Learning Disabilities and Learning Disorders
part 2

Kevin is 10 years old.  He reads at a grade two level.  An assessment shows that this Developmental Reading Disorder is made up of learning disabilities in visual perception (He can't tell "b" from "d"), Visual sequencing (He reads backwards sometimes), and Auditory perception ( He things "ch" and "sh" sound the same).

Laura is 10 years old.  She also reads at a grade two level.  This is due to very severe learning disability in visual short term memory.  She can read fine, but in order to recall and comprehend, it takes ten readings of a passage.

A learning disability is caused by the brain not working correctly.  Some of these learning disabilities actually involve multiple sites in the brain and often can involve different sites in men and women.  This damage to the brain can be genetic or it can be caused by problems at birth or during pregnancy.  Alcohol exposure during pregnancy can cause this damage, too.  The nerve cells aren't where they are supposed to be, the cells are not organized correctly, and some are missing.  If a child has a stroke and ends up with deficits like a learning disability, we don't call it that, even though it may look exactly like a learning disability.  Learning disabilities can be strongly inherited.  In the case of reading disabilities, 35-45 % of the family members will have a learning disability in reading (1) In some cases, if a father has a learning disability, half their children will also.

People are born with learning disabilities.  They do not increase in number with time or suddenly appear in a child who has always shown no evidence of a learning disability.  If there is a pattern like this, many, many tests are done to determine if a tumor, stroke, unusual blood vessel growth, or some other disease is the cause.  However, if the signs of the learning disability have been present lifelong and are unchanging, you can be sure it is not caused some other neurologic disease.

On the other hand, there are some things that can make a mild learning disability lots worse.  Family chaos, drugs and alcohol, malnutrition, other neuropsychiatric disorders, abuse, and sickness and death in the family can worsen any learning disability.

No one can quite agree what a Learning Disability is.  Each country and different groups in each country may use a different standard.  It is quite likely that two groups will not agree whether or not someone has a Learning Disability as a result.  Overall, it means that someone is having major problems with some aspect of learning when one would not expect that given their overall intelligence.  Even this can be hard to define.  For example social skills and coordination are much harder to define normal values for than reading and arithmetic.

How many children have learning disorders?  It is hard to say because no one can agree how far behind you have to be to in the disorder category.  Using two grade levels behind where they should be, 10-20% of all persons have a learning disorder.  This makes it by far the most common neuropsychiatric disorder.  About 2-10% of children have a reading disability.  About 1-6 % have an arithmetic disorder.  Girls are more likely than boys to have an arithmetic disorder.  Learning disabilities in written expression are found in 2-8% of children, with three times as many boys as girls.

Co-morbidity means that certain diseases and disorders tend to occur together.  For example heart disease and stroke often occur in the same person.  There are many neuropsychiatric disorders which tend to occur together.  This is very sad, because it is bad enough to have a learning disorder, much less one to three other neuropsychiatric disorders.  About 50% of children with Learning Disabilities have another neuropsychiatric disorder.  If you have seen me, your child probably has at least two disorders, counting the learning disorder.  Your child may have five.  Assessing children for only learning disabilities and learning disorders without looking for other co-morbid conditions is a waste of time.  The most important advances in pediatric psychiatry have been the result of researchers carefully checking children for all possible conditions.  Here are the common ones.

Attention Deficit Hyperactivity Disorder (ADHD). If you have a learning disorder, you have a 20-25% chance of having ADHD.  That is about a five times increase over the general population.  Looking at it the other way, if you have ADHD, you have a 30-70% chance of having a learning disorder.  Everyone who is checked for ADHD needs to be checked for a learning disorder and vice versa.

Tourettes Disorder.  This is tics which are disabling.  About 60% of children with Tourette's have a learning disorder.

Personality Disorders - Some people have particularly nasty parts of their personalities.  Common names of these are Conduct Disorder and Oppositional Defiant Disorder.  About one third have learning disorders.

Language Disorders - Children who are not developing language well often have other learning disorders.

The diagnosis of these conditions is based on three things.  A history from the person and his family, a clinical examination, and testing.

The history should show that these problems have been present since school began to one degree or another.  The clinician should be able to get a fairly good idea where the problems lie by finding out what teachers and parents have found when they work with the child.

The examination consists of reading with the person, asking them questions about how they read, having them write, do math, draw, and check their coordination.

The testing consists of a test of the child's overall intelligence, a test of how good they are at school skills compared to other children, and tests for each of the learning disabilities noted above.  This testing can only be done by a psychologist.