Children With School Problems E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Bildung
• Sprache: Englisch

Seitenzahl: 557

Veröffentlichungsjahr: 2012

Beschreibung

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. * The only book on learning disabilities in children specifically designed for physicians * Written by trusted experts from the Canadian Paediatric Society * Covers important issues including literacy promotion, screening for disabilities, medication options, and much more * Gives physicians the tools they need to help 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.

Leseprobe

Table of Contents

Title Page

Copyright

About the Canadian Paediatric Society

Our Mission

Who We are

What We do

On the Internet

Acknowledgements

Editors

Authors

Reviewers

Other Acknowledgements

Introduction

How to Use this Book

Part I: Foundations

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

Prevalence of Learning Problems

Types of Learning Disabilities

Response to Intervention

Etiology/Mechanisms of LDs

Natural History

Treatment/Management

Summary

References

Chapter 2: Understanding and Working with Schools

Educational Legislation and School Organization

Terms Used by the Education System

Controversies in Education

Summary

References

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

Brain Development in Utero

Brain Development and the Origin of Learning Difficulties

Disruptions in CNS Development—Critical Periods in Utero

The Newborn Period

Acquired Biologic Childhood Factors

Childhood Social Factors

Summary

Resources

References

Chapter 4: Development and School Entry

School Readiness

Age of Entry

Typical Preschool Learning and Skills Present at the Time of School Entry

Other Predictors of Success at the Time of School Entry

Summary

References

Chapter 5: Provincial/Territorial Special Education Legislation

British Columbia

Alberta

Saskatchewan

Manitoba

Ontario

Quebec

Prince Edward Island

Nova Scotia

New Brunswick

Newfoundland and Labrador

Northwest Territories

Nunavut

Yukon Territory

Part II: Diagnostics

Chapter 6: Data Gathering

Reviewing Previous Reports

Interpreting Psycho-educational Assessments

Anatomy of a Psycho-educational Assessment

The History

Setting the Stage

Interviewing Parents

Interviewing Children

Introducing the Idea of Counselling

Summary

Resources

References

Chapter 7: Questionnaires

Collection of Information from Parents and Teachers

Summary

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

Rule out Physical Disease

Evaluate Co-morbid Medical Conditions

Look for Minor Physical Anomalies

Describe Neurological Findings

Rule out Contraindications and Establish a Baseline for Medication Use

Summary

Resources

Chapter 9: Medical Investigations of Children with Learning Problems

Medical Conditions

Medical Investigations

Summary

References

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

Levels of Assessment by Physicians

Screening, Sampling, and Assessment

References

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

The Differential Diagnosis of Poor Academic Achievement

The Differential Diagnosis of Noncompliance and Oppositional Behaviour

The Differential Diagnosis of Motor Incoordination

The Differential Diagnosis of Social Interaction Problems

Summary

References

Part III: Management

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

Formulation

Feedback to Parents

Feedback to the School

Sample Formulation

Summary

Chapter 13: Educational Interventions

Demystification

Classroom Placement

Out-of-school Instruction

Specific Remediation

Role of Physicians' Advice to Students

Organization, Studying, and Homework

Summary

Selected Resources

References

Chapter 14: Behavioural Management

Underlying Factors Affecting Behaviour: Cognitive Abilities

Underlying Factors Affecting Behaviour: Regulation

Strategies for Helping with Regulatory Problems

Evidence-based Approaches to Behaviour: Programs, Resources, and General Principles

