Learning disabilities in children
By Mark S. Puczynski, M.D.
Over the past decade, child health providers have become more aware of
mild impairments in development, which are often identified as learning
disabilities. These impairments are often first noted when children
enter school and have trouble meeting the academic and social challenges
of their new environment. The school setting presents the child with
increased demands and expectations, and the child must learn new social
as well as developmental skills. For the child with a learning
disability, faced with mastering academic tasks and becoming familiar
with new buildings and strange adults, school can become a center of
struggle.
Each child is born with a unique developmental profile and can exhibit
strengths and weaknesses in different aspects of development, such as
fine and gross motor activity, attention span, memory function,
language, perception, and productivity. Weaknesses in any of these areas
may affect the ability of a child to function well in a regular
classroom environment.
Disabilities related to these developmental areas are often expressed in
a variety of symptoms, and at times it is difficult to distinguish
between normal variations in a child’s learning style and a true
learning disability. Although the number of children affected by
learning disabilities has not been determined, it does appear that boys
are more frequently affected than girls.
Through the past years, many labels have been suggested to describe
children with learning disabilities, including such terms as minimal
brain damage, minimal cerebral dysfunction, hyperactivity, hyperkinesis,
and
developmental dyslexia. The use of these terms is often misleading and
is not beneficial in the treatment of children with learning
disabilities.
To date, a specific cause for learning difficulties in children has not
been identified. We do know, however, that certain risk factors may
predispose a child to learning difficulties. Some children may have a
genetic abnormality. Others may have experienced serious medical
problems that damaged the central nervous system and affected
development. Exposure to toxins and infections while still in the uterus
may have adversely affected the development of the central nervous
system before birth, and the resulting developmental disabilities may
not be noted until later in life. However, with the vast majority of
children who have school-related difficulties, the cause of the learning
disability is not easily identified.
Developmental skills
In order to function well in school, a child must acquire a variety of
developmental skills, including auditory and visual memory, expressive
and receptive language, motor skills, attention, higher order reasoning,
and motivation. The presence or absence of these skills in the
developmental profile of a child can affect the child’s performance in
such academic areas as reading, spelling, science, mathematics, and
social development. The child who has not acquired these developmental
skills may have difficulty with academic subjects and may experience
early failure in school.
The desire to be accepted by other children in the classroom is an
important goal for any school-age child. When children enter school,
they leave the security of the home for an environment where they face
peer pressure every day. For most children, this change produces
positive results. By interacting with other children in this new
environment, they learn more about themselves, as well as about patterns
of socially accepted behavior. But for the learningdisabled child, the
change can be painful. The main goal of any child in the classroom is
not to be embarrassed by one’s performance. “Looking bad” can cause the
child with a learning disability to lose confidence in his or her
abilities—and, consequently, to lose self-esteem.
Children who constantly experience failure in the classroom express
their frustration and unhappiness in different ways. Some children
become socially withdrawn and depressed. Others may “act out” in class
in undesirable ways. This can lead to problems with other children and
with teachers. Children may also experience such symptoms as headaches,
stomachaches, limb pains, nail- biting, wetting, and soiling.
In later school years, the learning challenges increase. Junior high
school students are expected to begin to think on more abstract levels
and to reason in certain ways. Some children whose academic performance
has been average in earlier years may blossom and excel when they can
exercise their superior ability for abstract thinking. On the other
hand, some children who have done well during earlier school years may
begin to experience problems caused by an inability to work at a more
abstract level. It is important for parents to recognize that early
academic success does not predict success in later years.
What parents can do
A parent’s own observations of the child’s development in the years
before school begins are often important in identifying a child who may
be at risk for school failure. Children who are delayed in reaching
developmental milestones, especially in language
skills, are more likely to fail in school. Parents who feel that
language skills, attention, and basic self-help skills that involve
organization, such as dressing, are developing slowly should contact
their pediatrician.
Early identification and intervention can help a child develop his or
her full capabilities.
In most cases, however, the problems of children with learning
difficulties do not become obvious until the children are in school. A
teacher’s concerns about a child’s difficulties in paying attention or
learning a specific skill, such as recognizing letters, may be a
parent’s first clue that a learning disability exists. If a child is
unable to master skills that are readily learned by classmates, a
complete evaluation of the child should be performed. This evaluation
should include a battery of tests to identify a child’s academic
achievements and identify the developmental skills needed to function
efficiently in a classroom setting. The child should also have a
physical examination, including vision and hearing screening, in order
to rule out any medical causes of learning impairment. A thorough social
evaluation should also be included, since environmental factors may also
adversely affect the child’s performance.
When the evaluation is completed, parents and teachers can be provided
with a description of the child’s developmental strengths and
weaknesses, and recommendations can be made for an appropriate classroom
environment and for changes in the home that would benefit the child, as
well.
Medications are sometimes prescribed as part of the treatment of
children with an attention deficit disorder. It is important for parents
and teachers to understand that medications will not cure a learning
disability, even though they sometimes do help children who have serious
problems with inattention and impulsive behavior. Counseling for a child
and family is also sometimes recommended in order to help a child deal
with problems as they are encountered. With these kinds of support, and
with continued observation and help, children with learning disabilities
can be expected to develop academically and socially to their full
capabilities.
