Sandra Laujin

What is a learning disorder?

A learning disorder is characterised by abnormalities with the process of the acquisition of knowledge. Its origin is neurological and corresponds to an impairment of one or several cognitive functions.

Various disorders may be specifically related to impaired cognitive functions that are required to acquire knowledge:

• Reasoning disabilities / Intellectual Disability
• Memory disabilities
• Attention Deficit Disorder
• Language disorders
• Motor disorder
• Visiospatial disorders
• Dysexecutive disorders

Learning disorders may concern specific capacities related to learned knowledge and skill such as reading or spelling. These disorders have names beginning with “dys”:

• Dyslexia: difficulties learning to read
• Dyscalculia: difficulties gaining arithmetic skills
• Dysorthographia: difficulties gaining spelling skills
• Dysgraphia: difficulties learning to write
• Dysphasia: difficulties gaining language skills
• Dyspraxia: difficulties gaining motor skills

What are the origins of learning disorder?

The origins of impaired cognitive functioning can be neurodevelopmental. This means that the origin is neurological and that the symptoms appear as the child’s brain develops and matures.

Some learning disorders, such as autism for example, can be the consequence of neurodevelopmental conditions. A child with autism indeed often exhibits disorders in the realms of attention, executive function, language, motor skills and visuospatial processing.

Changes in brain functioning can also be acquired and can be the consequence of brain trauma, exposure to toxins etc. Certain types of cognitive impairment may also have emotional origins. For example, attention deficit disorder (with or without hyperactivity) is often a symptom of anxiety.

To summarise, learning disorders may be related to:

• A major emotional disorder: anxiety disorder or depression

• A particular neurodevelopmental difficulty: a difficulty in the optimal development of one or more cognitive functions. For example, multilingualism, due to the cognitive overload associated with learning several languages, can sometimes cause difficulties in developing linguistic functions in one or more languages, and may be associated with difficulties in thinking or memorizing information in the affected language(s).

• A neurological condition: cerebral palsy and other mobility-impairing illnesses, attention deficit disorder, intellectual disability, specific learning disorder (dyslexia, …), Down’s syndrome, an autistic spectrum disorder such as Asperger’s, epilepsy, genetic disorders, neurodevelopment disorder, etc.

• Brain injury following brain trauma, concussion, a stroke, neurodegenerative disease, an infection such as encephalitis or meningitis, hydrocephalus, brain tumour, etc.

• Exposure to toxics: mercury, lead, cancer treatment by radiation or chemotherapy, in utero alcohol exposure, drug abuse, prolonged exposure to chemical products (residence near to a field for example)

What are the signs and symptoms of a learning difficulty or disorder?

Learning difficulty or disorder?

First and foremost it is essential to determine whether the child has a learning difficulty or a leaning disorder.

The prior may be resolved by psychoeducational support or psychotherapy. The latter requires a full psychological and neuropsychological assessment in order to determine the best treatment plan potentially involving occupational therapy, speech therapy, neuropsychological rehabilitation, psychotherapy etc.

Signs and symptoms of learning difficulties

Several factors should alert us to the presence of a learning difficulty. The child may be experiencing difficulties if the following activities are carried out slowly or painstakingly:

• Reading
• Understanding written text or spoken instructions
• Oral expression – finding the words to communicate his or her thoughts
• Writing or drawing quickly or in a detailed manner
• Holding an handling small objects such as scissors, a ruler, crayons or cutlery
• Finding their way around at school
• Time orientation: telling the time, understanding the meaning of yesterday or tomorrow
• Body awareness: managing to not knock themselves, fall, drop their glass, being clumsy during playground sporting activities or extracurricular activities
• Concentrating on what is being said or shown to them: looking and listening with attention, being ‘present’ when spoken to, not skipping lines when reading
• Planning the steps required to carry out a task or exercise
• Organising their school notes, their files and their school bag
• Learning and remembering a poem, their school work, events
• Counting on their fingers

Children with learning difficulties may also show:

• Considerable tiredness
• Delayed learning in certain areas
• A slowness carrying out tasks/exercises
• Refusal to go to school, to write or to draw
• Difficulties at homework time due to tensions in the parent-child relationship
• A drop in self-confidence, anxiety

Signs and symptoms of a learning disorder

Those children who suffer from permanent and persistent learning difficulties may be suffering from a learning disorder (or cognitive disorder). The presence of the following factors may indicate a permanent and persistent learning difficulty:

• Every school year, the new teacher informs you of specific learning difficulties encountered by your child

• Your child struggles to learn irrespective of the context (whether at home or at school)

• The school psychoeducational programs are insufficient or inefficient

• An assessment has previously been carried out by a healthcare professional, such as a speech therapist, but the care plan has not been successful

How to diagnose learning disorder?

Let’s start by taking a look at how the brain works…

At any one point in time, our brain is carrying out complex procedures to gather and process the information it encounters. In order to do so, it uses what are known as "cognitive functions". Cognitive functions can be defined as the cerebral activities that lead to knowledge (cognition). They include all types of mechanisms for acquiring information, namely:

• Functions non-focused on emotions: reasoning, attention, memory, language, motor skills, planning etc.
• Functions focused on emotions: functions known as affective and social

It is thanks to the efficiency of our cognitive functions that we can participate in the world around us and learn. When a child has difficulties learning or being in the world, it means that there are deficits or at least difficulties with one or more of their cognitive functions.

