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Important aspects of the examination of a child with learning difficulty*

Important aspects of the examination of a child with learning difficulty*
Examination feature Potential clinical implicationΔ
General observations and appearance
Sadness, anxiety, attention span, impulsivity, activity Emotional or behavioral problems may affect learning
Ability to communicate and respond to instructions Measure of language skills other than phonologic processing
Stigmata of genetic syndromes (eg, Klinefelter, Turner, fragile X) Klinefelter syndrome: Tall stature, small testes
Turner syndrome: Short stature, webbed neck, micrognathia, short metacarpals, nail dysplasia, widely spaced nipples
Fragile X syndrome: Narrow face, large jaw, long, prominent ears, large testes (after puberty)
Growth parameters
Head circumference Head circumference <10th percentile may suggest fetal alcohol syndrome
Children with fragile X syndrome usually have head circumference >50th percentile
Height and weight Height and weight <10th percentile may suggest fetal alcohol syndrome
Short stature is a feature of Turner syndrome
Tall stature is a feature of Klinefelter syndrome
Skin
Café-au-lait spots, ash leaf spots, adenoma sebaceum Neurocutaneous disorders (eg, neurofibromatosis, tuberous sclerosis) are associated with learning problems
Genitalia
Delayed sexual maturation May be associated with Turner syndrome, Klinefelter syndrome
Small testes Suggestive of Klinefelter syndrome
Large testes (after puberty) Suggestive of fragile X syndrome
Sensory screening
Hearing assessment Hearing impairment may affect learning
Vision assessment Vision impairment may affect learning
Neurologic examination
Asymmetry, increased or decreased muscle tone Cerebral palsy
Coordination problems Developmental coordination disorder
Weakness Muscular dystrophy
Tics Tourette syndrome
Staring episodes Seizure disorder
* In this table, "learning disability" refers to a heterogeneous group of disorders characterized by the unexpected failure of an individual to acquire, retrieve, and use information competently, rather than intellectual disability (formally referred to as mental retardation).
¶ Most children with learning disability have a normal physical examination.
Δ Learning disability is rarely the first manifestation of these disorders.
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