Specific learning difficulties

Specific learning difficulties (SLDs), of which dyslexia is the most widely recognized, may not be identified early and specialist resources for remediation are not always available in mainstream education in the UK. The prevalence, causes and cognitive mechanisms of different types of SLD are described in this article, together with their inter-relationships and association with other developmental disorders such as language disorders, autism and attention deficit hyperactivity disorder (ADHD). Especially when unrecognized, SLDs can contribute to the development of emotional and behavioural difficulties and can complicate the management of ADHD. SLDs are common, especially in boys referred to child and adolescent mental health services, and professionals must be alert to the possible contribution of an SLD to emotional and/or behavioural problems and understand the impact on the individual child’s functioning, especially at school. The assessment and management of SLDs are discussed, together with respective roles of health and education professionals to facilitate liaison. Health professionals can, when necessary, support families in making the case for a psychometric assessment, a full assessment of special educational needs and for additional resources in school. Phonological impairment causes persistent literacy, mathematical and subtle language difficulties that, even in highly intelligent children, affect educational progress and contribute to emotional difficulties. Disadvantaged children and those who also have ADHD, dyspraxia or a history of language disorder are particularly at risk of antisocial behaviour and school exclusion. For complex or comorbid SLD, treatment of ADHD with methylphenidate and therapeutic work with the child and his family are vital as early as possible to prevent the development of academic failure, low self-esteem or serious behaviour problems.