Self-esteem and the Child with School Problems

Relationships with Peers

Summary

Resources

References

Chapter 15: Medical Management

The Role of Medications in Managing Children with School Problems

Use of Medication for ADHD

Treating Associated Medical Conditions

Summary

References

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

Evaluating Research on CAM

Discussing CAM with Parents

Summary

Resources

References

Part IV: Trajectories

Chapter 17: Supporting the Adolescent with Learning Problems

The Challenges of Transition: Junior High and High School

Working with Teens Who Have Learning Problems

Strategies and Supports for Home and School

Evaluating Teens with Learning Problems

Management Issues When Following Adolescents

Summary

Resources

Chapter 18: Learning Problems from Adolescence into Adulthood

Factors Contributing to Quality of Outcome

Adults with Learning Disabilities

ADHD in Adult Life

Adults with Intellectual Disability

Delinquency and Learning Problems

Learning Problems and Adult Psychiatric Disorders

Indicators of Learning Problems in Adults

Resources for Adults with Learning Problems

Summary

References

Part V: Resources

Chapter 19: Encouraging Reading

What Can Physicians Do?

What Can Parents Do?

Choosing Books for Children

Reading Resources

Summary

References

Chapter 20: Illustrative Cases

CASE I: Derek—Attention Weakness and Academic Delay

CASE II: Parminder—Reading Difficulties and English as a Second Language (ESL)

CASE III: Jewel—Academic Delay, Behavioural Concerns in the Context of Prenatal Alcohol Exposure

CASE IV: Tristan—Gross Motor and Fine Motor Skill Clumsiness, Poor Attention, and Impulsivity

Resources

References

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

Summary

Glossary

Index

List of Tables

3-1 Early Risks for Learning Difficulties

3-2 Childhood Risks for Learning Difficulties

6-1 IQ Classifications in Current Use

8-1 Common Minor Physical Anomalies

8-2 Testing for “Soft” Neurological Signs

8-3 Details of the Physical Examination for School Learning Problems

15-1 Medical Treatment for Uncomplicated ADHD in Children

15-2 Medical Treatment for Uncomplicated ADHD in Adolescents

List of Figures

1-1 Executive Functions Impaired in ADHD

6-1 Normal Standard Distribution and Standard Scores

16-1 Evaluation Framework for Complementary and Alternative Therapies

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

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

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

20-4 The Three Diagnostic Facial Features of FAS

List of Tools

10-1 Complex Sentences (Ages 4 to 6 Years)

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

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

10-4 Verbal Instructions

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

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

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

10-8 Human Figure Drawings

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

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

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

10-12 The Gesell Copy Forms

10-13 Reading Tests

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

10-15 Evaluation of Written Stories Using BASIS

10-16 Reading and Writing Skills in School-aged Children

10-17 Sample Spelling Battery

10-18 Sample Mathematics Tests

10-19 Assessment of Auditory Memory from Repetition of Digits

Copyright © 2012 by the Canadian Paediatric Society

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Library and Archives Canada Cataloguing in Publication Data

Children with school problems: a physician's manual / Canadian Paediatric Society. --2nd ed.

Includes bibliographical references and index.

ISBN 978-1-118-30251-4

1. Learning disabilities--Handbooks, manuals, etc. 2. Learning disabilities--Diagnosis--Handbooks, manuals, etc. 3. Learning disabled children--Handbooks, manuals, etc. 4. Learning disabled children--Education--Handbooks, manuals, etc. 5. Pediatrics--Handbooks, manuals, etc. I. Canadian Paediatric Society

LC4704.C55 2012 678.92'85889 C2012-902324-8

978-1-118-45710-8 (ebk); 978-1-118-45274-5 (ebk); 978-1-118-45275-2 (ebk)

Production Credits

Cover design: Adrian So

Cover image: iStockphoto

Printer: Friesens

Editorial Credits

Executive editor: Robert Hickey

Managing editor: Alison Maclean

Production editor: Jeremy Hanson-Finger

John Wiley & Sons Canada, Ltd.

6045 Freemont Blvd.

Mississauga, Ontario

L5R 4J3

About the Canadian Paediatric Society

Our Mission

The Canadian Paediatric Society is the national association of paediatricians, committed to working together to advance the health of children and youth by nurturing excellence in health care, advocacy, education, research, and support of its membership.

