LEARNING DISABILITIES IN CHILDREN

DEFINITION
Those [children] with a disorder in the basic psychological process involved in
understanding or in using language,spoken or written .the disorder may
manifest itself in the imperfect ability to listen, speak,read,write, spell or do
mathematics.disorders include perpetual mhandicaps, brain injury, minimal brain
dysfunction,dyslexia and developmental aphasia. The term does not include
children whose learning problems are primarily the result of visual, hearing or
motor handicaps , of mental retardation, of emotional disturbance or of
environmental, cultural or economic disadvantage.
( The Law And Disabled People, 1980)
Kinsbourne and caplan (1979) subdivided this diagnosis into:
O Attention deficit disorders&
O $pecific learning disabilities.

ATTENTION DEFICIT DISORDERS
DEFINITION
Attention deficit disorders reflect a problem of selecting what to attend to and of
maintaining concentration in that area, that is, attention may be over focussed
or under focussed.
ADHD is a symptom complex characterised by poor ability to attend to a task,
motor overactivity and impulsivity.
These children are not primarily mentally retarded or autistic.
INCIDENCE
ADHD affects 3-4% of children in U$A. Boys are more affected than girls in the
ratio 6:1.ADHD persists into adolescents and adult life.
Age of onset is usually before 4 years but diagnosis is made around 3-4 years of
age.
$tatistical data is not available for Indian children, experts agree that it is
roughly trhe same % as in the western population.
ETIOLOGY
O xact cause : unknown

OVERFOCUSSED ADHD
hen attention is over focussed or compulsive; such children concentrate so
long on one thing that they fail to learn enough overall. The problem is in
actually encountering the change rather than being unmotivated or cognitively
incapable of the change.
FATUR$
O They can think well, but they concentrate too long in one area.
O They appear socially withdrawn and anxious, fearful.
O hen stressed , they may respond with stereotypic mannerisms such as
nail biting, twitching, head banging or rocking.
O They are quiet and do not seek attention, so their problems are likely to
go unnoticed.
UNDERFOCUSSED ADHD
hildren suffering from this type of attention deficit disorder are overly impulsive
and are therefore unable to maintain their focus long enough to learn. xtreme
impulsiveness is referred to as " hyperactivity or hyperkinesis
The problem is not with cognitive capacity or innate intelligence; it is considered
an immaturity with respect to intensity and duration of concentration.
These children shift their attention very quickly from one task to the next, often
with out completing the first.
This impulsiveness is noted in any behaviour requiring focussed attention, not
limited to learning situation.
MANIFESTATIONS
Motor behaviour
Feeding problems gulps food, swallows air; resulting in symptoms like
infantile colic
$hort sleep periods awakens after a few hours of sleep with out being
wet or hungry
Intense response to stimuli explores to get into everything, easily
distracted and startled, at high risk for injuries
xcessive movement difficulty sitting still, constantly shifts
positions, tendency to rush everywhere


!roblem solving
Difficulty maintaining focus does not finish tasks, appears not to
listen, moves quickly from one task to next
Impulsive decision making decision making process is overtly obvious,
jumps to conclusions, poor academic
performance

Interactional style
Poor peer relations imposes needs on others, socially aggressive,
abrupt, controls situations through attention
seeking behaviour
Poor parental relations responds to discipline with temper tantrums,
heedlessness, whining;seems to always be in
trouble
Low frustration tolerance constantly seeks attention, evokes resentment
from others

Delinquent behaviour Usually develops in adolescents, due to
inability to gain attention and peer relations in
more appropriate ways

Emotional style
$hallow communications inability to focus attention and has poor peer
relations, tends to deny problems when they
blatantly exist
gocentric existence intense response to constant stimuli
Low self esteem feels like a dummy, feels unliked, feels cannot
do anything well and always being punished
Poor impulse control cannot control impulses in behaviour, thoughts
actions and relationships

