We generally speak of learning difficulties when a child does not learn as expected, for the support and access to education he/she is receiving.
Learning difficulties are undoubtedly one of the most frequent reasons for consultation in Child Neurology. In these cases we must make a complete and thorough review of the evolutionary history and psychomotor development of the child, to locate us in the current time and course, as this will allow us to guide the diagnosis and distinguish between the different problems that can lead a child to have difficulty learning.
What characterizes children with learning difficulties or disorders?
The first thing we must be clear about is that “children are not lazy”. If a child in the first years of primary school rejects learning or reading and writing, we must look for the cause. If a child in these early stages of schooling does not want to learn, it is probably because the effort he is making is excessive for him, and the performance he obtains is not commensurate, which generates frustration and rejection.
There are several disorders that can lead to this “imbalance” between effort and results. This imbalance is, in my professional experience, the great problem and common point of all of them.
What learning disorders are there?
Among them we find, among others, the so-called “Specific Learning Disorders” (reading and / or writing disorder, dyscalculia …). These are characterized by making school learning difficult, causing a lower than expected performance in a subject, despite having a normal intelligence and receiving appropriate instruction. They affect a particular area and are classified according to the specific content affected (reading, written expression, mathematical calculation…).
When there is a “Specific Learning Disorder” the academic repercussion is usually very early, so that already in the first years of primary school there is a significant difficulty to keep up with their peers. In the case of reading and writing disorders (among which dyslexia is included), this difficulty towards a basic tool for classroom work generates, as I anticipated before, a great rejection towards reading (being, therefore, children who, in addition, practice it little) and, in many occasions, towards school in general.
There are also very specific signs of each of these disorders, which can alert us. For example, children with literacy disorders have very specific difficulties in learning sequences (months of the year, days of the week, seasons…), multiplication tables or the time on the clock hands.
Another major disorder that can generate learning difficulties is the “Attention Deficit Hyperactivity Disorder” (ADHD), either in its combined form or in the inattentive profile. It is not a “Specific Learning Disorder” as such, but it is certainly part of its differential diagnosis. Moreover, it is very common for these disorders to appear grouped together in the same child.
Within the different subtypes of ADHD, it is the inattentive profile that can most easily be confused with a Specific Learning Disorder. Unlike the combined type, they are generally quiet children who do not attract attention in class and do not usually show early school failure, so they can go unnoticed. It is common for them to achieve more or less adequate results throughout primary school, but with a lot of effort and parental support at home. In the natural history of undiagnosed inattentive ADHD, school failure usually appears with the transition to secondary school (ESO), when the level of demand increases and the need for organization and autonomy becomes essential. The fundamental risk of reaching these stages without diagnosis is that the price of having spent all of primary school making a great effort for results that are not always in accordance (the imbalance I mentioned earlier), is low self-esteem and insecurity, which can complicate not only the academic performance of the following years, but also such a delicate stage as adolescence. Hence the importance of early diagnosis.
At what age are learning disorders usually detected and how?
As I have explained in the previous point, it depends on each disorder. Specific Learning Disorders usually become apparent in the first years of primary school (6-8 years), and it is usually the teachers who raise the alarm.
In the case of ADHD the variability is greater. It is true that awareness of this problem has improved in recent years and it is being detected earlier and earlier, but diagnoses continue to be made in adolescents (12-14 years of age), which complicates management and worsens the prognosis, despite initiating treatment.
What treatments are resorted to, what is the objective and results?
In the case of Specific Learning Disorders the treatment consists of “rehabilitating the affected area”, it is necessary to “train the brain” in the circuits that make it difficult to read, write or calculate, and this is done through speech therapy or psycho-pedagogical support. This rehabilitation is essential and more effective the younger the child is, so it should never be delayed once the problem has been identified.
As for ADHD, treatment must be comprehensive. Psychopedagogical support should not be missing in order to work on the academic, planning and organization difficulties they have. Psychological support is also essential to work on the emotional aspects that may be most affected in each patient. And, lastly, pharmacological treatment should be considered, which, managed by the relevant specialists, is safe and effective (we will talk about it in the next article).