Developmental Learning Disorders: Clues to Their Diagnosis and Management
Donna M. Capin MD1
1 Assistant Professor of Pediatrics, Tufts University School of Medicine; Center for Children with Special Needs, Division of Pediatric Neurology, Floating Hospital for Children at New England Medical Center, Boston, MA.
Introduction
The observant physician can make a truly life-enhancing difference with the timely diagnosis of a learning disorder. Approximately 6% to 7% of all school-aged children are identified as "learning disabled" and receive special educational services. In the 1992 to 1993 school year, 4,633,674 students ages 6 to 21 years received services under Federal formula grant programs. In medical settings, roughly twice as many boys as girls are diagnosed formally, a ratio that most likely is biased by the different phenotypes of learning problems among boys and girls. High-profile disorders that cause disruption in classroom and family functioning are the earliest to be identified and often are referred for help as early as the preschool years. More subtle or nearly "invisible" disorders (such as isolated attention deficit without hyperactivity) are masked by unexceptional or even "good" (passive) behavior and can persist undetected into adulthood, becoming symptomatic in college or graduate school. Long-term follow-up studies and evaluations of the parents of children who have learning disorders have taught two lessons: 1) learning disorders are not "outgrown" and 2) they can be extremely subtle and well hidden, especially among adolescents, who are more likely able to compensate (albeit at a price) through most of their formal schooling.
