A Diagnostic Approach to Developmental Specific Learning Disorders

Abstract

Children and adolescents who are not doing well in school are often referred to physicians for evaluation. Many of these children have average or above-average intelligence but are academically frustrated, low achievers. Parents state that although they are convinced that their child is bright, he or she does not seem to learn, and does not behave acceptably in school and at home. Results of the usual pediatric and neurologic examinations are frequently unrevealing. In evaluating children who are doing poorly in school, the clinician must determine whether the child has a developmental specific learning disorder and whether primary affective illness, disturbed vigilance, or hyperactivity complicates the picture. Children who are intelligent but failing in school frequently manifest either one or several of these conditions. Although there are reasonably well-established criteria for affective illness in children, clinically useful criteria for evaluating the variety of childhood learning problems have not been available. We present criteria for the diagnosis of developmental specific learning disorders and briefly mention some aspects of management and treatment. We also describe a primary disorder of vigilance that becomes manifest in school, worsening the learning and performance process, which is further worsened by affective illness.

An assessment of hemineglect in children with attention‐deficit hyperactivity disorder

“…Anxiety is believed to contribute to an increased incidence of errors in the left visual field during visual effort (Rapcsae, Verfaelie, Fleet, & Heilman, 1989). The contribution of these factors is difficult to rule out completely; there is also the possibility that ADHD represents a heterogeneous population with dissimilar pathophysiology (Barkley, 1976), but united by the presence of right-parietal deficit (Semrud-Clikeman & Hund, 1990;Weinberg & McLean, 1986).…”

Affective Illness in Children and Adolescents: Patterns of Presentation in Relation to Pubertal Maturation and Family History

“…10,11,33,65 Since the Pediatric Behavioral Neurology Program is a university-based private practice, there is a racial and social class referral bias, with most of the patients being Caucasian, middle class (Hollingshead social classes II and III), and of normal intelligence. Patients were referred by physicians, psychologists, and other professionals because of the reputation of this program for comprehensive evaluation of children and adolescents doing poorly in school or with problematic behavior and because of the program's specific interest in affective illness, learning disabilities, and school failure.…”

Use of the Symbol Language and Communication Battery in the Physician's Office for Assessment of Higher Brain Functions

“…By defini tion, young people with developmental specific learning disor ders are not demonstrating symbol, verbal, or nonverbal com munication skills at an age-appropriate level. 1,8,9 Disorders of mood and affect (depression, mania, classic manic-depressive illness, hypomania, cyclothymia, and juvenileonset rapid-cycling bipolar disorder) impair communication skills and lower vigilance. 9,11,12 Primary disorder of vigilance, 12 a common cause of the attention deficit hyperactivity disorder (ADHD) symptom complex, worsens order and graphic skills and limits learning.…”

“…However, competent verbal communication requires right cerebral hemi sphere functioning, 46 ' 7 including the ability to recognize the visual (pictorial/symbolic) environment, with appropriately meaningful picture-to-picture and picture-to-word storage and representation (symbolization); prosody; timing, context, and order; coordination (praxias); vigilance; logic, wit, and humor; diligence; and volition (Table 1). 1,8,9 Nonverbal communication or gestural communication requires temporal, parietal, and frontal lobes of the right cere bral hemisphere. 7 These functions include picture-to-picture and picture-to-word representation/utilization (symbolization), prosody, ordering and timing, and social competency (Table 1).…”

“…1 The use of this expanded battery allows the examiner to understand, in an organized manner, the communication skills of the developing young person. The tasks presented and observations noted relate directly to the 10 basic symbol and verbal skills needed for a pen cil, paper, and book curriculum: (1) reading; (2) spelling; (3) arith metic; (4) drawing, printing, and writing; (5) nominal recall; (6) sequencing; (7) spatial orientation; (8) listening comprehension (^tening to and understanding the spoken word); (9) phasic ver bal expression (recalling and using with appropriate prosody and emotionality common nouns and action verbs in speaking); and (10) phasic writing expression (writing answers to questions and essay writing).…”