What is Generalized Inadequate Learning in Children?
The classifications of diseases ICD-10 and DSM-IV use the expression “mental retardation” to indicate generalized insufficient learning, but in society and among specialists, this term is considered offensive. Although in the USA the term “insufficient learning” is often applied to children who have a normal intellectual level, but there are some problems with reading and writing, nevertheless this term can be applied to children with mental retardation.
Generalized lack of learning – a child’s condition characterized by a decrease in intelligence to a level below 69. There are two forms of GNO in children – mild and severe. With mild IQ, it ranges from 50 to 69, and with severe its level is less than 50. This condition also includes impaired social functioning, including reduced personal independence or the need for special care and protection. Most children and adolescents also have educational problems, but when determining the generalized lack of learning in children, they are not considered to be the main ones.
1. Easy GNO
This form is determined by IQ criteria. Most children with this intelligence are not detected, as a rule, neither by educational nor by medical services. Sometimes it functions normally in society and has sufficient performance in school, so it is difficult to understand that a child has a mild form of generalized lack of learning.
2. Severe GNO
Diagnosed with a child’s IQ of less than 50. They are detected by health authorities, schools and other educational institutions, as well as social services. Severity in the educational process, as well as physical characteristics, for example, epilepsy or cerebral palsy, helps to identify them.
Causes of Generalized Inadequate Learning in Children
A mild form of generalized lack of learning in children appears as a consequence of polygenic and environmental factors. The polygenic component is understood as genetic heritage. The psychosocial component also affects the level of intelligence.
A mild form of GNA can occur as a result of such adverse psychosocial factors as parental indifference to the child’s academic achievement, reduced access to books, and a lack of early stimulation. An adverse environmental situation may also affect a child. For example, elevated levels of lead are very harmful.
The severe form of GNA in children is explained by organic causes, which are divided into groups according to the time factor of their appearance: prenatal, perinatal, postnatal. The prenatal causes include defects of one gene, chromosomal abnormalities, fetal alcohol syndrome, intrauterine infections. Perinatal include severe neonatal jaundice, intraventricular hemorrhage in premature infants. Today, it is questionable that obstetric complications affect GNO. The postnatal causes of STD in a child are meningitis, encephalitis, severe lead poisoning, trauma due to violence against a child or an accident. This includes the fragile X-chromosome syndrome and fetal alcohol syndrome, as well as:
1. Down syndrome
It occurs in one of 600 newborns. The risk is higher for mothers from 35 years old. Down syndrome is the cause of 1/3 of all cases of generalized insufficient learning. Physical signs of a child with this diagnosis: a small head, a round face, an oblique cut of the eyes, epicanthus folds are observed, a large tongue with grooves, ears are set low, growth is low, palmar one is folded, small fingers are bent inward, hypotension is observed. For children with Down syndrome, gastrointestinal tract and heart defects are characteristic. In the future, they have deafness, Alzheimer’s disease, leukemia.
2. Disorders of one gene
Such disorders are mostly autosomal recessive. The exceptions are gender-related Lesch-Nyhan and Hunter syndromes, as well as autosomal dominant neurofibromatosis and tuberous sclerosis.
3. Anomalies of sex chromosomes
In children with Turner syndrome and Klinefelter syndrome, as a rule, intelligence is normal, although some excess of mild and severe GNO is recorded.
Pathogenesis during Generalized Inadequate Learning in Children
Two Population Model
A distinction is made between two types of GNO in children: organic and normal. If GNO appeared due to organic diseases, the child has short stature, more medical problems. If this is a variant of the norm, the child has many relatives below average height. But no boundary of growth can completely distinguish between a group of variants of the norm from the organic one.
Two different populations can be identified by level of intelligence, but not completely. Severe GNA compared with mild is more often associated with a neurological disorder and less often with social distress. If the child has a slight generalized lack of learning, there is a high probability that his relatives (at least one of them) have an IQ below average.
Characteristics of severe and mild generalized insufficient learning (data by Broman et al, 1987).
Diagnosis of Generalized Inadequate Learning in Children
Often, children with severe generalized lack of learning receive a referral to a pediatrician due to slow development or physical abnormalities that parents notice or that are detected during development screening. Light GNO may remain undetected until the child goes to school.
Father, mother, and teachers can almost accurately estimate a child’s mental age. But they can make mistakes. For example, if a child has poor performance of verbal tests and a lack of “common sense”, it can be assumed that the child has a severe form of GNO. But he may have autism and a normal intellectual level.
Frequent situations where teachers do not know that the child has a mild form of GNA, explaining his average grades with insufficient diligence, emotional issues or social problems. Therefore, they begin to put pressure on the child or do not provide him with educational conditions adequate to his needs. Therefore, when diagnosing it is impossible to focus only on the words of parents and teachers, it is necessary to apply formal psychometric testing. Measure the level of IQ and derive a useful profile of the strengths and weaknesses of the cognitive aspects of the child.
For the diagnosis of generalized insufficient learning in children requires:
1. A detailed medical history, with details regarding family history, prenatal infections, and the effects of alcohol on the fetus.
2. A careful physical examination, with emphasis on neurological signs, skin signs of neurocutaneous syndromes, signs of dysmorphism.
3. Individually selected special studies to identify chromosomal abnormalities, etc.
Treatment Generalized Inadequate Learning in Children
It should strive to provide the child with the most normal life in society, as far as possible.
Children develop as normally as possible if they are in a family, and not in an orphanage. Parents can seek additional support and help if they feel a significant burden. You can turn to social services. If a family decides that it cannot cope with raising such a child, it can be placed in an alternative family setting. In such cases, an adoption or long-term upbringing is arranged in a foster family. In extremely rare cases, children are placed in a special institution.
All children have the right to education, even if the process is difficult for them. The child cannot be denied education. Children with a severe form of generalized lack of education are most often sent to a special school or special unit within a comprehensive school. And children with a mild form of GNO can study in regular schools.
Typically, a child and his family require a family doctor and a pediatric team, which is located at the child’s development center. At the same time, the participation of the children’s mental health service is not necessary, but it can be useful for a large part of children with generalized insufficient learning, who have coexisting psychiatric problems.
Prevention of Generalized Inadequate Learning in Children
There are preventive measures that can minimize organic syndromes that lead (but not always) to GNO in children. Rubella vaccination helps prevent intrauterine rubella. To prevent the neural tube from becoming pregnant, a folic acid supplement is prescribed during conception and early pregnancy, and fetal alcohol syndrome can be prevented by advice on non-alcohol use during pregnancy.
Many organic syndromes are diagnosed when the baby is in the womb. Blood tests, ultrasound, sampling of villous chorion and amniocentesis are done. Specific treatment is rarely possible, but parents may choose to terminate the pregnancy.
Screening newborns for phenylketonuria, galactosemia and hypothyroidism allows treatment to begin before irreversible brain damage occurs. Immunization can protect children from diseases that cause meningitis and encephalitis. Secondary brain damage after a head injury can be reduced with measures that reduce the incidence of home accidents, physical violence and car accidents.