MANAGEMENT
O Parent counselling
O Provide understanding and direction by preserving the childs self esteem
O Focus of management: organise life and discipline.
O $tructured behavioural modification program for increasing attention
span, proper disciplining should be adopted: child on special program in
school.
%reatment
O ethyl phenidate, dextro amphetamine, magnesium pemoline and tricyclic
anti depressants: [ needs liver functions to be monitored]
O Reduce over activity, increase attention span, improves interaction
between child and mother.
HEALTH EDUCATION
O xplain the problem; help parents to understand the problem and accept
the childs condition
O That the hyperactive behaviour is not intentional.
O That the attempts to change an energic child into a quiet socially
acceptable, may seem and prove to be difficult.
O These children need to be provided with outdoor activities; play with
minimal instruction would be beneficial.
O rganise the life of these children to get adequate rest and sleep.
O A structured home schedule for daily activities like wake up time, meal
time, bed time etc should be followed with consistency.
O These children need a carefully planned discipline to be followed.
O Aggressive behaviour such as biting, hitting, pushing should not be
tolerated
O All risks must be enforced with non physical punishment.
O verwhelming situations such as big gatherings should be avoided till
child learns to control himself
SPECIFIC LEARNING DISABILITIES [LD]
This group of diagnoses refers to children with a particular deficit in ability to
acquire age appropriate reading, arithmetic, language or articulation skills. LD is
suspected when there is unexpected underachievement in adequate educational
settings.
DEFINITION
LD is defined as a disorder in one or more of the basic psychological process
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.
CAUSE
According to Kinsbourne And aplan(1979) , specific learning disabilities are best
viewed as resulting from a selective developmental lag. Preasumably the brain
area relevant to a specific skill acquisition is slow to mature, so the child is
unready and unable to perform the required behaviour.
A learning disability is generally considered a lag of 2 years behind grade
expectancy in a specific subject area ( walzer and Richmond, 1973)
ETIOLOGY
Neuro biologic or other intrinsic factors are often implicated in etiology.
It is not caused primarily by cultural, educational, environmental and socio
economic factors, or by other disabilities ( mental deficiency, visual or hearing
impairments or emotional disturbance)
Factors associated with increased risk for LD include
O First degree relative with dyslexia
O P
O Lead exposure and
O Pre natal cigarette exposure
MANIFESTATIONS
hildren with specific learning disabilities usually have a cluster of symptoms,
such as
O Attention deficits (hyperactivity)
O Impulsiveness
O Distractability,
O Labile emotions,
O Poor motor co-ordination,
O Perceptual deficits and
O Poor peer relations.

TYPES OF DEVELOPMENTAL DISORDERS
O Developmental reading disorder
O Developmental arithmetic disorder
O Developmental language disorder [expressive/receptive]
O Developmental articulation disorder
DIAGNOSIS
O Identifying discrepancy between ability IQ and achievement
$creening for LD includes:
O Detailed history : medical & developmental history
O Physical and neurologiacal examinations,
O Ancillary diagnostic studies
O Psychologic evaluation,
O Informed perceptive interaction with child &
O bservation of the child during interaction with others
MANAGEMENT
O Focus is remediation.
O $pecial reading programs needs to be designed including use of
computers.
O To learn to read children must discover that spoken words can be broken
down into a smaller unit of sound, that letters on the page represent these
sounds and written words have the same number and sequence of sounds
heard in the spoken word
O Requires practice in reading stories
O Allow enough time to decode each word
O Provision of computers with spelling checkers, tape recorders and recorded
books.
NURSING MANAGEMENT
The overall goals of nursing management for the family are to assist them
O To achieve a comprehensive understanding of the diagnosis and its sequel
O To be aware of the laws and available community services for children
who have learning disabilities
O To promote coping strategies to deal with life stresses that may be
compounded by a learning disability and for the child
O To develop internal means of self-control,&
O To remain free of insults and injuries from the environment

Provide education and support to prevent hopelessness and guilt among
the family members
Prepare the parents for home care
Administer the medications, monitor for adverse reactions and educating
the parents to do the same.
Family therapy: to help family cope with stress and guilt
Need of family members to participate in the therapies
Help the parents to obtain support and information from community
organisations
Parents and other family members should be encouraged to attend a
support vgroup
Use the family as a resources when caring for the child
PROGNOSIS
The prognosis for success in school and for later adjustment is related to the
age of detection, severity of the disorder, available family support systems,
associated emotional problems and access to appropriate educational
resourses. Although many learning disabled children have a very difficult time
during the school years, by adulthood most of them have learned to cope
reasonably well.
As adults, however some continue to be impulsive and to have impaired self
esteem. nly a minority of adults have serious anti social behaviour or serious
psychopathology.
PREVENTION
The prevention of learning disability lies in the early identification of at risk
children, improved detection or diagnostic techniques, and appropriate special
education programs to provide the attention they need.
BIBLIOGRAPHY
Hockenberry ..J. ongs ssentials f Paediatric Nursing,7
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edition:Noida,2007
arlow D R, Redding B.A.Textbook of Paediatric Nursing,6
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Noida,2008
Parthasarathy A.IAP Text Book f Paediatrics,4
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dition: New Delhi , 2010
hai .P. ssential paediatrics, 6
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edition:New Delhi,2007
Nelson.Text Book f Peadriatrics, volume 2: second edition,2008