1. PREDICTORS IN DEVELOPMENT OF LEARING DISABILITIES INTRODUCTION-PURPOSE
Stavroula Papadakou1,2, Alexandra Palili2, Stavroula Gini2
1“Spyros Doxiadis” Diagnostic and Therapeutic Unit for Children, Athens, Greece
2Asclepieio Voulas General District Hospital, Paediatric Departments, Athens, Greece
INTRODUCTION-PURPOSE
Learning Disabilities (LD) are an area of great interest as they involve ever-increasing percentages of the student population and, indeed, children even from infancy or early childhood. According to recent studies, % of children with normal intelligence exhibit LD, while 1 in 3 Greek children seem to have learning difficulties. The causes that lead to the emergence of MD are still unclear. Given the high heterogeneity of children with LD, it is most likely to blame several mechanisms for their appearance: environmental and cultural, emotional and cognitive, genetic and neurobiological ones.
Of all these factors, it is very important to trace those that can act as predictors of LD as early as possible so as to ensure timely recognition of LD and early personalized response. The purpose of this study is to analyze the epidemiological characteristics of children with LD, to investigate the related factors and to reveal those parameters that can be considered as LD predictors
POPULATION AND METHOD
The sample of the study included all children who were followed up over time from 2001 to 2013 at the Developmental Pediatrics Clinic of Asklipieion Hospital at Voula. A total of 1500 children were studied. Children were assessed by means of various questionnaires in which responses were generally closed and pre-coded, while there were some open questions as well, used for short descriptions, personal interviews with the parents who were present (one or both) during the assessment, as well as for a clinical consideration of each child. Single factor analysis was conducted using the X2 test together with multiple logistic regression in order to assess in the best way the relationship between LD and the characteristics under investigation. The significance level for all processing methods was defined at 5% (p <0,05).
OUTCOMES
Boys were more than girls (56% vs 44%)
All children with LD had at least one relative of the first degree with learning difficulties.
LDs were linked to sleeping disorders in all children (100%):
shorter total sleep duration (OR 3,7, 95% Cl:2,09-6,54)
night awakenings and attention-seeking without crying (OR 13,19, 95% Cl:12,55-13,87)
teeth bruixism (OR 4,2, 95% Cl:3,57-4,96)
difficulties in falling asleep (OR 1,42, 95% Cl:1,14-1,77)
LDs have been associated to attention deficit and hyperactivity (OR 2,28, 95% Cl:1,8-4,08)
LDs have been associated to emotional and social problems:
anxiety, isolation, depression (OR 5,3, 95% Cl:3,05-6,79)
adjustment disorders (OR 5,22, 95% Cl:3,39-7,05)
reduced ability to establish complex social relations (OR 6,54, 95% Cl:4,68-8,48)
DISCUSSION
Familiar distribution of LD is known since the beginning of the century (14). Large family studies have confirmed the familial nature and the genetic heterogeneity of the LD
Several candidate gene regions on chromosomes 1, 2, 3, 6, 7, 11, 15 and 18 have been associated with dyslexia. Presumably, genetic influences seem to modify or limit the extent of neuronal development and lead to changes that short circuit the neural circuit
It is known that the most effective kind of knowledge acquisition is achieved during sleep possibly in relation to the higher activation and better functioning of the hippocampus region
Constructive performance of children has been associated with the amount of sleep obtained during the night
It is likely that children that had sleep problems in their early childhood often develop LD later on
As regards emotional and behavioral problems is necessary to emphasize that these are not primary disorders (which were excluded from the study population)
Behavioral problems that inevitably occur in children with LD, attention deficit issues that prevent children from completing their tasks and the frustration they experienced because of cognitive deficits seemed to be the possible reasons of isolation, depression and difficulty in social contacts with peer children of the same age
As regards the direction of this association, it could be assumed that tracing such problems, especially in the critical infant-toddler-preschool age, is extremely important to identify children who run increased risk to face LD later on
CONCLUSION
The earliest possible diagnosis of LD, considering the potential predictive factors analyzed in this study (1st degree relative with LD and sleep problems that found to be associated predictively with LD for first time in bibliography), with the aim of early, multidisciplinary and comprehensive intervention in the wide range of the complex disorders that these children face, may contribute to their better academic progress and social adjustment.