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Important elements of the history for students with learning failure

Important elements of the history for students with learning failure
  Potential significance
History of the learning problem
When did the family first notice learning problems in the child? Is the child learning successfully now or still struggling? Persistent learning problems over time are more highly associated with LD than a learning problem of recent onset; LD can first manifest at any time throughout the primary and elementary school years but usually manifests in the primary school years
What helps the child learn more successfully (eg, small group instruction; 1:1 instruction, etc)? Greater success in small groups as opposed to the general classroom may be related to LD or may be related to other factors such as a language disorder or weak executive skills
School performance
What are the child's grades? Past or current poor academic achievement is a risk factor for LD
Can the child complete homework independently? Inability to complete homework independently, especially after grade one, can indicate LD
Did the child receive any early intervention or special education services? Past early intervention or special education services are a risk factor for LD, regardless of the type of service that was offered and regardless of whether the child was found to be no longer eligible for services
Did the child's teachers provide any indication that they were concerned about the child's educational progress? Although not all teachers can identify LD specifically, teacher observations of learning failure is a sensitive indicator of LD
Past grade retention Past grade retention is a risk factor for LD
School attendance
Does the child attend school regularly, now and in the past? Past school absences have an impact upon learning success and can mimic LD or be due to LD
Does the child have a history of school avoidance? School avoidance may be due to perceived lack of competence because of LD and may also lead to school absences, aggravating learning problems
Current psychiatric or behavioral conditions
Mental health conditions often occur with LD and are a risk factor for LD
Ability to focus and sustain attention to complete tasks of the daily routine; participate in social activities; and/or complete homework independently Symptoms of inattention are associated with attention deficit hyperactivity disorder, which co-occurs with LD; LD can also cause inattention during academic tasks
Capacity to regulate anxiety (eg, separation anxiety when leaving the home to go to school or elsewhere); other symptoms of anxiety Symptoms of anxiety are a risk factor for LD, either as a co-occurring condition or as a result of LD
Capacity for managing frustration (waiting his/her turn in a game; capacity to self-soothe when angry) Symptoms of difficulty regulating anger are a risk factor for behavior disorders, which co-occur with LD; low frustration tolerance for school activities specifically is a risk factor for LD
Medical history
Prenatal health problems; prenatal exposure to medications, toxins (alcohol, nicotine, etc), or infection Past neurologic insults are a risk factor for learning problems in general and for LD
Perinatal course and complications Perinatal complications are a risk factor for learning problems in general and for LD
Gestational age; birth weight Prematurity is a risk factor for learning problems in general and for LD
Past illnesses, especially affecting the CNS Past neurologic insults are a risk factor for learning problems in general and for LD
Past lead exposure Lead exposure is associated with lower cognitive potential
Past or current medications Medications may interfere with CNS functioning and may be associated with learning failure
Current neurologic symptoms to suggest seizures Seizures can interfere with learning
Current sleeping habits Poor sleeping habits may interfere with learning success
Developmental history
Age-appropriate attainment of gross motor skills Motor problems are related to cerebral palsy and other neurologic conditions, which co-occur with learning failure in general and may be associated with LD
Age-appropriate attainment of language skills Language problems co-occur with LD
Age-appropriate attainment of adaptive skills such as personal care, toileting Age-appropriate attainment of adaptive skills requires general cognitive skills, as well as attention regulation skills; poor adaptive function may be associated with learning failure and with LD
Attainment of social and play skills (ability to play successfully with same-age peers without caregiver supervision; capacity for friendships) Social skills may be delayed as a primary problem (eg, autism spectrum disorder) or may be due to perceived lack of self-confidence due to LD
Able to participate in community activities such as sports teams or other recreational activities Motor, adaptive, and social skills are required for success in community activities; LD is associated with lower success in these areas
Family history
Do any first- or second-degree relatives have learning problems? LD is often inherited
Do any first- or second-degree relatives have mental health or developmental conditions such as anxiety, depression, attention problems, learning problems, etc? Mental health conditions often occur with LD and are a risk factor for LD
What are the parents'/caregivers' or family's current reading habits? The history of current reading habits can serve as a proxy for an unidentified reading disability
How far did the parents/caregivers take their education? Poor educational achievement is related to LD
Social history
Current parent employment status Current parental employment status may be related to the parents' success at school and maybe an indicator of LD
Past abuse or neglect Past abuse or neglect is a risk factor for poor educational achievement in general and may be related to LD, regardless of current social status
Past or current homelessness Past homelessness is a risk factor for poor educational achievement in general and may be related to LD, regardless of current living circumstances
Past or current parental/caregiver illnesses in family members Past illnesses in the family is a risk factor for poor educational achievement, for both social and heritable reasons
This table is derived from UpToDate content on specific learning disorders. Refer to UpToDate content for additional details. Poor educational achievement may occur because of LD, weak language skills, weak executive skills, or lower overall cognitive potential. The risk factors identified in the table are associated with learning difficulty and support the request for an evaluation for LD or other causes of learning failure. The timing of the evaluation is an important consideration because some types of learning difficulty can only be identified after exposure to education.
LD: learning disorder; CNS: central nervous system.
Graphic 76081 Version 11.0

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