Specific learning disabilities in children: Role of the primary care provider
- L Erik von Hahn, MD
L Erik von Hahn, MD
- Associate Professor of Pediatrics
- Tufts University School of Medicine
- Section Editors
- Carolyn Bridgemohan, MD
Carolyn Bridgemohan, MD
- Section Editor — Developmental and Behavioral Pediatrics
- Assistant Professor of Pediatrics
- Harvard Medical School
- Marc C Patterson, MD, FRACP
Marc C Patterson, MD, FRACP
- Section Editor — Pediatric Neurology
- Professor of Neurology, Pediatrics, and Medical Genetics
- Chair, Division of Child and Adolescent Neurology
- Mayo Clinic College of Medicine
Routine supervision of a child's educational status, including advocacy to assure the child's access to quality educational practices, is an important component of health supervision . Educational status has significant effects on long-term health . Factors that are associated with positive health outcomes include attending a high-quality preschool, social-emotional status in elementary school, and completion of high school . Early intervention programs, offered before the age of five years, appear to be particularly important predictors of future health status . For these reasons, routine supervision of a child's education is an important component of well-child care.
The role of the primary care provider in the evaluation and management of learning disabilities (LD) in children will be discussed here. The clinical features, evaluation, and management of LD in the educational system, and laws pertaining to specific learning disabilities in the United States, are discussed separately. (See "Specific learning disabilities in children: Clinical features" and "Specific learning disabilities in children: Evaluation" and "Specific learning disabilities in children: Educational management" and "Definitions of specific learning disability and laws pertaining to learning disabilities in the United States".)
The evaluation and management of learning disabilities (LD) is a primary responsibility of the school system, but it requires input from multiple professionals, including the primary care provider. The primary responsibilities of the primary care provider are to assist in the identification of LD, assure management of LD, address co-occurring conditions, and to provide case management under a medical home model . (See 'Early identification' below and "Children with special health care needs", section on 'Medical home'.)
Secondary roles include serving as a resource to families about community services, advocating for the child's rights and needs at school, serving as a mediator between the family and the school team, and serving as a consultant and resource to the school team. (See 'Resources' below and 'Advocacy and support' below and 'Mediator' below.)
●Primary roles – The diagnosis of learning disability (LD) using psychometric tests usually is made by educators and/or psychologists. Nonetheless, the primary care provider's expertise and unique clinical perspective play a vital role in the identification and evaluation of children with LD. A primary role of the pediatric clinician is to help identify the student who may have LD and/or who may need to be evaluated for LD. In addition, the pediatric clinician completes a medical evaluation for co-occurring conditions such as attention deficit hyperactivity disorder, sleep problems, and seizures, amongst others. Once identified, the primary care provider should discuss reasons for learning failure with the family, and provide information about LD and its co-occurring conditions. (See 'Early identification' below and 'Education and counseling' below.)
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- EARLY IDENTIFICATION
- MEDICAL EVALUATION
- Informal testing
- Ancillary medical testing
- Education and counseling
- - Learning disabilities
- - Nonstandard therapies
- - Psychosocial management
- - Legal rights
- - Resources
- Care coordination
- Advocacy and support
- Communicating with the school team
- - Medical information
- - Written documentation
- - Service delivery decisions: PCP's role
- - Services at school: Educational versus rehabilitative