Neurodevelopmental comorbidity profile in specific learning disorders
Keywords:
Dyslexia, Specific learning disorder, Comorbidity, ADHDAbstract
Background: Specific learning disorders (SLD) are the common reasons for referral of an otherwise healthy child from a main stream school. Although children do have difficulties even in early learning years in pre-primary and primary school; a significant number of preadolescent children from mainstream school do present with such disabilities. Primary objective was to study the differential distribution of various comorbidities across SLD spectrum. Secondary objective was to check for prevalence of abnormal neurological examination findings including soft signs.
Methods: After approval of institutional ethics committee, 100 consecutive case records of children presenting to the center were studied. Diagnosis was confirmed as per DSM V criteria. The clinical, psychological and neurological information was derived from notes of pediatrician, after SLD certification. Details about history, ADHD and comorbidities if any were recorded from parents where documented information was not sufficient. The prevalence of comorbidities was expressed as a percentage of total cases studied.
Results: ADD of combined type was the commonest comorbidity seen in 53% cases. Other occasional comorbidities noted were epilepsy, autism, cerebral palsy, history of meningitis and febrile seizures. Speech and visuospatial skills were affected 10% and 41% in children with SLD and all of these had ADD. Soft neurological signs like astereognosis, graphesthesia, dysdiadochokinesia, dysmetria were seen in more than 20% cases. Abnormal antenatal and perinatal history was more common in ADHD with SLD.
Conclusions: SLD children from mainstream schools usually have ADHD as commonest comorbidity. Often they should be looked for various neurological comorbidites like autism, epilepsy, cerebral palsy. Soft signs and motor delay need not be overlooked in view of comprehensive management. A large multicentric study is needed to look for soft neurological signs; neuroimaging may be needed in SLD to understand the disorders in cognitive spectrum.
References
Kulkarni M, Kalantre S, Upadhye S, Karande S, Ahuja S. Approach to learning disability. Indian J Pediatr. 2001;68(6):539-46.
Specific learning disorder. Available at: http://www.dsm5.org/Documents/Specific Learning Disorder Fact Sheet. Accessed March 8, 2016.
Alves LM, Siqueira CM, Ferreira Mdo C, Alves JF, Lodi DF, Bicalho L et al. Rapid naming in Brazilian students with dyslexia and attention deficit hyperactivity disorder. Front Psychol. 2016;7:21.
Schulte-körne G. [Specific learning disabilities - from DSM-IV to DSM-5]. Z Kinder Jugendpsychiatr Psychother. 2014;42(5):369-72.
Pham AV, Riviere A. Specific learning disorders and ADHD: current issues in diagnosis across clinical and educational settings. Curr Psychiatry Rep. 2015;17(6):38.
Sahoo MK, Biswas H, Padhy SK. Psychological co-morbidity in children with specific learning disorders. J Family Med Prim Care. 2015;4(1):21-5.
Huang YF, Chang HL, Wu YY, Huang YS, Liang HY. Clinical characteristics of children with learning disorders in Taiwan. Chang Gung Med J. 2007;30(5):423-9.
Karande S, Satam N, Kulkarni M, Sholapurwala R, Chitre A, Shah N. Clinical and psycho educational profile of children with specific learning disability and co-occurring attention-deficit hyperactivity disorder. Indian J Med Sci. 2007;61(12):639-47.
Choudhary M, Jain A, Chahar C, Singhal AK. A case control study on specific learning disorders in school going children in Bikaner city. Indian J Pediatr. 2012;79(11):1477-81.
Al-mamari WS, Emam MM, Al-futaisi AM, Kazem AM. Comorbidity of learning disorders and attention deficit hyperactivity disorder in a sample of Omani school children. Sultan Qaboos Univ Med J. 2015;15(4):e528-33.
Landerl K, Moll K. Comorbidity of learning disorders: prevalence and familial transmission. J Child Psychol Psychiatry. 2010;51(3):287-94.
Karande S, Kulkarni M. Specific learning disability: the invisible handicap. Indian Pediatr. 2005;42(4):315-9.
Margari L, Buttiglione M, Craig F, Cristella A, de Giambattista C, Matera E et al. Neuropsychopathological comorbidities in learning disorders. BMC Neurol. 2013;13:198.
Mayes SD, Calhoun SL, Crowell EW. Learning disabilities and ADHD: overlapping spectrumn disorders. J Learn Disabil. 2000;33(5):417-24.
Dupaul GJ, Gormley MJ, Laracy SD. Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment. J Learn Disabil. 2013;46(1):43-51.
Yoshimasu K, Barbaresi WJ, Colligan RC, Killian JM, Voigt RG, Weaver AL et al. Written-language disorder among children with and without ADHD in a population-based birth cohort. Pediatrics. 2011;128(3):e605-12.
O'byrne JJ, Lynch SA, Treacy EP, King MD, Betts DR, Mayne PD et al. Unexplained developmental delay/learning disability: guidelines for best practice protocol for first line assessment and genetic/metabolic/radiological investigations. Ir J Med Sci. 2016;185(1):241-8.
Shapiro BK, Palmer FB, Antell S, Bilker S, Ross A, Capute AJ. Precursors of reading delay: neurodevelopmental milestones. Pediatrics. 1990;85:416-20.
Lhatoo SD, Sander JW. The epidemiology of epilepsy and learning disability. Epilepsia. 2001;42(1):6-9.
Oliveira EP, Neri ML, Capelatto LL, Guimarães CA, Guerreiro MM. Rolandic epilepsy and dyslexia. Arq Neuropsiquiatr. 2014;72(11):826-31.
Nørgaard M, Ehrenstein V, Mahon BE, Nielsen GL, Rothman KJ, Sørensen HT. Febrile seizures and cognitive function in young adult life: a prevalence study in Danish conscripts. J Pediatr. 2009;155(3):404-9.