Learning Disorders: Causes, Symptoms, Diagnosis, Treatment

Adequate training depends on a number of factors, including cognitive functions, motivation, familiarity with the spoken language in which the school is taught, the level of expected academic success, and the quality of the explanation in the class. Low academic performance can have an adverse effect on self-esteem, leading to social exclusion, exclusion from the full cultural life and economic activities of society.

Historical background

Until the 40s of the 20th century, academic failure in the US was associated exclusively with mental retardation, emotional disorders, and socio-cultural deprivation. Later, academic failure was attributed to neurological causes and introduced the unfortunate terms "minimal brain damage" (reflecting hypothetical neuroanatomical damage) and "minimal brain dysfunction" (reflecting hypothetical neurophysiological dysfunction). Subsequently, the terms "dyslexia" - for the designation of reading disorders, "dysgraphia" - for writing disorders, "dyscalculia" for the violation of the formation of mathematical skills, appeared. It was assumed that these disorders have a common etiology and should have a single treatment strategy. Currently, it is believed that each of these states has an independent etiology.

Definition of learning disorders

According to DSM-IV, learning disabilities are characterized by inadequate development of educational, linguistic, speech and motor skills that are not associated with sheer neurological disorders, mental retardation, general developmental disability, or lack of educational opportunities (APA, 1994). In ICD-10, the term "specific developmental disorders" is used to refer to similar conditions. A learning disability is diagnosed if a particular ability of an individual is significantly lower than one would expect from its age, intelligence level or age-appropriate education. The term "substantially" usually assumes at least two standard deviations from the standard, which is determined taking into account the chronological age and the coefficient of intelligence (IQ).

In the United States, teachers often use the term "learning disability". The definition of a learning disorder is of great importance, since it determines the level at which a child can be trained in specialized educational classes operating in accordance with the federal program. There are a number of differences between the terms "learning disability" and "learning disability". The education disorder, according to the special act "Education for all disabled children", does not include those children whose low learning ability is caused by visual, hearing or motor impairment, mental retardation, emotional disorders, cultural or economic factors. Consequently, many children who have an inability to read on the background of diagnosed mental retardation, which is much more pronounced than would be expected from the level of their intelligence, may be denied the help of these services. Given such situations, the Federal Committee on Learning Disability proposed a new definition of learning disability that allows diagnosing this condition in patients with mental retardation, attention deficit with hyperactivity, social or emotional disorders.

Classification of learning disorders

In DSM-IV, the following options for learning disabilities are highlighted.

1. Reading disorder.
2. The breakdown of mathematical abilities.
3. A letter breakdown.
4. Communication disorders.
5. Disorder of development of expressive speech.
6. Mixed disorder of receptive and expressive speech.
7. Phonological disorder (articulation disorder).
8. Disorders of motor skills.

Since such conditions are often combined with other disorders, in DSM-IV they are assigned to the axis II.

Prevalence and epidemiology of learning disabilities

The prevalence of learning disabilities remains unknown, primarily because of the lack of a single definition. According to the preliminary data of the Centers for Disease Control and Prevention, 5-10% of schoolchildren are diagnosed with learning disabilities. Among the patients, the boys predominate in the ratio from 2: 1 to 5: 1, although this may be the result of the fact that boys with learning disabilities more prone to destructive behavior are more often referred for examination.

Pathogenesis of learning disorders

The origin of learning disorders is largely unclear and probably multifactorial in nature. Difficulties of schooling can be associated with attention deficit, memory impairments, perceptual or speech production disorders, weakness of abstract thinking, organizational problems. The cause of these disorders may also be visual or auditory impairment. Due to impaired visual perception, the patient is not able to find subtle differences in the contours of objects, for example, can not distinguish closely-shaped letters (for example, "n" and "n") and numbers (for example, "6" and "9" ). There are also difficulties in separating the figure from the background or establishing a distance, which can lead to motor awkwardness. In some cases, the ability to fine-tune sounds, to separate sounds from a noise background, or to quickly recognize a sequence of sounds is impaired.

Even if the learning disabilities are biologically deterministic, their development and manifestations are influenced by socio-cultural factors. External factors, such as the peculiar "culture of poverty" peculiar to certain quarters of American cities, as well as emotional factors often cause children to learn below their capabilities. To such emotional factors can be attributed special personality traits (negativism, narcissism), the desire to go against the expectations of parents. The frequency of learning disabilities is higher among late children growing up in large families. Smoking and consumption of alcoholic beverages by pregnant women is associated with a higher frequency of school problems in their children. At present, the study of the long-term effect on the fetus of medicines taken during pregnancy continues. The autoimmune origin of learning disorders is also assumed.

Criteria for diagnosis of learning disorders

Diagnosis of learning disability requires the exclusion of other causes that may cause similar symptoms. Since people with learning disabilities often go to doctors because of inadequate behavior, it is important to find out whether behavioral disorders are the cause or the consequence of academic failure. But it is difficult to draw this line. Below are some recommendations to facilitate the solution of this issue. For example, a neuropsychological examination of a child with a primary affective disorder usually does not reveal the partiality of the defect with the presence of "strong" and "weak" cognitive abilities, which is characteristic of developmental disorders. The physician should receive information about the child's progress in all the subjects taught, and if, in any of the studies, special difficulties are noted, subject it to a thorough neuropsychological study.

Tests used to diagnose learning disorders are based on the cybernetic model of information processing. According to this model, several stages of information processing are identified. Initially, information is perceived and recorded, then interpreted, integrated and stored for later playback. Finally, the individual must be able to reproduce the information and transfer it to other people. Psychopedagogical research assesses the state of intellectual abilities and cognitive style, placing particular emphasis on the discrepancy between intellectual potential and academic achievement. Such discrepancies are noted in the evaluation of each test. The current level of school academic skills is measured using standardized achievement tests. It should be remembered that, by definition, half the children of the results of these tests will automatically be below the average.

Neurological examination is an important part of the examination, which allows, first of all, to reveal micro-focal symptoms, on the other hand, to exclude a serious pathology of the central nervous system. For example, when a patient complains of a headache, special examination is necessary to avoid missing a rare neurological pathology, for example, repeated hemorrhages from arteriovenous malformation in the region of the speech zones of the temporal lobe. Often consultations are needed for other specialists, for example, speech therapist - to clarify the nature of verbal disorders, as well as specialists in therapeutic physical therapy and labor therapy - to test basic and fine motor skills, as well as sensorimotor coordination.

It is important to diagnose learning disabilities as early as possible, since early intervention is more effective and avoids the psychological trauma that arises later due to the underdevelopment of a function. In preschool-age children, a lag in motor and speech development, insufficient development of thinking and other cognitive abilities, which is revealed in games, may indicate a possible learning disability.

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