Learning Difficulties

Learning difficulties are a group of disorders involving significant difficulties in the acquisition and use of listening, speaking, reading, writing, reasoning or mathematical abilities. A child with a learning difficulty finds it more difficult to learn, understand and do things compared to other children of the same age. When a child is younger than school age, these difficulties are likely to be called Global Development Delay.

Like all children and young people, children with a learning difficulty will generally continue to progress and learn throughout their childhood – but more slowly. In some rare medical conditions, intellectual progress may be more uncertain. Children with a learning difficulty are likely to need extra support at school to help them to learn to the best of their ability.

What are the common features of learning difficulties?

Most learning difficulties are categorised as:

Verbal:

• Difficulty with both spoken and written words.
• Some people with verbal learning disabilities may be able to read or write adequately but have trouble with other aspects of language (e.g. they may be able to sound out a sentence or paragraph perfectly (thus reading well), but they can’t ‘make sense’ of what they are reading or form a mental picture of the situation they have read about).

Non-verbal:

• Difficulty with the act of writing because the brain struggles to coordinate the many simultaneous tasks required (e.g. from moving their hand to form letter shapes to remembering the correct grammar required in a sentence).
• Difficulty processing what they see (e.g. having trouble making sense of visual details like numbers on a blackboard, confusing the ‘+’ for ‘-‘ in Maths).
• Difficulties understanding abstract concepts such as fractions.

Significant difficulty with ‘adaptive functioning’.

• This means that the child will not meet the expected standards of independence and responsibility for his or her age.
• Difficulties in being able to feed or dress themselves
• Not being able to manage money independently when they get older.
• The difficulties are likely to affect their activities of daily life, such as being able to communicate with others, participate in social events or gain independence.
• These difficulties occur in different environments, such as at home, school and during leisure time.

Common difficulties often (but not always) experienced by the child with learning difficulties:

• Slow vocabulary growth, often unable to find the right word.
• Difficulty rhyming words.
• Trouble learning numbers, alphabet, days of the week, colours and shapes.
• Extremely restless and easily distracted.
• Trouble interacting with peers.
• Difficulty following directions or routines.
• Fine motor skills are slow to develop.
• Transposes number sequences and confuses arithmetic signs (+, -, x, /, =).
• Slow to remember facts.
• Slow to learn new skills, relying heavily on memory.
• Impulsive and has difficulty planning
• Poor pencil grip and subsequent handwriting.
• Trouble learning to tell the time.
• Poor coordination and tends to appear unaware of physical surroundings.
• Unable to complete tasks within given time frames.
• Reverses letters or confuses words.

Other difficulties

Children with a learning difficulty can have other developmental difficulties and differences and might be described with multiple diagnoses, such as Autistic Spectrum Disorder or Attention Deficit Hyperactivity Disorder (ADHD). It is important that these difficulties and differences are well understood so that children can get the support that they need day to day.

Children with a learning difficulty may also have other medical conditions such as epilepsy or cerebral palsy.

The role of a Community Paediatrician

We see children where there is an emerging or identified developmental delay, who have a Mid-Essex GP or attend a school in Mid-Essex and children requiring investigation for possible medical causes of a learning disability where the learning disability has been identified by education services.

It is important that any developmental delay is diagnosed as early as possible so that the child can get the right early support and help to enable him or her to learn and progress well and fulfil their optimal and best potential.

Who can refer and how?

We accept referrals from any professional – if you are concerned about your child, please discuss your worries with your GP, health visitor or other professional who is working with you and your child, as they can make a referral.

While we do not accept referrals directly from families, the referral must include acknowledgement that you have consented to the referral.

Referral Triaged

All referrals are triaged by a Consultant paediatrician or Associate Specialist – if accepted your child will be seen in a paediatric clinic well within the national requirement of 18 weeks. Depending on the complexity of your child and the information available, additional referrals can be made at this time to therapy services to help reduce your time waiting for services.

Assessment

It may take a number of appointments to complete the diagnostic evaluation and to get all the investigation results back for your child.

The Paediatrician will discuss with you:

• Any investigations as part of the diagnostic work up and on-going management
• Tertiary referrals as required
• Prescribing of medications as indicated

If a diagnosis can be confirmed this will be discussed in detail with you and we will do our best to answer any questions that you may have.

Follow Up

For most children with developmental delay the focus of their support is within their educational setting. As such and unless there are any identified medical problems, children are usually discharged from the Community Paediatric Service once they are in school. The terminology also changes from ‘developmental delay’ to ‘learning difficulty’ or ‘learning disability’.

If there is any follow up planned this will be agreed with you and will be based on any on-going medical issues your child may have.

Transition to adult services

Most children in this pathway will have been discharged from community paediatric follow up well before their adult years. As such preparation for and transition into adult services usually sits with education and social care.

However if your child is under follow up with the Community Paediatric Service then we will participate in the transition process to adult services and make any relevant referrals to adult medical services and/or the Adult Disability Service.