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P24 Pediatrics
Development Toronto Notes 2019 Specific Learning Disorder
Definition
• specificandpersistentfailuretoacquireacademicskillsdespiteconventionalinstruction,adequate intelligence, and sociocultural opportunity
• asignificantdiscrepancybetweenachild’sintellectualabilityandtheiracademicperformance
• types:reading(dyslexia),writing,mathematics(dyscalculia)
Epidemiology
• prevalence: 10%
• highincidenceofpsychiatriccomorbidity:anxiety,dysthymia,conductdisorder,majordepressive
disorder, oppositional defiant disorder, ADHD
Etiology
• pathogenesisisunknown,likelygeneticfactorsinvolved
• learningdisabilitiesmaybeassociatedwithanumberofconditions:
■ genetic/metabolic: Turner syndrome, Klinefelter syndrome
■ perinatal: prematurity, low birth weight, birth trauma/hypoxia
■ postnatal: CNS damage, hypoxia, environmental toxins, FAS, psychosocial deprivation
(understimulation), malnutrition • poorvisualacuityisNOTacause
Risk Factors
• positivefamilyhistory,prematurity,otherdevelopmentalandmentalhealthconditions,neurologic disorders (e.g. seizure disorders, neurofibromatosis), history of CNS infection/irradiation/traumatic injury
Clinical Presentation
• historyandphysicalexam
■ school difficulties (academic achievement, behaviour, attention, social interaction, over-reliance on
teacher)
■ development of negative self-concept → reluctance to participate even in areas of strength
■ social issues: overt hostility towards parents/teachers; difficulties making friends, bullying, and
anxiety
■ look for dysmorphisms, complete physical exam
• investigations
■ psychoeducational assessment
■ individual scores on achievement tests in reading, mathematics, or written expression (WISC III,
WRAT) >2 SD below that expected for age, education, and IQ
■ evaluate childs attention, memory, expressive language, coordination skills
Management
• providequalityinstructionforspecificlearningdisability
• supportstudentbymodifyingthecurriculumand/orprovidingaccommodations(e.g.scribefor
writing, extra time for tests, photocopied notes, etc.)
• considergraderetentionincertainstudents(noguidelinesexist,veryrareinOntario)
• specializededucationplacementsthatcanprovideeducationalremediation
Prognosis
• limitedinformationavailableaboutpersistenceoflearningdisabilitiesovertime • lowself-esteem,poorsocialskills,40%schooldrop-outrate
Fetal Alcohol Spectrum Disorder
Definition
• termdescribingtherangeofeffectsofprenatalexposuretoalcohol,includingphysical,mental, behavioural, and learning disabilities
• abstinencefromalcoholduringpregnancyisrecommended
• spectrumincludes:FAS,partialFAS,ARBD(alcoholrelatedbraindamage)andARND(alcoholrelated
neurodevelopmental disorder)
Epidemiology
• prevalenceofFASandFASDis0.1%and1.0%,respectively • mostcommonpreventablecauseofintellectualdisability
Pathogenesis
• specificmechanismofFASDisunknown,buthypothesesincludenutritionaldeficits,toxiceffects of acetaldehyde, alteration of placental transport, abnormal protein synthesis, and altered cerebral neurotransmission