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LEARNING DISABILITIES IN CHILDREN

Introduction
Learning disabilities, or learning disorders, are an umbrella term for a wide variety
of learning problems. A learning disability is not a problem with intelligence or
motivation. Kids with learning disabilities arent lazy or dumb. In fact, most are
just as smart as everyone else. Their brains are simply wired differently. This
difference affects how they receive and process information.
Simply put, children and adults with learning disabilities see, hear, and understand
things differently. This can lead to trouble with learning new information and
skills, and putting them to use. The most common types of learning disabilities
involve problems with reading, writing, math, reasoning, listening, and speaking.
Definition
Learning disabilities is defined as a disorder in one or more of the basic
psychological processes involved in understanding or in using language, spoken or
written, which may manifest itself in an imperfect ability to listen, speak, read,
write, spell, or to do mathematical calculations.
Etiology of learning disorder
1. Neurobiologic or other intrinsic factors are often implicated in etiology
2. It is not caused primarily by culture, educational and socio-economic factors
or by other disabilities (mental deficiency, visual or hearing impairment, or
emotional disturbance).
3. Factors associated with increased risk for learning disabilities include
a) First degree relative with dyslexia
b) PEM
c) Lead exposure
d) Prenatal cigarette exposure
Using a telephone analogy, faulty wiring in the brain disrupts normal lines of
communication and makes it difficult to process information easily. If service was
down in a certain area of the city, the phone company might fix the problem by re-
wiring the connections.
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Similarly, under the right learning conditions, the brain has the ability to
reorganize itself by forming new neural connections. These new connections
facilitate skills like reading and writing that were difficult using the old
connections.
Other disorders that make learning difficult
Difficulty in school doesnt always stem from a learning disability. Anxiety,
depression, stressful events, emotional trauma, and other conditions affecting
concentration make learning more of a challenge. In addition, ADHD and autism
sometimes co-occur or are confused with learning disabilities.
ADHD Attention deficit hyperactivity disorder (ADHD), while not
considered a learning disability, can certainly disrupt learning. Children with
ADHD often have problems sitting still, staying focused, following
instructions, staying organized, and completing homework.
Autism Difficulty mastering certain academic skills can stem from
pervasive developmental disorders such as autism and Aspergers syndrome.
Children with autism spectrum disorders may have trouble communicating,
reading body language, learning basic skills, making friends, and making
eye contact.