Who We are

As a voluntary professional association, the CPS represents more than 3,000 paediatricians, paediatric subspecialists, paediatric residents, and other professionals who work with and care for children and youth.

What We do

Advocacy

: The CPS works to improve public policy that affects the health of children and youth.

Public education:

The CPS helps parents and caregivers make informed decisions about their children's health by producing reliable and accessible health information.

Professional education:

The CPS supports the continuing learning needs of paediatricians and other child and youth health professionals through position statements, a peer-reviewed journal, and educational events.

Surveillance and research:

The CPS monitors rare diseases and conditions, and ensures continued research into vaccine-associated adverse reactions and vaccine-preventable diseases.

Because the needs are so great, the CPS also works with many other organizations to promote the health of children and youth.

On the Internet

www.cps.ca: This is the primary online home of the Canadian Paediatric Society. Visit this site to access position statements, written by Canada's paediatricians on a range of child and youth health topics, and learn more about the organization. You can also find a series of resources and links to complement the material in this book.

www.caringforkids.cps.ca: Caring for Kids is the CPS website for parents and caregivers, with more than 150 documents with practical, easy-to-use information on everything from pregnancy and babies to behaviour and development. To access the French version of the site, Soins de nos enfants, visit www.soinsdenosenfants.cps.ca.

Acknowledgements

Children with School Problems reflects the efforts and wisdom of some of Canada's most respected paediatricians. Led by Dr. Debra Andrews and Dr. William Mahoney, the authoring team brings insight and expertise from years of caring for Canadian children and working with families. The Canadian Paediatric Society is tremendously grateful to them for sharing their wealth of knowledge.

We must also recognize the authors of the first edition of this book. Published in 1998 under the guidance of editors Dr. Mervyn Fox and Dr. William Mahoney, the book included contributions from Dr. Debra Andrews, Dr. Mark Handley-Derry, Dr. Helena Ho, Dr. Wendy Roberts, and Dr. Jay Rosenfield.

Editors

Dr. Debra Andrews is one of the original contributing authors to Children with School Problems: A Physician's Manual, and is currently associate professor of pediatrics and divisional director for developmental pediatrics 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 children with complex learning and behavioural problems. Dr. Andrews divides her time between providing clinical care to this population and teaching medical students, residents, fellows, and practising physicians how to assess and care for children with developmental disorders.

Dr. William Mahoney is one of the co-editors of the first edition (1998) of Children with School Problems: A Physician's Manual and a contributing author. He is a clinical associate professor of Pediatrics, Faculty of Health Sciences, McMaster University, and former medical director of the Developmental Pediatric, Rehabilitation, and Autism Programs of McMaster Children's Hospital. He teaches about developmental problems to all levels of trainees, and participates in research in acquired brain injury in children and the genetics of autism spectrum disorders. He provides clinical care for children with developmental problems, including children with learning disabilities and attention deficit hyperactivity disorder.

Authors

Dr. Brenda Clark is an associate professor at the University of Alberta's Department of Pediatrics, Division of Developmental Pediatrics. Her clinical and research areas of interest are related to the diagnosis and treatment of developmental disorders, including learning disabilities, attention deficit hyperactivity disorder, and autism, and the rehabilitation of brain injury.

Dr. Cara Dosman is a developmental-behavioural paediatrician at the Glenrose Rehabilitation Hospital in Edmonton, and is medical director of the 1–2–3 Go! Glenrose Child and Family Early Intervention Service. She has experience in the assessment and management of children with developmental disorders in both community-based and tertiary hospital-based clinics. Dr. Dosman is an assistant professor of pediatrics and rotation coordinator for the general paediatric residents' rotation in Developmental Pediatrics at the University of Alberta.

Dr. G. Tyna Doyle is a developmental paediatrician at the Janeway Children's Health and Rehabilitation Centre in St. John's, and an assistant professor at Memorial University of Newfoundland. She received her medical degree and completed her paediatrics residency at Memorial University, and then completed a subspecialty residency in Developmental Pediatrics at the University of Alberta in 2010. At the Janeway, Dr. Doyle divides her clinical time between the child development and rehabilitation teams. Her interests include ASD, ADHD, LD, and CP.

