Learning difficulties

cognitive learning difficulties
borderline or mild LD (IQ 70-80)
1. support by learning support assistants in mainstream schools
2. apparent on starting school or later
require special schools
1. moderate LD (IQ 50-70)
  1. prevalence= 30 per 1000 kids
  2. children of parents of lower socioec class over-represented
2. severe LD (IQ 35-50)
  1. usually present from infancy
    1. marked global delay
  2. able to learn minimal self care skills
  3. acquire simple speech & language
  4. require high supervision & support throughout life
  5. prevalence= 3-4 per 1000 children
  6. cause often organic
    1. regardless of social class
3. profound LD (IQ <35)
  1. usually present from infancy
    1. marked global delay
  2. child has no sig language
  3. completely dependent for all needs
  4. require total supervision & support throughout life
causes of learning difficulty
1. as part of abnormal development (i.e. global delay)
  1. prenatal
    1. genetic
      1. chromosome/DNA disorders
        Down syn
        fragile X
        chromosome microdeletions or duplications
      2. cerebral dysgenesis
        microcephaly
        absent corpus callosum
        hydrocephalus
        neuronal migration disorder
    2. vascular
      1. occlusions
      2. haemorrhage
    3. metabolic
      1. hypothyroidism
      2. phenylketonuria
    4. teratogenic
      1. drug and alcohol abuse
    5. congenital infection
      1. rubella
      2. CMV
      3. toxoplasmosis
      4. HIV
    6. neurocutaneous syndromes
      1. tuberous sclerosis
      2. neurofibromatosis
  2. perinatal
    1. birth asphyxia
      1. hypoxic-ischaemic encephalopathy
    2. metabolic
      1. symptomatic hypoglycaemia
      2. hyperbilirubinaemia
    3. extreme prematurity
      1. intraventricular haemorrhage/periventricular leucomalacia
  3. postnatal
    1. infection
      1. meningitis
      2. encephalitis
    2. anoxia
      1. suffocation
      2. near drowning
      3. seizures
    3. trauma
      1. head injury- accidental or not
    4. metabolic
      1. hypoglycaemia
      2. inborn errors of metabolism
    5. vascular
      1. stroke
  4. other- unknown (~25%)
specific learning difficulty
1. skill described is more delayed than one'd expect for child's level of cognitive ability
2. dyscalculia
  1. disorder in development of calculation skills
3. dysgraphia
  1. disorder in development of writing skills
4. developmental coordination disorder (DCD)
  1. aka dyspraxia
  2. disorder of motor planning &/or execution
    1. but no significant findings on neuro exam
  3. disorder of higher cortical processes
    1. may be assoc problems w/
      1. perception
      2. use of lang
      3. putting thoughts together
  4. impact on
    1. educational progress
    2. self-esteem
  5. features- probs w/
    1. handwriting
      1. akward
      2. messy
      3. slow
      4. irregular
      5. poorly spaced
    2. dressing
      1. buttons
      2. laces
      3. clothes
    3. cutting up food
    4. poorly established laterality
    5. copying and drawing
    6. messy eating from difficulty coordinating biting, chewing & swallowing (oromotor dyspraxia)
      1. dribbling common
  6. Mx
    1. occupational therapy assessment & advice
    2. speech & lang therapy
      1. for oromotor skills/speech
    3. visual assessment
    4. therapy focuses on
      1. sensory integration
      2. sequencing
      3. executive planning
    5. should improve w/ therapy & maturity
  7. often undetected in 1st few years of life
    1. as child reaches gross motor milestones at normal times
5. dyslexia
  1. disorder of reading skills disprop to child's IQ
  2. reading age > 2 years behind chronological age
  3. Mx
    1. assess vision
    2. involve educational psychologist
6. disorder of executive functions
  1. executive funcs= cognitive processes responsible for
    1. planning
    2. organisation
    3. self-regulation
    4. cognitive flexibility
    5. problem-solving
    6. abstract reasoning
    7. vital to function in & interact w/ one's social env
  2. deficits occur due to acq brain injury
    1. ff stroke
    2. ff infection
    3. ff trauma
  3. manifestations
    1. poor concentration
    2. forgetfulness
    3. volatile mood
    4. overeating
    5. poor social skills
7. assoc comorbidities
  1. Attention deficit disorder
    1. -> probs w/ conc and attn
      1. ADHD too
  2. hyperactivity
  3. poor sensory integration skills (touch, balance)
  4. depression
  5. conduct disorders
8. Mx
  1. assessment
    1. vision
    2. hearing
    3. occupational therapist
    4. language therapist
    5. educational psychologist
  2. ID comorbidities
  3. Rx
    1. improving skill acquisition
    2. educational and IT support

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Learning difficulties

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