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 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.
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, 5-10% of all persons have a learning disorder. In the past, it was thought that more males were affected. It isn't true.
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. If you received this handout from me, your child probably has at least two disorders, counting the learning disorder. Your child may have five. Assessing children for 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.
The diagnosis of these conditions is based on three things. A history from the person and his family, a clinical examination, and testing.
The difficulty in diagnosing learning disorders and disabilities is with the testing. First of all, it is not easy or cheap. It takes about 4-8 hours to test and at least as much to score and prepare a report. Our clinic contracts out this service to private psychologists. It costs about 700-800 dollars to do the testing on one child. Parts of this can be done by a special education teacher or aide. There is usually about one testing school psychologist to 5-15 schools. If the psychologist just did testing every day, he or she could never test everyone with a learning disorder. Our clinic has a budget for testing about 10-20 children a year. That is about 10% of the children who actually come in with a learning disability.
Secondly, it isn't always accurate, partly because of co-morbidity with ADHD. If people have ADHD, they have a hard time paying attention to boring things. Testing is sort of boring and totally inflexible. I have seen many children with marked ADHD who I was sure had a learning disability. Sure, that is, until we treated the ADHD and the learning disability disappeared!
Therefore, testing is usually reserved for more complicated cases and for those who can convince the schools to do it or pay for it themselves. I don't think this is a big problem. A clinical examination as noted above, along with a careful history, can pick up the vast majority of learning disabilities and disorders.
Most parents want to know, will my son ever read? Will he ever learn math? Will he every write legibly? The answer is dependent on the age of the child when the learning disability is identified and what is done about it. With early intervention (ages 4-7) and vigorous treatment of the learning disability and any co-morbid condition, people can usually overcome their learning disorders to an extent that they are no longer disabling. On the other hand, if a learning disability is first identified at age 10 and nothing is done about it and other neuropsychiatric disorders are left untreated, the future is bleak indeed.
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