Types of learning disabilities
Problems with reading, writing, and math
Learning disabilities are often grouped by school-area skill set. If child is in
school, the types of learning disorders that are most conspicuous usually revolve
around reading, writing, or math.
Learning disabilities in reading (dyslexia)
There are two types of learning disabilities in reading.
Basic reading problems occur when there is difficulty understanding the
relationship between sounds, letters and words.
Reading comprehension problems occur when there is an inability to grasp
the meaning of words, phrases, and paragraphs.
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Signs of reading difficulty include problems with:
letter and word recognition
understanding words and ideas
reading speed and fluency
general vocabulary skills
Learning disabilities in math (dyscalculia)
Learning disabilities in math vary greatly depending on the childs other strengths
and weaknesses. A childs ability to do math will be affected differently by a
language learning disability, or a visual disorder or a difficulty with sequencing,
memory or organization.
A child with a mathbased learning disorder may struggle with memorization and
organization of numbers, operation signs, and number facts (like 5+5=10 or
5x5=25). Children with math learning disorders might also have trouble with
counting principles (such as counting by 2s or counting by 5s) or have difficulty
telling time.
Learning disabilities in writing (dysgraphia)
Learning disabilities in writing can involve the physical act of writing or the
mental activity of comprehending and synthesizing information. Basic writing
disorder refers to physical difficulty forming words and letters. Expressive writing
disability indicates a struggle to organize thoughts on paper.
Symptoms of a written language learning disability revolve around the act of
writing. They include problems with:
neatness and consistency of writing
accurately copying letters and words
spelling consistency
writing organization and coherence
Other types of learning disabilities and disorders
Reading, writing, and math arent the only skills impacted by learning disorders.
Other types of learning disabilities involve difficulties with motor skills
(movement and coordination), understanding spoken language, distinguishing
between sounds, and interpreting visual information.
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Learning disabilities in motor skills (dyspraxia)
Motor difficulty refers to problems with movement and coordination whether it is
with fine motor skills (cutting, writing) or gross motor skills (running, jumping). A
motor disability is sometimes referred to as an output activity meaning that it
relates to the output of information from the brain. In order to run, jump, write or
cut something, the brain must be able to communicate with the necessary limbs to
complete the action.
Signs that child might have a motor coordination disability include problems with
physical abilities that require hand-eye coordination, like holding a pencil or
buttoning a shirt.
Learning disabilities in language (aphasia/dysphasia)
Language and communication learning disabilities involve the ability to understand
or produce spoken language. Language is also considered an output activity
because it requires organizing thoughts in the brain and calling upon the right
words to verbally explain something or communicate with someone else.
Signs of a language-based learning disorder involve problems with verbal language
skills, such as the ability to retell a story and the fluency of speech, as well as the
ability to understand the meaning of words, parts of speech, directions, etc.
Auditory and visual processing problems: the importance of the ears and eyes
The eyes and the ears are the primary means of delivering information to the brain,
a process sometimes called input. If either the eyes or the ears arent working
properly, learning can suffer.
Auditory processing disorder Professionals may refer to the ability to
hear well as auditory processing skills or receptive language. The ability
to hear things correctly greatly impacts the ability to read, write and spell.
An inability to distinguish subtle differences in sound, or hearing sounds at
the wrong speed make it difficult to sound out words and understand the
basic concepts of reading and writing.
Visual processing disorder Problems in visual perception include missing
subtle differences in shapes, reversing letters or numbers, skipping words,
skipping lines, misperceiving depth or distance, or having problems with
eyehand coordination. Professionals may refer to the work of the eyes as
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visual processing. Visual perception can affect gross and fine motor skills,
reading comprehension, and math.
Common types of learning disabilities
Dyslexia Difficulty reading Problems reading,
writing, spelling, speaking
Dyscalculia Difficulty with math Problems doing math
problems, understanding
time, using money
Dysgraphia Difficulty with writing Problems with
handwriting, spelling,
organizing ideas
Dyspraxia (sensory
integration disorder)
Difficulty with fine motor
skills
Problems with hand-eye
coordination, balance,
manual dexterity
Dysphasia/Aphasia Difficulty with language Problems understanding
spoken language, poor
reading comprehension
Auditory processing
disorder
Difficulty hearing
differences between
sounds
Problems with reading,
comprehension language
Visual processing
disorder
Difficulty interpreting
visual information
Problems with reading,
math, maps, charts,
symbols, pictures


Diagnostic evaluation of learning disabilities
Screening for learning disabilities includes a detailed history, physical and
neurological examination, ancillary diagnostic studies, psychologic evaluation,
informed perceptive interaction with the child, and observation of the child during
interactions with others.
1. Medical and developmental history
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The medical history include information on
Genetic and familial traits
Pregnancy and delivery
Trauma the infant sustained
Acute and chronic illnesses and other disorders
The developmental history includes
Survey of the childs attainment of the normal development milestone
Any behavioral difficulties the child has had during preschool or school age

2. The physical and neurologic examinations in most children who are learning
disabled are usually normal. A neurologic assessment of the mental status,
cranial nerve functioning, cerebellar functioning, gait, muscle tone and
strength and tendon reflexes is done to detect any associated neurologic
problems.

3. On the basis of the findings, ancillary diagnostic test is done. These may
include electroencephalogram, if subclinical seizures are suspected.

