Learning
Patients
- As part of the ongoing care of children, ask parents about their children’s functioning in school to identify learning difficulties.
- In children with school problems, take a thorough history to assist in making a specific diagnosis of the problem (e.g., mental health problem, learning disability, hearing).
- When caring for a child with a learning disability, regularly assess the impact of the learning disability on the child and the family.
- When caring for a child with a learning disability, ensure the patient and family have access to available community resources to assist them.
- To maximize the patient’s understanding and management of their condition,
- Determine their willingness to receive information,
- Match the complexity and amount of information provided with the patient’s ability to understand.
Self Learning
- Continuously assess your learning needs.
- Effectively address your learning needs.
- Incorporate your new knowledge into your practice.
Learning disability
Learning disability
- General Overview
- Intrinsic cognitive difficulty that results in academic achievement at a level less than expected for the individual's intellectual potential
- Reading disability (dyslexia)
- Disorders of written expression (dysgraphia)
- Mathematical disorders
- Nonverbal LD (nonlanguage-based LD, right hemisphere dysfunction)
- Language-based LD
- Intrinsic cognitive difficulty that results in academic achievement at a level less than expected for the individual's intellectual potential
- Suspect learning disability in a child with any school-related problem (eg. behaviour, peer interactions, learning problems)
History
History
- Learning problem
- Onset, persisting
- Academic performance in a range of skills (spelling, writing, oral, math)
- Weaknesses and strengths
- Previous interventions
- Teacher concerns
- Failing grades
- School attendance/avoidance
- Psychiatric
- Attention (ADHD)
- Anxiety
- Managing frustration (waiting turns, self-soothe when angry)
- Medical
- Prematurity and perinatal complications
- Past illnesses (CNS)
- Medications/toxins (lead)
- Seizures
- Sleep
- Hearing/Vision
- Developmental
- Motor
- Language
- Adaptive (hygiene, toileting)
- Social/Play
- Family
- Learning disability
- Psychiatric
- Education level
- Social
- Poverty
- Abuse/Neglect
Physical Exam
Physical Exam
- General Appearance (r/o Genetic syndromes)
- Head circumference, height, weight
- Hearing and Vision
- Skin
- Neurocutaneous disorders (neurofibromatosis, tuberous sclerosis)
- Genitalia
- Small testes (Klinefelter)
- Large testes (Fragile X)
- Neurological
- Assymetry in muscle tone (cerebral palsy)
- Weakness (msucular dystrophy)
- Coordination
Investigations
Investigations
- Objective vision and hearing evaluation
- Rule out medical, neurologic, and/or behavioral causes
- Psychiatric: ADHD, autism spectrum disorder, oppositional defiant disorder, conduct disorder, mood disorder
- Genetic conditions: 22q11.2 deletion and Klinefelter, Down, fragile X, Prader-Willi, Angelman’s, and Rett syndromes.
- Prematurity, congenital hydrocephalus, meningitis, encephalitis, traumatic brain injury, and lead or methylmercury poisoning
- Consider
- CBC, iron studies, lead level, TSH
- Genetic testing, metabolic testing, EEG, brain imaging if indicated
Management
Management
- Referral to early intervention programs/specialists (psychology, social work, educator, counsellor) and community resources
- Pediatric or psychiatry consultation
- Multidisciplinary approach
- Treat co-occuring conditions
- Advocate and support for the child and family
References:
- LDAO http://www.ldao.ca/introduction-to-ldsadhd/articles/about-education/helping-young-children-with-learning-disabilities-at-home/
- School Children with Learning Disabilities https://www.mdcme.ca/courseinfo.asp?id=170
- AAFP 2006. http://www.aafp.org/afp/2006/1215/p2079.html
- AAFP 1999. http://www.aafp.org/afp/1999/0515/p2816.html