Learning

Patients

1. As part of the ongoing care of children, ask parents about their children’s functioning in school to identify learning difficulties.
2. 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).
3. When caring for a child with a learning disability, regularly assess the impact of the learning disability on the child and the family.
4. When caring for a child with a learning disability, ensure the patient and family have access to available community resources to assist them.
5. To maximize the patient’s understanding and management of their condition,
   1. Determine their willingness to receive information,
   2. Match the complexity and amount of information provided with the patient’s ability to understand.

Self Learning

1. Continuously assess your learning needs.
2. Effectively address your learning needs.
3. Incorporate your new knowledge into your practice.

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
• Suspect learning disability in a child with any school-related problem (eg. behaviour, peer interactions, learning problems)

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

• 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

• 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

• 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