Developmental Disorders- Neurology, Pediatrics

Learning disorders are often seen in children during school-age years. Common signs include difficulty completing school work at an appropriate level for their age. This can affect reading, writing, mathematics, or even oral presentations. For most types of learning disorders, signs and symptoms usually persist for at least 6 months.

Possible Causes

Genetics

Around 45 to 80% of learning disorders may be inherited. Studies have shown that certain variations in the expression of some genes may lead to problems in different aspects of learning. In some cases, abnormalities in chromosomes may also lead to these disorders. Examples include Turner syndrome and fragile X syndrome.

Perinatal Factors

Problems during the perinatal period, which refers to the last few months before birth up until one month afterwards, can contribute to the development of learning disorders.

The brain of an unborn child can be influenced by what the mother is exposed to during pregnancy. These may include alcohol, unsafe drugs and medications, and environmental toxins, such as lead. Certain infections during pregnancy, such as HIV and Zika, may affect how the child’s brain develops, even before they are born. During birth and delivery, significant head trauma can also lead to dysfunction in important areas of the brain.

Infants who are born with a very low birthweight (less than 1500 grams), intrauterine growth restriction or hypoxic-ischemic encephalopathy (insufficient oxygen intake for a certain amount of time) may be prone to develop neurodevelopmental and learning disorders.

Early psychological trauma

Trauma during the first few months of life, including neglect and deprivation, can cause problems with an infant’s learning, data processing and memory.

Diagnosing Learning and Developmental Disorders

Screening and Surveillance

Healthcare providers, including pediatricians, may perform screening and do surveillance tests on children who are at risk for learning and other neurodevelopmental disorders.

During routine health visits, unusual behavior or delayed developmental milestones may prompt a need for screening. This may be done through history and physical examination, as well as standardized developmental screening questionnaires, depending on the age of the child.

History and Physical Examination

History taking includes pertinent information during pregnancy, delivery and in the first few weeks of life. The child’s academic performance and behavior in school may be monitored. For adolescents, any history of substance abuse may also cause a sudden change in academic performance. A family history of neurodevelopmental, learning and genetic disorders may also be elicited.

In physical examination, a healthcare provider may search for unusual growth or dysmorphic features. A significant delay in sensory development may require further testing of the child’s vision and hearing.

Neurodevelopmental and Emotional Assessment

This type of assessment notes for any problems with movement and coordination.  For school-age children, school report cards are an invaluable tool in assessing their development and behavior.

Referral to Specialists

If necessary, a healthcare provider may suggest a referral to other specialists, for further evaluation. This may include a psychologist, developmental-behavioral pediatrician, a subspecialist (depending on the doctor’s findings), and a developmental therapist.

Common Types

Although there are many types of learning disorders, this article will focus on the common ones that most people are familiar with.

Autism Spectrum Disorder (ASD)

In autism spectrum disorder, or ASD, a child exhibits 1) difficulties in social communication or interaction, and 2) repetitive and restrictive movements.

In terms of social interactions, a child may have problems with responding to their playmates and other people. They may prefer to play alone, avoid children their age, or have difficulty in conversations with others. They avoid eye contact and body language, such as gestures. They also have difficulty comprehending the rules of social interactions and personal boundaries and may be unaware of others’ feelings.

Children with ASD restrict themselves to one or few areas of intense interest, and disregard other potential sources of interest. A young child may cling to a certain toy or line up a set of cars in one particular order, while an older one may focus on odd interests, such as remembering telephone numbers or license plate numbers. They loathe changes in their everyday routine schedule. They also exhibit repetitive speech or movements, such as repeating others’ words, turning switches on and off, hand flapping, or even spinning around.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-deficit/hyperactivity disorder, or ADHD, is one of the most common neurodevelopmental disorders in children. The two main features of these children are inattention and hyperactivity. Females are more likely to be inattentive, while males are more likely to be hyperactive or a combination of both.

Examples of inattention include frequently losing objects needed for schoolwork, difficulty finishing assigned chores or homework, failing to listen to instructions, and lack of attention to detail. On the other hand, examples of hyperactivity or impulsivity include frequently running or climbing around in a room, uncomfortable and fidgeting on their seat, talking excessively, answering questions even before being prompted to, and intruding into others’ conversations.

Dyslexia

In dyslexia, a child who is otherwise at par with others, in terms of cognitive ability and intelligence, may have a reading ability that is not compatible with the level of his other abilities. This is attributed to problems with processing the sounds of written or spoken words.

