School skills acquisition disorders in children

Scholastic acquisition disorders are conditions in which there is a discrepancy between a child's actual and potential level of school performance, as determined by the child's intellectual abilities. Scholastic acquisition disorders include impairment or difficulty in concentration or attention, language development, or visual or auditory processing. Diagnosis includes assessment of intellectual abilities, academic performance, language development, health, and psychological evaluation. Treatment primarily involves modification of the educational process and sometimes medication, behavioral, or psychotherapy.

Specific scholastic acquisition disorders involve impairments in the ability to understand or use spoken or written language, perform mathematical calculations, coordinate motor movements, or pay attention to a task. These impairments include problems with reading, mathematics, written expression, or handwriting, and understanding or using verbal or nonverbal expression. Most scholastic acquisition disorders are complex or mixed, with impairments in more than one system.

Common disorders of scholastic acquisition

Disorder	Manifestations
Dyslexia	Problems with reading
Phonological dyslexia	Problems with analyzing and remembering sounds
Surface dyslexia	Problems with visual recognition of word shapes and structures
Dysgraphia	Problems with written expression or handwriting
Dyscalculia	Problems with mathematics and difficulties in solving problems (tasks)
Ageometry	Problems due to violation of mathematical justification
Anarithmia	Disturbances in the formation of basic concepts and inability to acquire calculation skills
Dysnomia	Difficulty recalling words and information on demand

Although the number of children with scholastic learning disabilities is unknown, approximately 5% of school-age children in the United States require special education services due to learning disabilities. Boys are more commonly affected, with a 5:1 ratio of boys to girls.

Learning disorders may be congenital or acquired. No specific cause has been identified, but neurological deficits are either obvious or suspected. Genetic factors are often involved. Other possible factors include maternal illness, complicated pregnancy or delivery (rashes, toxemia, prolonged labor, precipitous labor), and problems in the neonatal period (eg, prematurity, low birth weight, severe jaundice, intrapartum asphyxia, postmaturity, respiratory failure). Potential risk factors include toxic exposures (eg, lead intoxication), CNS infections, neoplasms and their treatment, trauma, malnutrition, severe social isolation, and deprivation.

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Symptoms of scholastic acquisition disorders in children

Children with scholastic acquisition disorders usually have at least average intelligence, although such disabilities may also occur in children with intellectual disability. Symptoms and signs of severe disabilities usually appear early in life. Mild to moderate learning disabilities usually remain undetected until the child enters school, when the demands of school learning become more intense. Children may have difficulty learning the alphabet and may be delayed in learning paired associations (e.g., color names, object labels, counting, letter names). Language comprehension may be limited, language learning may be slower, and vocabulary may be below average. Children may have difficulty understanding what is read; handwriting may be sloppy, with an awkward pen hold; difficulty organizing or starting tasks or telling stories sequentially; and the child may confuse mathematical symbols and misread numbers.

Impaired or delayed development of active language or oral language comprehension predict learning problems in preschool years. Memory may be impaired, including short-term and long-term memory, memory application (e.g., retelling), and word recall. There may be problems with conceptualization, summarizing, generalizing, reasoning, and organizing and planning information to solve tasks and problems. Visual and auditory processing may be impaired, including cognitive impairments and difficulties with orientation (e.g., object location, spatial memory, awareness of place and location), visual attention and memory, and sound recognition and analysis.

Some children with scholastic acquisition disorders may have difficulty following social rules (e.g., taking turns, sitting too close to the listener, not understanding jokes); this is also a common component of autism spectrum disorders. Inability to pay attention to an object for long periods of time, motor restlessness, fine motor impairments (e.g., problems typing, copying), and variability in behavior and performance over time are other early symptoms. Impulsive behavior, non-goal-directed behavior and hyperactivity, discipline problems, aggressiveness, avoidance behavior, excessive shyness, modesty, and fearfulness may be present. As noted above, scholastic acquisition disorders and attention deficit hyperactivity disorder often coexist.

Diagnosis of scholastic acquisition disorders in children

Children with learning disabilities are typically identified when their school performance is found to be below their potential. Assessment of intellectual abilities, academic performance, speech development, health, and psychological assessment are necessary to determine deficits in skills and cognitive processes. Social and emotional-behavioral assessments are also necessary to plan treatment and monitor its effectiveness.

An intellectual assessment typically includes verbal and nonverbal tests and is usually administered by school personnel. Testing to describe the child's preferred mode of learning (e.g., holistic or analytical, visual or auditory) may be helpful. Neuropsychological testing is especially useful in children with a history of CNS injury or disease to identify areas of the brain that correspond to functional weaknesses and strengths. Language development testing measures understanding and use of language, phonological processing and analysis, and verbal memory.

Teacher observations of the child's behavior at school and academic performance are essential. Reading assessments measure word decoding and recognition abilities, comprehension, and fluency. Handwritten samples should be obtained to assess the child's ability to understand syntax and conceptual mastery. Mathematical ability should be assessed as calculation skills, knowledge of operations, and understanding of basic ideas.

The medical evaluation includes a thorough family history, the child's medical history, a physical examination, a neurological examination, and a neurodevelopmental assessment to determine possible causes of the disorder. Although uncommon, physical abnormalities and neurological abnormalities may indicate causes of some learning disorders that are treatable with medication. Impaired coordination of general movements may indicate neurological problems or neurodevelopmental delays. Developmental levels are assessed according to standardized criteria.

Psychological examination allows to identify attention deficit hyperactivity disorder, anxiety disorders, depression and low self-esteem, which often accompany learning disorders and which should be differentiated. Attitude to school, motivation, relationships with peers and self-confidence are assessed.

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Treatment of scholastic acquisition disorders in children

Treatment focuses on learning correction, but may also include medication, behavioral, and psychological therapy. Educational programs may be aimed at correction, compensation, or development of a learning strategy (i.e., teaching the child how to learn). Mismatch between the learning method and the child's characteristics (the nature of the disorder, preferred ways of perceiving information) increases the severity of the disorder.

Some children require specialized instruction in only one area, while otherwise they can attend the regular curriculum. Other children require separate and intensive instructional programs. Ideally, as required by U.S. law, children with learning disabilities should participate in activities with peers who do not have learning disabilities as much as possible.

Medications have minimal impact on school achievement, intelligence, and general learning abilities, although some medications (e.g., psychostimulants such as methylphenidate and some amphetamines) may improve attention and concentration, allowing the child to more effectively follow educational programs and instructions. Many treatments (e.g., elimination of dietary supplements, use of antioxidants or high doses of vitamins, use of sensory stimulation and passive movement, sensory integrative therapy using postural exercises, auditory nerve training, optometric training to correct visual-perceptual and sensory-motor processes) have not been proven effective.