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Examination of the child—the paediatrician's role

After collecting information from the parents (referred to as taking a history), the paediatrician will examine the child (referred to as, performing a ‘physical examination’). He or she may also arrange for some special tests to be performed, depending on the findings of the history and the physical examination.

In taking a history and examining the child, the paediatrician will call upon his or her knowledge of the many conditions that can cause learning impairment.

Table 2.1 Causes of learning impairment that must be excluded before a diagnosis of specific learning disability can be made

Vision or hearing impairment

Intellectual disability

Physical disability (e.g. cerebral palsy)

Lack of familiarity with the language of instruction

Lack of family support

Poor teaching

Lack of motivation

Frequent absenteeism

Brain damage (e.g. following head trauma or meningitis)

Petit mal epilepsy

Medicines or drugs that impair learning

In most cases, no cause will be found, but such a search is essential if certain rare, treatable causes of poor academic achievement are not to be missed. The causes of learning impairment that have to be excluded are listed in Table 2.1.

In some children, one of the conditions listed in Table 2.1 may be present but may not adequately explain the child’s poor academic achievement. The condition may then be acting as an aggravating factor in a child whose primary problem is a specific learning difficulty. Poor motivation is a particular trap for the unwary, as many children with specific learning difficulties become poorly motivated or truant as a result of their difficulties. In such cases, their poor school attainments may be incorrectly attributed to poor motivation or school absences alone. It often requires careful judgement by the paediatrician and psychologist to determine whether a particular problem is the only cause of the child’s difficulties, or is an aggravating factor in a child with an underlying specific learning difficulty.

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