Possible reasons for poor school progress

Global learning difficulty

Learning difficulties affecting all areas of development occur in between 3% and 10% of children. The most common causes are chromosomal anomalies; Down’s syndrome and fragile X syndrome are the most common, although they are most likely to present before school age. Mild or moderate learning difficulties may not present until the child starts school; in a majority no cause can be identified. Nevertheless, referral to a pediatrician to consider the possible etiology and appropriate intervention is appropriate.

Specific learning difficulty

Some children whose general cognitive abilities are average have specific problems with learning. However, these specific problems may also present in combination, i.e. more than one difficulty may coexist.

Dyslexia or specific difficulties with reading are described in detail in Chapter 61. These problems frequently lead to referral to the eye clinic so that vision problems can be excluded. The diagnosis will be confirmed by a detailed assessment by an educational psychologist or neuropsychologist and specific educational support will be required.

Developmental coordination disorder (DCD) (or dyspraxia) is a specific problem of motor coordination affecting the coordination of large and fine movements and may lead to difficulty with physical activities, writing, and speech clarity. These children may have difficulty with visual and spatial perception, general organization, and self-help skills, e.g. dressing. They may experience additional emotional and social difficulties. A physiotherapist or an occupational therapist (OT) can provide assessment, advice, and treatment. A psychologist can help in assessing any associated specific cognitive difficulty which may coexist.

Speech and language disorders usually present prior to starting school, but more subtle difficulties of comprehension may not be recognized without detailed assessment. Assessment and support from a speech and language therapist will be necessary and may include a language program delivered as part of the school curriculum. Specific difficulties with literacy are associated with particular speech and language disorders.