What does the neuropsychological assessment of learning disabilities look like?
This is what is explored in the neuropsychological evaluation of learning disabilities.
The postpartum stage of development is one of the most important and delicate periods in the life of every human being. We are born with some neural and motor development, but neural connections and cortical circuits show their maximum expression between 8 months of gestation and 2 years of age. For example, the myelination process of the neurons of the nervous system responsible for the psychomotor process is not completed until 24 months of age.
Something similar happens with infant learning and development. To put it bluntly, the brain makes 1.8 million neuronal synapses between 2 months of gestation and 2 years of age, but in the years following this synaptic overproduction, there is a "selective pruning" typical of maturation. It is also estimated that 83% of dendritic growth (neuron prolongations) takes place at this stage of cerebral hyperexcitability.
As you can see, at birth the neonate perceives a new world, and undergoes a process of nervous maturation that is impossible to achieve at other times of life. With special emphasis on the physiological phenomena that take place at this time, we present you the current perspective of neuropsychological assessment of learning disabilities, especially in children..
Basis of child neuropsychological development
First of all, we find it interesting to clarify some of the terms and figures already cited. Neuronal synapses are the contacts that neurons have with each other or with another functional unit (muscle, for example), the purpose of which is to transmit a message from one organ to a distant one. In general, neuronal synapses are produced by electrical potentials, based on cell hyperpolarization and depolarization.
When a new activity is performed, different synapses (or neuronal pathways) may be established. As everything a newborn observes is novel, synapse production is triggered during the first few years of life.. In any case, a later "pruning" takes place, where excessive connections that are not useful are eliminated. On the other hand, when an activity or pathway is consulted very often, synapses are strengthened and mature, thus reinforcing functional connections. On these bases, learning is explained in a cursory manner.
The evaluation of learning disabilities
The American Psychological Association uses the term Specific Learning Disorder (SLD) to refer to learning disabilities as clinical entities. This group includes those neurodevelopmental disorders that begin during childhood, although sometimes not detected until adulthood, that hinder individual functioning. In these patients, there are problems in three different areas: reading, writing or calculating, all of them essential pillars for the learning process.
An ASD can only be diagnosed once the learning process begins. According to the Diagnostic and Statistical Manual of Mental Disorders, for an infant to have one of these conditions, he or she must meet the following criteria:
- Presenting difficulty in one of these areas for at least 6 months despite having received help: reading, reading comprehension, pronunciation, written expression, calculation problems or mathematical reasoning problems.
- The patient has academic skills well below what is expected for his age and these cause problems at school, at work or in routine.
- The problems begin during childhood, although the patient does not perceive them until adulthood.
- Learning problems cannot be explained by intellectual disability, vision/hearing problems, a neurological condition (such as an infantile stroke) or atypical socioeconomic status.
Thus, a specific learning disorder only applies when there is no specific cause to explain it.. A person with Down syndrome or Fragile X syndrome does not have an ASD because of their condition, as their neurological variability includes certain difficulties at some times and possibilities to Excel at others. Examples of ASDs are dyslexia, dysgraphia and dyscalculia, for example.
The neuropsychology of learning disabilities.
In the last 30 years, special emphasis has been placed on approaching children's learning problems from an interdisciplinary point of view. Not all of the clinical picture lies in the child's genes, nor is the environment the only trigger.. To integrate all these frameworks, different categories of approach have been proposed.
At the first "rung" of the learning disability we have the neurobiological basis, which includes genetic factors and the nature of the brain. genetic factors and the nature of the brain and its functionality. For example, the connection of the auditory cortex with the high-level processors of the inferior frontal gyrus is weakened in people with dyslexia, something that could explain, in part, the onset of their condition. Moreover, about 40% of the siblings of a dyslexic patient also have dyslexia: it is clear that genetic inheritance plays an essential role in learning problems.
In the second step we have cognitive processes, i.e., those that allow us to process information based on perception, acquired knowledge (experience) and the set of characteristics (experience) and the set of subjective characteristics that allow us to evaluate information. Cognition is strongly associated with many other abstract mental processes, such as mind, perception, reasoning, intelligence, learning and many others.
If we move away from the basal physiological and neurological conditions of the infant, we see that the next category is psychological factors. A chronically anxious or depressed child has difficulty learning because his or her altered hormonal circuits do not allow the body to integrate information as it should.The child's altered hormonal circuits do not allow the organism to integrate information as it should, due to a continuous state of alertness. These altered states (short and long term) must be taken into account to explain the dynamics of learning problems.
Ultimately, and to package the clinical packaging, we have environmental factors.. The socioeconomic status of the family, the type of school the child attends, the teaching and many other parameters can balance the scales. These are not the absolute cause of an ASD, but they can promote its manifestation and make the symptomatology more or less evident.
Summary
As you can see, learning disabilities should be conceived as an interdisciplinary network, not only as a product of the patient's brain or as a consequence of an environmental stressor. It is necessary to take into account each of these "layers" to find the appropriate treatment in each case. In any case, at the first signs that a child has learning problems, it is important to seek professional help as soon as possible, it is important to seek professional help as soon as possible.
(Updated at Apr 12 / 2024)