Dr. Barbara Fitzgerald is a developmental paediatrician and clinical associate professor in the Division of Developmental Pediatrics at the University of British Columbia. She runs a unique outreach program that provides developmental assessment to inner-city children in their schools. She teaches child development to medical students, emphasizing a social paediatrics approach to learning and behavioural disturbances, and is a passionate advocate for children living in poverty. Dr. Fitzgerald developed an initiative providing a longitudinal experience for medical students in the inner city and is president of a charity aimed at alleviating child poverty and improving developmental outcomes.

Dr. A. Mervyn Fox is professor emeritus in the Department of Paediatrics at the University of Western Ontario in London. He was one of the co-editors of the first edition (1998) of Children with School Problems: A Physician's Manual. Before accepting an invitation to work in Canada in 1975, Dr. Fox was a lecturer in developmental paediatrics at London University's Wolfson Centre, Institute of Child Health, where he had qualified in medicine in 1960. In England he worked as principal physician in the Inner London Educational Authority, then the world's largest organization of elementary and secondary schools. Dr. Fox is a past chair of the CPS Psychosocial Paediatrics Committee and a past president of the Developmental Paediatrics Section.

Dr. Ana Hanlon-Dearman is a developmental paediatrician at the Child Development Clinic in Winnipeg. She trained at the University of Manitoba and completed her paediatric residency and fellowship training in developmental pediatrics at the Children's Hospital in Winnipeg. She is certified with the American Board of Pediatrics in developmental behavioural paediatrics, and is certified in behavioural sleep medicine with the American Association of Sleep Medicine. Dr. Hanlon-Dearman is currently an associate professor of pediatrics and child health at the University of Manitoba.

Dr. Helena Ho is a developmental paediatrician and clinical professor emeritus at the University of British Columbia, specializing in caring for children with learning and behaviour problems. She received degrees from the University of Ottawa, Radcliffe College, and McGill University. Dr. Ho founded the Multicultural Committee at Sunny Hill Health Centre for Children, and headed the autism team and child development diagnostic program there for many years.

Dr. Janet Kawchuk is a developmental paediatrician, autism team member, and residency program director for developmental pediatrics at the IWK Health Centre and assistant professor at Dalhousie University in Halifax. Dr. Kawchuk received her MD from the University of Alberta, completed her paediatric residency at the IWK, and worked as a community consultant paediatrician. She is an executive member of the Canadian Paediatric Society's Developmental Paediatrics Section, and a member of the section's curriculum committee.

Dr. Elizabeth Mickelson is a clinical associate professor, Division of Developmental Pediatrics, Department of Pediatrics, at the University of British Columbia. She initially trained as a physiotherapist and has had a long-standing interest in neurologically based conditions affecting development as well as the behavioural phenotypes of children with underlying genetic conditions/syndromes. In addition to clinical evaluation, Dr. Mickelson participates in academic teaching and clinical research activities related to this population.

Dr. Ruth Neufeld is a developmental paediatrician at the Alvin Buckwold Child Development Program and assistant professor of pediatrics at the University of Saskatchewan in Saskatoon. She completed medical school and paediatric residency at the University of Saskatchewan, followed by subspecialty training in developmental pediatrics through the University of Alberta at the Glenrose Rehabilitation Hospital in Edmonton. Before entering medical school, Dr. Neufeld worked as an itinerant speech- language pathologist, serving rural school divisions in Saskatchewan.

Dr. S. Wendy Roberts is a developmental paediatrician at Holland Bloorview Kids Rehabilitation Hospital and co-director of the Autism Research Unit at the Hospital for Sick Children. She is a professor in the Department of Paediatrics at the University of Toronto and adjunct scientist at the Bloorview Research Institute. She has led the first Canadian site of the Autism Treatment Network in Toronto, with the goal of improving the quality of evidence-based medical care offered to all individuals with autism and their families.

