Learning Disorders of Scholastic Skills

Neurological Examination

• Neurological examination may reveal soft neurological signs, such as fine abnormalities found during detailed examination, including difficulty in copying age-appropriate figures, performing rapid alternating movements, and right-left discrimination.

ADHD

• ADHD has three subtypes: combined presentation, predominantly inattentive presentation, and predominantly hyperactive/impulsive presentation.
• Around 50% of patients achieve remission before puberty and early adulthood, while others achieve only partial remission and are at risk of developing substance use disorders, antisocial personality disorder, and mood disorders.
• Treatment:
  • Pharmacological: CNS stimulants (e.g., methylphenidate) are the first-line drugs, followed by non-stimulant medications (e.g., atomoxetine, clonidine) if stimulants are not effective or contraindicated.
  • Psychosocial interventions: social skill training, psychoeducation for parents, behavioral therapy, and cognitive behavioral therapy.

Pervasive Developmental Disorders (Autism Spectrum Disorder)

• Characterized by disturbance of social interaction, abnormalities of communication, and restricted behaviors.
• Subtypes:
  • Autism (Childhood autism, autistic disorder): neurodevelopmental disorder with a strong genetic basis, characterized by impairment in social interaction, communication, and restricted behaviors.
    • Associated with genetic abnormalities, such as chromosome 7, 2, 4, 15, and 19.
    • Frequently comorbid with mental retardation.
  • Rett's disorder (Rett's syndrome): characterized by normal development till the age of 5 months, followed by loss of acquired hand skills, language, and social interaction, and stereotyped hand movements.
  • Childhood disintegrative disorder (Heller's syndrome): characterized by normal development till the age of 2 years, followed by loss of acquired skills and social interaction.

Learning Disorders (Specific Developmental Disorders of Scholastic Skills)

• Characterized by significant impairment in one or more of the scholastic skills, out of proportion to the intellectual functioning of the child.
• Subtypes:
  • Specific reading disorder (Dyslexia): impaired reading performance, with errors in reading, slow reading speed, or difficulty in comprehension.
  • Disorder of written expression (specific spelling disorder): frequent spelling mistakes, errors in grammar and punctuation, and poor hand writing.
  • Specific disorder of arithmetic skills: impairment in arithmetic skills.
  • Mixed disorders of scholastic skills: impairment in reading, writing, and arithmetic skills combined.

Mental Retardation

• Characterized by incomplete development of intellectual functions and adaptive skills.
• Diagnosed if the IQ is less than 70.
• Categories:
  • Mild mental retardation (IQ 50-69): educable, with some independent living skills.
  • Moderate mental retardation (IQ 35-49): trainable, with some needs for education and support.
  • Severe mental retardation (IQ 20-34): dependent, with needs for attention and supervision.
  • Profound mental retardation (IQ < 20): needs life-long support, with no formal education.
• Common chromosomal causes: Down syndrome and fragile-X syndrome.
• Behavioral problems: maladaptive behavior, such as aggression, self-injurious behaviors, and hyperactivity, can be modified using behavioral therapy techniques.

Autism Spectrum Disorders

• Between 2-10 years, there is a loss of acquired motor skills, social skills, language skills, and bowel or bladder control.
• Three core symptoms: impaired communication, impaired social interaction, and repetitive, stereotyped behavior.
• The course is usually progressive, but some patients may show improvement.
• Treatment is symptomatic.

Asperger's Syndrome

• Characterized by impairment of social interaction and restricted, repetitive, and stereotyped behavior.
• No language delays or disturbances are seen.
• Treatment is usually supportive.

Conduct Disorder and Oppositional Defiant Disorder

• Conduct disorder: repetitive and persistent pattern of disregard for rights of others and aggressive behavior.
• Frequently associated with unsatisfactory family relationships and failure at school.
• Later on, may develop antisocial personality disorder (dissocial personality disorder).
• Oppositional defiant disorder: persistently negativistic and defiant behavior, but without serious violations.
• Management involves family intervention and behavioral therapy, and in some cases, low-dose antipsychotics.

Child Psychiatric Illness

• Disorders of childhood and adolescence fall into categories: anxiety disorders, stress-related disorders, mood disorders, obsessive-compulsive disorder, and disruptive behavioral disorders.
• Schizophrenia is also a category.

Neurodevelopmental Disorders

• Affect both mental health and overall development in children.
• Examples: autism spectrum disorders, Rett syndrome, Fragile X syndrome.

Attention Deficit Hyperactivity Disorder (ADHD)

• Predominant symptoms: inattention, hyperactivity, and impulsivity.
• Inattention: difficulty in giving close attention to details, frequent mistakes, distractibility, and frequent shifting from one activity to another.
• Hyperactivity and impulsivity: restlessness, excessive talking, and difficulty in waiting for one's turn and interrupting others.
• Frequently shows destructive and aggressive behavior and is irritable.

Learning Disorders (Specific Developmental Disorders of Scholastic Skills)

• Characterized by significant impairment in one or more scholastic skills out of proportion to the intellectual functioning of the child.
• Subtypes: specific reading disorder (dyslexia), disorder of written expression (specific spelling disorder), specific disorder of arithmetic skills, and mixed disorders of scholastic skills.
• Associated problems: inattention, hyperactivity, and emotional disturbances.

Mental Retardation

• Condition characterized by incomplete development of intellectual functions and adaptive skills.
• Diagnosed if IQ is less than 70.
• Category IQ:
  • Normal: 90-109
  • Borderline: 70-89
  • Mild mental retardation: 50-69
  • Moderate mental retardation: 35-49
  • Severe mental retardation: 20-34
  • Profound mental retardation: < 20