Due to the complexity of the brain and it’s functioning, an exploration of the different capacities that may have an influence on the relationship with the world and learning, is essential. For example, children with autism often display varying difficulties that should be assessed, such as emotional, social, attention, language-based and mobility impairments.

Full Assessment of cognitive, emotional and social functioning

Assessment for children aged over 6 years old

In case of a suspected learning disorder, for children from the age of 6 and above, a full psychological and neuropsychological assessment should be carried out. The full assessment links together cognitive development with emotional and affective development.

* Neuropsychological assessment examines cognitive development. It analyses the totality of the cognitive (brain) functions. By exploring the symptoms displayed by the child, it enables deficits of any of the brains functions to be identified. It examines the following cognitive aspects of the child:

• Reasoning: conceptual, logical, crystallized, fluid
• Attention: selective, sustained, divided / visual, auditory, audio-verbal modes
• Executive functions: planning, flexibility, inhibition, working memory, speed of information processing
• Language: expressive (expression) and receptive (comprehension)
• Memory: short-term and long-term / visual, verbal, visuospatial modes
• Visuospatial processing: visual perception, visual analysis, 2D and 3D processing
• Sensorimotor processing: manual, ocular, orofacial
• Social cognition: emotions identification, Theory of mind
• Learning: written language (reading, writing), counting and calculation

* Psychological assessment examines emotional development. It allows the psychologist to identify the specificities of a child’s personality and whether or not any disorder is present. It examines the following psychological aspects of the child:

• Level of personality organization
• Level of adaptation to reality
• Level of emotional adaptation
• Level of social adaptation
• Individual issues
• Emotional state

Assessment for children under the age of 6 years

If a learning disorder is suspected before the age of 6, a developmental assessment can be carried out. This involves assessment of the child’s stage of development in relation to that of other children of the same age. The following aspects are examined:

• Motor skills: fine and gross
• Language: expression and comprehension
• Intellectual capacities
• Life skills
• Social skills
• Autonomy

A developmental assessment enables the detection of deficits as well as helping to make diagnostic hypotheses and to orient the therapeutic care plan as well as psychoeducational strategies at school and at home.

Under the age of 6, the child is in a stage of phenomenal neuronal and psycho-affective development. The diagnostic hypotheses based on the developmental assessment should be verified around the age of 6 once the brain functions are not in such a major phase of development.

As the brain functions are still in the process of developing, we cannot expect, for example, a 3-year-old to have fully developed attentional capacities and to be able to concentrate. For this reason, this cognitive cannot be assessed. Certain cognitive functions cannot be assessed before the age of 6.

Therefore, a full psychological and neuropsychological assessment at the age of 6 allows for the diagnosis to be confirmed or otherwise and for an evaluation of the totality of the cognitive functions in depth. In the meanwhile, psychological treatment can be offered to assist the child in their development.

When should an assessment be carried out?

An assessment can be carried out before the age of 6, as soon as developmental difficulties are detected, or after the age of 6 as soon as learning difficulties are detected. Frequently the school notifies the parents around the time of 1st grade – a critical time for learning. This is a key moment in which to carry out an assessment. Prior to 1st grade, it is often the parents that notice their child’s developmental difficulties and these may be indicators of future learning difficulties.

All too often, parents only seek an assessment after years of questioning and academic difficulties that have had the time to negatively affect the child’s self esteem.

The sooner the assessment, the sooner the therapeutic care plan and psycho-educational program can be put into place, potentially enabling/facilitating an improvement during this critical phase of brain development that marks childhood.

Assessment objectives

The assessment helps to respond to several questions.

What difficulties is my child being faced with?

The evaluation allows for difficulties to be identified and for a diagnosis or diagnostic hypothesis to be proposed. It enables:

• Understanding the nature of the difficulties faced by the child: are signs of cognitive and/or emotional/affective/mental deficits present?
• Evaluating the severity of the deficits and the level of skills
• Examining the consequences on the psychological functioning and the autonomy of the child of these deficits or disorders: are they affecting learning, social interaction, emotional regulation? If so, how and to what extent?
• Ascertaining the resources available to the child that can help them to develop

How to deal with these difficulties?

The evaluation can guide the follow-up treatment and maximise the learning potential and well-being of the child. The objective is to help the child to flourish on all levels - academic, social and emotional. The evaluation helps:

• Parents to better understand their child, respecting the child’s limits and providing better adapted support
• To provide parents with the knowledge required to explain their child’s needs and get them help from the relevant services
• To develop an effective therapeutic care plan adapted to the child’s needs (benefiting from the services of neuropsychology, psychology, occupational therapy, speech therapy etc.)
• To develop an efficient individual education plan adapted to your child’s needs (psychoeducational strategies at school and at home, teaching assistants, collaboration with teachers etc.)
• To provide the child with a vocabulary that gives meaning to the difficulties faced. Better understanding of the causes of suffering can provide comfort. For example, a child who knows that they have difficulties learning or learns differently may feel like a failure. However if he or she understands their difficulties, they can accept them and approach things in a different way. The final stage is to help the child to feel capable of overcoming, to whatever extent is possible, their difficulties and therefore engaging in the treatment plans offered. Indeed, motivation is the central factor in the success of treatment.