The Canadian Paediatric Society, Debra Andrews, William J. Mahoney

ISBN: 978-1-118-45275-2

Sep 2012

272 pages

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The physician's guide to diagnosing and treating learning disabilities in children

1 in 10 Canadians have a learning disability, and doctors must be able to identify, diagnose, treat, and manage children who are struggling in school. The first book specifically tailored for the needs of physicians working with kids with learning disabilities, Children With School Problems: A Physician's Manual covers such important areas as child development, diagnosing learning disabilities (including data gathering, screening and assessment, and physical examinations), management (medication, behavioral management, and educational interventions), and prevention (including literacy promotion).

Written by trusted experts from the Canadian Paediatric Society, Children With School Problems is filled with practical tools and resources that physicians—including paediatricians, family physicians, and paediatric learners—can use to diagnose and treat children with learning disabilities.

Physicians want to know more about learning disabilities, and parents want their pediatricians and family physicians to provide more help when their kids struggle in school. Children with School Problems provides that information, making it an invaluable resource for any doctor working with kids.

The Canadian Paediatric Society is a national professional association, representing more than 3,000 paediatricians, paediatric subspecialists, paediatric residents, and other health professionals who work with and care for children and youth. The CPS is active in professional education, public policy advocacy, surveillance and research, and education for parents and caregivers.

Dr. Debra Andrews is associate professor of paediatrics and divisional director for developmental paediatrics at the University of Alberta. She is medical director of two tertiary interdisciplinary programs at the Glenrose Rehabilitation Hospital that provide assessment and intervention for school-aged children with complex learning and behavioural problems.

Dr. William Mahoney is a clinical associate professor of paediatrics, Faculty of Health Sciences, McMaster University, and has worked with children with school problems for over thirty years. He is the former medical director of the developmental paediatric, rehabilitation, and autism programs of McMaster Children's Hospital.

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About the Canadian Paediatric Society xi

Acknowledgements xiii

Introduction xvii

Part I: Foundations 1

Chapter 1: Overview of Children with Learning Problems, Schools, and Approaches to Helping 1

Prevalence of learning problems 1

Types of learning disabilities 4

Response to intervention 5

Etiology/mechanisms of LDs 5

Natural history 7

Treatment/management 9

Chapter 2: Understanding and Working with Schools 12

Educational legislation and school organization 12

Terms used by the education system 13

Controversies in education 15

Chapter 3: Early Development of the Nervous System and School Performance 18

Brain development in utero 18

Brain development and the origin of learning difficulties 18

Disruptions in CNS development—critical periods in utero 19

The newborn period 21

Acquired biologic childhood factors 21

Childhood social factors 23

Chapter 4: Development and School Entry 27

School readiness 27

Age of entry 27

Typical preschool learning and skills present at the time of school entry 28

Other predictors of success at the time of school entry 30

Chapter 5: Provincial/Territorial Special Education Legislation 32

British Columbia 33

Alberta 34

Saskatchewan 35

Manitoba 36

Ontario 36

Quebec 38

Prince Edward Island 38

Nova Scotia 39

New Brunswick 40

Newfoundland and Labrador 41

Northwest Territories 42

Nunavut 42

Yukon Territory 43

Part II: Diagnostics 44

Chapter 6: Data Gathering 44

Reviewing previous reports 44

Interpreting psycho-educational assessments 44

Anatomy of a psycho-educational assessment 45

The history 47

Setting the stage 47

Interviewing parents 48

Interviewing children 49

Introducing the idea of counselling 53

Chapter 7: Questionnaires 55

Collection of Information from Parents and Teachers 55

Consent to Release Information from School 58

Parent Questionnaire 59

Preschool/Kindergarten Questionnaire 66

School Questionnaire (6–18 Years) 71

Chapter 8: The Physical Examination of the Child with Learning Problems 77

Rule out physical disease 77

Evaluate co-morbid medical conditions 78

Look for minor physical anomalies 79

Describe neurological fi ndings 79

Rule out contraindications and establish a baseline for medication use 80

Chapter 9: Medical Investigations of Children with Learning Problems 82

Medical conditions 82

Medical investigations 82

Chapter 10: Developmental and Academic Skills: Screening, Sampling, and Assessment 86

Levels of assessment by physicians 86

Screening, sampling, and assessment 87

Chapter 11: Differential Diagnosis of the Child Who Is Not Doing Well in School 137

