attitude toward school, motivation, peer relationships, and self-confidence are assessed. Diagnosis of learning disorders is made clinically based on criteria in theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and requires evidence that at least one of the following has been present for ≥ 6 months despite targeted intervention: Inaccurate, slow and/or effortful word reading Difficulty understanding the meaning of written material Difficulty spelling Difficulty writing (eg, multiple grammar and punctuation errors; ideas not expressed clearly) Difficulty mastering number sense (eg, understanding the relative magnitude and relationship of numbers; in older children, difficulty doing simple calculations) Difficulty with mathematical reasoning (eg, using mathematical concepts to solve problems) Skills must be substantially below the level expected for the child's age and also significantly impair performance at school or in daily activities. Also, the difficulties should not be better accounted for by Intellectual Disability or other neurodevelopmental disorders. 