Dr. Sarah Shea has been director and division head at the Developmental Pediatrics Clinic of the IWK Health Centre for more than twenty-five years, and is an associate professor in the Faculty of Medicine at Dalhousie University.

Reviewers

Thanks to all the reviewers who provided thoughtful comments on portions of this book: Ms. Michelle Bischoff; Dr. Susan Bobbitt; Dr. Heidi Carlson-Reid; Dr. Umberto Cellupica; Sharan de Waal, MScOT; Dr. Michael Dickinson; Dr. Mark Feldman; Dr. Charlotte Foulston; Dr. Frank Friesen; Dr. Sarah Gander; Dr. Anne Gillies; Dr. Fabian Gorodzinsky; Dr. Mark Handley-Derry; Dr. John Holland; Dr. Angie Ip; Dr. Elizabeth Jimenez; Dr. Kassia Johnson; Dr. Huma Kazmie; Connie Lillas, PhD, MFT, RN; Dr. Sally Longstaffe; Dr. Peter MacPherson; Dr. Marilyn Marbell; Dr. Susanna Martin; Dr. Rob Meeder; Dr. Oliva Ortiz-Alvarez; Dr. Wendy Roberts; Dr. R. Garth Smith; Dr. Joseph Telch; Dr. Sunita Vohra; Dr. Tannis Wiebe; and Dr. Sandra Woods.

Other Acknowledgements

Our thanks to the children who provided the original artwork for Chapter 10: Noah Hewett, Eliza Nadon, Meara Nadon, and Sydney Szijarto.

Finally, the editors and authors would like to acknowledge the hard-working CPS administrative team: Jennie Strickland, who helped with research and permissions; Lindsay Conboy, who patiently juggled schedules to set up our many teleconference meetings; and our team lead, Elizabeth Moreau, without whose excellent assistance and daily attention to this work over the past year this book would not have been possible.

Introduction

Debra Andrews and William Mahoney

It has been forty years since the Canadian Paediatric Society published Learning Disabilities: A Practical Office Manual. It was recognized that physicians needed information to help children who presented to their offices with the concern of having trouble in school. This initial volume, written by child neurologists John Crichton and Henry Dunn, provided physicians with both a framework and some tools to develop formulations and recommendations that could lead to improvements for their patients. The volume was revised in 1981 and was actually supplied by the CPS to new graduates in paediatrics.

At the time there were no Canadian training programs in developmental paediatrics, and child development issues were just being identified as core knowledge and skills for practicing paediatricians. By the mid-1990s, children with school problems had become a significant component of the practice of general, community-based paediatricians. The scientific basis of this practice had improved. It was this body of knowledge that led to the recognition of developmental paediatrics as a subspecialty by the Royal College of Physicians and Surgeons of Canada. Children with School Problems: A Physician's Manual, published by the Canadian Paediatric Society in 1998, was written and edited by a group of developmental paediatricians and aimed at community-based paediatricians to give them more precise information and tools to assist their assessment and management of children with learning disabilities, primarily. As the field has advanced over the past decade, it was felt that an updated, revised edition was in order.

We know that children don't appear in the physician's office with the diagnosis already made, and not all school problems are the result of a specific learning disability. The emphasis of the book has changed to become truer to its title of Children with School Problems. This revised edition provides information about a wider group of children, including those with intellectual disabilities. It also covers specific entities that affect a child both in school and in the community, such as developmental coordination disorder, recognizing that a community physician can make this diagnosis. We have also tried to make the information relevant to primary care physicians who see children with school problems.

How to Use this Book

As in the previous volume, the book is organized into sections:

Foundations

Diagnostics

Management

Trajectories

Resources

The components of each section were chosen to be useful to physicians in their clinical work with children with learning problems. Certain domains were not included, as this is not intended to be a textbook of developmental paediatrics or of child development.

