A Neurodevelopmental Approach to Specific Learning Disorders [Hardcover]

Kingsley Whitmore (Author), Hilary Hart (Author), Guy Willems (Author)

Book Description

Publication Date: June 15, 1999 | Series: Clinics in Developmental Medicine (Book 145)

This volume considers the neurodevelopmental disorders such as dyslexia, dyscalculia, dysgraphia, clumsiness and indeed all those learning difficulties to be found in a 'normal' school population with an IQ of more than 70. Specific ideas about the causes of these disorders are presented along with very practical preventative and management information which will be welcomed by a wide range of professionals with an interest in paediatrics, neurology, developmental and educational psychology.

Editorial Reviews

From The New England Journal of Medicine

Academic underachievement and misbehavior in school, either real or perceived, are common reasons for the referral of children for evaluation, diagnosis, and treatment of learning disorders. Although there are many potential causes for these problems in school, the initial referral is often to a physician to determine whether the symptoms are "neurologic" in origin. The person referring the child may not have a firm understanding of what question is actually being asked, but the referral is made nonetheless.

The first six chapters of this multiauthored book focus on a physician-centered approach to the initial evaluation of children with specific learning disabilities, including dyslexia, dysgraphia, and dyscalculia; the clumsy child syndrome; and attention-deficit disorder. The first chapter provides a historical review of the ever-changing definitions and nosologic classification of learning disorders, which are, in fact, complex and highly variable. The author's conclusion is that the best method of classifying these disorders is the application of a global concept, here defined as neurodevelopmental dysfunction, rather than trying to identify an underlying core disorder and associated coexisting conditions. In fact, the "lumping" rather than "splitting" of disorders, exemplified by the use of older terms, such as "minimal cerebral dysfunction," or newer ones, such as "deficits in attention, motor control, and perception," forms the conceptual underpinning of most of the chapters in which specific disorders are discussed. The second chapter presents a comprehensive review of what is known of the underlying neurobiologic basis of these conditions.

The chapters on each of the major disorders cover the normal development of the relevant cognitive functions, classification, and causes and assessment. Each author emphasizes the usefulness of the neurologic examination, including a search for "soft signs" (minor findings that do not suggest a focal abnormality of the nervous system) and the use of office-based screening tests in the diagnostic process. There is only scant mention of the role of neuropsychological and educational psychological evaluation.

At this point, older practitioners will probably experience deja vu. Over the past several decades in the United States, there has been a move away from such global constructs as minimal cerebral dysfunction, deficits in attention, motor control, and perception, and neurodevelopmental dysfunction and a decreasing reliance on neurologic examinations in the physician's office. There has also been movement away from screening tests administered by the physician and toward educational and neuropsychological tests that identify specific cognitive abnormalities. These tests are administered by trained professionals other than physicians. This approach not only has facilitated the development of empirically based nosologic classifications, but also forms the basis for studies of the underlying neuroanatomical and functional aspects of specific disorders. More precise understanding of the underlying cognitive deficits has also been important for the development of strategies for the early detection, early diagnosis, and targeted remediation of learning disorders in the educational setting. Moreover, federal legislation requires school systems to provide screening and diagnostic services for children who are not meeting expectations. Medical evaluation is no longer part of the services mandated for children with learning disabilities.

A number of chapters explore the psychosocial and biologic underpinnings of specific learning disorders. Topics covered include genetics, prenatal and perinatal precursors, temporal processing abilities in infants, psychosocial factors, and neuroimaging. Each chapter provides a thorough review of the literature in a specific area. Most of the authors present the data without attempting to evaluate critically the studies they have reviewed, but these chapters do serve as excellent compendiums of the important published papers.

The final chapters focus on the identification of children with specific learning disorders at the age of five years and the prevention and classroom management of specific learning disorders and behavioral problems. The emphasis, again, is on the physician's role, especially in screening and early diagnosis.

Most of the authors of this book are European. The physician-centered focus represents the approach that is used in the countries in which the authors practice, but as I have noted, this approach is very different from the dominant trend in the United States. Here, the physician's role is limited, and diagnosis and decisions about management depend much more heavily on information acquired through testing by educational psychologists and neuropsychologists. The differences in approach derive mainly from differences in the constructs applied to an understanding of these disorders; the global syndrome has been more or less replaced in this country by analysis of specific deficits.

These differences are also a function of the differences in the health care systems on the two continents. Health care practitioners in the United States would not have the time needed for the comprehensive evaluation of children suspected of having a specific learning disorder; in addition, this responsibility, and the funds required for carrying it out, have been given to the educational system. Finally, the gross inequities in our health care system work against poor children -- those most at risk for problems in school -- thus further limiting any possible role of the physician in the screening and diagnostic processes. These criticisms aside, this book provides a competent overview of the approaches used by those on the other side of the Atlantic and an excellent review of a large body of literature.

Reviewed by Gerald S. Golden, M.D.
Copyright © 2000 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

Review

' ... an excellent review of a large body of literature.' The New England Journal of Medicine

' ... essential reading for anyone planning epidemiological research in this area, both to provide information on individual disorders and putative mechanisms, and to demonstrate the difficulties in population ascertainment and the definition of variables to measure.' Paediatric and Perinatal Epidemiology

See all Editorial Reviews

Product Details

• Hardcover: 304 pages
• Publisher: Mac Keith Press; 1 edition (June 15, 1999)
• Language: English
• ISBN-10: 1898683115
• ISBN-13: 978-1898683117
• Product Dimensions: 10 x 7 x 0.8 inches
• Shipping Weight: 1.6 pounds
• Amazon Best Sellers Rank: #3,084,194 in Books (See Top 100 in Books)