Clinical Reference Systems: Pediatric Advisor 10.0

Parents are often worried and disappointed when their child has learning problems. There are many reasons for school failure, but a common one is a specific learning disability. A child with a learning disability is usually bright and initially tries very hard to follow instructions, concentrate, and be good at home and in school. Yet despite this effort, he or she is not mastering school tasks and falls behind. Some learning-disabled children also have trouble sitting still or paying attention. Learning disabilities affect as many as 15% of otherwise able school children.

It is believed that learning disabilities are caused by a difficulty with the nervous system that affects receiving, processing, or communicating information. Some learning-disabled children are also hyperactive and/or distractible with a short attention span.

Learning disabilities are treatable. However, if they are not detected and treated early, they can have a tragic "snowballing" effect. For instance, a child who does not learn addition in elementary school cannot understand algebra in high school. The child, trying very hard to learn, becomes more and more frustrated and develops emotional problems such as low self-esteem in the face of repeated failure. Some learning-disabled children misbehave in school because they would rather be seen as bad than stupid.

Parents should be aware of the most frequent signals of learning disabilities. These include when a child:

• has difficulty understanding and following instructions
• has trouble remembering what someone just told him or her
• fails to master reading, writing, or math skills, and thus fails schoolwork
• has difficulty distinguishing right from left (for example, confusing 25 with 52, "b" with "d," or "on" with "no")
• lacks coordination in walking, sports, or activities such as holding a pencil or tying a shoelace
• easily loses or misplaces homework, schoolbooks, or other items
• cannot understand the concept of time (is confused by "yesterday," "today," "tomorrow").

Such problems deserve an evaluation by an expert on the whole child and his or her health and mental health. An example of such an expert is a child and adolescent psychiatrist. The expert will work with the school professionals and others to have the necessary comprehensive evaluation and educational testing done to clarify if a learning disability does exist.

The evaluation will include talking with the child and family, reviewing the educational testing, and consulting with the school. Recommendations can then be made on appropriate school placement, the need for special help (such as special educational therapy or speech-language therapy), and steps parents can take to help their child maximize his or her learning potential.

Sometimes individual or family psychotherapy will be recommended. Sometimes medication will be prescribed for hyperactivity or distractibility. It is important to strengthen the child's self- confidence, so vital for healthy development. Parents and other family members can also use help coping with the realities of living with learning disabilities.