Develop. Meed. Child Neurol. 1982, 24, 731-732

EDITORIAL

LOOKING AT LEARNING DISORDERS

I AM going to have a shot at some definitions: the first two are broadly accepted, and, indeed, are derived from existing publications. A defect is a morphological imperfection or impairment of any part of the body, therefore it can be a blemish of the skin or a hole in the brain. A disability is a n impairment of function caused by a defect. The loss of a hand clearly causes a disability-bi-manual activities are impossible. On the other hand, a skin discolouration such as a port-wine stain causes no disability. Provided we can define the normal, defects and disabilities are absolutes.

Handicap, however, is more difficult. In my view, handicap is relative to the society in which the person lives. A handicap is caused by a disability (which is caused by a defect supra vide)or a defect and interferes with an individual’s functioning within the society to an extent that his way of living is significantly affected. Thus, an unsightly port-wine stain might mean an individual would not wish to be seen in public and might spend all his time shut indoors. Again, I would say they were handicapped. A person who lost a hand in an industrial accident but was able to retain a job in the same factory, with no retraining, might state that his defect did not affect him at all. He and I might then agree that he was not handicapped.

People who are wheelchair-bound have told me they are not handicapped, but observing them trapped in a basement when the lift fails, I think they are handicapped. Handicap, in part therefore, is in the eye of the beholder. Often the individual concerned and the observer agree that the person is handicapped, but sometimes only one of them wants to apply that label. The society in which the adult or child is placed influences one’s decision about whether or not they are handicapped. The child who has difficulty in learning to read in many societies is handicapped (in my view, not necessarily the child’s). But in a society (such as medieval England) in which 90 per cent of people were illiterate, the child’s problem would not be handicapping.

When a health professional uses the term learning disorder, it has 73 1

DEVELOPMENTAL M E D I C I N E A N D C H I L D NEUROLOGY. 1982, 24

a special connotation. Clearly, in a general sense a child’s learning can be disordered by anything from his school burning down to the lack of the appropriate textbook. When we (as health professionals) use the term ‘learning disorder’ we mean, I think, a learning disability because we think his learning is disturbed by a defect (in the brain) which interferes with his learning function, so that he fails to achieve at the level we expect from his chronological and mental ages.

But these definitions lead us into some difficulties. By ‘learning’, I submit that we are thinking of academic learning-reading, writing and arithmetic-not ‘learning’ (which indeed we do) to put on our shoes o r to talk in our own language. A learning disorder can be caused by emotional problems, such as parents divorcing, but such a child does not have a learning disability. What about a child with Down’s syndrome? Clearly, his learning is affected by his disability, but often it is appropriate to his mental age. He has a mental handicap but not (do you agree?) a learning disability. Does an overactive child with an attentional deficit have a learning disability? Certainly his learning is disordered and he might be said (to introduce a fresh term) to have a learning deficit: but I believe he does not have a learning disability. What I am suggesting is that we should restrict the term ‘learning disability’ to those instances in which the child attends to a task-such as reading-but is unable to acquire the ability to handle the material before him.

A learning disability, like cerebral palsy, is not a disease: it is a symptom of an encephalopathy. Theoretically it can occur with any static or progressive encephalopathy. We are beginning to be able to investigate the brains of people with learning disability. If we categorise the problem carefully, our diagnostic studies-see Gillberg and Rasmussen (p. 752) and Finucci ef al. (p. 7 3 3 ) in this issue-may teach us something about the nature of the child’s problem: a first step to helping him.

MARTIN BAX

Acknowledgemenr: A generous lectureship from the Folke Bernadotte Foundation gave me time to develop some of these ideas.

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