4. The battery of test used for psychologic evaluation should be suited for the
symptoms of the individual child and should sample a broad range of skills.
These tests should examine communication ability and perceptual strengths
and weaknesses, determine cognitive ability and academic strengths and
weaknesses and assess social and emotional adaptation.

5. Direct interaction with the child by the health professional and observation
of the child during interactions with others can provide additional
information. The children may develop maladaptive behavior patterns that
deter the psychosocial adjustment.
Types of specialists to diagnose learning disabilities include:
Clinical psychologists
School psychologists
Child psychiatrists
Educational psychologists
Developmental psychologists
Neuropsychologist
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Occupational therapist (tests sensory disorders that can lead to learning
problems)
Speech and language therapist
Treatment for learning disabilities
1. The most common treatment for learning disabilities is special education.
2. Specially trained educators may perform a diagnostic educational evaluation
assessing the child's academic and intellectual potential and level of
academic performance.
3. Once the evaluation is complete, the basic approach is to teach learning
skills by building on the child's abilities and strengths while correcting and
compensating for disabilities and weaknesses.
4. Other professionals such as speech and language therapists also may be
involved.
5. Psychological therapies may also be used.
6. Classroom adjustments:
a. Special seating assignments
b. Alternative or modified assignments
c. Modified testing procedures
d. Quiet environment
7. Special equipment:
a. Word processors with spell checkers and dictionaries
b. Text-to-speech and speech-to-text programs
c. Talking calculators
d. Books on tape
e. Computer-based activities

Nursing management of children with learning disabilities
The overall goal of nursing management for the family
1. To achieve a comprehensive understanding of the diagnosis and its
sequelae
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2. To be aware of the laws and available community services for children
who have learning disabilities
3. To promote coping strategies to deal with life stresses that may be
compounded with learning disabilities

For a child
1. To develop internal means of self-control
2. To remain free of insults and injuries from the environment

Praise the child when he or she does well. Children with learning disabilities
are often very good at a variety of things. Find out what the child really enjoys
doing, such as dancing, playing soccer, or working with computers. Give the
child plenty of opportunities to pursue his or her strengths and talents.
Find out the ways the child learns best. Does he or she learn by hands-on
practice, looking, or listening? Help the child learn through his or her areas of
strength.
Let the child help with household chores. These can build self-confidence
and concrete skills. Keep instructions simple, break down tasks into smaller
steps, and reward the child's efforts with praise.
Make homework a priority. Read more about how to help the child be a
success at homework.
Pay attention to the child's mental health. Be open to counseling, which can
help the child deal with frustration, feel better about himself or herself, and
learn more about social skills.
Allow the parents to talk with other parents whose children have learning
disabilities. Parents can share practical advice and emotional support.
Establish a positive working relationship with child's teacher. Through
regular communication, exchange information about child's progress at home
and at school.

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Health Education to parents and teachers how to deal with children having
learning disabilities
1. Seize the opportunity to make an enormous difference in this student's life!
Find out and emphasize what the student's strengths and interests are. Give
the student positive feedback and lots of opportunities for practice.
2. Review the student's evaluation records to identify where specifically the
student has trouble. Talk to specialists in school (e.g., special education
teacher) about methods for teaching this student. Provide instruction and
accommodations to address the student's special needs. Examples include:
breaking tasks into smaller steps, and giving directions verbally and in writing;
giving the student more time to finish schoolwork or take tests;
letting the student with reading problems use textbooks-on-tape
letting the student with listening difficulties borrow notes from a classmate or
use a tape recorder; and
letting the student with writing difficulties use a computer with specialized
software that spell checks, grammar checks, or recognizes speech.
3. Learn about the different testing modifications that can really help a student
with learning disabilities show what he or she has learned.
4. Teach organizational skills, study skills, and learning strategies. These help
all students but are particularly helpful to those with learning disabilities.
5. Work with the student's parents to create an educational plan tailored to meet
the student's needs.
6. Establish a positive working relationship with the student's parents. Through
regular communication, exchange information about the student's progress at
school.