Special Neurological Examination of Children with Learning Disabilities

Abstract

SUMMARY Children with ‘minimal brain dysfunction’ and learning disabilities were found to have significantly more minor neurological signs than control children. Many of these signs become less obvious or disappear by the age of 11 years; therefore older cases are more similar to controls, whereas younger cases show lags or deficits at the highest levels of central nervous system functioning—language, fine motor co‐ordination and cross‐modality integrations. RESUME Examen neurologique particulier chez les enfants présentant des troubles des apprentissages Les enfants avec des troubles cérébraux minimes et des difficultés d'apprentissage présentent plus de signes neurologiques mineurs que les contrôles. Beaucoup de ces signes deviennent moins évident ou disparaissent vers l'âge de onze ans; de ce fait, la similitude avec les contrôles chez les enfants plus âgés est plus grande tandis que les plus jeunes cas montrent dés retards ou des deficits au plus haut niveau de fonctionnement du système nerveux central: langage, coordination motrice fine et intégrations complexes. ZUSAMMENFASSUNG Eine spezielle neurologische Untersuchung der Kinder mit Kernschwierigkeiten Kinder mit minimaler cerebraler Dysfunktion und Lernschwierigkeiten haben significant häufiger leichte neurologische Symptome als Kontrollkinder. Viele dieser Symptome gehen zurück oder verschwinden bis zum elften Lebensjahr; daher sind die älteren Fälle ähnlich den Kontrollen, während die jüngeren Fälle Verzögerungen und Ausfälle im Bereich der differenzierten Zentralnervensystemfunktionen—Sprache, feinmotorische Koordination und komplexe cerebrale Funktionsmechanismen—zeigen. RESUMEN Un examen neurológico especial de niños con dificultades en el aprendizage Se encontró que niños con disfunción cerebral mínima y dificultades de aprendizage tenian significativemente más signos neurológicos menores que los controles. Muchos de estos signos se hacen menos aparentes o desaparecen a los 11 años de edad; por ello los casos de más edad son más semejantes a los controles, mientras que los más jóvenes muestran lagunas o déficits en los niveles más altos de las funciones del SNC: lenguage, coordinatión motora fina a integración cruzada.

Motor performance and dyslexia in a national cohort of 10‐year‐old children

“…The tests were selected on the basis of use in clinical practice and research to identify children with motor coordination difficulties and for ease of use with thousands of survey children in a standard manner. The tests were throwing a ball in the air, clapping and then catching it; standing on one leg and then the other; walking backwards along a line; sorting matches from one matchbox lid to another and recognizing shapes drawn on the palm of the hand (the graphaesthesia test used by Peters, Romine, & Dykman, 1975). Written instructions for administering the tests were included in the survey medical examination form.…”

Neurological subtle signs and cognitive development: A study in late childhood and adolescence

“…In addition to the standard neurological examination aimed to detect “hard signs”, six neurological subtle signs directed at aspects of fine motor development, coordination and balance were sought, adapted from the scale designed by Peters et al(1975). These items were selected from the original 80-item test, with the following criteria: a) NSS signs (44/80) that differentiated children with learning disabilities from normal controls in the study of Peters et al b) NSS that correlated with cognitive development, as demonstrated in a previous study performed in healthy Portuguese school children (Martins & Fernandes, 2003) (a subset of 18 out of the 44) and c) the six NSS that have proved to be reliable and easy “to transform in scales that summarize performance on related tasks” (Pine et al, 1996).…”

“…In that clinical evaluation healthy young children are likely to present a variety of signs described as “dysrythmia”, “motor overflow” and “clumsiness” (Cole, Mostofsky, Larson, Denckla & Mahone, 2008; Denckla, 1985; Fellick., Thomson, Sills, & Hart, 2001; Peters, Romine & Dykman, 1975) which are usually interpreted as clinical markers of neural immaturity, since they tend to disappear with age. Moreover their rate of extinction is also related to gender, being faster in girls than in boys (Cole et al, 2008; Larson, Mostofsky, Goldberg, Cutting, Denckla, & Mahone, 2007; Martins, Lauterbach, Slade, Luis, DeRouen, et al, 2008) in accordance with evidence showing that maturation of the central nervous system and age related peak brain volume does not follow the same pace in boys and girls (Lenroot, Gogtay, Greenstein, Molloy, Wallace et al, 2007).…”

Randomized Controlled Trial Demonstrates that Exposure to Mercury from Dental Amalgam Does Not Adversely Affect Neurological Development in Children

“…Observation of NSSs did not begin until follow-up year 2, so there were no baseline data for NSSs. NSSs were evaluated using the examination described by Peters et al, 2 and each item was scored from 0 (absent) to 3 (maximum deviation).…”