The differential diagnosis of poor academic achievement 137

The differential diagnosis of noncompliance and oppositional behaviour 144

The differential diagnosis of motor incoordination 144

The differential diagnosis of social interaction problems 145

Part III: Management 148

Chapter 12: Sharing the Formulation: Feedback to Parents and School 148

Formulation 148

Feedback to parents 149

Feedback to the school 149

Sample formulation 150

Chapter 13: Educational Interventions 152

Demystification 152

Classroom placement 153

Out-of-school instruction 154

Specific remediation 155

Role of physicians’ advice to students 160

Organization, studying, and homework 161

Chapter 14: Behavioural Management 164

Underlying factors affecting behaviour: Cognitive abilities 164

Underlying factors affecting behaviour: Regulation 164

Strategies for helping with regulatory problems 165

Evidence-based approaches to behaviour: Programs, resources, and general principles 166

Self-esteem and the child with school problems 172

Relationships with peers 175

Chapter 15: Medical Management 177

The role of medications in managing children with school problems 177

Use of medication for ADHD 177

Treating associated medical conditions 190

Chapter 16: Complementary and Alternative Therapies for Learning and Attentional Disorders 193

Evaluating research on CAM 193

Discussing CAM with parents 194

Part IV: Trajectories 197

Chapter 17: Supporting the Adolescent with Learning Problems 197

The challenges of transition: Junior high and high school 197

Working with teens who have learning problems 198

Strategies and supports for home and school 199

Evaluating teens with learning problems 199

Management issues when following adolescents 200

Chapter 18: Learning Problems from Adolescence into Adulthood 202

Factors contributing to quality of outcome 202

Adults with learning disabilities 204

ADHD in adult life 205

Adults with intellectual disability 205

Delinquency and learning problems 206

Learning problems and adult psychiatric disorders 207

Indicators of learning problems in adults 207

Resources for adults with learning problems 208

Part V: Resources 211

Chapter 19: Encouraging Reading 211

What can physicians do? 211

What can parents do? 212

Choosing books for children 216

Chapter 20: Illustrative Cases 217

Case I: Derek: Attention weakness and academic delay 217

Case II: Parminder: Reading diffi culties and English as a second language (ESL) 220

Case III: Jewel: Academic delay, behavioural concerns in the context of prenatal alcohol exposure 223

Case IV: Tristan: Gross motor and fine motor skill clumsiness, poor attention, and impulsivity 229

Chapter 21: A Resource Worksheet for Physicians Who Work with Students with Learning Problems 234

Glossary 243

Index 247

3–1 Early Risks for Learning Diffi culties 21

3–2 Childhood Risks for Learning Diffi culties 24

6–1 IQ Classifi cations in Current Use 46

8–1 Common Minor Physical Anomalies 79

8–2 Testing for “Soft” Neurological Signs 80

8–3 Details of the Physical Examination for School Learning Problems 81

15–1 Medical Treatment for Uncomplicated ADHD in Children 183

15–2 Medical Treatment for Uncomplicated ADHD in Adolescents 185

1–1 Executive Functions Impaired in ADHD 4

6–1 Normal Standard Distribution and Standard Scores 46

16–1 Evaluation Framework for Complementary and Alternative Therapies 195

20–1 Canadian Norms (Mean and SD) for Girls Aged 6 to 16 Years 226

20–2 Canadian Norms (Mean and SD) for Boys Aged 6 to 16 Years 227

20–3 The Palpebral Fissure Length Being Measured with a Small Plastic Ruler 227

20–4 The Three Diagnostic Facial Features of FAS 228

List of Tools

10–1 Complex Sentences (Ages 4 to 6 Years) 92

10–2 Complex Sentences (Ages 6 to 8 Years, 11 Months) 93

10–3 Story Comprehension (Ages 6 Years to 7 Years, 11 Months) 94

10–4 Verbal Instructions 95

10–5 Auditory Comprehension and Recall (Ages 9 Years to 12 Years, 11 Months) 97

10–6 Yes, No, Maybe: Higher-Level Language Function 99

10–7 Development of Oral Language Skills (Ages 5 to 12 Years) 100

10–8 Human Figure Drawings 106

10–9 Visual Matching Exercises (Ages 4 to 6 Years) 108

10–10 Visual Whole: Part Analysis (Ages 6 to 8 Years, 11 Months) 109

10–11 Lock-and-Key Designs (Ages 9 to 14 Years, 11 Months) 110

10–12 The Gesell Copy Forms 111

10–13 Reading Tests 112

10–14 Assessment of Handwriting Speed (Ages 6 to 9 Years) 118
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