A diagnostic approach to developmental specific learning disorders.

Children and adolescents who are not doing well in school are often referred to physicians for evaluation. Many of these children have average or above-average intelligence but are academically frustrated, low achievers. Parents state that although they are convinced that their child is bright, he or she does not seem to learn, and does not behave acceptably in school and at home. Results of the usual pediatric and neurologic examinations are frequently unrevealing. In evaluating children who are doing poorly in school, the clinician must determine whether the child has a developmental specific learning disorder and whether primary affective illness, disturbed vigilance, or hyperactivity complicates the picture. Children who are intelligent but failing in school frequently manifest either one or several of these conditions. Although there are reasonably well-established criteria for affective illness in children, clinically useful criteria for evaluating the variety of childhood learning problems have not been available. We present criteria for the diagnosis of developmental specific learning disorders and briefly mention some aspects of management and treatment. We also describe a primary disorder of vigilance that becomes manifest in school, worsening the learning and performance process, which is further worsened by affective illness.