Course:PostgradFamilyPractice/ExamPrep/99 Priority Topics/Learning

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Learning - Key Features

Patients:
1. As part of ongoing care of children, ask parents about their children’s functioning in school to identify learning difficulties.

• Often presents with parental concerns, usually when the child fails to achieve academic milestones alongside his/her peers (report cards, etc)
• Can be first identified by teachers who initiate referrals to special education teams or for formal psychometric testing and diagnosis
• Early identification = better outcomes, therefore ask routinely about child’s performance in school
• Consider a learning disorder with any of the following concerns: academic, behavioral, attention, or social interaction problems
• Have a low threshold for considering a learning disorder in children at risk, which includes:

o Family history of learning disorders
o Poverty
o Understimulating environment
o Premature
o Developmental or mental health disorders (ADHD, autism, anxiety, depression, etc)
o Neurologic disorders (seizures, neurofibromatosis, Tourette syndrome)
o Chromosomal disorders (Fragile X, Turner, etc)
o Chronic medical conditions (diabetes, etc)
o Traumatic brain injury
o CNS infection or radiation


2. In children with school problems, take a thorough history to assist in making a specific diagnosis of the problem (eg mental health problem, learning disability, hearing)

• Evaluation requires complete history and physical to identify potential medical, neurologic and/or behavioral conditions that may be related to the learning disorder
• Ask about education and learning (general questions about functioning in school)
• Ask about onset of the problem, whether it is improving or worsening, factors that improve or aggravate the problem
• Ask about hearing, vision, motor skills, attention and task completion skills, language skills, social skills
• Ask about school attendance
• Ask about developmental milestones, especially language
• Formal diagnosis requires psychometric testing (administered by psychologist or educator)

Note: lab work is not usually necessary, and physical examination is often normal

3. When caring for a child with a learning disability, regularly assess the impact of the learning disability on the child and the family.

• Self-explanatory: use FIFE when interviewing

o Feelings
o Ideas
o Function
o Expectations


4. When caring for a child with a learning disability, ensure the patient and family have access to available community resources to assist them.

• Will vary based on community, but are often available through the school system
• Some online resources include:

o www.kidsource.com/kidsource/content3/ada.idea.html (Provides information and advice about LD and ADHD for parents, teachers, and other professionals)
o www.fape.org (Provides information and advocacy for children with special needs)
o www.cps.ca (Canadian Pediatric Society: online general information)


5. To maximize the patient’s understanding and management of their condition,
a) Determine their willingness to receive information
b) Match the complexity and amount of information provided with the patient’s ability to understand.

• Self-explanatory: use SPIKES for sharing bad news

o SETTING up the interview,
o Assessing the patient’s PERCEPTION
o Obtaining the patient’s INVITATION,
o Giving KNOWLEDGE
o Addressing the patient’s EMOTIONS with EMPATHIC responses


Self-Learning:
6. Continuously assess your learning needs.

7. Effectively address your learning needs.

8. Incorporate your new knowledge into your practice.

Study Guide

Learning

Resources

www.kidsource.com/kidsource/content3/ada.idea.html (Provides information and advice about LD and ADHD for parents, teachers, and other professionals)
www.fape.org (Provides information and advocacy for children with special needs)
www.cps.ca (Canadian Pediatric Society: online general information)