The first section, Foundations, presents pertinent background information for physicians seeing children with learning problems in their offices and can be used as an introduction for medical students and residents. It begins with an overview of learning problems in children and general information about the education system, followed by discussions of the neurological underpinnings of children's development and how these and other factors influence child development leading to school entry. In Canada, children begin their formal education at four or five years of age. The section concludes with a summary of relevant educational processes in each province regarding children with special needs and key contacts that can help physicians and families access resources and supports. Assessing children with learning problems requires consideration of multiple dimensions and sources of information.

The second section, Diagnostics, provides tools and approaches to obtain the necessary information, to develop a diagnostic formulation and to begin to synthesize a plan. This section reviews history, use of questionnaires, physical exam, medical investigations, and developmental sampling and screening. If you are a primary care provider, you can use the questionnaires and other tools to assist you in triaging the less complex cases that you can manage in your practice from those that need a referral to a specialist. If you are a consulting general paediatrician or other specialist, you may use some of the materials in your own assessments. The assessment tools are also useful for trainees to get some direct experience of children with learning problems. A number of materials can be copied and used in your office, including questionnaires for parents and teachers, and the graded reading passages from the previous version. There is a specific teacher's questionnaire for the pre-school age group. These materials can also be downloaded from the CPS website at www.cps.ca.

There are many choices for treatments and interventions, depending on the diagnostic formulation. The third section, Management, provides information about the educational, behavioural, and medical management of children's learning problems, including options for community programs. The information can assist physicians at all levels in understanding and recommending management strategies for children across the range of challenges that they and their families experience.

Because learning problems tend to be lifelong and affect adolescents and adults in their functioning and educational and career options, the Trajectories section will help with managing students through the teen years and understanding prognosis, an important part of counselling families about these conditions, both initially and over the longer term. We hope that this will be especially useful for the primary care physicians, who remain the ongoing medical contact for older adolescents and adults and can incorporate the context of the individual's learning problem(s) in the provision of care.

The Resources section includes a chapter on our best tips for encouraging children to read, and a resource sheet to help you assemble the information about the key contacts in your area that you will need to assess and manage children with learning problems. There is a set of four illustrative cases that you can use to see how the pieces of assessment come together in a clinical setting; these cases may also be used for teaching trainees. There is also a glossary of items selected from the entire book, using the most up-to-date terminology, to help you easily negotiate the changes in diagnostic labels that have resulted from our increased understanding of developmental conditions.

Numerous e-resources have been added to the book. We have incorporated both key references and the websites to helpful documents and organizations. This is recognizing that much changes quickly in this electronic age. You can also find these links at www.cps.ca.

Finally, throughout the book we have included the best wisdom of the authors, as well as the supporting evidence. The research supporting the field remains at an early level, and there are inconsistencies between sources. We hope that our observations are helpful in filling gaps where good evidence is not yet available.

Part I

Foundations

Chapter 1

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

William Mahoney

In most societies, educating children is a universal goal that takes between ten and twenty years. One's level of education has long-term economic, social, and personal implications; a child's failure or perceived failure in school has a significant impact, leading to a series of responses by families and educators intended to solve the problem or improve academic performance.

The field of learning problems continues to evolve as new information emerges and approaches change. This chapter provides an overview of the field of learning problems and the different entities that lead to problems in school.

Prevalence of Learning Problems

Estimates of the prevalence of learning problems vary from 3% to 20%(1), but the current consensus is that 10% to 15% of school-aged children are experiencing difficulty at any point in time. This includes those with a number of different difficulties that require further definition for appropriate interventions.(2)(3)

For specific learning disabilities (LDs), the variability in prevalence is also a result of different cut-points or formulas used to define them. Depending on the range of intelligence quotient (IQ) chosen to determine average ability and the instrument used to measure academic achievement, different boundaries will lead to a different prevalence.(4) However, the figure of 10% remains the most consistent and supportable estimate.