Children with dyslexia have difficulty not just in written language, but in spoken language as well. In terms of written language, they are often seen struggling to decode words when reading, taking time to recognize different words and learn new ones. In terms of spoken language, children easily hesitate and take some time to recall certain words, frequently using “uhm”s when searching for the right term when speaking. 

Intellectual Disability

Children are diagnosed with intellectual disability, or ID, when there are limitations in developing intellectual or adaptive functions, as well as social skills, before they completely mature. If signs of ID are seen in a child less than 5 years old, he or she may be diagnosed with global developmental delay.

In ID, IQ scores may vary, but are usually 2 standard deviations below the mean IQ for age. Children may have difficulty with reading, writing and in using numbers. There may be some difficulty in following rules and laws. These children may also have problems with interpersonal skills and development of social responsibility. Practical skills are also affected, including feeding oneself and taking a bath on their own

Treatment

Specific treatment plans and goals depend on the type of learning disorder/s that were diagnosed in the child. The following are some of the components in the overall treatment plan of patients with learning disorders.

Demystification

This is simply providing a way for both the child and caregivers to understand the nature of the disorder. For the child, this may be a simple explanation that is tailored to their level of understanding. It is important to relay information through an honest, positive and open-minded approach.

Bypass Strategies or Accommodations

Children with learning disorders may be handicapped when it comes to learning in the confines of a typical classroom. Accommodating them based on their learning disability may help encourage them to develop and learn, as opposed to imposing regular rules in class that may highlight their disability and cause discouragement.

The accommodation or bypass strategy will depend on the type of learning disability. Examples include oral instead of written presentations, placing the child in front for an optimal seating arrangement in class, allowing the child to use a word processor instead of writing, removing time limits in an exam, and allowing the use of a calculator for certain tests.

Remediation

Remediation is providing more time and focus on academic skills and productive habits that the child needs improvement on. Examples of this would include reading, mathematics, organization, or writing. Employing the assistance of tutors and specialists may help when remediation is done at home or outside school.

Developmental Therapy

Developmental therapy may involve the help of speech-language pathologists (for those with language disabilities), physical therapists (for children with problems in movement and coordination), and occupational therapists (for issues with sensorimotor skills).

Curriculum Modifications

Beyond bypass strategies, some children may need modifications in their school curriculum, whether this may mean the addition, removal, or delay in certain subjects.

Family Counseling

Every treatment plan includes educating or counseling the child’s family and caregivers regarding the disease. For children with learning problems that are complicated by psychiatric disorders, psychotherapy may also be advised so the individual can cope well with their situation. An example of psychotherapy is cognitive-behavioral therapy.

Pharmacologic Therapy

In some cases, medications may be needed as part of the overall treatment plan. The type of medication depends on the diagnosis. For attention-deficit/hyperactivity disorder, stimulants (such as mixed amphetamine salts) and nonstimulants (such as atomoxetine) are usually prescribed. For children with anxiety or depression, anxiolytics or antidepressants may be advised.

Summary

Learning disorders may affect one’s reading, writing, computational ability, organizational skills, or adaptive functions. If a learning disorder is mild to moderate in a child, they may adapt and relatively improve, depending on the amount and quality of support given to them. Otherwise, it may be difficult for a child to go beyond their current intellectual and developmental functions.

Sources:

• Kliegman, R.M. et al. (2020). Learning and Developmental Disorders. Nelson Textbook of Pediatrics 21st edition. Elsevier.
• Learning Disorders in Children. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/ncbddd/childdevelopment/learning-disorder.html
• Facts About Intellectual Disability. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/ncbddd/childdevelopment/facts-about-intellectual-disability.html
• Symptoms and Causes for Learning Disorders and Disabilities in Childrens. Boston Children’s Hospital. Taken from: https://www.childrenshospital.org/conditions-and-treatments/conditions/l/learning-disorders-and-disabilities/symptoms-and-causes
• Kliegman, R.M. et al. (2020). Learning and Developmental Disorders. Nelson Textbook of Pediatrics 21st edition. Elsevier. 
• Learning Disorders in Children. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/ncbddd/childdevelopment/learning-disorder.html • Facts About Intellectual Disability. Centers for Disease Control and Prevention. Taken from: https://www.cdc.gov/ncbddd/childdevelopment/facts-about-intellectual-disability.html
• Symptoms and Causes for Learning Disorders and Disabilities in Childrens. Boston Children’s Hospital. Taken from: https://www.childrenshospital.org/conditions-and-treatments/conditions/l/learning-disorders-and-disabilities/symptoms-and-causes

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