Pediatrics
Learning Disabilities, ADHD and Autism
Specific learning disorder, ADHD and autism spectrum disorder for MBBS: DSM-5 criteria, joint attention, sensory screening and child guidance clinic role, mapped to NMC codes PE4.1 to PE4.6.
MedNext Academy | 3 min read
Learning Disabilities, ADHD and Autism
Specific learning disorder, ADHD and autism spectrum disorder for MBBS: DSM-5 criteria, joint attention, sensory screening and child guidance clinic role, mapped to NMC codes PE4.1 to PE4.6.
This chapter covers scholastic backwardness and its differential diagnosis, specific learning disorder, ADHD and autism spectrum disorder, along with the role of the child guidance clinic. It emphasises DSM-5 criteria, mandatory sensory screening and multidisciplinary management.
High-yield: Learning Disabilities, ADHD and Autism
- Poor school performance is a symptom, not a diagnosis, and its differential includes intellectual disability, specific learning disorder, ADHD, autism, sensory impairment, chronic illness, emotional disorder and poor instruction.
- DSM-5 specific learning disorder requires persistent academic difficulty for at least 6 months despite targeted help, with below-age achievement causing impairment and school-age onset.
- Specific learning disorder is diagnosed only after excluding intellectual disability, sensory deficits, inadequate instruction and language mismatch.
- Dyslexia is not simply letter reversal; its core problem is inefficient reading acquisition affecting decoding, fluency and spelling.
- Attention deficit hyperactivity disorder (ADHD) requires symptoms before age 12, duration of at least 6 months, presence in two or more settings, and functional impairment.
- ADHD is a diagnosis of impairment, not activity level, so a quiet child can still have disabling inattentive ADHD.
- No investigation is required to diagnose uncomplicated ADHD; it is a clinical diagnosis.
- Autism spectrum disorder requires deficits in social communication plus restricted, repetitive behaviours, with early onset and functional impairment.
- Hearing assessment is mandatory in a toddler who responds poorly to name before autism is diagnosed.
- The most discriminating early sign of autism is impaired joint attention, such as not pointing to share interest, rather than delayed speech alone.
- New-onset inattention after age 12, staring spells, loss of skills or family history of sudden unexplained death require broader assessment before routine stimulant use.
- Suicidal thoughts, abuse, severe aggression, psychosis, developmental regression or uncontrolled seizures need urgent escalation.
- The child guidance clinic team includes a paediatrician, child psychiatrist, psychologist, special educator, speech-language pathologist, occupational therapist, physiotherapist and social worker.
- The best child guidance clinic output is a shared formulation of diagnosis plus strengths, triggers, school needs and family capacity translated into a daily routine.
Core diagnostic criteria
- **Specific learning disorder:** Difficulty at least 6 months despite help, below-age achievement, school-age onset, exclusions met.
- **ADHD:** Symptoms before 12 years, at least 6 months, two or more settings, functional impairment.
- **Autism spectrum disorder:** Social-communication deficits plus restricted repetitive behaviour, early onset.
- **First step in a poor responder:** Assess hearing and vision before labelling any developmental problem.
NMC competencies in this chapter
- **PE4.1:** Scholastic backwardness: poor school performance
- **PE4.2:** Specific learning disorder and learning disabilities
- **PE4.3:** Attention deficit hyperactivity disorder
- **PE4.4:** Autism spectrum disorder
- **PE4.5:** Role of child guidance clinic in developmental problems
- **PE4.6:** Visit to the child guidance clinic
Frequently Asked Questions
What are the DSM-5 criteria for ADHD?
ADHD requires inattentive or hyperactive-impulsive symptoms present before age 12, lasting at least 6 months, occurring in two or more settings and causing functional impairment. Uncomplicated ADHD is a clinical diagnosis needing no routine investigation.
What is the earliest discriminating sign of autism?
The most discriminating early sign is impaired joint attention, such as not pointing to share interest or not looking back to check a caregiver's reaction, rather than delayed speech alone. Hearing must be assessed first in a toddler who responds poorly to name.
Is dyslexia just reversing letters?
No. Dyslexia is not letter reversal alone; its core problem is inefficient reading acquisition, especially difficulty with decoding, reading fluency and spelling, and it is diagnosed as a specific learning disorder after excluding other causes.
Who makes up the child guidance clinic team?
The team typically includes a paediatrician, child psychiatrist, clinical psychologist, special educator, speech-language pathologist, occupational therapist, physiotherapist and social worker, producing a shared formulation and daily-routine plan.
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